Journal of women's health最新文献

{"title":"Advanced Maternal Age and Pregnancy Outcomes in Oocyte Donation and Spontaneous Pregnancies: A Large Population-Based Cohort Study.","authors":"Roni Rahav-Koren, Hila Shalev-Ram, Einat Haikin-Herzberger, Mattan Levi, Amir Wiser, Netanella Miller","doi":"10.1089/jwh.2024.0552","DOIUrl":"https://doi.org/10.1089/jwh.2024.0552","url":null,"abstract":"<p><p><b><i>Background:</i></b> Data regarding pregnancy and perinatal outcomes of oocyte donation (OD) recipients older than age 45 are limited. <b><i>Materials and Methods:</i></b> A total of 459,528 singleton pregnancies with 946 OD pregnancies and 458,582 spontaneous pregnancies were grouped according to maternal age ≥45 years and <45 years. <b><i>Results:</i></b> The mean maternal age of the OD recipients was 47.6 for patients >45 and 40.7 for patients ≤45 (<i>p</i> < 0.001). Among the spontaneous conceptions, the mean maternal age was 47.8 years for patients >45 and 31.1 for patients ≤45 (<i>p</i> < 0.001). Multivariable logistic regression for preterm birth (PTB) <37 weeks and for small gestational age (SGA) among the OD recipients demonstrated that age >45 is a protective factor for PTB <37 weeks (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.4-0.9, <i>p</i> = 0.03) and for SGA (OR: 0.3, 95% CI: 0.1-0.7, <i>p</i> = 0.006, respectively). Among the spontaneous group, age >45 is a risk factor for PTB <37 weeks (OR: 3.2, 95% CI: 2.7-3.9, <i>p</i> < 0.001), PTB <34 weeks (OR: 4.7, 95% CI: 3.4-6.4, <i>p</i> < 0.001), SGA (OR: 1.6, 95% CI: 1.2-2.1, <i>p</i> < 0.001), and pregnancy-induced hypertension (OR: 3.1, 95% CI: 2.1-4.7, <i>p</i> < 0.001). Other obstetric complications were comparable between the age-groups of the oocyte recipients but were higher among patients >45 years who conceived spontaneously. <b><i>Conclusions:</i></b> As opposed to spontaneous pregnancies, OD pregnancies of recipients >45 are not associated with higher rates of obstetric or perinatal morbidity compared with younger recipients.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Urological Conditions Across the Life Course and Provoked Vulvodynia.","authors":"Bernard L Harlow, Hanna Mühlrad, Jane Yan, Donghao Lu, Nina Bohm-Starke","doi":"10.1089/jwh.2024.0933","DOIUrl":"https://doi.org/10.1089/jwh.2024.0933","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Vulvodynia is a condition characterized by chronic pain and discomfort in the vulvar region often accompanied with physical and psychological comorbidities. Interstitial cystitis (IC)/bladder pain syndrome (BPS), a chronic condition characterized by bladder pain and urinary urgency, has repeatedly been shown to comorbidly be present in a large proportion of women with vulvodynia. However, recent studies have shown that women with vulvodynia experienced additional bladder-related symptoms beyond that of just IC/BPS. <b><i>Materials and Methods:</i></b> Using Swedish National Registry data, we assessed the association between urological symptoms in the presence and absence of IC/BPS in women with vulvodynia/vaginismus relative to women with no vulvar pain history. <b><i>Results:</i></b> After adjustment for birth year, parity, education, and residential location, women with vulvar pain had a 2.2-fold greater risk of cystitis or urethritis as expected (95% confidence interval [CI] 1.9-2.6). However, when women with cystitis codes were excluded, those with urethra disorders or other urinary symptoms codes were 1.9 times more likely to be vulvar pain cases (95% CI 1.7-2.1). <b><i>Conclusions:</i></b> These findings support the belief that vulvodynia is not limited to being comorbid with IC/BPS but may also likely be associated with a wide range of urological disorders.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433350","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":"Self-Reported Psychological, Somatic, and Vasomotor Symptoms at Different Stages of the Menopause for Autistic and Non-autistic People.","authors":"Rebecca A Charlton, Francesca G Happé, Alanna J Shand, William Mandy, Gavin R Stewart","doi":"10.1089/jwh.2024.0784","DOIUrl":"https://doi.org/10.1089/jwh.2024.0784","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is growing awareness that the experiences of neurodivergent people during menopause are not well understood. Menopause may be particularly challenging for autistic people due to common co-occurring conditions such as depression and differences in sensory processing. The few (mostly qualitative) studies to explore autism and menopause suggest that autistic traits may be exacerbated. <b><i>Methods:</i></b> In an online cross-sectional survey, we examined self-reported menopause symptoms of 342 people (autistic, <i>n</i> = 242 and non-autistic, <i>n</i> = 100) at different stages of their reproductive life (premenopausal [∼20% of sample], menopausal [∼30%], postmenopausal [∼50%]). <b><i>Results:</i></b> Autistic people reported significantly higher rates of bothersome psychological and somatic menopause symptoms than non-autistic people, but no differences were observed for vasomotor symptoms. Results indicated different patterns of psychological, somatic, and vasomotor symptoms between the autistic and non-autistic groups. People in the menopause and postmenopause groups reported negative changes in symptoms, but non-autistic women reported these as more negative than autistic women. Whether this finding is related to the observation that autistic people report more bothersome psychological and somatic symptoms before the menopause requires further investigation. <b><i>Conclusion:</i></b> This cross-sectional analysis suggests that autistic people may experience more bothersome symptoms during menopause compared with non-autistic people. Longitudinal studies examining change are required to fully understand the variables that impact individual experiences for autistic people.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441190","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":"52 mg Levonorgestrel Intrauterine System as a Long-Term Contraceptive Option.","authors":"Dewonna Ferguson, Jelena Pejic, Sara Shihab, Suneela Vegunta","doi":"10.1089/jwh.2024.1135","DOIUrl":"https://doi.org/10.1089/jwh.2024.1135","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414132","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":"Patient Preferences for Provider Specialization for Induced Abortion and Miscarriage Care.","authors":"Colleen Judge-Golden, Sydney Sheffield, Lucero Hernandez, Norma Davis, Rebecca Fairchild, Jonas J Swartz","doi":"10.1089/jwh.2024.0884","DOIUrl":"https://doi.org/10.1089/jwh.2024.0884","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. <b><i>Materials and Methods:</i></b> We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (<i>n</i> = 54) or nonabortion gynecological care (<i>n</i> = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics. <b><i>Results:</i></b> This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is \"morally acceptable and should be legal.\" Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (<i>p</i> < 0.001), with no differences by appointment type. Educational attainment (<i>p</i> = 0.03) and Democratic party affiliation (<i>p</i> = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, <i>p</i> = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, <i>p</i> < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care. <b><i>Conclusions:</i></b> Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414220","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":"Quality Improvement Opportunities for Better Blood Pressure Management in Pregnancy and the Postpartum Period: The Hypertension in Pregnancy Change Package.","authors":"Hilary K Wall, Lisa M Hollier, Wanda D Barfield, Janet S Wright","doi":"10.1089/jwh.2024.1157","DOIUrl":"https://doi.org/10.1089/jwh.2024.1157","url":null,"abstract":"<p><p>Hypertension in pregnancy, which includes both chronic hypertension and pregnancy-associated hypertension, is on the rise in the United States and is associated with an increased incidence of maternal and neonatal complications and future cardiovascular disease. Recent clinical recommendations suggest a lower blood pressure threshold for initiating treatment of chronic hypertension in pregnancy. Here we present a new quality improvement resource for outpatient clinicians to support changes to care processes for managing chronic hypertension in pregnancy and the postpartum period.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408768","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":"State Policy Variation in Implementation of Federal Drug and Child Abuse Laws and Stigmatization of Pregnant and Postpartum Individuals with Opioid Use Disorder.","authors":"MacKenzie R Peltier, Destiny D Pegram, Geetanjali Chander, Constance M Weisner, Sherry A McKee, Hendree E Jones, Grace Chang","doi":"10.1089/jwh.2024.0638","DOIUrl":"10.1089/jwh.2024.0638","url":null,"abstract":"<p><p><b><i>Importance:</i></b> Despite increased initiatives and funding to improve access to evidence-based treatments for opioid use disorder (OUD), including medications for OUD (mOUD), pregnant/postpartum individuals have significant obstacles to accessing these life-saving medications. <b><i>Observations:</i></b> Current legislation, specifically the <i>Comprehensive Addiction and Recovery Act (CARA)</i>, mandates that the Governor of each state has systems in place to identify and address the needs of substance-exposed infants. However, this legislation removed the word \"illegal\" when defining substance use and left other important words in the law up to each individual state to define. These changes resulted in pregnant/postpartum individuals with OUD who were receiving legally prescribed mOUD, being subject to legal actions. In many states, such notifications result in investigation and punitive actions, which may include the removal of children from the care of postpartum individuals. These state policies have created additional barriers to accessing mOUD for pregnant and/or postpartum individuals. Research has demonstrated that pregnant individuals delay and/or avoid recommended prenatal care or decide to stop taking mOUD altogether, to prevent potential legal and child welfare-related consequences. This situation is problematic as it places individuals at risk of overdose and death and infants at risk of health complications. Importantly, such policies are subject to bias and disproportionately impact individuals of color and those from lower socioeconomic backgrounds. <b><i>Conclusions and Relevance:</i></b> The need to address and change the criminalization of pregnant/postpartum substance use laws to not penalize individuals adhering to the recommended standard of evidence-based care is urgent. Specific recommendations include: not relying on toxicology testing, reinstating \"illegal/non-prescribed\" language in legislation, implementing Plans of Safe Care, use of a two \"track\" reporting system, and federal support for states complying with Child Abuse Prevention and Treatment Act Reauthorization of 2010 (CAPTA) laws, increasing resources to improve outcomes for infants/postpartum individuals with OUD, and additional mandated training to educate key individuals, such as hospital/outpatient clinic providers and child-welfare workers.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391174","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":"Inequitable Screening for Pregnancy Intention by Race, Insurance, and Site of Care in Two High-Volume Urban Obstetric Hospitals.","authors":"Alice Abernathy, Miatta Goba, Markolline Forkpa, Jesse Chittams, Sunni L Mumford, Sindhu K Srinivas, Courtney A Schreiber","doi":"10.1089/jwh.2024.0859","DOIUrl":"https://doi.org/10.1089/jwh.2024.0859","url":null,"abstract":"<p><p><b><i>Background:</i></b> In the United States, public health efforts are focused on reducing unintended pregnancy. Yet, differences in rates of unintended pregnancy, abortion, and unintended births by race are driven by a combination of patient-, health system-, and provider-related factors. Despite this complicated scaffolding underpinning pregnancy intention, patients are often screened for pregnancy intention or planning when they have a positive pregnancy test. We hypothesized screening may vary by patient and health system characteristics. <b><i>Objective:</i></b> To identify associations between patient and health system characteristics and receiving screening for pregnancy intention or planning. <b><i>Study Design:</i></b> We performed a secondary analysis of a retrospective cohort study of all singleton deliveries in 2019 at two Philadelphia hospitals. Our primary outcome was the presence or absence of pregnancy intention screening by the clinical team. We used logistic regression to determine patient and hospital characteristics associated with screening for pregnancy intention. <b><i>Results:</i></b> We identified 9,672 deliveries, 48% of births were among Black individuals, 91% were non-Hispanic, and 45% had public or no insurance; of all births, 33% were screened for pregnancy intention or planning. Patients were more likely to be asked if their pregnancy was intended if they were: Black (2.38 [2.10-2.750]) or publicly insured or uninsured (2.78 [2.43-3.20]). The hospital site where the patient received care was the primary driver of whether a patient was asked about pregnancy intention (10.59 [9.35-12.0]). After accounting for the hospital sites, patients of Black race remained significantly more likely to be screened than White patients. <b><i>Conclusions:</i></b> Inequities in pregnancy intention or planning screening were driven by differences in institutional practices and patient race. These findings underscore the need for equitable screening practices that ensure all patients receive high-quality, unbiased, and patient-centered reproductive care.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399566","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":"Improving Access to Expanded Genetic Carrier Screening Through Multimodal Interventions.","authors":"Lauren N Meiss, Shefali Pathy, Sarah E Baxley","doi":"10.1089/jwh.2024.0894","DOIUrl":"https://doi.org/10.1089/jwh.2024.0894","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The American College of Obstetricians and Gynecologists recommends offering genetic carrier screening (GCS) to all patients desiring pregnancy or who currently are pregnant. At our urban academic center, we observed that not all appropriate patients were offered GCS. This study aimed to target identified barriers, including health care provider comfort in offering GCS and lack of standardized resources, ultimately increasing the number of patients offered this testing. <b><i>Methods:</i></b> This project was implemented in an urban academic medical center's obstetrics and gynecology (OBGYN) clinic. A needs assessment was performed to determine the baseline comfort level of OBGYN providers regarding expanded GCS and identify barriers. Interventions, including a didactic educational session and template changes in the electronic medical record, were tailored to address the identified concerns. The impact of these interventions was evaluated using a postdidactic evaluation, statistical analyses, and tracked documentation of GCS counseling. <b><i>Results:</i></b> The average mean number of visits with documentation of GCS preference in the initial obstetric visit in the preintervention period (August to November 2020) was 38%. Preintervention needs assessment revealed limited provider comfort with offering expanded GCS. Evaluations following the didactic session demonstrated a significant increase in providers' comfort levels, particularly regarding pre- and post-GCS test counseling. The average number of visits documenting carrier screening preference substantially increased during and after the study period. Statistical analyses confirmed the significance of these improvements. <b><i>Conclusions:</i></b> Despite identified challenges and limitations, targeted educational interventions proved effective in improving provider confidence and increasing the number of visits with documentation of GCS preference.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391163","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":"Asthma and Asthma Symptoms Associated with Endometriosis and Dysmenorrhea in a Nordic-Baltic Population.","authors":"Sanjay Gyawali, Cecilie Svanes, Anders Flataker Viken, Svein Magne Skulstad, Eva Lindberg, Nils Oskar Jõgi, Mathias Holm, Vivi Schlunssen, Elin Helga Thorarinsdottir, Francisco Gómez Real, Marianne Lønnebotn","doi":"10.1089/jwh.2024.0170","DOIUrl":"https://doi.org/10.1089/jwh.2024.0170","url":null,"abstract":"<p><p><b><i>Background:</i></b> Endometriosis, dysmenorrhea, and respiratory symptoms affect large numbers of women. A possible association between asthma and endometriosis has been suggested; however, this relationship is unclear. Dysmenorrhea is very common, and potential associations with asthma symptoms are not known. <b><i>Aim:</i></b> To study asthma symptoms associated with endometriosis and dysmenorrhea in women. <b><i>Methods:</i></b> We used data from the main and women's questionnaires of the Respiratory Health in Northern Europe study, which included data from women (aged 39-65 years) from Aarhus, Gothenburg, Umeå, Uppsala, Reykjavik, Tartu, and Bergen. Current asthma status was defined by asthma medication usage or asthma attacks in the past 12 months. Asthma symptoms were defined as having ≥3 asthma symptoms in the last 12 months. The data were analyzed using logistic regressions adjusted for age, body mass index, and smoking status. <b><i>Results:</i></b> Among 4778 study participants, 201 had endometriosis, and 2154 had dysmenorrhea. Current asthma and asthma symptoms were reported by 14.9% and 12.9%, respectively, of women with endometriosis compared with 9.1% and 9.2%, respectively, of women without endometriosis. The associations of current asthma and asthma symptoms with endometriosis were statistically significant (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.25-2.81; and OR: 1.56, 95% CI: 1.01-2.39, respectively). Similar associations were found for dysmenorrhea (current asthma: OR: 1.48, 95% CI: 1.21-1.81; ≥3 asthma symptoms: OR: 1.61, 95% CI: 1.31-1.97). <b><i>Conclusion:</i></b> Our study revealed that asthma symptoms were associated with both endometriosis and dysmenorrhea. The associations with dysmenorrhea, which affects a large proportion of women, were almost as strong as the associations with diagnosed endometriosis.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391161","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}