Maarten C Eisma, Lara O Schmitt, Rakel Eklund, Filip K Arnberg, Paul A Boelen, Josefin Sveen
{"title":"A 1-year follow-up of the My Grief app for prolonged grief.","authors":"Maarten C Eisma, Lara O Schmitt, Rakel Eklund, Filip K Arnberg, Paul A Boelen, Josefin Sveen","doi":"10.1002/jts.23181","DOIUrl":"10.1002/jts.23181","url":null,"abstract":"<p><p>Mobile health applications (apps) are increasingly used to reduce mental health problems. However, few effective apps are available for bereaved adults. Recently, a randomized controlled trial demonstrated the short-term beneficial effects of access to the My Grief app in mitigating symptoms of prolonged grief and posttraumatic stress in bereaved parents. The present study examined the long-term outcomes of app access and their predictors in a longitudinal survey of participants who had access to the My Grief app. We assessed symptoms of prolonged grief (PG-13), posttraumatic stress (PCL-5), and depressive symptoms (PHQ-9) at 3-, 6-, and 12-month follow-up assessments. Potential predictors of symptom change included baseline symptom levels, sociodemographic and loss-related variables, rumination (UGRS), negative grief-related cognitions (GCQ-SF), avoidance processes (DAAPGQ), and self-reported app use reported at each follow-up. Significant small-to-moderate reductions in prolonged grief, posttraumatic stress, and depressive symptoms were observed in people with app access at most follow-ups, ds = 0.26-0.66. For each symptom type, more severe baseline symptoms significantly predicted larger symptom reductions, Bs = 0.37-0.55. Lower baseline negative grief-related cognitions significantly predicted larger 3-month prolonged grief, B = -0.15, and posttraumatic stress symptom reductions, B = -0.23. Lower baseline anxious avoidance significantly predicted larger 3-month depressive symptom reductions, B = -0.23. Self-reported app use did not significantly predict symptom changes. Participants with access to the My Grief app experienced decreased symptom levels over a 1-year period. Specific cognitive behavioral processes (avoidance, negative cognitions) appear to be implicated in the short-term effects of app access.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333422","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}
Jamila Ismayilova, Josef I Ruzek, Gunel Muradova, Aygun Sultanova, Nigar Mammadli, Gulsabah Guliyeva, Fuad Ismayilov, Kathleen M Chard
{"title":"The effectiveness of cognitive processing therapy for posttraumatic stress disorder in Azerbaijan.","authors":"Jamila Ismayilova, Josef I Ruzek, Gunel Muradova, Aygun Sultanova, Nigar Mammadli, Gulsabah Guliyeva, Fuad Ismayilov, Kathleen M Chard","doi":"10.1002/jts.23183","DOIUrl":"https://doi.org/10.1002/jts.23183","url":null,"abstract":"<p><p>Posttraumatic stress disorder (PTSD) poses a significant mental health challenge in postconflict Azerbaijan. This study explored the effectiveness of cognitive processing therapy (CPT) in this context, addressing a critical gap in psychotherapeutic interventions for PTSD. The study employed an intent-to-treat (ITT) analysis to assess the impact of CPT on PTSD and depressive symptoms, evaluate sustainability over 3 months, and examine changes in psychosocial functioning and well-being. A single-arm, open-label pilot dissemination project was conducted from October 2022 to April 2023. Participants (N = 103) underwent CPT led by local clinicians trained by U.S. experts. Measures included the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), World Health Organization Well-Being Index (WHO-5), and Brief Inventory of Psychosocial Functioning (B-IPF). Post-CPT, significant reductions were observed in PTSD symptoms, ΔM<sub>baseline-posttreatment</sub> = -35.9, p < .001, d = 3.56, and depressive symptom, ΔM <sub>baseline-posttreatment</sub> = -12.9, p < .001, d = 2.91. Sustained improvements in PTSD symptoms were noted at the 3-month follow-up assessment. Psychosocial functioning notably improved posttreatment ΔM <sub>baseline-posttreatment</sub> = -5.6, p < .001, d = 0.75, and well-being showed a significant increase, ΔM <sub>baseline-posttreatment</sub> = 7.1, p < .001, d = 1.52. This pilot trial highlights CPT's effectiveness in alleviating PTSD and depressive symptoms, improving psychosocial functioning, and enhancing well-being. Despite limitations, the findings suggest that CPT is a promising psychotherapeutic intervention for PTSD in Azerbaijan, warranting further research with larger samples and extended follow-up periods.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333424","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}
Isabel Garces-Davila, Taylor A Teckchandani, Laleh Jamshidi, Danielle M Caissie, Tamara Taillieu, Julie-Anne McCarthy, Lauren MacGowan, Lisa M Lix, Sherry H Stewart, Shannon Sauer-Zavala, Gregory P Krätzig, Jitender Saren, R Nicholas Carleton, Tracie O Afifi
{"title":"The association between childhood adversity and resilience among cadets: Evidence from The Royal Canadian Mounted Police Study.","authors":"Isabel Garces-Davila, Taylor A Teckchandani, Laleh Jamshidi, Danielle M Caissie, Tamara Taillieu, Julie-Anne McCarthy, Lauren MacGowan, Lisa M Lix, Sherry H Stewart, Shannon Sauer-Zavala, Gregory P Krätzig, Jitender Saren, R Nicholas Carleton, Tracie O Afifi","doi":"10.1002/jts.23177","DOIUrl":"10.1002/jts.23177","url":null,"abstract":"<p><p>In this study, our aims were to (a) examine the associations between adverse childhood experiences (ACEs; i.e., childhood maltreatment, household challenges, and peer victimization) and resilience, adjusting for sociodemographic variables, and (b) test the moderating effect of emotional regulation on the association between childhood maltreatment ACEs and resilience in Royal Canadian Mounted Police (RCMP) cadets. Study data were from the RCMP Study. Participants were Cadets (N = 597, 75.0% men) who underwent a full assessment before the Cadet Training Program (CTP). Logistic regression models were used to estimate the associations between ACEs and resilience while adjusting for sociodemographic variables and to test the moderating effect of emotional regulation; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. Several childhood maltreatment ACEs were associated with decreased resilience among cadets after adjustment for sociodemographic covariates: physical abuse, aOR = 0.26, 95% CI [0.10, 0.68]; emotional abuse, aOR = 0.28, 95% CI [0.10, 0.79]; neglect, aOR = 0.22, 95% CI [0.09, 0.55]; exposure to intimate partner violence, aOR = 0.18, 95% CI [0.04, 0.73]; and peer victimization, aOR = 0.30, 95% CI [0.12, 0.76]. The interaction between exposure to any childhood maltreatment ACE and emotional suppression, as assessed using the Emotion Regulation Questionnaire, was significantly associated with low resilience scores, aOR = 0.94, 95% CI [0.89, 0.99]. The current results underscore the critical importance of mitigating the adverse impact of childhood maltreatment ACEs on resilience processes among cadets before the CTP.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333423","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":"Introduction to the special section on the long-term health impact of trauma, posttraumatic stress disorder, comorbid conditions, and aging.","authors":"Brian N Smith, Anica Pless Kaiser","doi":"10.1002/jts.23184","DOIUrl":"https://doi.org/10.1002/jts.23184","url":null,"abstract":"<p><p>This article introduces a special section of the Journal of Traumatic Stress devoted to new research investigating and addressing the associations among trauma exposure, posttraumatic stress disorder (PTSD), comorbid conditions, and aging. As the global population is rapidly aging, it is critical to advance understanding of the long-term health implications of trauma, PTSD, and comorbid conditions, including impacts on health, functioning, and well-being across the life course. In addition to understanding these trauma-related risks in varying populations, it is important to evaluate potential sources of resilience as well as to consider implications for health care services, including trauma-informed care, in the context of aging. This opening article introduces themes reflected in this collection of new scientific manuscripts examining a range of relevant questions and populations, which collectively contribute to this important and growing area of research in the traumatic stress field.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326157","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}
Ana Luísa Patrão, Teresa M McIntyre, Eleonora C V Costa, Ângela Maia, Eduardo Matediana, Vanessa Azevedo
{"title":"Sexual abuse among Mozambican women at risk for HIV/AIDS infection: The temporal stability of self-report.","authors":"Ana Luísa Patrão, Teresa M McIntyre, Eleonora C V Costa, Ângela Maia, Eduardo Matediana, Vanessa Azevedo","doi":"10.1002/jts.23178","DOIUrl":"https://doi.org/10.1002/jts.23178","url":null,"abstract":"<p><p>Many researchers have expressed concern regarding the reliability and validity of retrospective self-reports of sexual abuse. This study aimed to quantify the frequency of self-reported sexual abuse among vulnerable Mozambican women and evaluate the temporal stability of self-report across assessments. Participants (N = 173) were patients at the gynecology outpatient clinic of a public central hospital in Mozambique who were referred for recruitment by gynecologists and completed measures of sexual abuse, assessed using six items from the National Women's Study survey. Women reported a frequency of sexual abuse ranging from 9.2% (third assessment) to 10.4% (initial assessment). Concerning the temporal stability of self-reports, the percentage of agreement was above 90% for all sexual abuse items, and general sexual victimization achieved almost perfect kappa values, κs = .93-1.00. This work has implications for the promotion of sexual health and the prevention of violence.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302395","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}
Anu Asnaani, Lily Brown, Bita Ghafoori, Manuel Gutierrez Chavez, Lori Zoellner
{"title":"Taking efficacious treatments for posttraumatic stress beyond the bedside: Exploration of successes and challenges in training community and lay providers across the globe.","authors":"Anu Asnaani, Lily Brown, Bita Ghafoori, Manuel Gutierrez Chavez, Lori Zoellner","doi":"10.1002/jts.23174","DOIUrl":"https://doi.org/10.1002/jts.23174","url":null,"abstract":"<p><p>Although there is considerable data to support the efficacy of several treatments for trauma-related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real-world settings, which greatly contributes to persistent health disparities in these disorders. Task-shifting, or the ability to train frontline providers in evidence-based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma-related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large-scale, city-wide implementation and evaluation of providers' fidelity to evidence-based traumatic stress treatment within a major U.S. city for further exemplification around how task-shifting can happen at a larger, systemic, top-down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302396","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}
Angela Nickerson, B Heidi Ellis, Naser Morina, Frank Neuner, Lori Zoellner
{"title":"Understanding and improving the mental health of refugees and asylum-seekers: Reflections from the closing panel of the 2024 International Society for Traumatic Stress Studies Annual Meeting.","authors":"Angela Nickerson, B Heidi Ellis, Naser Morina, Frank Neuner, Lori Zoellner","doi":"10.1002/jts.23176","DOIUrl":"https://doi.org/10.1002/jts.23176","url":null,"abstract":"<p><p>Forcible displacement due to war and persecution has reached unprecedented heights across the globe. The mental health impact of trauma and displacement on refugee communities is profound. Although there are several evidence-based therapies that are efficacious in reducing symptoms of posttraumatic stress disorder and depression in refugees, many refugees do not have access to these, and, for those who do, a significant proportion do not respond. This article summarizes the closing panel at the 2024 International Society for Traumatic Stress Studies Annual Meeting, where four researchers and clinicians with expertise in refugee mental health reflected on core outstanding questions in the field and promising approaches to addressing these knowledge gaps. Common themes emerged from this discussion, including the importance of considering and addressing environmental stressors when providing psychological treatment for refugees, the critical role of the social and cultural context in refugee mental health, and the necessity of partnering with refugee communities to improve the quality and efficacy of research and clinical activities. This article concludes with suggestions for early-career researchers and clinicians who are working with refugee communities to facilitate trauma recovery and improve well-being.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302397","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}
Laura Nohr, Yuriy Nesterko, Freya Specht, Nadine Stammel, Ingrid Sotelo, Maria Böttche
{"title":"Distinctive factors contributing to psychological distress in second-generation offspring of Holocaust survivors: Posttraumatic stress and sense of coherence.","authors":"Laura Nohr, Yuriy Nesterko, Freya Specht, Nadine Stammel, Ingrid Sotelo, Maria Böttche","doi":"10.1002/jts.23173","DOIUrl":"https://doi.org/10.1002/jts.23173","url":null,"abstract":"<p><p>The psychological impact of historical trauma can be passed on to future generations. The simultaneous presence of historical and individual trauma may increase psychological distress, especially in older adults. Older age potentially represents a phase of life with increased challenges, distress, life review, and reminiscence. Though both historical and individual trauma appear to contribute to psychological distress, a strong sense of coherence (SOC) may reduce psychological distress and posttraumatic stress in older age and in the context of historical trauma. We conducted a cross-sectional online survey among offspring of Holocaust survivors (OHS) from Germany, Israel, and the United States, focusing on the second generation and individuals aged 60-80 years who reported having survived individual trauma. Descriptive statistics, zero-order correlation analyses, and multiple regression were used to investigate factors influencing psychological distress, including gender, age, posttraumatic stress disorder (PTSD) symptoms, past victimization, family Holocaust knowledge, and SOC (balance, manageability, and reflection). The sample comprised 116 participants (70.1% female- identified, M<sub>age</sub> = 67.85 years, SD = 4.45, range: 60-79 years). Multiple regression indicated that PTSD symptoms, B = 2.78, β = .58 (SE = .37), p < .001, and manageability, B = -0.54, β = -.20 (SE = .25), p = .034, were significantly associated with psychological distress. The final model accounted for 50.5% of the total variance in current psychological distress among older second-generation OHS. These findings highlight the importance of individual risk and protective factors in understanding distress among older people in the context of historical trauma.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285121","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}
Meghan R Elliott, Susan T Charles, E Alison Holman, Dana Rose Garfin, Roxane Cohen Silver
{"title":"Psychological distress across 2 years of the COVID-19 pandemic differs by age and by race/ethnicity.","authors":"Meghan R Elliott, Susan T Charles, E Alison Holman, Dana Rose Garfin, Roxane Cohen Silver","doi":"10.1002/jts.23169","DOIUrl":"https://doi.org/10.1002/jts.23169","url":null,"abstract":"<p><p>The COVID-19 pandemic profoundly impacted mental health, with psychological distress varying across age and racial/ethnic groups. This study examined trajectories of five distress measures-symptoms of posttraumatic stress (PTS), anxiety, depression, anger, and somatization-over the first 2 years of the pandemic, adjusting for prepandemic mental health. Participants in a nationally representative, probability-based U.S. sample (N = 4,298, age range: 18-97 years) completed four online surveys from March 2020 to June 2022. Multilevel models revealed that symptom levels and changes over time varied by age group across outcomes. Across time, PTS and anxiety symptoms declined for most age groups at different rates, F(6, 85,660) = 6.21, p < .001. Younger adults initially reported higher PTS symptom levels at Wave 1, Bs = 0.10-0.14, p < .001, but levels converged across age groups by Wave 4. Rates of anxiety symptoms were similar across age groups at Wave 4 except for older adults, who reported significantly lower levels. Depressive symptoms and anger increased in the initial waves but declined by Wave 4, Bs = -0.25-0.02, p < .001. For all participants, somatization increased after Wave 1, B = -0.30, p < .001, and never returned to initial levels, B = -0.04, p < .001. Additionally, somatization was the only symptom with similar levels across age groups at each wave. Across race/ethnicity, Hispanic adults reported higher distress and less decline over time. Findings highlight distinct symptom trajectories across the pandemic, with generally lower distress levels among the oldest adults.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266525","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}
Enzo G Plaitano, Shengzi Zeng, Mariel Emrich, Emily E Patton, E Kate Webb, Maria L Pacella-LaBarbara, Marley S Barduhn, Bryce Hruska
{"title":"Examining the between- and within-person associations among perceived sleep quality and mental health symptoms in emergency medical service clinicians.","authors":"Enzo G Plaitano, Shengzi Zeng, Mariel Emrich, Emily E Patton, E Kate Webb, Maria L Pacella-LaBarbara, Marley S Barduhn, Bryce Hruska","doi":"10.1002/jts.23180","DOIUrl":"https://doi.org/10.1002/jts.23180","url":null,"abstract":"<p><p>Disturbed sleep is a known risk factor for heightened mental health symptoms, and this association may be particularly problematic among emergency medical service (EMS) clinicians. Yet, associations between daily sleep quality and daily mental health symptoms are understudied among this vulnerable group. We used ecological momentary assessments to examine between- and within-person associations between perceived sleep quality and mental health symptoms in 79 EMS clinicians employed at a large agency in central New York. Participants completed eight daily assessments (558 total) on perceived sleep quality and symptoms of posttraumatic stress disorder (PTSD) and depression. Multilevel regression models examined between- and within-person effects of sleep quality, controlling for covariates. Between-person effects in each model accounted for 17.0% and 31.0% of the total variance, respectively; within-person effects explained 1.0% per model. Poorer between-person perceived sleep quality was associated with higher PTSD and depressive symptom severity; perceived sleep quality 1.0 standard deviation (SD) below the sample mean was related to 58.8% and 16.3% increases in PTSD and depressive symptoms, respectively. There was also a within-person effect for depressive symptoms: On days when a participant's perceived sleep quality was 1.0 SD below their average, depressive symptom severity increased by 3.0%. Poorer subjective sleep may be an important risk factor for mental health symptoms at the between-person level. EMS policies supporting healthy sleep may benefit clinicians who routinely experience poor sleep. Day-to-day subjective sleep quality may increase the risk for depressive symptoms. Interventions to improve sleep and manage depressive symptom fluctuations when sleep is poor might be helpful.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275224","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}