Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

{"title":"The Dose-Response Relationship of Aerobic Exercise on Cardiorespiratory Fitness in Cardiac Rehabilitation: A SYSTEMATIC REVIEW AND META-ANALYSIS.","authors":"Blake E G Collins, Brett A Gordon, Daniel W T Wundersitz, David Carey, Michael I C Kingsley","doi":"10.1097/HCR.0000000000000963","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000963","url":null,"abstract":"<p><strong>Objective: </strong>To explore the incremental dose-response effect of aerobic exercise-based cardiac rehabilitation programs (ExCRP) on cardiorespiratory fitness in comparison to non-exercise controls among people with coronary heart disease (CHD).</p><p><strong>Review methods: </strong>Medline, CINAHL, Cochrane, SCOPUS, and SPORTDiscus were searched from January 1, 2000 until December 4, 2023. Articles were eligible for selection if they satisfied the following criteria: randomized controlled studies assessing change in cardiorespiratory fitness among people with CHD in non-exercise and aerobic intervention groups, established peak oxygen uptake via cardiopulmonary exercise test, minimum of 4-week program duration, and reported frequency, intensity, and duration of prescribed exercise. The study was prospectively registered (PROSPERO ID: CRD42021274924).</p><p><strong>Summary: </strong>Thirty-three studies, including 1901 participants were included in the continuous dose-analysis. A significant difference in cardiorespiratory fitness was identified between ExCRP and non-exercise control that favored exercise by 3.4 (3.0-3.9) mL·kg -1 ·min -1 . No difference existed between interval and continuous training when matched for exercise dose. Dose-response analyses identified a significant increase in cardiorespiratory fitness (3.4 [2.9-5.5] mL·kg -1 ·min -1 ) associated with program completion, with no additional benefit related to increased exercise dose. When compared to non-exercise control, participating in ExCRP with a minimum total program intervention dose of 2194 metabolic equivalent minutes significantly improves cardiorespiratory fitness. However, no additional benefit was discernible from higher exercise doses. Although the recommended dose for ExCRP augments medical treatment and is sufficient to improve cardiorespiratory fitness, it is likely that the narrow range in prescribed exercise dose and variations in the fidelity of exercise interventions limit interpretation.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608462","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":"Evaluation of a Rehabilitation Program With Blood Pressure-Guided Exercise Intensity Restrictions for Patients With Thoracic Aortic Dissection or Aneurysm.","authors":"Karoline Stentoft Rybjerg Larsen, Mariann Tang, Jacob William Budtz-Lilly, Lotte Sørensen","doi":"10.1097/HCR.0000000000000965","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000965","url":null,"abstract":"<p><strong>Purpose: </strong>Aortic disease presents a significant risk of mortality and morbidity, with hypertension considered the primary driver of disease progression. Blood pressure naturally increases during physical activity, and patients need guidance on the optimal level of exercise. The purpose of this study was to evaluate change in cardiopulmonary fitness after attending a rehabilitation program using blood pressure-guided exercise intensity.</p><p><strong>Methods: </strong>The cohort included patients with thoracic aortic dissection (type A and B) and surgically operated thoracic aortic aneurysm. All participated in a rehabilitation program with maximum workload recommendations based on cardiopulmonary exercise tests which were performed before and after the rehabilitation program.</p><p><strong>Results: </strong>63 patients were included. At ventilatory threshold, workload increased by 17-32 watt and oxygen uptake by 1.8-2.9 ml/kg/min. 22 patients were able to perform both tests to exhaustion without exceeding blood pressure restrictions of 160-180 mmHg. These patients improved maximum workload by 20.6 watt (95% CI, 13.0-28.3) and peak oxygen uptake by 2.3 ml/kg/min (95% CI, 1.2-3.5). Only two cases of light dizziness at the end of test were reported.</p><p><strong>Conclusions: </strong>Generally, patients with aortic disease improved oxygen uptake and workload during the rehabilitation program. One-third of the patients were able to perform both cardiopulmonary exercise tests to exhaustion without exceeding blood pressure restrictions. No serious adverse events occurred during test or exercise.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591325","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":"Comparison of Cardiovascular and Perceptual Responses During Guideline-Recommended and Self-Selected Intensity Exercises in Patients With Peripheral Artery Disease: A Randomized Crossover Study.","authors":"Deivide Rafael Gomes de Faria, Max Duarte de Oliveira, Hélcio Kanegusuku, Breno Quintella Farah, Tiago Peçanha, Nelson Wolosker, Gabriel Grizzo Cucato, Raphael Mendes Ritti-Dias, Marilia Almeida Correia","doi":"10.1097/HCR.0000000000000966","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000966","url":null,"abstract":"<p><strong>Purpose: </strong>Exercises with a self-selected intensity (SSI) have emerged as an alternative to guideline-recommended sessions to improve adherence to exercise programs. We compared the cardiovascular and perceptual responses during a walking exercise performed at SSI and in a session with intensity recommended by clinical guidelines.</p><p><strong>Methods: </strong>Twenty patients (mean 69.2 ± 7.7 years, 55% male, and mean ankle brachial index 0.59 ± 0.15) participated in two experimental sessions: guidelines (3-5 minutes of walking sets, 2-3 minutes of recovery, and moderate intensity by pain perception) and SSI (preferred walking speed and set duration) sessions. Blood pressure, heart rate, heart rate variability threshold, rating of perceived exertion, perception of pain, and affective response were assessed during the exercise.</p><p><strong>Results: </strong>Independent of time, perceived exertion (∆0.8: 95% CI, 0.1-1.5, Psession = .035) and pain (∆0.6: 95% CI, 0.3-0.9, Psession < .001) were lower, while affective responses (∆-0.8: 95% CI, - 1.5 to -0.1, Psession = .029) were higher in SSI session compared to the guideline session. Independent of time, the heart rate (∆5.5: 95% CI, 1.2-9.8 beats/min, Psession = .013) was lower in the SSI session, while blood pressure responses were similar between sessions (Psession > .05). The time spent above the heart rate variability threshold was significantly lower in the SSI session (∆4.2: 95% CI, 1.6-7.0 minutes, Pinteraction = .005).</p><p><strong>Conclusion: </strong>The SSI sessions promoted lower cardiovascular overload and better perceptual responses than guideline sessions in patients with symptomatic PAD.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591324","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":"Impact of Lower-Extremity Muscle Strength on Exercise Capacity in Patients With Cardiovascular Disease and Diabetes Mellitus.","authors":"Koya Takino, Takuji Adachi, Yoji Kuze, Takashi Nagai, Masaya Hori, Masayasu Nakagawa","doi":"10.1097/HCR.0000000000000962","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000962","url":null,"abstract":"<p><strong>Purpose: </strong>Although skeletal muscle abnormalities caused by diabetes mellitus (DM) suggest that peripheral muscle impairment may have a greater effect on exercise tolerance in patients with DM, the magnitude of this effect on reduced exercise capacity remains unclear. As such, this study aimed to compare the strength of the association between lower-extremity muscle strength and exercise capacity in patients diagnosed with cardiovascular disease (CVD) with and without DM.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included data from 262 patients divided into two groups: patients with DM (DM group; n = 106); and without DM (non-DM group; n = 156). Peak oxygen uptake (VO2peak) and isometric knee extensor strength (IKES) were measured. Correlations between VO2peak and IKES were analyzed using Pearson's correlation test in the DM and non-DM groups. Linear regression analyses were performed with VO2peak as the dependent variable, and IKES, confounders, and the interaction term DM × IKES as the independent variables. Separate linear regression analyses were performed for the DM and non-DM groups.</p><p><strong>Results: </strong>The correlation coefficient between VO2peak and IKES was 0.58 in the DM group and 0.26 in the non-DM group. The interaction term DM × IKES had a significant effect on VO2peak. The IKES was significantly associated with VO2peak in the DM group (β = 0.83, P < .001), but not in the non-DM group (β = 0.01, P = .96).</p><p><strong>Conclusion: </strong>A specific association between lower-extremity muscle strength and VO2peak was observed in patients with both CVD and DM.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591326","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":"The Effects of Smoking Status on Patients in Cardiac Rehabilitation: Results From a National Registry.","authors":"Diann E Gaalema, Bashar Al Hemyari, Melissa M Morrow, Blair Yant, Yu Zhang, Katherine E Menson","doi":"10.1097/HCR.0000000000000961","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000961","url":null,"abstract":"<p><strong>Purpose: </strong>Smoking cessation is challenging, and many patients entering cardiac rehabilitation (CR) continue to smoke. Those who smoke may experience less improvement during CR. This study examined improvements during CR based on smoking status.</p><p><strong>Methods: </strong>Data were collected from patients enrolled between 2012-2021 at CR programs participating in a national registry. Patients were categorized by self-reported cigarette smoking status (current vs. former/never). Variables examined included patient characteristics (age, sex, race, educational attainment, insurance coverage, qualifying diagnosis, and body mass index), number of CR sessions attended, and baseline and change in psychological (depression/anxiety symptoms) and cardiorespiratory fitness (6-minute walk test distance [6MWT], max metabolic equivalent of task [MET]) measures. Baseline values were compared using Chi-square tests or unpaired t-tests as appropriate, and changes in outcome variables were examined using multivariable linear regression.</p><p><strong>Results: </strong>Of the 447 921 patients, 34 656 (8%) reported current smoking at the time of entry. Current smoking was associated with younger age (58.8 vs. 66.9 years), lower socioeconomic status (Medicaid-enrolled, 11% vs. 3%), qualifying for CR due to myocardial infarction (42% vs. 26%), higher anxiety (50.0 vs. 45.3) and depression (6.5 vs. 4.6) scores, lower cardiorespiratory fitness at entry (max MET 3.4 vs. 3.6), and completing fewer CR sessions (17.7 vs. 23.3). Current smoking was independently associated with significantly less improvement in cardiorespiratory fitness (-17.6 meters in 6MWT distance and -0.26 in max MET) and worse depression scores at exit (0.53 higher).</p><p><strong>Conclusions: </strong>Those who enter CR and are smoking are at high risk and may not benefit as much from CR as those who do not smoke. Continued effort must be placed on improving smoking cessation efforts within CR.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584013","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":"Supervised Exercise Training Improves Quality of Life in Chronic Heart Failure With Preserved Ejection Fraction: A META-ANALYSIS OF RANDOMIZED TRIALS.","authors":"Eric S Leifer, Kathryn E Flynn, Steven J Keteyian, Dalane W Kitzman, Vandana Sachdev","doi":"10.1097/HCR.0000000000000972","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000972","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with heart failure with preserved ejection fraction (HFpEF) have significant impairments in patient-reported outcomes (PRO) including physical functioning and quality of life (QOL). We conducted a meta-analysis of randomized clinical trials of supervised exercise training (SET) to examine the efficacy of such training.</p><p><strong>Methods: </strong>We included six single-blinded SET trials in patients with HFpEF, defined as a left ventricular EF ≥50%, published since 2010 in which participants were randomized to a facility-based exercise training program or usual care. We identified trials from a 2024 Cochrane review of exercise-based cardiac rehabilitation for adults with heart failure as well as other reviews and meta-analyses in PubMed. We used random effects meta-analysis to estimate the respective SET effects for five endpoints: the 36-Item Short Form Survey (SF-36) Physical Functioning Scale (PFS), the SF-36 Physical Component Summary, the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) total score, the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score, and the KCCQ QOL subscale.</p><p><strong>Results: </strong>The treatment effect estimate favored SET for all five endpoints. However, the SET effect was only statistically significant for the SF-36 PFS (P < .0001) and the MLWHFQ total score (P = .01).</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated clear evidence that patient-reported physical functioning, an outcome that patients with HFpEF identify as a prominent disability, is significantly improved with SET. It also showed consistent improvements across several other multi-dimensional measures of QOL.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584012","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":"How \"Global\" are Globally Oriented Pulmonary Rehabilitation Studies? Strategies to Promote Equitable Participation From Low- and Middle-Income Countries: A Systematic Review.","authors":"Fanuel M Bickton, Josan Sutherland, Patrick K Kalonde, Alice Namanja, Alison Lupton-Smith, Tao Li, Gift T Banda, Brian W Allwood, Gm Monsur Habib, Rik Gosselink, Jamlick Karumbi, Susan Hanekom, Harriet Shannon, Jamie Rylance, Joyce L Browne, Enock Chisati, Martin Heine","doi":"10.1097/HCR.0000000000000959","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000959","url":null,"abstract":"<p><strong>Purpose: </strong>To perform a systematic review of globally oriented pulmonary rehabilitation (PR) studies and describe low- and middle-income country (LMIC) participation including its enablers and barriers.</p><p><strong>Review methods: </strong>Systematic search of PubMed was performed on November 18, 2024 using a search string \"pulmonary rehabilitation\" AND (\"global\" OR \"international\" OR \"consensus\" OR \"standards\" OR \"guidelines\" OR \"recommendations\" OR \"statement\" OR \"position\") followed by citation searching. All PR publications from January 1, 2010 onwards were included if they were globally oriented, reported original research data, and targeted people with chronic respiratory disease (with or without comorbidity). The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.</p><p><strong>Summary: </strong>Of the initial 1302 records screened in PubMed, 17 were assessed for eligibility by reviewing their full-text articles, which excluded 7 articles. Citation searching and snowballing yielded 5 more eligible articles, resulting in a total of 15 eligible articles included for analysis. Of these, 6 (40%) were explicitly global while the remainder were implicitly global. Study participants (n = 823) originated from 40 different countries, based on reported data or provided by correspondence. Of these, high-income countries contributed 748 participants (91%), followed by upper-middle-income countries with 59 participants (7%), lower-middle-income countries with 15 participants (12%), and one low-income country with 1 participant (<1%). Potential enablers of LMIC participation were using multiple participant recruitment and data collection methods, channels, platforms, and collecting data from participants using their native languages. Limited resources were identified as a potential barrier.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584011","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":"Effects of Cardiovascular Rehabilitation on Myocardial Perfusion and Functional Exercise Capacity in Patients with Stable Coronary Artery Disease and Myocardial Ischemia: Erratum.","authors":"Guillermo Mazzucco, Leonardo Pilón, Rodrigo Torres-Castro, Ana Lista-Paz, Silvana López, Nicolás Chichizola, Gerardo Zapata, Jorge López, Alejandro Berenguel-Senén, Abel Magini, Ane Arbillaga-Etxarri","doi":"10.1097/HCR.0000000000000974","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000974","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 4","pages":"303"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512017","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":"Recommendations for Providing Feedback and Medical Reassurance Following Maximal-Graded Exercise Testing for Exercise Prescription in Cardiac Rehabilitation.","authors":"Samantha G Farris, Jasmin C Hutchinson, Clinton A Brawner, Steven J Keteyian, Daniel E Forman, Quinn R Pack","doi":"10.1097/HCR.0000000000000968","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000968","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 4","pages":"236-238"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512018","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":"Joint Associations Between Cardiorespiratory Fitness, Adiposity, and Mortality in Cardiac Outpatients Within a Secondary Prevention Program.","authors":"Andrea Raisi, Tommaso Piva, Jonathan Myers, Valentina Zerbini, Erica Menegatti, Sabrina Masotti, Giovanni Grazzi, Gianni Mazzoni, Simona Mandini","doi":"10.1097/HCR.0000000000000945","DOIUrl":"10.1097/HCR.0000000000000945","url":null,"abstract":"<p><strong>Purpose: </strong>Both cardiorespiratory fitness (CRF) and obesity have been well-established as predictors of cardiometabolic risk and mortality. This study sought to investigate the joint association of CRF and adiposity measures with all-cause and cardiovascular (CVD) mortality in a cohort of patients with stable CVD.</p><p><strong>Methods: </strong>Data were extracted from the ITER registry. The sample was composed of 2860 cardiac patients involved in an exercise-based secondary prevention program between 1997 and 2023. Patient CRF was estimated using the 1-km treadmill walking test, and measures of body mass index (BMI) and predicted body fat percentage (pBF%) were determined. Cox proportional hazard models were used to determine associations with mortality. All results were adjusted for demographic and clinical confounders.</p><p><strong>Results: </strong>A total of 1034 deaths (463 of CVD) occurred over a median of 11 years. Each of the fitness-fatness combinations was associated with an increased risk of mortality as compared with normal weight-fit or low pBF%-fit groups. As regards BMI, compared to the reference group, higher mortality risks were observed for overweight-unfit (HR = 1.93: 95% CI, 1.55-2.41; P < .0001), and obese-unfit patients (HR = 1.63: 95% CI, 1.28-2.08; P < .0001). Similar magnitudes were detected in the moderate pBF%-unfit (HR = 2.47: 95% CI, 1.99-3.06) and high pBF%-unfit (HR = 2.07: 95% CI, 1.69-2.54; P < .0001) groups. A similar pattern was observed for CVD mortality.</p><p><strong>Conclusion: </strong>While overweight and obesity have been associated with an increased risk of death, maintaining CRF can mitigate this risk. These findings support the fundamental role of CRF in exercise assessment and prescription in secondary prevention programs.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"258-264"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998743","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}