Contraception最新文献

{"title":"The impact of Dobbs v. Jackson on abortion training in obstetrics and gynecology residency programs: A qualitative study","authors":"Danielle Vachon ,&nbsp;Marisa C. Hildebrand ,&nbsp;Sarah Averbach ,&nbsp;Jema Turk ,&nbsp;Jody Steinauer ,&nbsp;Sheila K. Mody","doi":"10.1016/j.contraception.2024.110808","DOIUrl":"10.1016/j.contraception.2024.110808","url":null,"abstract":"<div><h3>Objectives</h3><div>The Ryan Program collaborates with obstetrics and gynecology (OBGYN) residency programs in the United States (U.S.) to ensure that abortion and contraception care are incorporated into resident curriculum as required. We sought to understand the impact of the <em>Dobbs v. Jackson</em> decision on OBGYN residency abortion training programs from the perspective of Ryan directors and to understand barriers and facilitators to maintaining abortion training in OBGYN residency programs post-<em>Dobbs</em>.</div></div><div><h3>Study design</h3><div>We conducted qualitative, semi-structured in-depth interviews with Ryan program directors at U.S. academic medical centers. We coded the data iteratively and analyzed the data thematically.</div></div><div><h3>Results</h3><div>From January to April 2023, we conducted 24 interviews, representing 21% (<em>n</em> = 23) of eligible U.S. Ryan directors. Participants were evenly distributed across four geographic regions of the U.S.; 50% (<em>n</em> = 12) of participants were from programs in abortion-restrictive settings. Two themes emerged: (1) Ryan directors experienced stressors related to the administration of Ryan programs post-<em>Dobbs,</em> including perceived difficulty satisfying requirements for abortion training in restrictive states, burnout, and increased financial needs to support training partnerships. (2) Directors face challenges in recruitment and clinical care post-Dobbs.</div></div><div><h3>Conclusions</h3><div>Increased state restrictions on abortion place logistical and financial burdens on OBGYN abortion training programs. <em>Dobbs</em> impacted training experiences across the U.S. and made it more difficult for many OBGYN residencies to provide abortion training.</div></div><div><h3>Implications</h3><div>The research findings will inform strategies for improving the delivery of abortion education post-<em>Dobbs. We anticipate findings will enhance procedures to establish and maintain partnerships post-Dobbs and identify areas where philanthropy and advocacy can be effectively utilized.</em></div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110808"},"PeriodicalIF":2.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate postpartum contraceptive implant placement and breastfeeding success in postpartum people at risk for low milk supply: A randomized non-inferiority trial","authors":"Erika E. Levi ,&nbsp;Karina Avila ,&nbsp;Haotian Wu","doi":"10.1016/j.contraception.2024.110806","DOIUrl":"10.1016/j.contraception.2024.110806","url":null,"abstract":"<div><h3>Objectives</h3><div>Our goal was to measure the impact of postpartum contraceptive implant insertion timing on breastfeeding success and duration in a population at high-risk for low milk supply.</div></div><div><h3>Study design</h3><div>We conducted a three-armed randomized non-inferiority study of postpartum people who plan to breastfeed and have known risk factors for low milk supply. Participants were randomized to one of three groups for the timing of implant placement: within 30 minutes of placental delivery, 24–72 hours postpartum, or 6+ weeks postpartum. The primary outcome was time to lactogenesis II (LII). Secondary outcomes included duration and exclusivity of breastfeeding and implant satisfaction through 6 months postpartum.</div></div><div><h3>Results</h3><div>We enrolled 155 participants. Compared to those who received implants 6+ weeks postpartum, those who received it ≤30 minutes postpartum (mean difference: 2.92 hours, 95% CI: −9.26, 15.1, <em>p</em> = 0.64) or 1–3 days postpartum (mean difference: −0.75 hours, 95% CI: −13.02, 11.51, <em>p</em> = 0.90) had similar time to LII. Similar results were observed for intention to treat analysis. Duration and exclusivity of breastfeeding and implant satisfaction were similar among all groups.</div></div><div><h3>Conclusions</h3><div>Unfortunately, our results did not meet the threshold of non-inferiority because the confidence intervals included the 8 hours non-inferiority margin defined a priori. However, our results indicate similar time to LII between groups. Ultimately, our study suggests that early etonogestrel implant insertion does not affect breastfeeding success among postpartum people at risk for low milk supply.</div></div><div><h3>Implications</h3><div>Etonogestrel implant insertion can be offered anytime postpartum to meet the needs of postpartum people.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110806"},"PeriodicalIF":2.8,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society of Family Planning Clinical Recommendation: Medication management for early pregnancy loss","authors":"Jessica L. Tarleton ,&nbsp;Lyndsey S. Benson ,&nbsp;Ghazaleh Moayedi ,&nbsp;Jayme Trevino ,&nbsp;with the assistance of Leah Coplon, Anitra Beasley, and Elise Boos on behalf of the Society of Family Planning Clinical Affairs Committee","doi":"10.1016/j.contraception.2024.110805","DOIUrl":"10.1016/j.contraception.2024.110805","url":null,"abstract":"<div><div>Early pregnancy loss (EPL) occurs in 15% to 20% of clinically recognized pregnancies. We recommend that patients experiencing EPL have equal access to all treatment options, including expectant, medication, and procedural management, when urgent treatment is not necessary (GRADE 1A). We recommend a patient-centered approach that uses shared decision-making to diagnose EPL through ultrasonography, serial quantitative hCG measurements, or symptoms (GRADE 1C). We suggest a shared decision-making approach for continuing expectant management of EPL up to 8 weeks after diagnosis in the absence of medical complications or symptoms requiring urgent intervention (GRADE 2C). We suggest against Rh testing and Rh-immunoglobulin administration before 12 weeks of gestation for patients undergoing medication management of EPL (GRADE 2B). We recommend a combined regimen of mifepristone with misoprostol for medication management of EPL (GRADE 1A), using mifepristone 200 mg orally followed 7 to 48 hours later by misoprostol 800 mcg vaginally or buccally (GRADE 2A). When used without mifepristone, we recommend misoprostol in two or more doses of 600 to 800 mcg sublingually or vaginally at intervals of at least 3 hours (GRADE 1B). We suggest ibuprofen 800 mg orally for pain control during medication management of EPL (GRADE 2A). Clinicians should offer all patients, but not require, in-person confirmation of completed EPL (GRADE 2B). We recommend against using endometrial thickness alone as a criterion for recommending additional intervention after medication management of EPL (GRADE 1B). We recommend institutions and clinicians make thorough efforts to obtain and maintain access to mifepristone in clinical settings where patients receive EPL care (GRADE 1C).</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110805"},"PeriodicalIF":2.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unanswered questions from abortion seekers: An application of the Research Prioritization by the Affected Community (RPAC) protocol in the Central Valley, California","authors":"Shalmali Bane ,&nbsp;Michelle Rivera ,&nbsp;Jennifer Sumin Soh ,&nbsp;Abeer Yakzan ,&nbsp;Kenia Lopez ,&nbsp;Andrea Henkel ,&nbsp;Erica Cahill ,&nbsp;Patricia Rodriguez Espinosa ,&nbsp;Suzan Carmichael ,&nbsp;Namrata Mastey","doi":"10.1016/j.contraception.2024.110803","DOIUrl":"10.1016/j.contraception.2024.110803","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite protections offered in California, there is limited understanding of abortion access in underserved regions, including the Central Valley. Furthermore, there has been limited community involvement, especially from those directly affected, in the development of research priorities in abortion care. We utilized the Research Prioritization of Affected Communities protocol to identify research priority topics and research questions for future abortion-related research.</div></div><div><h3>Study design</h3><div>This project was designed and implemented through a partnership between a community-based reproductive justice organization and academic and community researchers. We recruited individuals ≥18 years old, English or Spanish speaking, who previously accessed abortion care in Central California. Over two Research Prioritization of Affected Communities sessions, participants shared uncertainties about the abortion care they received (session 1) and ranked their unanswered questions (session 2). The audio recording of sessions were transcribed and analyzed using rapid qualitative analysis to identify themes.</div></div><div><h3>Results</h3><div>Participants (<em>n</em> = 7) raised 79 unique questions, 57 of which were deemed unanswered and categorized into 11 prioritized topics. Topics with the most questions included costs associated with care (<em>n</em> = 9); the role of community; interactions with clinicians; and resources for patients (<em>n</em> = 7 for each topic). Participants discussed challenging experiences, barriers, and the importance of social support when receiving abortion care.</div></div><div><h3>Conclusions</h3><div>Using a community-centered approach, we identified topics and questions for future abortion-related research, to guide researchers and funders. Many questions raised by participants have already been answered in prior research, suggesting that implications of research are not clearly conveyed to those impacted the most.</div></div><div><h3>Implications</h3><div>Using a community-centered approach, this study convened individuals who previously received abortion care in the Central Valley of California to identify key research priority topics and questions for future abortion-related research. The list of prioritized topics and questions is a guide for researchers, advocacy groups, and funders.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110803"},"PeriodicalIF":2.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of progestin type on the risk of drug interactions between combined oral contraceptives and psychotropic drugs: A pooled analysis of real-world data","authors":"Tanja Boehnke ,&nbsp;Christian Franke ,&nbsp;Anja Bauerfeind ,&nbsp;Klaas Heinemann ,&nbsp;Cornelia Kolberg-Liedtke ,&nbsp;Katja Koelkebeck","doi":"10.1016/j.contraception.2024.110786","DOIUrl":"10.1016/j.contraception.2024.110786","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the risk of contraceptive failure and adverse events (AEs) associated with the type of progestin when coadministered with psychotropic drugs within a routine clinical practice setting.</div></div><div><h3>Study design</h3><div>A pooled analysis of four large, prospective, multinational cohort studies including women with a new prescription of combined oral contraceptives (COCs) and concomitant psychotropic drug use from 13 European countries and the United States. We determined the frequency of contraceptive failures and AEs within 6 months after COC initiation by progestin type. Furthermore, we calculated crude and propensity score weighted incidence rate ratios with corresponding 95% confidence intervals via Poisson regression. Covariates used for propensity score estimation included age, body mass index, smoking, medical history, history of hormonal contraceptive use, and education level.</div></div><div><h3>Results</h3><div>Our analysis comprised 7679 COC users reporting psychotropic drug use at baseline. The most common progestin type was drospirenone (30.0%) followed by norethisterone acetate/norethindrone acetate (20.5%), levonorgestrel (17.3%), norgestimate (11.6%), norethindrone (5.7%), nomegestrol/nomegestrol acetate (5.6%), desogestrel (4.9%), and dienogest (4.4%). Overall, 39 (0.5%) contraceptive failures and 156 (2.0%) AEs occurred within the first 6 months of follow-up. Head-to-head comparison of different progestins against levonorgestrel regarding AEs showed a significantly lower risk for drospirenone (weighted incidence rate ratio 0.5, 95% confidence interval [0.3–0.9]), while no difference was observed for other progestins.</div></div><div><h3>Conclusions</h3><div>Among women using psychotropic drugs, drospirenone was associated with a lower risk of AEs compared to levonorgestrel, while other progestins showed no significant differences. The number of contraceptive failures was low across progestins.</div></div><div><h3>Implications</h3><div>Compared to levonorgestrel, drospirenone has shown a reduced risk of adverse events when coadministered with psychotropic drugs, whereas other common progestins showed no significant differences. Contraceptive failures were rare across progestins. This analysis provides valuable real-world data on potential drug interactions and may be used for future updates of evidence-based guidelines on contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110786"},"PeriodicalIF":2.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vacuum-induced management of hemorrhage using intrauterine foley catheter: A report of two cases","authors":"Frank I. Jackson ,&nbsp;Leah Stork-Binyamin ,&nbsp;Matthew J. Blitz ,&nbsp;Sharon Gerber","doi":"10.1016/j.contraception.2024.110802","DOIUrl":"10.1016/j.contraception.2024.110802","url":null,"abstract":"<div><div>Hemorrhage is a common postpartum complication which can also occur during abortion. Most cases can be managed with uterine evacuation and uterotonics, but some require additional procedures. We present cases of hemorrhage following dilation and evacuation, and delayed postpartum hemorrhage, where a Foley catheter was used for vacuum-induced hemorrhage control.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110802"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare provider communication and current contraceptive use among transgender men and gender-diverse people: Results from an online, cross-sectional survey in the United States","authors":"Jasmine Berry ,&nbsp;Juno Obedin-Maliver ,&nbsp;Sachiko Ragosta ,&nbsp;Jen Hastings ,&nbsp;Mitchell R. Lunn ,&nbsp;Annesa Flentje ,&nbsp;Matthew R. Capriotti ,&nbsp;Zubin Dastur ,&nbsp;Micah E. Lubensky ,&nbsp;Elizabeth M. Inman ,&nbsp;Heidi Moseson","doi":"10.1016/j.contraception.2024.110784","DOIUrl":"10.1016/j.contraception.2024.110784","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore whether discussing contraceptive use with a healthcare provider is associated with current contraceptive use among transgender men and gender-diverse (TMGD) individuals.</div></div><div><h3>Study design</h3><div>In 2019, we conducted a cross-sectional survey among transgender men and gender-diverse adults in the United States who were assigned female or intersex at birth. We measured whether respondents had ever discussed contraception with a healthcare provider as well as current use of contraception, reasons for use, and barriers to use. We described frequencies and ranges for key variables and implemented a series of nested logistic regression models to evaluate the association between ever having spoken to a provider about contraception and current use of contraception for any reason, overall and by method type.</div></div><div><h3>Results</h3><div>Among 1694 respondents, about half (48%) were currently using a method of contraception for any reason, most commonly barrier methods (17%) and long-acting-reversible-contraception (LARC) (17%). Compared to those who never had a conversation about contraception with a provider, respondents who spoke with a provider were more likely to be currently using contraception – particularly among those who self-initiated the conversation (aOR: 3.8, 95% CI: 2.5–5.6). Having discussed contraception with a healthcare provider was most strongly associated with current LARC use.</div></div><div><h3>Conclusions</h3><div>Having had a conversation with a provider about contraception use was positively associated with current contraception use among a large, national sample of transgender men and gender-diverse people. Facilitating patient participation in contraception counseling for transgender and gender-diverse patients should be emphasized in provider training.</div></div><div><h3>Implications</h3><div>Given formidable barriers to healthcare faced by TMGD people, training providers on how to initiate affirming and relevant conversations with TMGD patients about contraceptive needs and preferences is essential, as are efforts to educate and empower TMGD individuals to advocate for the information they need in these interactions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110784"},"PeriodicalIF":2.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A statewide analysis of uptake of highly effective contraception offered immediately postpartum in Massachusetts, 2017–2021","authors":"Preetha Nandi ,&nbsp;Devika Lekshmi ,&nbsp;Alysa St. Charles ,&nbsp;Erika Werner ,&nbsp;Megan L. Evans","doi":"10.1016/j.contraception.2024.110785","DOIUrl":"10.1016/j.contraception.2024.110785","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate provision of immediate postpartum (iPP) highly effective contraception in Massachusetts.</div></div><div><h3>Study design</h3><div>We performed logistic regressions evaluating contraceptive implant, intrauterine device, and permanent contraception procedures occuring during delivery admissions between 2017 and 2021, analyzing outcomes by method reversibility and delivery type.</div></div><div><h3>Results</h3><div>Hispanic and privately-insured patients had higher odds of receiving any iPP method, whereas patients delivered at non-teaching hospitals had lower odds of receiving any method. Patients who were Hispanic, publicly-insured, or delivered at non-teaching hospitals had lower odds of receiving reversible compared to permanent methods.</div></div><div><h3>Conclusion</h3><div>Differential uptake of iPP contraception suggests programming opportunities to address unmet postpartum contraception needs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110785"},"PeriodicalIF":2.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New endocrine method of oral male contraception","authors":"Herjan J.T. Coelingh Bennink","doi":"10.1016/j.contraception.2024.110782","DOIUrl":"10.1016/j.contraception.2024.110782","url":null,"abstract":"<div><div>Essential for hormonal male contraception (HMC) is the inhibition of follicle-stimulating hormone (FSH), the hormone responsible for spermatogenesis. No drugs exist that can selectively suppress FSH without also inhibiting luteinizing hormone (LH), the hormone responsible for the biosynthesis of testosterone (T) and estradiol (E2) in men. The consequences are a loss of T and E2, with the accompanying symptoms and signs of T deficiency and E2 deficiency, respectively. The loss of T causes sexual function problems, including reduced libido and problems with erection and ejaculation. Moreover, T is not orally bioavailable, and there is a lack of suitable, orally bioavailable androgens to replace the loss of T. This has led to the use of nonoral T replacements, such as patches, gels, or parenteral administration of T or other androgens in current methods for HMC under development. In case these new HMC methods do not contain a testosterone preparation that is metabolized into E2, the suppression of LH will cause loss of E2 and symptoms of estrogen deficiency.</div><div>We propose to investigate a new oral endocrine approach for HMC using a triple hormone drug called MANTE (Male oral contraception by a GnRH ANtagonist, Testosterone and an Estrogen). This method combines three novelties: (1) the use of an oral gonadotrophin-releasing hormone antagonist to suppress FSH and spermatogenesis, (2) a high dose of the natural adrenal androgen dehydroepiandrosterone to replace T, and (3) a low dose of an orally bioavailable estrogen, preferably estetrol (E4), to prevent signs and symptoms of estrogen deficiency.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110782"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemiplegic migraine associated with etonogestrel 68 mg implant insertion case report","authors":"Hallie N. Nelson,&nbsp;Rebekah Sugarman,&nbsp;Melissa L. Wong","doi":"10.1016/j.contraception.2024.110783","DOIUrl":"10.1016/j.contraception.2024.110783","url":null,"abstract":"<div><div>We present a case of suspected induced intractable headaches and paralysis after receiving an etonogestrel 68 mg implant. After extensive neurological evaluation, the etonogestrel implant was removed and neurological symptoms resolved.</div><div>The case raises concerns about a potential rare risk of progestin-containing contraceptives in patients with migraines with aura warranting further investigation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110783"},"PeriodicalIF":2.8,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}