European Journal of Public Health最新文献

{"title":"Basing healthcare decisions on value: patient-reported outcomes for patients diagnosed with breast cancer in a European cohort.","authors":"Ania Gorostiza, Jon Cacicedo, Itxaso Alayo, Andere Frias, Patricia Cobos Baena, Inés Gallego Camiña, Isabel Álvarez López, Marta Fernández Calleja, Alina Rigabert, Maria Victoria Alonso Martínez, Carolina Varela Rodríguez, Valentina Danesi, Andrea Roncadori, Mario Campone, Ane Fullaondo, Borja García-Lorenzo","doi":"10.1093/eurpub/ckaf064","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf064","url":null,"abstract":"<p><p>Improvements in breast cancer survival rate have been achieved through a variety of multimodal therapeutic approaches, which play a key role in the patients' healthcare pathway and their Patient-Reported Outcomes (PROs) from a Value-Based Healthcare (VBHC) perspective. This paper analyses differences in PROs of patients diagnosed with breast cancer according to their healthcare pathway. A cohort of 690 patients diagnosed with breast cancer between 2018 and 2020 at six European sites was used. PROs were assessed at baseline and 6 months using the International Consortium for Health Outcome Measures standard set. Archetypes defined by patient characteristics and treatment trajectories served as the basis for comparison. Multivariate linear regression models were used to analyse differences in PROs across archetypes. Functional scores generally worsened over 6 months, particularly in physical functioning, whereas emotional functioning improved. Archetypes undergoing mastectomy, with or without reconstruction, showed significant decreases in body image perception and satisfaction with breasts. Pain, fatigue, and peripheral symptoms were prevalent in most archetypes, with those receiving chemotherapy reporting the greatest symptom burden. Patients with in situ carcinoma and patients undergoing conservative surgery plus radiotherapy showed minimal deterioration. The use of PROs in a real-world setting enables the identification of differences across patient archetypes based on their therapeutic pathways. This information provides valuable insights for refining patient-centred care guiding VBHC strategies in oncology, developing of personalized care solutions, and facilitating Shared-Decision Making.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-borne virus testing in European emergency departments: current evidence and service considerations.","authors":"Elizabeth Smout, Murad Ruf, Maria Buti, Inês Vaz Pinto, Gaia Nebbia, Laura Hunter, Mark A Aldersley, Catarina Esteves, Diogo Medina, Jordi Llaneras, Sam Douthwaite, Emma E Page","doi":"10.1093/eurpub/ckaf103","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf103","url":null,"abstract":"<p><p>Innovative testing approaches are needed to meet global targets for the blood-borne viruses (BBVs) HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). We conducted a systematic review of BBV testing in emergency departments (EDs) in Europe to evaluate prevalence, effectiveness of ED testing and linkage to care (LTC). We searched PubMed, Embase and Cochrane Library for articles on ED BBV testing published between January 2012 and July 2022. Studies conducted outside Europe or prior to 2012 were excluded owing to epidemiological and healthcare service variation, together with studies that did not report core parameters. Reference lists from included articles were manually searched. Seventeen original articles met the inclusion criteria. Seven studies reported on HIV testing only. ED prevalence: HIV Ab, 0.0%-1.1%; HBsAg, 0.2%-0.9%; and HCV RNA, 0.2%-3.9%. BBV testing uptake varied by policy and offer methodology: opt-out, provider-initiated: 9.7%-44.2%; electronic health record (EHR) modification: 52.1%-88.9%; and opt-in, provider-initiated: 3.9%-37.7%. LTC rates were 8.1%-100% and varied by BBV, generally highest for HIV and lowest for HCV. There was variable detail in outcome reporting and description of clinical LTC pathways. ED BBV testing in Europe is feasible and identifies high numbers of infections (including, where reported, new diagnoses and disengaged patients), often among marginalized populations who use open-access EDs for healthcare. Factors associated with higher levels of sustained testing uptake included opt-out testing (vs opt-in), EHR (vs provider-initiated) and integration of community services. We propose a toolkit of components necessary for a high-performing ED BBV testing programme.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic delay in rare diseases in the Campania region: addressing ageing, gender disparities, and the \"postcode lottery effect\" to reduce the patient odyssey.","authors":"Chiara Cirillo, Rossella Duraccio, Mario Fordellone, Emanuele Monda, Bruno De Rosa, Chiara De Stasio, Anna Francesca Smimmo, Anna Fusco, Salvatore Rega, Martina Caiazza, Francesca Marzullo, Raffaele Scarpa, Gioacchino Scarano, Antonio Postiglione, Pietro Buono, Ugo Trama, Massimo Di Gennaro, Giuseppe Borriello, Maria Galdo, Barbara Morgillo, Paolo Chiodini, Giuseppe Limongelli","doi":"10.1093/eurpub/ckaf088","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf088","url":null,"abstract":"<p><p>Our study assessed the time to diagnosis of rare diseases (RDs) in Campania and whether there are determinants of diagnostic delay (DD). Demographic characteristics, date of first medical contact and diagnosis, disease macro-groups, and area of residence of patients were recorded. DD was calculated as the time elapsed (in years) from the onset of symptoms to the RD diagnosis date. Based on the Rare Disease Research Consortium consensus document, a time to diagnosis more than one year was considered DD. A multilevel logistic regression was performed. Seven thousand nine hundred and nine patients were included in the analysis; 47.4% were male. The mean DD was 3.4 years and 46% of patients experienced DD. Predictors of DD were female gender (OR 0.90, 95% CI 0.80-0.98, P < .005), age at diagnosis (OR 1.36, 95% CI 1.27-1.45, P < .001), and province of residence (residence in Naples vs. others; OR 0.80, 95% CI 0.73-0.88, P < .001). Immunological, connective tissue, digestive, genitourinary system diseases, and congenital malformations showed more DD than other disorders. Nearly half of the patients with RD experienced DD. The main determinants of DD were female sex, older age at diagnosis.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A model based on artificial intelligence for the prediction, prevention and patient-centred approach for non-communicable diseases related to metabolic syndrome.","authors":"Alejandro Clarós, Andreea Ciudin, Jordi Muria, Lluis Llull, Jose Àngel Mola, Martí Pons, Javier Castán, Juan Carlos Cruz, Rafael Simó","doi":"10.1093/eurpub/ckaf098","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf098","url":null,"abstract":"<p><p>Metabolic syndrome (MetS) is related to non-communicable diseases (NCDs) such as type 2 diabetes (T2D), metabolic-associated steatotic liver disease (MASLD), atherogenic dyslipidaemia (ATD), and chronic kidney disease (CKD). The absence of reliable tools for early diagnosis and risk stratification leads to delayed detection, preventable hospitalizations, and increased healthcare costs. This study evaluates the impact of Transformer-based artificial intelligence (AI) model in predicting and managing MetS-related NCDs compared to classical machine learning models. Electronical medical data registered in the MIMIC-IV v2.2database from 183 958 patients with at least two recorded medical visits were analysed. A two-stage AI approach was implemented: (1) pretraining on 60% of the dataset to capture disease progression patterns, and (2) fine-tuning on the remaining 40% for disease-specific predictions. Transformer-based models was compared with traditional machine learning approaches (Random Forest and Linear Support Vector Classifier [SVC]), evaluating predictive performance through AUC and F1-score. The Transformer-based model significantly outperformed classical models, achieving higher AUC values across all diseases. It also identified a substantial number of undiagnosed cases compared to documented diagnoses fold increase for CKD 2.58, T2D 0.78, dyslipidaemia 1.89, hypertension 3.33, MASLD 5.78, and obesity 4.07. Diagnosis delays ranged from 90 to 500 days, with 35% of missed intervention opportunities occurring within the first five appointments. These delays correlated with an 84% increase in hospitalizations and a 69% rise in medical procedures. This study demonstrates that Transformer-based AI models offer superior predictive accuracy over traditional methods by capturing complex temporal disease patterns. Their integration into clinical workflows and public health strategies could enable scalable, proactive MetS management, reducing undiagnosed cases, optimizing resource allocation, and improving population health outcomes.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining systemic differences in mortality after hip repair: a comparative analysis of 30- and 180-day adjusted mortality rates in five health systems.","authors":"Francisco Estupiñán-Romero, Santiago Royo-Sierra, Javier González-Galindo, Jinru Wei, Tania Sawaya, Astrid Van Wilder, Yu Qing Bai, Clas Rehnberg, Nils Janlöv, Reijo Sund, Walter P Wodchis, Irene Papanicolas, Enrique Bernal-Delgado","doi":"10.1093/eurpub/ckaf074","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf074","url":null,"abstract":"<p><p>Outcomes after a hip repair in the older adult population are highly dependent on patients' characteristics. However, contextual factors such as the hospital of treatment may have an impact not sufficiently studied. We aimed to elicit the effect of hospital providers on all-cause-adjusted mortality rates after hip fracture repair. Observational study on virtually all potentially eligible hip fracture patients treated in 2240 hospitals from Ontario (Canada), Aragon (Spain), Finland, Sweden, and the USA (40 states). The primary endpoint was the risk-adjusted all-cause mortality after hip repair measured 30 days and 180 days after surgery. Following a federated approach, GAMM-logit models were run for each region. Median odds ratio (MOR) were estimated to elicit the variation at hospital level. The study included 535 519 hip repairs. The overall predicted 30-day adjusted mortality rate was 40.5 per 1000 hip repair episodes; 136.3 per 1000 hip repair episodes in the 180-day adjusted mortality rate. 30- and 180-day adjusted mortality rates were larger within the regions than across regions. Variance in patients' mortality at the hospital provider accounted for MOR: 1.43 in 30-day mortality and MOR: 1.35 in 180-day mortality. Beyond differences in the individual risk of death, our study found wide systemic variations in mortality rates in older adult patients exposed to hip fracture repair attributable to the hospital of treatment. Our results call for a reorientation of care pathways after hip repair in frail patients, both in the short- and the long-term.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'It showed everyone what it was like in lockdown and how we felt': exploring short film-making with children to produce public health research dissemination.","authors":"Laura Basterfield, Hannah Batten, Kathryn L Weston, Naomi L Burn, Brook Galna, Helen Ferguson, Scott Wilson, Claire Rimington, Kiz Crosbie","doi":"10.1093/eurpub/ckaf105","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf105","url":null,"abstract":"<p><p>Creative participation may allow children involved in health research to better describe their experience. Using participatory methods, we co-produced a short film with children to express their experiences of the COVID-19 lockdowns and as participants in health research conducted around the pandemic. Thirteen children (10-11 years) from an area of deprivation in Newcastle-upon-Tyne, England, worked with theatre practitioners to develop their spoken and written reflections and memories into a script. The subsequent short film (https://tinyurl.com/YoungSciComms) was perceived by classmates as an accurate and entertaining representation of their experiences. Film-making with children can facilitate effective peer-led communication in public health research.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social patterns of miscarriage reporting and risk: insights from survey data in France.","authors":"M C Compans, Heini Väisänen","doi":"10.1093/eurpub/ckaf099","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf099","url":null,"abstract":"<p><p>Miscarriages, which are spontaneous pregnancy losses before 20-28 weeks of gestation, affect approximately 15% of recognized pregnancies. Existing population-based evidence of social inequalities in miscarriage risk is inconsistent, partly due to a lack of data. Surveys can be representative of a national population but are subject to underreporting of miscarriages. We examine whether miscarriages are underreported in a French nationally representative survey, FECOND (2010-11), and analyse socioeconomic risk factors for miscarriage. First, we apply a model that estimates miscarriage underreporting. Second, we use multilevel multinomial logistic regressions to examine socio-demographic and epidemiological factors associated with miscarriage. We estimate that 92% of miscarriages were reported, and underreporting was slightly more pronounced among lower-educated women. The estimated prevalence of miscarriages (14% of all pregnancies) is unaffected by underreporting rates and only with small educational differences. Thus, investigating social disparities in miscarriage risk can be done without correcting for reporting bias. Advanced reproductive ages are associated with higher miscarriage risk. Unobserved time-consistent individual characteristics explain the association between miscarriage risk and prior reproductive history. Conversely, education and self-assessed financial conditions are not associated with miscarriage risk. Younger cohorts exhibit a higher miscarriage risk, suggesting an age effect on recall, a cohort effect on pregnancy recognition, or reduced stigma resulting in more reliable reporting of miscarriage. In sum, the miscarriage reporting rate in FECOND survey is relatively high and with only slight social disparities. No large socioeconomic differences were found in miscarriage risk.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sickness absence trajectories and retirement pathways among industrial workers.","authors":"Subas Neupane, Prakash K C, Lily Nosraty, Saila Kyrönlahti, Clas-Håkan Nygård, Jodi Oakman","doi":"10.1093/eurpub/ckaf104","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf104","url":null,"abstract":"<p><p>We studied the trajectories of sickness absences among industrial workers over 6 years and examined whether the membership of trajectories was associated with subsequent retirement type for 11 years. We used data from one of the largest Finnish food industry companies that responded to a questionnaire survey in 2003. Sickness absence days per year from 2003 to 2008 were obtained from the company's registers and linked to the register of Finnish Centre for Pension data (statutory and non-statutory) until the end of 2019. We analysed data from 633 individuals who had information on sickness absence and the type of retirement. Latent class growth modelling was used to identify trajectories of sickness absence days per year, and Cox-regression models were used to examine the association of trajectories with retirement type. The models were adjusted for baseline sociodemographic, work-related physical, and psychosocial factors. We identified three distinct trajectories of sickness absence during the 6-year period. Most respondents (51.2%) had low-fluctuating, one-third (33.9%) had moderate-stable, and 14.9% had a high-stable sickness absence trajectory throughout. The high-stable trajectory was associated with a higher risk of non-statutory retirement (hazard ratio 2.67, 95% confidence interval 1.69-4.23) when adjusted for sociodemographic, perceived health, and work-related variables. We found significant heterogeneity in the number of sick absence days per year among the private sector employees over a period of 6 years. An increase in the risk of non-statutory retirement among those with high-stable sickness absences signifies the importance of early intervention to support individuals experiencing recurring sickness absence whilst employed.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse childhood experiences as a risk factor for depression-overweight comorbidity in adolescence and young adulthood.","authors":"Fanny Kilpi, Ana Goncalves Soares, Laura D Howe","doi":"10.1093/eurpub/ckaf102","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf102","url":null,"abstract":"<p><p>The comorbidity of depression and overweight is a manifestation of mental-physical multimorbidity, a marker of complex healthcare needs. We sought to examine how adverse childhood experiences (ACEs) are associated with depression-overweight comorbidity in the period of adolescence and early adulthood, and the extent to which associations are sensitive to age, sex, and socioeconomic background. Using data from 4734 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, we estimated relative risk ratios (RRR) for the associations of multiple ACEs (physical, emotional, and sexual abuse, emotional neglect, being bullied, parental substance abuse, violence between parents, parental criminal conviction, parental separation, parental mental illness, or suicide) with depression only, overweight only or their comorbidity at ages 17 and 24. We tested whether associations differed by sex and socioeconomic background, indicated by parental education. Most ACEs were associated with depression-overweight comorbidity, and there was a dose-response relationship whereby a greater number of ACEs was associated with greater risk, and this continued from adolescence to young adulthood. Some ACEs associations with comorbidity appeared to be influenced by sex: at age 17, females had stronger associations for parental separation and mental health problems, and at age 24, sexual abuse had a stronger association in males. We did not find evidence that the sensitivity to ACEs varied by parental education. ACEs across childhood are associated with depression and depression-overweight comorbidity in late adolescence, which indicates their potential impact on the early manifestation of complex healthcare needs.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and socio-economic disparities in vegetarianism and flexitarianism over 15 years: the Dutch Lifelines Cohort.","authors":"Yinjie Zhu, Marga C Ocké, Emely de Vet","doi":"10.1093/eurpub/ckaf095","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf095","url":null,"abstract":"<p><p>Transitioning to more plant-based diets is crucial for both planetary and human health, and ensuring an equitable transition across all socio-economic groups is also important. However, empirical evidence on the prevalence and socio-economic disparities in vegetarianism and flexitarianism over time in the same population is scarce. This study investigated this in a general Dutch adult population over 15 years. From three general assessments of the Dutch Lifelines study, 143 359 participants from assessment 1 (2006-2013), 100 859 participants from assessment 2 (2013-2017), and 55 282 participants from assessment 3 (2019-2024) were included in this study. The dietary identity was self-reported, collected at each assessment, and categorized into following a vegetarian, flexitarian, other, and no special diet. Socio-economic status was indicated by education attainment. The association between socio-economic status and different dietary identities was estimated using multinomial logistic regression. The prevalence of individuals following vegetarian or flexitarian diet doubled over the three assessment periods, with the proportion of vegetarians and flexitarians increasing from 2.02% to 4.11% and from 3.50% to 7.16%, respectively. Across three assessments, lower education attainment was consistently associated with a lower likelihood of following a vegetarian or flexitarian diet. For example, in assessment 1 individuals with low education attainment were 77% (relative risk ratio [95% CI]: 0.23 [0.20-0.25]) less likely to follow a vegetarian diet compared to those with high education attainment. In a Dutch population cohort, we observed an increasing trend of vegetarian and flexitarian diets over 15 years, along with persistent socio-economic inequalities in these diets.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}