{"title":"Impact of the Covid-19 Pandemic on Health Emergency and Disaster Risk Management Systems: A Scoping Review of Mental Health Support Provided to Healthcare Workers.","authors":"Jargalmaa Amarsanaa, Oyundari Batsaikhan, Badamtsetseg Jargalsaikhan, Tatsuhiko Kubo, Nader Ghotbi, Ryoma Kayano, Odgerel Chimed-Ochir","doi":"10.1093/joccuh/uiaf020","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf020","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic scoping review examined the strategies used by different countries and institutions to support the mental health of healthcare workers (HCWs) during the COVID-19, to identify effective practices and the lessons learned in dealing with the associated challenges.</p><p><strong>Methods: </strong>Out of 1330 retrieved articles from PubMed, Scopus, and the Web of Science, 34 articles were ultimately included in the final analysis.</p><p><strong>Results: </strong>The analysis revealed that mental health consultation services, especially telephone support lines, online interventions, and apps played a critical role in addressing the psychological burden experienced by HCWs. Group activities and peer support strategies offered personalized support, and educational programs offered crucial information regarding stress management. Improvements in the work environment, such as the addition of dedicated rest areas, enhanced the well-being of HCWs. However, many interventions suffered from low participation and a lack of tailored content, despite their apparent effectiveness.</p><p><strong>Conclusion: </strong>Many interventions have focused on psychological support and resilience-building for HCWs, but they often overlook systemic issues. Comprehensive mental health support must address these systemic factors, such as adequate staffing, training, and resource allocation. Future strategies should emphasize leadership commitment to tackling root causes and actively involve HCWs in program design to ensure relevance and effectiveness. Educational resources and wellness interventions, while reported as effective, need to be tailored and adapted to specific emergencies. Additionally, research gaps, especially in low-resource settings, highlight the need for further studies to enhance preparedness for future crises.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aya Wada, Jihoon Kim, Satoru Kanamori, Takahiko Yoshimoto, Rumi Tsukinoki, Naoki Kagi, Wataru Umishio, Ryo Asaoka, Tomoko Shiomitsu, Kayo Kawamata, Natsumi Yoshioka, Kaori Yoshiba, Masahiko Gosho, Yoshio Nakata, Yuko Kai
{"title":"Multicomponent occupational lifestyle intervention to improve physical activity, musculoskeletal health, and work environment among Japanese teleworkers (TELEWORK study): protocol for a cluster randomized controlled trial.","authors":"Aya Wada, Jihoon Kim, Satoru Kanamori, Takahiko Yoshimoto, Rumi Tsukinoki, Naoki Kagi, Wataru Umishio, Ryo Asaoka, Tomoko Shiomitsu, Kayo Kawamata, Natsumi Yoshioka, Kaori Yoshiba, Masahiko Gosho, Yoshio Nakata, Yuko Kai","doi":"10.1093/joccuh/uiaf014","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf014","url":null,"abstract":"<p><strong>Objectives: </strong>Teleworking from home was widespread during the 2019 coronavirus disease pandemic. This working practice is expected to maintain popularity among employers and employees. Compared with in-person workers, teleworkers tend to be less physically active and have more musculoskeletal pain. Interventions specific to reducing health risks among teleworkers have not been identified. This study examined the effects of an occupational lifestyle intervention encompassing three components: physical activity promotion, musculoskeletal health, and work environment improvement.</p><p><strong>Methods: </strong>This cluster randomized trial has a target sample size of 500 participants. The target population is healthy adults aged 18-64 years who telework at least once per week. Randomization will be conducted on a stratified block basis for clusters of 20 to 100 individuals within the recruited companies. The intervention period will be 12 weeks and comprise individual (online lectures, feedback, and periodic email messages), sociocultural (team building through step competition), physical (poster and tabletop pop-up), and organizational (encouraging message from an executive) strategies. The intervention group will be compared to a wait-list control group. The primary outcome will be the number of steps taken, as assessed by an accelerometer, and the secondary outcomes will be musculoskeletal pain and a telecommuting environment.</p><p><strong>Results: </strong>Study enrollment began in March 2024, and the intervention will be completed by March 2025.</p><p><strong>Conclusions: </strong>The results of this study are expected to provide helpful data for promoting healthy teleworking practices.</p><p><strong>Trial registration: </strong>The study protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (ID: UMIN000053861). https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000061478&type=summary&language=J.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of perceived workplace health support on absenteeism and presenteeism among Japanese workers: a prospective cohort study.","authors":"Kazushirou Kurogi, Kazunori Ikegami, Hajime Ando, Akira Ogami","doi":"10.1093/joccuh/uiaf018","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf018","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the impact of perceived workplace health support on absenteeism and presenteeism among Japanese workers to determine the significance of health and productivity management in improving labor productivity.</p><p><strong>Methods: </strong>This prospective cohort study, using data from the Workers' Health Internet-based Survey Research study, involved 1,879 Japanese workers aged 20-69 years. The intensity of perceived workplace health support was assessed using self-administered questionnaires. The participants were followed up from October 2021 to October 2022 to evaluate the incidence of absenteeism and presenteeism based on the perceived workplace health support level.</p><p><strong>Results: </strong>The study findings revealed that higher perceived workplace health support significantly correlated with lower presenteeism, indicating better work productivity. Conversely, the relationship between perceived workplace health support and absenteeism was less clear, with no consistent trend observed across different levels of perceived workplace health support intensity. Conclusion\" Enhanced perceived workplace health support was associated with reduced presenteeism among Japanese workers, underscoring the importance of workplace health support for improving employee productivity. This finding emphasizes the need for companies to focus on health promotion activities and recognize the potential of perceived workplace health support as a performance indicator in corporate health management.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inn-Kynn Khaing, Odgerel Chimed-Ochir, Emma M Rath, Seiichiro Tateishi, Nahoko Enokida, Koji Mori, Yoshihisa Fujino, Tatsuhiro Nagata, Ogawa Hanako, Akihiro Taji, Noriyuki Shiroma, Ami Fukunaga, Yui Yumiya, Tatsuhiko Kubo
{"title":"Relationship between days of work and presenteeism, and mediation of this relationship by fatigue among disaster responders.","authors":"Inn-Kynn Khaing, Odgerel Chimed-Ochir, Emma M Rath, Seiichiro Tateishi, Nahoko Enokida, Koji Mori, Yoshihisa Fujino, Tatsuhiro Nagata, Ogawa Hanako, Akihiro Taji, Noriyuki Shiroma, Ami Fukunaga, Yui Yumiya, Tatsuhiko Kubo","doi":"10.1093/joccuh/uiaf019","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf019","url":null,"abstract":"<p><strong>Objectives: </strong>Occupational health studies have identified positive associations between work duration and presenteeism, but there is limited understanding of this relationship in disaster responders. We examined the relationship between the number of work days and presenteeism and the mediating effect of fatigue in disaster responders deployed after the Noto Peninsula earthquake.</p><p><strong>Methods: </strong>This cross-sectional study examined disaster responders deployed after the Noto Peninsula earthquake (Japan, 2024). Data were collected using the health management version of the app for Japanese Surveillance in Post-extreme Emergencies and Disasters, and included days of work, fatigue score, and presenteeism. Structural equation modeling (SEM) was employed to examine the direct and indirect effects of the number of work days on presenteeism, with fatigue as a potential mediator. Sensitivity analysis was also performed.</p><p><strong>Results: </strong>We analyzed 4656 disaster responders who were deployed after the Noto Peninsula earthquake. Presenteeism increased with the number of work days, and ranged from 3.4% (1 day) to 16.9% (>7 days). However, fatigue decreased as the number of work days increased. SEM demonstrated a significant direct effect of the number of work days on presenteeism, and that fatigue slightly decreased this effect for work durations of 4 to 7 days and more than 7 days. Sensitivity analyses supported these findings.</p><p><strong>Conclusions: </strong>Working more days led to increased presenteeism in disaster responders, but fatigue decreased as the number of work days increased. Future longitudinal studies should examine additional factors that may affect presenteeism in disaster responders and other individuals exposed to stressful environments.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association between health literacy and behaviors among shift workers: an observational cross-sectional study with mediation analysis.","authors":"Yuko Morikawa, Keiko Teranishi, Masaru Sakurai, Masao Ishizaki, Teruhiko Kido, Hideaki Nakagawa","doi":"10.1093/joccuh/uiae070","DOIUrl":"10.1093/joccuh/uiae070","url":null,"abstract":"<p><strong>Objectives: </strong>Previous research has indicated that shift workers exhibit fewer healthy behaviors than those working regular daytime hours. Although health literacy influences health behaviors, studies comparing health literacy levels between shift and fixed-day workers and investigating whether differences in health behaviors between these 2 groups are mediated by health literacy are lacking.</p><p><strong>Methods: </strong>This cross-sectional study used a self-administered questionnaire in a large-scale manufacturing company. Overall, 2152 manual workers aged 18-64 years were enrolled in this study (961 and 1191 fixed-day and shift workers, respectively). Logistic regression structural equation models were used for analyzing the mediating role of health literacy in the relationship between shift work and health behaviors.</p><p><strong>Results: </strong>Shift and fixed-day workers did not show differences in age-adjusted health literacy. Compared with fixed-day workers, the odds ratios of shift workers for leisure time exercise, not currently smoking, having breakfast, brushing their teeth, and eating green and yellow vegetables were 0.85 (95% CI, 0.70-1.02), 0.68 (95% CI, 0.56-0.80), 0.63 (95% CI, 0.52-0.76), 0.79 (95% CI, 0.65-0.95), and 0.58 (95% CI, 0.48-0.70), respectively. Mediation analysis showed that the odds ratios of the direct effects of shift work on favorable habits were almost the same as the total effect.</p><p><strong>Conclusions: </strong>This study observed that health literacy did not mediate health behavior and shift work. Further research is needed to clarify the causes of these differences.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":"67 1","pages":"uiae070"},"PeriodicalIF":2.6,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of COVID-19 on health status of self-employed workers.","authors":"Se-Eun Oh, Sangjun Choi","doi":"10.1093/joccuh/uiaf017","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf017","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the impact of the COVID-19 pandemic on the health status of self-employed workers by comparing their status before and during the pandemic, using nationwide data from the Korean Working Conditions Survey (KWCS).</p><p><strong>Methods: </strong>The final study included 16,620 and 14,342 self-employed participants in the 5th (2017) and 6th (2020-2021) surveys. Musculoskeletal symptoms, systemic fatigue, headache, and eye strain, as well as mental health status, such as anxiety, depression, and insomnia, were assessed using a structured questionnaire. Gender, age, education level, and income were adjusted for the multivariable logistic regression analysis to assess pre- and peri-pandemic changes in the health status based on working conditions.</p><p><strong>Results: </strong>Compared to the pre-pandemic period, all aspects of health status of self-employed individuals surveyed during the peri-pandemic period showed deterioration. Back pain increased 3.4 times (adjusted OR 3.44, 95% CI: 3.15-3.75) compared to the pre-pandemic period, followed by anxiety, which increased 2.1 times (adjusted OR 2.13, 95% CI: 1.79-2.54). For single-person businesses, the overall health status showed statistically significant deterioration, highlighting the heightened vulnerability of these groups during this period.</p><p><strong>Conclusions: </strong>This study confirmed that the physical and mental health status of self-employed individuals significantly deteriorated during the COVID-19 pandemic period compared to the pre-pandemic period. These findings suggest the need for government health protection policies for vulnerable groups, such as self-employed individuals, during future pandemics when social control measures are implemented.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Increased risk of proximal tubular dysfunction due to occupational cadmium exposure: a survival analysis study.","authors":"Kento Hoshino, Satoko Iwasawa, Noriyuki Yoshioka, Satoko Suzuki, Itsumi Hashimoto, Shoko Ukita, Genta Toshima, Kengo Nagashima, Toru Takebayashi, Masashi Tsunoda","doi":"10.1093/joccuh/uiaf016","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf016","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of the current study is to elucidate the relationship between blood cadmium (Cd-B) levels and proximal tubular dysfunction using urinary β2-microglobulin (B2M-U) as an indicator among workers in nickel-cadmium battery plants in Japan.</p><p><strong>Methods: </strong>Medical check-up data from 338 workers exposed to cadmium at 2 plants were collected from 1997 through 2020. Workers with at least 2 check-ups were included, excluding those with other renal dysfunctions. Proximal tubular dysfunction was defined as a B2M-U of 300 μg/g creatinine or higher in 2 or more consecutive check-ups. A multivariable Cox proportional-hazards regression model with time-dependent covariates was performed to analyze the relationship between Cd-B levels and the time to onset of proximal tubular dysfunction, adjusting for age, sex, and smoking history.</p><p><strong>Results: </strong>Of the 338 workers, 238 met the study eligibility criteria for the analyses. The geometric mean of Cd-B was 1.97 μg/L. The Cox proportional hazards analysis demonstrated that higher time-dependent Cd-B levels were significantly associated with an increased risk of proximal tubular dysfunction, with a hazard ratio (HR) of 1.17 (95% confidence interval [CI]: 1.06-1.29).</p><p><strong>Conclusions: </strong>Higher Cd-B levels are associated with an increased risk of proximal tubular dysfunction in workers exposed to cadmium, indicating an increased risk of renal disease under the current industrial health management in Japan. Continuous monitoring and improved management of cadmium exposure are necessary to protect workers' health even in developed countries such as Japan.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Carcinogenicity assessment: \"Modern Toxicology\" considerations from an experience in the evaluation of a carbon nanotube.","authors":"Jun Kanno","doi":"10.1093/joccuh/uiaf013","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf013","url":null,"abstract":"<p><p>The novel properties and functions of nanomaterials have naturally alerted the toxicologists to the fact that such materials may also have novel effects on the human body and living organisms. In particular, materials with high stability or biopersisteny have been shown to have a tendency to accumulate in the body, leading to chronic toxicity including carcinogenicity. However, at the early stages of toxicity research, the information is often limited to the effects of short-term exposure studies, and findings on chronic effects are very much delayed. In this context, it was rather exceptional that studies on multiwall carbon nanotubes (MWCNTs) have started with the verification of their potential to induce mesothelioma. This toxicological endpoint was expected on the basis of existing knowledge of asbestos and asbestos-like fiber particles. This movement has led to the achievement of the original mission of the \"Modern Toxicology\", which is \"to achieve a win-win situation where both industrial promotion and safety assurance are ensured by communicating and sharing toxicity information to developers and consumers at a stage before mass production and consumption begins, that is, before massive exposure of the general public begins\". Inaccurate toxicity assessments of asbestos in the 1980s and 1990s allowed its spread to our living environment, which is difficult to decontaminate, and the damage still continues to this day. However, the case described here could be an example of realizing the proposition that 'nanomaterials, the flagship of high technology, must not repeat the same mistakes.'</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health risks of N,N -dimethylacetamide (DMAC) in humans.","authors":"Tetsuo Nomiyama, Teruomi Tsukahara, Kohei Hasegawa","doi":"10.1093/JOCCUH/uiaf010","DOIUrl":"https://doi.org/10.1093/JOCCUH/uiaf010","url":null,"abstract":"<p><p>N,N-Dimethylacetamide (DMAC), which is widely used as an industrial solvent, can be absorbed via the respiratory tract and skin of humans exposed to DMAC. Hepatotoxicity is a main health risk of DMAC exposure in humans, and the relevant cases and epidemiological studies are reviewed herein. No hepatotoxicity was identified in workers exposed to approx. 3-ppm DMAC, and among workers exposed to > 9-ppm DMAC the DMAC exposure was not observed to contribute significantly to the liver damage. However, a case of liver damage was identified in which the calculated 8-hour weighted average was 12.8 mg/m3 (3.6 ppm). The skin absorption notation for DMAC is indicated based on human volunteer studies. The evidence regarding DMAC's potential carcinogenicity in humans is not sufficient, and our literature search identified no report of DMAC as a reproductive toxicant in humans. Further case reports and epidemiological studies are necessary to determine the acceptable DMAC exposure limit for workers and thus protect them from DMAC's toxicity.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health risks of N,N -dimethylacetamide (DMAC) in humans.","authors":"Tetsuo Nomiyama, Teruomi Tsukahara, Kohei Hasegawa","doi":"10.1093/joccuh/uiaf010","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf010","url":null,"abstract":"<p><p>N,N-Dimethylacetamide (DMAC), which is widely used as an industrial solvent, can be absorbed via the respiratory tract and skin of humans exposed to DMAC. Hepatotoxicity is a main health risk of DMAC exposure in humans, and the relevant cases and epidemiological studies are reviewed herein. No hepatotoxicity was identified in workers exposed to approx. 3-ppm DMAC, and among workers exposed to > 9-ppm DMAC the DMAC exposure was not observed to contribute significantly to the liver damage. However, a case of liver damage was identified in which the calculated 8-hour weighted average was 12.8 mg/m3 (3.6 ppm). The skin absorption notation for DMAC is indicated based on human volunteer studies. The evidence regarding DMAC's potential carcinogenicity in humans is not sufficient, and our literature search identified no report of DMAC as a reproductive toxicant in humans. Further case reports and epidemiological studies are necessary to determine the acceptable DMAC exposure limit for workers and thus protect them from DMAC's toxicity.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}