Journal of Women's & Pelvic Health Physical Therapy最新文献

{"title":"Association Between Intimate Partner Violence (IPV) and Physical, Psychological, and Social Health Outcomes for Women in Bangladesh","authors":"Shamima Islam Nipa, Asma Islam, Fabiha Alam Disha, Veena Raigangar","doi":"10.1097/JWH.0000000000000296","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000296","url":null,"abstract":"Background: Intimate partner violence (IPV) is a global issue impacting 1 in 3 women worldwide. IPV has been shown to have direct impact on the physical, psychological, and social aspects of life and overall well-being. Objective: The purpose of this study was to explore associations between report of IPV and physical, psychological, and social health outcomes with special emphasis on relationship of IPV to pelvic floor, pelvic pain, and urinary incontinence for Bangladeshi women. Study Design: A cross-sectional study was conducted using purposive sampling. Methods: Married women between 18 and 50 years were recruited in the study. IPV was measured using the Hurt-Insult-Threaten-Scream (HITS) screening tool and complex trauma was measured utilizing the Complex Trauma Inventory (CTI) Scale. Data were analyzed through SPSS version 21.0, and reported as descriptive statistics. Results: The total number of the respondents was n = 100. The mean age of respondents was 36.57 years (standard deviation ± 9.66). According to the HITS screening tool 27% respondents reported IPV. There was a significant, strong correlation between HITS scores for IPV and negative health outcomes of chronic disease and disability (r = 0.8; P ≤ .05). There was a direct association between HITS scores and (1) CTI scores for complex trauma, (2) pelvic floor dysfunction, and (3) duration of marriage. Conclusion: High prevalence of IPV was reported for this cohort of women living in Bangladesh. HITS scores for IPV were direct significant associations with severity and intensity of posttraumatic stress disorder on the CTI, and with low back pain, pelvic floor dysfunction, postpartum complications, and cardiac problems.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"15 3","pages":"4 - 10"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539277","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":"A Physical Therapist's Role in Providing a Trauma-Informed, Whole-Body, Holistic Approach to Address the Spiritual and Mental Health of Patients","authors":"Michelle Johnson","doi":"10.1097/JWH.0000000000000298","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000298","url":null,"abstract":"It is well documented that patient outcomes improve when providers address the patient's mental and spiritual needs in addition to their physical needs. There is currently a shift from the biomedical model to the biopsychosocial model and now a focus on the dynamic biopsychosocial model. Trauma is known to have spiritual, cultural, mental, and physical implications, and people who have experienced trauma want their providers to address it. Transitioning to a biopsychosocial model can be challenging, but the physical therapist is in a unique position to provide quality care within their scope of practice, while addressing the complexity of the whole person. Physical therapists must look introspectively at their own beliefs and practices to provide improved holistic, trauma-informed care. Through personal experience and literature reviews, a case is made for addressing both spiritual beliefs and mental health needs in the clinical setting (see Supplemental Digital Content Video Abstract, available at: http://links.lww.com/JWHPT/A130).","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"18 4","pages":"40 - 46"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540536","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":"Effects of High-Intensity Resistance Versus Aerobic Training in PCOS Women at Risk for Psychological Trauma","authors":"Huma Riaz, Mobeena Maqsood, A. Afridi, Sarah Ehsan, Sadiq Jan","doi":"10.1097/JWH.0000000000000295","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000295","url":null,"abstract":"Background: Polycystic ovarian syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. Its physical manifestations as the change in body image, fertility challenges, menstrual irregularities, and associated chronic health conditions increase their vulnerability to psychological trauma. Negative effects on psychological health significantly impact their quality of life. Objectives: The current study aimed to compare the effects of high-intensity resistance versus aerobic training on psychological health and quality of life in women with PCOS. Study Design: This was a single-blinded, randomized controlled trial. Methods: A randomized controlled trial was conducted from November 22 to April 23 at Riphah Rehabilitation Center, Islamabad, Pakistan. The female university students (n = 60), with an age range of 18 to 30 years, who were not part of any planned physical activity program, were not taking any medication, and were willing to participate in the exercise trial, were recruited. They were randomly allocated into 2 groups: high-intensity resistance (HIRG) and high-intensity aerobic (HIAG) groups. Both groups underwent exercise interventions for a duration of 12 weeks. Clinical and psychological health and quality of life were assessed using validated measures, including the polycystic ovary syndrome questionnaire (PCOS-Q) and the 36-item Short Form Survey (SF-36). Assessments were conducted at baseline, 6th, and 12th weeks. Data analysis was done using SPSS-21. Results: The mean age of women in the HIRG (n = 30) versus the HIAG (n = 30) was 22.40 ± 2.4 years versus 20.63 ± 2.1 years. Between-group analysis revealed no significant difference (P > .05) between the groups in terms of postintervention total scores of the PCOS-Q and SF-36 quality of life. However, within-group analysis has shown statistically significant improvement (P < .01) in both outcome measures. Conclusion: It is concluded that both high-intensity modes of exercise, resistance, and aerobic training were found to be equally effective interventions for improving psychological health and quality of life in women with PCOS. Individualizing exercise programs to meet individual needs and preferences may aid in maximizing the psychological benefits of each exercise modality. Further investigation into the underlying processes and long-term impact of these therapies in this vulnerable population is required.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"15 5","pages":"11 - 20"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539809","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":"Prevalence, Knowledge, and Perceived Impact of Urinary Incontinence in Female Collegiate Athletes","authors":"Lois Stickley, Debra McDowell","doi":"10.1097/JWH.0000000000000274","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000274","url":null,"abstract":"Background: Urinary incontinence (UI) is prevalent among collegiate female athletes at much higher rates than in sedentary women. Athletes participating in high-impact sports have a greater risk of UI, which can negatively impact performance. Objectives: The objectives of this study were (1) to assess the prevalence of UI among female collegiate athletes, (2) to evaluate the impact of incontinence on individual function and perceived athletic performance, and (3) to determine athletes' awareness of physical therapist management of UI. Study Design: An observational, cross-sectional design with convenience sampling was used. Methods: Two hundred seventy-nine female collegiate student athletes were invited to participate in an online survey. The survey included informed consent, questions about age and athletic participation, and questions about participants' experience with UI and knowledge of pelvic floor physical therapy. Descriptive statistics were performed to identify frequencies for age and sports/athletic participation. Frequencies for all variables were used as an exploratory measure to assess sample characteristics. Pearson correlation analyses were used to examine relationships between demographic variables and survey responses. Results: Online surveys were received from 52 respondents. Twenty-one (40.4%) reported never experiencing UI. In those who did report UI, it was consistent with activities related to stress UI. Most respondents were not aware that physical therapists treat pelvic floor dysfunction including UI. Conclusion: Prevalence of UI among female college athletes was consistent with prior research. More education is needed in this population on the impact and treatment of UI, including the role of physical therapists.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"115 1","pages":"237 - 244"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139339196","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":"Managing Pelvic Floor Functional Roles of Stability and Respiration: Part of the Job for All Physical Therapists","authors":"Patricia R. Nelson, Kim McCole Durant, Dylan Ziehme, Amy Hammerich","doi":"10.1097/JWH.0000000000000280","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000280","url":null,"abstract":"All patients with neuromusculoskeletal conditions managed by a physical therapist (PT) could have pelvic floor (PF) dysfunction contributing to their condition. Yet many PTs do not include assessment and management of the PF and pelvic floor muscles (PFMs) in their practice. While complex primary disorders of the PF, including continence and sexual function, are appropriately managed by pelvic health specialists, these specialists are few in numbers and availability across the country. This leaves patients with secondary PF involvement, specifically related to PF roles of stability and respiration, undermanaged. Lack of assessment of PFM contributions to respiration and stability leaves a practice gap for PTs and patient care across populations and settings. Clinicians, educators, and administrators are invited to join together to solve this practice gap. The purpose of this article is a call to action for PTs across all practice settings to address the PF functional roles in stability and respiration critical for neuromuscular function in our patients (see the Supplemental Digital Content Video Abstract, available at: http://links.lww.com/JWHPT/A114).","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"26 1","pages":"278 - 287"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139341077","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":"Trust Your Fingers: Determining the Reliability and Validity of the Measurement of the Diastasis of the Rectus Abdominis Muscle by Palpation and Tape Measure","authors":"Käthi Zavagni, Mirjam Stauffer, Hannah Meier, Rudolf H. Knols, Nina Kimmich","doi":"10.1097/JWH.0000000000000279","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000279","url":null,"abstract":"Background: Diastasis of the rectus abdominis muscle (DRAM) occurs in about 60% of pregnant women and often persists after delivery. Currently, the reference standard to measure DRAM is ultrasonography, and physiotherapy is considered first-line treatment. Most physiotherapists do not base their DRAM assessment on ultrasonography but instead on palpatory evaluation with tape measures. This method is neither standardized nor has been tested for its reliability or validity in women with interrectus distance (IRD) of 30 mm and greater. Objectives: To assess the reliability of the measurements of DRAM by palpation with tape measure and to evaluate its validity compared with ultrasonography. Study Design: Prospective observational study. Methods: Two physiotherapists assessed test-retest, intra- and interrater reliability of this method in 20 women with IRD of 30 mm and greater, using intraclass correlations (ICC) and compared the values with ultrasonography to establish its validity using Spearman ρ and Bland-Altman plots. The interval between the 2 sessions was 7 days and greater. Results: The ICC values for test-retest reliability ranged from 0.67 to 0.95 and between 0.40 and 0.85 for intrarater reliability. The ICC values for interrater reliability ranged from 0.13 to 0.29. In terms of validity, correlations were inconsistent with Spearman ρ ranging from −0.24 to 0.74. Conclusion: Single palpatory measurement with tape above the umbilicus and during partial curl-up might detect changes in IRD of 15.5 mm and greater over time in women with IRD of 30 mm and greater. It cannot replace ultrasonographic measurements in accuracy but might be the only available option for IRDs larger than the ultrasonographic probe.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"237 1","pages":"245 - 254"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139342936","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":"Integrating Pelvic Health and Orthopedic Programs to Treat Incontinence at the Community Level for Female Runners: A Pilot Study","authors":"Jennifer R. Kinder, V. Cheuy, T. Davenport","doi":"10.1097/JWH.0000000000000271","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000271","url":null,"abstract":"Background: The female athlete population is at an increased risk for urinary incontinence. Few studies have investigated the use of a generalized home exercise program (HEP) at the community level to treat incontinence in sports, particularly running. Objective: This study investigated whether a 1-time pelvic health (PH) workshop with a generalizable HEP had positive changes in incontinence at 2-week and 6-month follow-ups for female runners. Study Design: Pilot study. Methods: Participants attended a workshop about PH and received a PH- and orthopedic-based HEP. A blinded assessor evaluated overall trunk strength (CoreFirst® Strategy, 0-5 scale) pre- and postworkshop. Questionnaires evaluated the frequency of leakage during activities. Time points were baseline (preworkshop) and 2-week and 6-month follow-up. Paired t tests, McNemar-Bowker tests, and Cochran Q with Dunn post hoc tests were used for comparisons. Results: Twenty-two participants enrolled in the study (age: 44 ± 11 years; body mass index: 22 ± 2 kg/m2). Trunk weakness improved after the workshop by 2 stages. Home exercise program adherence was 86% and 55% through 2 weeks and 6 months, respectively. Significant improvements in the incidence of reported incontinence were found after 2 weeks for jumping (41 to 5%, P = .006), landing from jumping (46 to 9%, P = .003), coughing (64 to 14%, P = .001), sneezing (59 to 14%, P < .001), and walking to bathroom (59 to 32%, P = .016), and after 6 months for coughing (64 to 14%, P = .001) and sneezing (59 to 23%, P = .006). Conclusions: Educating female runners and providing a generalized HEP focused on PH had immediate positive significant changes in overall trunk strength and incontinence at 2 weeks and generally maintained through 6 months. See Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A91.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115231951","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":"Self-Reported Factors Associated With Bone Stress Injuries in Female Dancers: Results of a Survey","authors":"T. Johnston, Weihong Ni, Alison Clodfelter, Maria DiNenno, L. A. Eisenberg, Kelsey Kreider, Ifunanya Nwanonyiri, Jeremy D. Close, E. Wolff","doi":"10.1097/JWH.0000000000000275","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000275","url":null,"abstract":"Background: Female dancers are at risk of bone stress injuries (BSIs). Few studies compare dancers with and without BSI, and most focus on ballet. Objectives: Compare risk factors between adult female dancers with and without BSI history and identify factors associated with BSI occurrence. Study Design: Case-control. Methods: An online survey focused on dancing style, physical impact, anatomical features, training hours, cross-training, injury history, medical/menstrual history, and medications. Respondents with BSI answered questions about location, number, and changes made. Data were compared between groups using χ2 tests/Fisher exact tests, Mann-Whitney U test, Wilcoxon signed rank tests, and multiple logistic regression models. Results: Data from 110 respondents were analyzed. The most common style was modern/contemporary (50%). Bone stress injuries (BSIs) were reported by 36.4%, with most common sites being the second metatarsal (17.5%) and fibula (17.5%). Forty-one percent with BSI reported more than 1. A higher incidence was found for dancing greater than 5 hours per day/20 hours per week, and for leg length discrepancy and anterior ankle impingement. Odds of a BSI were greater for White than for non-White dancers and for dancers who reported an anterior ankle impingement. Post-BSI, common changes were decreased dancing time, increased warm-up, strengthening/stretching, and diet and nutrition intake. Pain was the most common complication. Time away from dancing following BSI varied, with some dancers taking no time off. Conclusion: This study supports findings of other studies that primarily include ballet dancers. Increased screening for risks and education about safe return to dancing are needed.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129793606","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":"Women With Self-Reported Stress Urinary Incontinence Had Differences in Clinical Measures Depending on Whether Jumping Jacks Provoked Leakage","authors":"Erin H. Hartigan, J. McAuley, Michael A. Lawrence, Megan Clarenbach, Jessica Sterling, Emily Quirion, C. Lewis","doi":"10.1097/JWH.0000000000000273","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000273","url":null,"abstract":"Background: Pelvic floor muscle (PFM) and hip impairments have been inconsistently reported in women with stress urinary incontinence (SUI) across studies. Subclassifying women with SUI based on a task that provokes leakage may identify more distinct groups. Objectives: To subclassify women with SUI who did and did not leak during jumping jacks (JJ) and to compare PFM and hip function among the SUI-leak and SUI-no leak groups and women without SUI (non-SUI). Study Design: A cross-sectional, exploratory study. Methods: Forty-one women completed 60 seconds of JJ and self-reported whether leakage occurred. Demographic data, PFM function, passive hip range of motion (ROM), and hip strength (manual muscle testing [MMT] and handheld dynamometry [HHD]) were compared among groups and limbs. Results: Nineteen women with SUI were subclassified based on self-reported leakage while JJ (SUI-leak, n = 9; SUI-no leak, n = 10) and 22 non-SUI. Age, parity, PFM power, vertical lift, hip internal (IR) and external rotation (ER) strength, and hip IR ROM differed among groups (P ≤ .040). SUI-leak group's PFM power did not differ between limbs (P = 1.00), whereas the other 2 groups' dominant limb (D-limb) was greater than nondominant limb (ND-limb) (P ≤ .002). SUI-leak group's hip ER HHD strength was greater in D-limb than in ND-limb (P = .02), whereas the SUI-no leak group's ER strength did not differ between limbs (P = .065). Conclusion: Both SUI groups were not able to lift during a PFM contraction; however, women with SUI who did not leak during JJ appear to use a unique interlimb strategy, and had less hip IR ROM, and stronger hip ER than those in the SUI-leak group.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114907554","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":"Prevalence and Associated Factors of Urinary Incontinence in Female Recreational Runners","authors":"H. Hamilton, M. Mariano, R. Kakar","doi":"10.1097/JWH.0000000000000260","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000260","url":null,"abstract":"Background: Urinary incontinence (UI) is prevalent among female athletes and can interfere with their ability to exercise. Running is a popular sport but involves high impact that may contribute to UI. It is important to understand factors related to UI in female runners to optimize participation in this activity. Objectives: The primary aim of this study was to identify the proportion of female runners experiencing UI during running and identify variables that are associated with UI during running. A secondary aim of this study was to understand factors related to women's decision to seek treatment of UI. Study Design: Cross-sectional survey study. Methods: An online anonymous survey was developed, including questions related to running behavior, childbirth history, running history surrounding pregnancy, and UI. Inclusion criteria included women who were at least 20 years old and running at least once per week. Univariate logistic regression was used to determine associations between variables of interest and UI. Results: A total of 803 subjects participated in the study. The prevalence of UI during running was 16%. Most runners reporting UI did not consult health care providers (70%). Risk factors for UI included number of deliveries (P < .001), number of vaginal deliveries (P < .001), the 40- to 44-year-old age range (P = .027), and the perimenopausal phase (P = .044). Conclusion: It is important to screen female runners for UI, particularly after vaginal deliveries and into perimenopause, to help manage UI-related symptoms. Increased education about interventions for UI is needed for female runners.","PeriodicalId":114037,"journal":{"name":"Journal of Women's & Pelvic Health Physical Therapy","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122894735","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}