Journal of pediatric and adolescent gynecology最新文献

{"title":"NASPAG Advocacy Committee Statement Addressing the Barriers to Adolescent and Young Adult Abortion Access in the Post-Dobbs Era in the United States.","authors":"Kristl Tomlin, Amitha Ganti, Swetha Naroji","doi":"10.1016/j.jpag.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.03.008","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022813","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":"\"Really Hard to Navigate\": A Qualitative Study of Motivators, Barriers, and Supports of Adolescent-Clinician Communication on Patient Portals.","authors":"Andrea J Hoopes, Alina Metje, Creagh Miller, Charissa M Tomlinson, Thang D Dao, Marlaine Figueroa Gray","doi":"10.1016/j.jpag.2025.03.007","DOIUrl":"10.1016/j.jpag.2025.03.007","url":null,"abstract":"<p><strong>Purpose: </strong>To understand how patient portals can support adolescent sexual and reproductive health (SRH) care needs and to identify factors impacting use of patient portals for adolescent-clinician communication.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with adolescents, parents/guardians, and primary care providers (PCPs) by video or phone. Interview guides explored experiences with adolescent healthcare-seeking generally and SRH care specifically, as well as perspectives regarding adolescent portal use. Interviews were recorded, transcribed, and deidentified. Interviewer summaries written after each interview noted key themes that informed analysis. The analysis team collaboratively coded transcripts. Codes were synthesized into analytic memos, which were refined to develop results.</p><p><strong>Results: </strong>We interviewed 31 people from 1 health system: 10 adolescents 14-17 years old and 10 parents/guardians of adolescents aged 14-17, and 11 primary care providers (PCPs). A motivator of portal use shared by all participants included convenience of use. Clinicians and parents/guardians also viewed portals as a tool to support adolescent independence and improve quality of care. Barriers shared by all participants included lack of adolescent portal uptake and dissatisfaction with functionality. Clinicians and adolescents raised concerns about confidentiality while parents and clinicians raised concerns about safety of care. Supports shared by all participants included encouragement and guidance from trusted adults, while adolescents and clinicians described the reinforcing nature of positive care experiences using the portal.</p><p><strong>Discussion: </strong>Through the perspectives of adolescents, parents/guardians, and clinicians, we elucidated key factors that may influence adolescent portal use for SRH care needs. We identified critical intervention targets for future research.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795696","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":"The Financial Return from Investing on Girls and Women Health.","authors":"Saverio Bellizzi, Dina Said, Catello Mario Panu Napodano, Miriam Orcutt, Alessandra Nivoli","doi":"10.1016/j.jpag.2025.03.009","DOIUrl":"10.1016/j.jpag.2025.03.009","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780375","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":"Inaction Despite Motivation: Assessing Systemic and Personal Barriers to Pediatricians' Post-Dobbs Emergency Contraception Utilization.","authors":"Elizabeth Hovel, Michelle Pickett, Alexis Visotcky, Kelsey Porada, Wendi Ehrman, Margaret Thew, Vanessa McFadden","doi":"10.1016/j.jpag.2025.03.006","DOIUrl":"10.1016/j.jpag.2025.03.006","url":null,"abstract":"<p><strong>Purpose: </strong>Following the US Supreme Court's Dobbs vs Jackson Women's Health (Dobbs) decision and subsequent changes to abortion access, increasing emergency contraception (EC) access for adolescents is vital. The first step is understanding providers' knowledge, attitude and practices regarding EC post-Dobbs.</p><p><strong>Methods: </strong>This cross-sectional internet-based survey was sent to providers within 3 general pediatric primary care systems from November 2023 to January 2024. Questions addressed EC knowledge, attitudes (perceived barriers and desired support to increase EC prescription) and practices post-Dobbs.</p><p><strong>Results: </strong>There were 51 participants. Most (81%) providers felt adolescent EC prescription was more important post-Dobbs, but very few (7%) had increased their own prescribing practices. Overall, providers had a mean knowledge score of 71%. Providers closer to training had a higher EC knowledge score (77% vs 68%, P = .02), as did providers who were generally willing to provide EC (72% vs 58%, P = .004). Providers in urban and rural areas were more likely to have prescribed EC than suburban counterparts (54% urban, 40% rural, 16% suburban, P = .04). Various barriers were elicited, most commonly relating to lack of awareness and knowledge about EC. Over half of respondents noted they would be more likely to prescribe EC with clinical decision support built into the EMR (69%), an order set in the electronic medical record (57%), and education sessions (55%).</p><p><strong>Discussion: </strong>This study highlights a strong need to bolster provider EC education in pediatrics and address systems factors that will facilitate easier, more confident EC prescription.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663707","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":"Effects of Combined Hormonal Contraceptives (CHCs) on Bone Health in Adolescent Girls-A Systematic Review.","authors":"Leek Mei Lim, Wogud Ben Said, Pallavi Latthe","doi":"10.1016/j.jpag.2025.03.004","DOIUrl":"10.1016/j.jpag.2025.03.004","url":null,"abstract":"<p><strong>Objective: </strong>To summarize the effects of combined hormonal contraceptives (CHCs) on bone health in adolescent girls DESIGN: A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane Library clinical trials register, from inception to July 2024.</p><p><strong>Eligibility: </strong>Intervention and cohort studies that assessed the use of CHCs on bone health in adolescent girls aged 10-19 years old were included.</p><p><strong>Data synthesis: </strong>Four randomized control trials and 8 observational studies (n = 2689) were included.</p><p><strong>Conclusion: </strong>Current evidence indicates that the use of CHCs in postmenarchal adolescent girls reduces bone accrual compared with non-users. The negative impact on bone accrual is likely related to the estrogen dose in the CHC preparation, the regimen used, and the duration of use.</p><p><strong>Prospero registration number: </strong>PROSPERO CRD 42024574905 on 31 July 2024.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649461","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 Transdermal Estrogen Therapy on Bone and Neurobehavioral Health in Youth with Premature Ovarian Insufficiency: A Case-Control Study.","authors":"Halley Wasserman, Heidi J Kalkwarf, Mekibib Altaye, Kimberly Yolton, Catherine M Gordon","doi":"10.1016/j.jpag.2025.03.005","DOIUrl":"10.1016/j.jpag.2025.03.005","url":null,"abstract":"<p><strong>Study objective: </strong>Estrogen replacement therapy (ERT) improves bone and neurocognitive health in adult women with premature ovarian insufficiency (POI). However, the response in adolescents is largely unknown. We aimed to assess the impact of transdermal estrogen replacement therapy on these outcomes in adolescents with POI.</p><p><strong>Methods: </strong>Nine adolescents with idiopathic POI, naïve to ERT, and 9 controls with regular menses matched for age, race, and body mass index were recruited between 2018 and 2023 for a 24-month study. The primary bone health outcomes were changes in lumbar spine bone mineral density (BMD) Z-score and 3% distal radius trabecular volumetric BMD. The primary neurocognitive outcomes were quality of life (CHQ-87 survey) and memory (ChAMP).</p><p><strong>Results: </strong>Adolescents with POI experienced significant increases in BMD Z-scores at all dual-energy x-ray absorptiometry skeletal sites (lumbar spine ∆ +0.68, total hip ∆ +0.37, femoral neck ∆ +0.56, total body less head ∆ +0.82, all P < .05). Control participants exhibited an increase in BMD Z-score at the total body less head (∆ 0.43, P = .034) with no significant change at other skeletal sites. There were no significant changes from baseline to 24 months in peripheral quantitative computed tomography measures. Total memory index significantly increased in both groups from baseline to 24 months (controls ∆ +17.2, cases ∆ +24.6, P = .041 and .001, respectively), but there was no difference between groups. There were no other significant differences in neurocognitive outcomes among or between groups.</p><p><strong>Conclusion: </strong>Central BMD increased in adolescents with idiopathic POI in response to transdermal estrogen replacement therapy, but peripheral BMD measures were unchanged. The impact on neurocognitive outcomes in these adolescents remains uncertain.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649460","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":"Maternal Factors During Pregnancy and Pubertal Timing in Offspring: A Systematic Review of the Literature.","authors":"Siyu Zhou, Bregje C D van Uden, Margot Smets, Lisa Kamperdijk, Jiexin Tang, Hristiyanna I Ivanova, Joost Daams, Theodorus B Twickler, Tanja G M Vrijkotte","doi":"10.1016/j.jpag.2025.03.003","DOIUrl":"10.1016/j.jpag.2025.03.003","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aims to identify, assess the quality of, and synthesize evidence on nongenetic maternal factors, such as psychological factors, lifestyle, nutrition, and endocrine conditions that may be associated with pubertal timing in male and female offspring.</p><p><strong>Methods: </strong>The search was conducted in Medline, Embase, PsycInfo and Web of Science. The reference lists of retrieved articles were checked to avoid missing relevant studies. There were no restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa Scale. This review has been registered on PROSPERO (CRD42023394102). A best-evidence approach was applied to qualitatively summarize the findings and draw conclusions on the level of evidence.</p><p><strong>Results: </strong>The search yielded 4199 studies, of which 73 were included in this systematic review. In both boys and girls, there is strong evidence of a positive association between maternal gestational weight gain and an earlier pubertal timing, while no association was found with maternal substance use, thyroid dysfunction, or gestational hypertension. In addition, there is insufficient evidence of an association with maternal psychological factors, smoking, diet, physical activity, prepregnancy weight/body mass index, diabetes, menstruation-related disorders, and steroid medication use.</p><p><strong>Conclusion: </strong>This review provides a comprehensive overview of the quality and consistency of existing evidence regarding maternal factors during pregnancy that may be associated with the pubertal timing in their offspring. This review may serve as an orientation for future research initiatives, with a particular focus on exploring these associations among male offspring and in low- and middle-income countries.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615792","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":"21. Case report: Premature ovarian insufficiency as a cause of primary amenorrhea","authors":"Daniela Capella,&nbsp;Ignacia Reyes","doi":"10.1016/j.jpag.2025.01.054","DOIUrl":"10.1016/j.jpag.2025.01.054","url":null,"abstract":"<div><h3>Background</h3><div>Premature ovarian insufficiency (POI) is the loss of ovarian function in women under 40 years, diagnosed through amenorrhea or oligomenorrhea and two elevated follicle-stimulating hormone (FSH) levels. Its prevalence ranges from 1% to 3.7%, with 1 in 10,000 cases in women under 20 years. In 70-90% of cases the etiology is unknown. Known causes include Turner syndrome, fragile X syndrome, autoimmunity, infections and iatrogenic. Untreated POI can lead to osteoporosis, cardiovascular risk, Alzheimer's disease, mental health disorders and infertility. We present a case of POI manifesting as primary amenorrhea, with the aim of emphasizing the need of early identification and treatment.</div></div><div><h3>Case</h3><div>A 16-year-old girl with no prior medical history presented with primary amenorrhea. Her physical exam showed a height of 172 cm, 10 cm above her target height. She had Tanner stage 2 in breasts and pubic hair, anatomically normal female external genitalia and hypoestrogenized mucous membranes. Lab tests showed FSH levels of 69 mIU/ml and undetectable anti-Müllerian hormone. The gynecological ultrasound indicated uterine length of 52 mm and ovarian volumes of less than 1cc. POI was suspected and confirmed with a second elevated FSH level. Investigations into possible etiologies were carried out, revealing a 46 XX karyotype, negative fragile X premutation studies, normal thyroid function and negative thyroid antibodies. A genetic evaluation was requested, which included testing for 53 genes in Disorders of Sexual Development Panels, all of which were negative. Additionally, to rule out the diagnosis of Triple X syndrome, which can cause tall stature and POI, an extended karyotype with 50 metaphases was requested, and the result is pending. Due to prolonged hypoestrogenism, a bone densitometry was performed, with normal results. The patient began low-dose transdermal estradiol, gradually increasing to 2 mg over two years, after which she had her first menstrual bleed. Monthly cyclic micronized progesterone was added. During treatment, she progressed to Tanner stage 5 for breast and pubic hair development, and her final height was 175 cm. Serial ultrasounds indicated progressive uterine growth, reaching 77 mm by age 20.</div></div><div><h3>Comments</h3><div>POI is a very rare diagnosis in women under 20 years, especially as a cause of primary amenorrhea. In our case, the patient presented arrested puberty at Tanner stage 2. While the cause is often unknown, ruling out common causes and monitoring for conditions like osteoporosis is crucial. Hormonal treatment should always be initiated promptly and continued until the average age of menopause to prevent hypoestrogenism-related complications.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 240"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519935","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":"10. Improving counseling on treatment options for heavy menstrual bleeding via an educational aid: a pilot study","authors":"Erin Isaacson,&nbsp;Rebecca Richardson,&nbsp;Kate McCracken,&nbsp;Melina Dendrinos,&nbsp;Monica Rosen","doi":"10.1016/j.jpag.2025.01.022","DOIUrl":"10.1016/j.jpag.2025.01.022","url":null,"abstract":"<div><h3>Background</h3><div>Heavy menstrual bleeding (HMB) affects a significant number of reproductive-aged adolescents assigned female at birth (AFAB). There is limited literature examining the use of educational aids (EDA) or videos for adolescent patients initiating hormonal treatment for HMB. EDA could help to eliminate bias and ensure patients receive high-quality information. We hypothesized that use of an EDA would be non-inferior to traditional counseling from a Pediatric and Adolescent Gynecology (PAG) physician on patient's knowledge of treatment options and confidence in method selection</div></div><div><h3>Methods</h3><div>This is a prospective, randomized controlled trial. IRB approval was obtained. An EDA was created by the PAG department within our institution. Patients AFAB ages 11-21 presenting with a complaint of HMB were recruited to the study. Participants completed a short demographic and knowledge survey and were randomized based on medical record number to traditional versus EDA counseling. Traditional counseling was performed by PAG attendings or fellows. After EDA or traditional counseling, participants completed an additional survey of questions assessing their counseling experience, knowledge of options, and their decision-making process</div></div><div><h3>Results</h3><div>17 patients were recruited, 8 in the EDA group and 9 in the traditional group. There were no differences between groups in patient ages, race or ethnicity (Table 1). Patients in both groups felt the amount of information they received was “perfect” (p=.76). Patients in the traditional group felt they received more new information compared to the EDA group (p=.02) (Table 1). Both groups felt they learned equally about all options (p=.28). The EDA group answered more post-survey knowledge questions correctly on average compared to the traditional group (p= .02) (Table 1). The traditional counseling group felt significantly more confident than the EDA group when choosing a method (p=.02), though both groups fell into the “confident” range</div></div><div><h3>Conclusions</h3><div>Patients learned equally about options in both the EDA and traditional counseling groups but felt more confident about choosing an option in the traditional group. EDAs may be a useful tool to eliminate potential bias, improve efficiency in clinic, and increase adolescents’ confidence in making health care choices</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 225"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520009","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":"5. Evaluating an Adolescent and Young Adult-Focused Medication Abortion Curriculum for Pediatric Trainees","authors":"Julia Raney ,&nbsp;Chelsea Garnett ,&nbsp;Amanda Bryson ,&nbsp;Lisa Mihaly ,&nbsp;Sara Buckelew ,&nbsp;Marissa Raymond-Flesch","doi":"10.1016/j.jpag.2025.01.017","DOIUrl":"10.1016/j.jpag.2025.01.017","url":null,"abstract":"<div><h3>Background</h3><div>22 states ban or restrict abortion, limiting access for adolescents and young adults (AYAs) and reducing number of abortion providers. Further, AYA-focused medication abortion (MAB) curricula are lacking. We developed, implemented, and evaluated an AYA-focused MAB curriculum for pediatric trainees (pediatric residents, nurse practitioner students, and medical students).</div></div><div><h3>Methods</h3><div>Using Kern's Six Steps, we designed a curriculum of four online modules (videos with readings on adolescent pregnancy options counseling, MAB provision, post-abortion care, and harm reduction strategies) and a 2-hour workshop (module review, a values clarification exercise, and a clinical case). Adolescent themes included AYA-specific barriers and health equity concerns, developmental considerations, and confidentiality concerns. 9 workshops were held over the 2023-2024 academic year. Pre- and post-surveys assessed key components of behavior change according to Social Cognitive Theory including learner satisfaction, knowledge, intentions, values, and self-efficacy. McNemar test and Wilcoxon signed-rank test assessed differences in quantitative pre/post results; we analyzed open-ended responses using a thematic content approach. This study received IRB approval.</div></div><div><h3>Results</h3><div>29 of 53 participants completed both surveys (54%); most learners were pediatric residents (52%) or nurse practitioner students (45%), with one medical student also participating (3%). Learners’ cumulative knowledge score increased after curriculum completion (60% vs 90%; p&lt;.001). Overall intentions to provide, refer, and advocate for MAB did not change significantly (average of 3 questions on a Likert scale 1-5: 4.3 vs 4.3; p=.92). Similarly, learners' feelings around caring for patients seeking abortions did not change significantly (average of 7 questions on a Likert scale 1-5: 4.4 vs 4.4, p=.76). After completion, learners felt fairly or completely confident in counseling on pregnancy (72%) and abortion options (66%), determining medical eligibility (88%), and providing anticipatory guidance (89%). 85% of learners rated the overall curriculum excellent or outstanding. In open-ended responses, learners described the curriculum as highly valuable.</div></div><div><h3>Conclusions</h3><div>This AYA-focused MAB curriculum improved pediatric trainees' knowledge of MAB management with learners feeling fairly confident or greater to perform key aspects of MAB care after curriculum completion. Intentions to provide MABs did not change significantly, possibly due to high pre-scores. While values scores did not shift significantly, many learners noted this curriculum was a valuable contribution to their pediatric training.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 221-222"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520113","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}