Journal of the National Medical Association最新文献

{"title":"Impact of Etonogestrel-releasing contraceptive implant use in cisgender women with Sickle cell disease","authors":"Milena Bastos Brito ,&nbsp;Andrea Queiroz Vilas Boas ,&nbsp;Anelise Maria Nicolau Silva ,&nbsp;Flávia Pimentel Miranda ,&nbsp;Carolina Brabec Barreto Matos ,&nbsp;Oziemile Silva Santos ,&nbsp;Tais Paiva da Costa","doi":"10.1016/j.jnma.2024.09.003","DOIUrl":"10.1016/j.jnma.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease is a hereditary hemolytic anemia that exposes women to increased health risks especially in pregnancy, with serious implications for the woman and fetus. Acute pain episodes can occur multiple times per month and result in reduction of quality of life and disruption of her life.</div></div><div><h3>Objective</h3><div>To assess the clinical, including pain and metabolic parameters of women with sickle cell disease using etonogestrel-releasing contraceptive implants.</div></div><div><h3>Methods</h3><div>Women with sickle cell disease, aged 18–40 years, with reports of pain crises in the preceding 3 months were included and followed up for 12 months. Blood samples were collected to evaluate the blood count, reticulocytes, liver profile (alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin and its fractions), lipid profile, and lactate dehydrogenase levels before and 6 and 12 months after implant insertion. The following clinical variables were analyzed every 3 months: bleeding pattern, blood pressure, weight, body mass index, pain intensity (assessed using a visual analogic scale (VAS) from 0 to 10), and frequency of pain crises.</div></div><div><h3>Results</h3><div>Twenty-three women completed the study. There were no differences in laboratory variables between baseline and 6 and 12 months after implant insertion. Similarly, clinical variables did not differ, except for pain intensity (VAS pre-insertion = 8 vs. VAS 12 months post insertion = 4; p = 0.005) and frequency of pain crises (pre-insertion = 6 vs. 12 days/month post insertion = 0; p = 0.000).</div></div><div><h3>Conclusions</h3><div>Etonogestrel-releasing contraceptive implants were associated with a reduction in the intensity and frequency of pain crises in women with sickle cell disease. Moreover, it was safety among these population due to no changes in laboratory parameters during the first 12 months of use.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 569-575"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485016","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":"Life's essential eight as targets for cardiometabolic risk reduction among non-Hispanic black adults: A primary care approach","authors":"Ebubechukwu Ezeh ,&nbsp;Onyedika Ilonze ,&nbsp;Maddie Perdoncin ,&nbsp;Archana Ramalingam ,&nbsp;Gurleen Kaur ,&nbsp;Bisher Mustafa ,&nbsp;Samson Teka ,&nbsp;Keith C. Ferdinand","doi":"10.1016/j.jnma.2023.11.003","DOIUrl":"10.1016/j.jnma.2023.11.003","url":null,"abstract":"<div><div>Cardiovascular diseases remain the leading cause of death in the United States. Several studies have shown racial disparities in the cardiovascular outcomes. When compared to their Non-Hispanic White (NHW) counterparts, non-Hispanic Black (NHB) individuals have higher prevalence of cardiovascular risk factors and thus, increased mortality from atherosclerotic cardiovascular diseases. This is evidenced by lower scoring in the indices of the American Heart Association's Life Essential 8 among NHB individuals. NHB individuals score lower in blood pressure, blood lipids, nicotine exposure, sleep, physical activity level, glycemic control, weight, and diet when compared to NHW individuals. Measures to improve these indices at the primary care level may potentially hold the key in mitigating the health care disparities in cardiovascular health experienced by NHB individuals.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 468-476"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541418","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":"Relationship between race, income-level, and Cardiovascular Disease","authors":"Khawaja M. Talha ,&nbsp;Eisha Waqar ,&nbsp;Heather M. Johnson ,&nbsp;Michael D. Shapiro ,&nbsp;Vijay Nambi ,&nbsp;Salim S. Virani ,&nbsp;Anurag Mehta ,&nbsp;Khurram Nasir ,&nbsp;Michael E. Hall ,&nbsp;Dmitry Abramov ,&nbsp;Abdul Mannan Khan Minhas","doi":"10.1016/j.jnma.2024.07.115","DOIUrl":"10.1016/j.jnma.2024.07.115","url":null,"abstract":"<div><h3>Aim</h3><div>To study the prevalence of cardiovascular disease (CVD) and associated risk factors among different races/ethnicities across different income groups.</div></div><div><h3>Methods</h3><div>This retrospective analysis included data from the National Health and Nutrition Examination Survey from 2005-2018. Adults &gt;20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic were included. Family income-to-poverty ratio (PIR) was calculated by dividing family income by poverty guidelines specific to the survey year and divided into four quartiles. Weighted logistic regression was performed to estimate adjusted odds ratios to determine association of race/ethnicity and CVD in each PIR quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, education level, and PIR.</div></div><div><h3>Results</h3><div>We included 31,884 adults that corresponded to ∼191.3 million weighted, nationally representative participants. Of these, 8,009, 7,967, 7,944, and 7,964 participants belonged to 1^st, 2^nd, 3^rd, and 4^th quartiles, respectively. The prevalence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased with each successive PIR quartile. NH Black participants had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH White participants. The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity (p-interaction=0.002), DM (p-interaction=0.027), and stroke (p-interaction=0.053) in the 4^th PIR quartile (highest income) compared to the 1^st PIR quartile (lowest income).</div></div><div><h3>Conclusion</h3><div>Racial and ethnic disparities in the risk of CVD persists across income levels, with a greater difference in prevalence of select CVD and risk factors between NH Black and NH White participants in the highest income quartile compared to the lowest income quartile.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 539-552"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141940104","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":"COVID-19 vaccine uptake and intention of Black adults: A county-wide analysis of an online survey","authors":"Krissy Moehling Geffel ,&nbsp;Harika P. Dyer ,&nbsp;Andrea D. Casas ,&nbsp;Stephanie N. Christian-Afflu ,&nbsp;Dara D. Méndez ,&nbsp;Tiffany L. Gary-Webb","doi":"10.1016/j.jnma.2024.07.007","DOIUrl":"10.1016/j.jnma.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>There are demonstrated racial inequities in coronavirus 2019 (COVID-19) disease burden, and the initial vaccine rollout did not equitably address these disparities.</div></div><div><h3>Methods</h3><div>We conducted analyses of a national Facebook survey restricted to Black adult residents of Allegheny County, Pennsylvania for the period of May 2021 to January 2022. We assessed the associations between demographics, health status, social normative context, perceived racial discrimination, and beliefs about COVID-19 mitigation strategies on vaccine uptake and intention and compared reasons reported for vaccine hesitancy, and vaccine non-intention among the unvaccinated. Multivariable logistic regression was conducted on a subset of unvaccinated respondents to explore variables associated with vaccine intent.</div></div><div><h3>Results</h3><div>Over 85 % of 1,552 respondents were vaccinated against COVID-19 at the time of the survey. Compared to the unvaccinated, vaccinated respondents were older and more highly educated (<em>P </em>&lt;<em></em>0.001), more likely to have at least one chronic health condition (<em>P </em>=<em></em>0.03) and had a stronger social normative context in support of vaccination (<em>P </em>&lt;<em></em>0.001). Vaccinated respondents also reported greater personal adherence to wearing face masks when out in public and were more likely to report positive perceptions of the effectiveness of mitigation strategies (e.g., face masks) towards preventing COVID-19 transmission (<em>P </em>&lt;<em></em>0.001).</div><div>Unvaccinated respondents were more likely to report intention to be vaccinated if they felt that face masks were very effective in the prevention of COVID-19 compared to those who felt this mitigation strategy was only moderately/slightly/not at all effective (OR: 4.52; 95 % CI: 1.23–16.59; <em>P </em>=<em></em>0.02) and if they did not report mistrust in the government or COVID-19 vaccines compared to those reporting mistrust (OR: 7.72; 95 % CI: 1.34–44.64; <em>P </em>=<em></em>0.02).</div></div><div><h3>Conclusion</h3><div>COVID-19 vaccination levels were high among Black adult residents of Allegheny County who responded to the survey. Future efforts should continue to strive towards addressing reasons for mistrust with focused attention from healthcare institutions and the government on increasing their trustworthiness, alongside employment of evidence-based strategies to increase vaccination rates. Additionally, efforts should continue to engage unvaccinated and vaccine hesitant persons’ perspectives to inform ongoing health equity interventions.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 526-538"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020096","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":"Cardiovascular complications of sickle cell disease: A primer for the general clinician","authors":"Chibuzo Ilonze ,&nbsp;Gift C. Echefu ,&nbsp;Alexandria L. Broadnax ,&nbsp;Adedoyin Johnson ,&nbsp;Aniekeme Etuk ,&nbsp;Onyedika J. Ilonze","doi":"10.1016/j.jnma.2023.11.010","DOIUrl":"10.1016/j.jnma.2023.11.010","url":null,"abstract":"<div><div><span>Sickle cell disease<span> (SCD) is the most common hereditary hemoglobinopathy and mainly affects individuals of African ancestry. As survival has improved especially in high-income countries, increased rates of cardiopulmonary complications such as pulmonary hypertension, heart failure with </span></span>diastolic dysfunction<span>, and sudden death are encountered in clinical practice. These complications are the leading causes of morbidity and mortality as these individuals survive into adulthood. Understanding the need for, early identification, timely intervention, and implementation of preventive strategies are critical in reversing this trend and improving quality of life and survival rates. This manuscript aims to provide a comprehensive review of the pathogenesis of cardiovascular complications associated with sickle cell disease and equip the clinician with tools to facilitate the early diagnosis and management of patients with SCD as increasing numbers survive into adulthood.</span></div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 517-525"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138683604","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":"Protecting black lives: Reducing disparities in cardiovascular morbidity and mortality","authors":"Onyedika J. Ilonze ,&nbsp;Hakeem Ayinde ,&nbsp;Keith C. Ferdinand","doi":"10.1016/j.jnma.2023.11.011","DOIUrl":"10.1016/j.jnma.2023.11.011","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 466-467"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138505073","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":"Trends in fatal opioid overdoses and opioid-related emergency department visits among the black population in California, 2011–2022","authors":"Sabrina L. Smiley,&nbsp;Heesung Shin","doi":"10.1016/j.jnma.2024.10.002","DOIUrl":"10.1016/j.jnma.2024.10.002","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 607-610"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515782","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":"Knowledge, attitudes, and practices of sickle cell hemoglobinopathies: A case-control study from the sickle cell belt of Odisha, India","authors":"Basanta Kumar Bindhani ,&nbsp;Kallur Nava Saraswathy ,&nbsp;Jayanta Kumar Nayak ,&nbsp;Naorem Kiranmala Devi","doi":"10.1016/j.jnma.2024.10.003","DOIUrl":"10.1016/j.jnma.2024.10.003","url":null,"abstract":"<div><div>Despite the high prevalence of sickle cell haemoglobin (HbS) in Odisha, awareness and understanding of sickle cell trait (SCT) and sickle cell disease (SCD) remain low in affected communities. This cross-sectional study assesses the knowledge, attitude, and practice (KAP) regarding sickle cell hemoglobinopathies among 182 sickle cell carriers and 200 age-sex-community matched controls. The overall knowledge of sickle cell hemoglobinopathies was very low among both case and control groups (score 2.8/10). Although most respondents had heard about SCD (85.71% vs. 82%), few were aware of SCT (34.07% vs. 27%). Notably, none of the participants knew their haemoglobin genotype or carrier status. Only a very small proportion were aware of symptoms, causes, and preventive measures. The overall attitude score was marginally higher in the control group (4.75/11) than in the case group (4.55/11), with an average score of 42.25%. While most recognized the need for regular treatment and screening of children (82.4% carriers, 90.5% controls), many were undecided about the necessity of premarital screening. The overall practice score was very low in both groups (0.4/5), but the mean practice score was significantly higher in cases than controls (11.01% vs. 7.55%). Most participants did not undergo regular health check-ups or engage in preventive measures (97.25%). Traditional health practices were commonly relied upon for treatment. Participants reported a lack of awareness about SCT and fear of discrimination, social isolation, and marriage refusal as major barriers to screening participation.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 611-625"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515780","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":"Primary care physician density and mortality in the United States","authors":"Ali Bin Abdul Jabbar ,&nbsp;Khawaja M Talha ,&nbsp;Vijay Nambi ,&nbsp;Dmitry Abramov ,&nbsp;Abdul Mannan Khan Minhas","doi":"10.1016/j.jnma.2024.10.001","DOIUrl":"10.1016/j.jnma.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Geographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established.</div></div><div><h3>Methods</h3><div>The study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI).</div></div><div><h3>Results</h3><div>A total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824–832) in the first quartile, 798 (95% CI, 796–801) in the second quartile, 737 (95% CI, 735–739) in the third quartile, and 679 (95% CI, 678–680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443–449), 439 (95% CI, 437–441), 403 (95% CI, 402–404), and 365 (95% CI, 364–366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783–812) and 430 (95%CI, 419–440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of −4.11 (95% CI, −18.31, 10.08), −35.37 (95% CI, −49.57, −21.17) and −85.79 (95% CI, −100.10, −71.48). Similar results were observed for CVD-related AAMR.</div></div><div><h3>Conclusion</h3><div>Higher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 600-606"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515781","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":"Validating the factor structure and reliability of the sleep quality scale in a community-based study in Ibadan, Nigeria","authors":"Osahon Jeffery Asowata ,&nbsp;Aderonke Busayo Sakpere ,&nbsp;Anthony Ike Wegbom ,&nbsp;Charles Emaikwu ,&nbsp;David Kadan Danladi ,&nbsp;Innocent Okoro ,&nbsp;Sunday Oladiran ,&nbsp;Tobi Elisha Adekolurejo ,&nbsp;Akinkunmi Paul Okekunle ,&nbsp;Onoja Matthew Akpa","doi":"10.1016/j.jnma.2024.09.001","DOIUrl":"10.1016/j.jnma.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The sleep quality scale (SQS) is a comprehensive multidimensional sleep assessment scale used to evaluate sleep quality (SQ) among adults in the general population. However, the scale is yet to be validated among indigenous African populations such as in Nigeria. This study validated the factor structure and evaluated the reliability of a previously developed SQS among community-based adults in Ibadan, Nigeria.</div></div><div><h3>Methods</h3><div>Data on SQ was extracted from 3,635 adult (≥18 years) from the Community-based Investigation of the Risk Factors for Cardiovascular Disease (COMBAT-CVDs) study. Cronbach-alpha (<span><math><mi>α</mi></math></span>) was used to evaluate the internal consistency or reliability of the SQS (&gt;50 % cut-off), while the original 6-factor model of the SQS was explored using exploratory (≥0.5 cut-offs) and confirmatory factor analyses. The chi-square goodness of fit test and multiple fit indices were used to assess model fit at a two-sided <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Overall, the participant's mean age was 35.33±15.20 years, and 54.60 % were male. The overall reliability estimate for the SQS was 86.00 %, while the restoration after sleep subscale reliability was 93.00 %. The exploratory and confirmatory factor analysis showed that the original 6-factor model of the SQS is a more plausible model for this sample of community-based adults: comparative fit index &gt;0.92, Tucker-Lewis index &gt; 0.91, root mean square error of approximation ≤ 0.05.</div></div><div><h3>Conclusion</h3><div>Our findings revealed that the SQS is promising for population-based assessment of SQ and may also assist in identifying sleep-related disorders and monitoring the efficacy of sleep treatment among indigenous Africans.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 553-565"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515783","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}