Paediatric and perinatal epidemiology最新文献

{"title":"The Joint Effects of Extreme Heat and Wildfire Smoke on Paediatric Acute Care Utilisation.","authors":"Amal Syed, Chen Chen, Tarik Benmarhnia, Rupa Basu","doi":"10.1111/ppe.70080","DOIUrl":"https://doi.org/10.1111/ppe.70080","url":null,"abstract":"<p><strong>Background: </strong>As climate change worsens, instances of combined extreme heat and wildfire smoke events are becoming more frequent. Despite their increased vulnerability, investigations on the joint effect of wildfire smoke and extreme heat on children's health are limited.</p><p><strong>Objective: </strong>To investigate the joint effects of extreme heat and wildfire smoke on paediatric acute care utilisation (ACU) in California from 2006 to 2019.</p><p><strong>Methods: </strong>In this case-crossover analysis, we assembled a time-series dataset of warm seasons, (May-September) for 1772 ZIP Code Tabulation Areas (ZCTA) in California from 2006 to 2019 to evaluate daily ACUs in the paediatric population (0-19 years). For wildfire smoke, we identified ZCTA-days exposed using a previously developed time-series dataset. For extreme heat, we calculated the daily ZCTA-specific maximum heat index. There were four exposure types: exposed to extreme heat alone, exposed to wildfire smoke alone, exposed to both events simultaneously (compound event) and not exposed to either event. We quantified the synergistic effects by comparing a child's exposures on the day when an ACU occurred to the child's exposure during control days.</p><p><strong>Results: </strong>We found 1100-105,788 ZCTA-days where exposure to both extreme heat and wildfire smoke events occurred across eight combinations of event definitions. The relative excess risk due to interaction (RERI) ranged up to 0.11 (95% confidence interval [CI]: 0.03, 0.19) with thresholds of the 95th percentile for extreme heat and 35 μg/m³ for wildfire PM_2.5, indicating a synergistic effect of extreme heat and wildfire smoke on paediatric ACUs. Positive RERIs were consistently observed for infectious enteritis, heat-related illness, asthma, endocrine nutritional and metabolic disease, and respiratory disease.</p><p><strong>Conclusion: </strong>Investigating the synergistic effects of extreme heat and wildfire smoke events in paediatric populations is necessary to develop effective health protection strategies.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258698","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":"Health and Development of Children Born Moderate and Late Preterm and Early Term at Age 10 in French Birth Cohorts ELFE and EPIPAGE 2.","authors":"Laura Pavicic, Laetitia Marchand-Martin, Ayoub Mitha, Marie-Noelle Dufourg, Véronique Pierrat, Valérie Benhammou, Marie-Aline Charles, Pierre-Yves Ancel","doi":"10.1111/ppe.70069","DOIUrl":"https://doi.org/10.1111/ppe.70069","url":null,"abstract":"<p><strong>Background: </strong>Lower gestational age (GA) is linked to higher mortality and morbidity. Long-term health and developmental difficulties of individuals born moderate (MPT, 32-33 GA) and late (LPT, 34-36 GA) preterm, and early term (ET, 37-38 GA) are less explored than those of their very preterm peers.</p><p><strong>Objectives: </strong>To test how being born MPT, LPT, or ET affects health and development at age 10, compared to full-term (FT, 39-40 GA) births.</p><p><strong>Methods: </strong>Data from two ongoing French nationwide birth cohorts, initiated in 2011, were collected at 10 years via telephone interview (n = 8372) and home visit (n = 6418). Weighting procedures accounted for study design, non-inclusion, and participation. Outcome-wide regressions (modified Poisson, linear), adjusted for socioeconomic situation and pregnancy complications, were used to calculate adjusted relative risks (aRR) and beta-coefficients (β).</p><p><strong>Results: </strong>No increased risk of asthma/atopy was observed for our MPT, LPT, and ET populations, except for allergic rhinitis in MPT. Strabismus was more prevalent among MPT, LPT, and ET (2.3%-3.0%) than FT (1.3%), corresponding to aRR of 1.99 (95% CI 0.91, 4.39), 1.67 (95% CI 0.85, 3.28), and 2.18 (95% CI 1.37, 3.47), respectively. MPT and LPT had increased risk of balance problems, with aRR of 1.63 (95% CI 0.81, 3.32) and 1.80 (95% CI 1.14, 2.82), respectively. MPT scored on average lower on the WISC-V full-scale IQ Matrix β = -0.6 (95% CI -1.17, -0.11) and performance IQ Puzzle β = -0.7 (95% CI -1.23, -0.26) subtests, compared to FT, and had an increased risk of dental malposition, aRR = 1.42 (95% CI 1.15, 1.75).</p><p><strong>Conclusions: </strong>While most outcomes (respiratory, anthropometry, cardiometabolic) did not differ between MPT, LPT, ET, and their FT peers, others, including strabismus, were more prevalent among preterm and ET. Some outcomes were specific to MPT, including lower WISC-V average scores and dental issues.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192363","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":"Trends in Risk of Pregnancy Loss Among US Women by Metropolitan Status, 2000-2018.","authors":"Sarah E Forrest, Lauren M Rossen, Katherine A Ahrens","doi":"10.1111/ppe.70066","DOIUrl":"10.1111/ppe.70066","url":null,"abstract":"<p><strong>Background: </strong>Approximately 20% of pregnancies end in spontaneous loss, an outcome associated with adverse health consequences. Statistically stable estimates of the risk of pregnancy loss are limited for nonmetropolitan populations due to small sample sizes.</p><p><strong>Objectives: </strong>This study evaluated the utility of the enhanced Modified Kalman Filter (eMKF) in producing estimates of the risk of pregnancy loss for subgroups of US women with small sample sizes to examine recent trends.</p><p><strong>Methods: </strong>Data from the National Survey of Family Growth (NSFG; 2006-2019) were used to estimate trends in the risk of self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one completed pregnancy (excluding induced abortions) conceived during 2000-2018 (n = 17,314 women, 35,988 pregnancies) by metropolitan status and maternal age. The eMKF was used to smooth estimates over groups and time. We compared the relative 95% confidence intervals (95% CIs) of model-based estimates to direct estimates to assess improvements in precision.</p><p><strong>Results: </strong>Among completed pregnancies conceived during 2000-2018, 21.6% ended in pregnancy loss. Relative 95% CIs for model-based estimates were 33.0% and 53.0% smaller for metropolitan and nonmetropolitan groups, respectively, than direct estimates. After adjustment, the risk of pregnancy loss for women ages 15-44 increased by a relative 1% annually for both metropolitan (risk ratio [RR] 1.01, 95% CI 1.01, 1.02) and nonmetropolitan (RR 1.01, 95% CI 1.00, 1.01) women. The risk of pregnancy loss increased for metropolitan women ages 15-19 (RR 1.01, 95% CI 1.00, 1.01), 20-24 (RR 1.01, 95% CI 1.00, 1.01), 25-29 (RR 1.02, 95% CI 1.01, 1.02), and 30-34 (RR 1.02, 95% CI 1.01, 1.03).</p><p><strong>Conclusions: </strong>Risk of pregnancy loss increased by a relative 1% annually for women overall, and by 1%-2% annually among subgroups of women ages 15-34 in metropolitan areas. The eMKF provided improvements in estimate precision relative to direct estimates.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Increasing Midwifery-Led Prenatal Care on Birth Outcomes: An Application of the g-Formula and Target Trial Emulation.","authors":"Elizabeth Simmons, Anna Austin, Mollie Wood, Alyssa J Mansfield, Karen Sheffield-Abdullah, Kavita Singh","doi":"10.1111/ppe.70077","DOIUrl":"10.1111/ppe.70077","url":null,"abstract":"<p><strong>Background: </strong>Compared to undergoing prenatal care with a physician, care with a midwife reduces the risk of medical interventions and complications during labor and delivery among low-risk pregnant individuals. However, many analyses that assess the relationship between midwifery-led care and birth outcomes condition on live births, potentially inducing a type of collider bias.</p><p><strong>Objective: </strong>The objective was to analyse the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection under hypothetical scenarios where midwifery-led prenatal care was increased.</p><p><strong>Methods: </strong>Our sample included commercially insured, midwifery-eligible pregnant people in an insurance claims data source. We used g-computation to assess the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection if 10%, 20%, and 50% more pregnant people enrolled in prenatal care with a midwife rather than a physician, among a cohort of low-risk pregnant people with commercial insurance in the U.S. between 2004 and 2015.</p><p><strong>Results: </strong>With a 50% increase in midwifery-led care compared with no increase, we found the prevalence of caesarean deliveries was reduced by 5.4 percentage points (95% confidence interval [CI] -5.7, -5.1) and of maternal infection decreased by 1.3 percentage points (95% CI -1.6, -1.0), while the prevalence of primary postpartum haemorrhage increased by 0.5 percentage points (95% CI 0.4, 0.6) and of secondary postpartum haemorrhage increased by 0.6 percentage points (95% CI 0.4, 0.7).</p><p><strong>Conclusions: </strong>Increasing midwifery-led prenatal care reduced the prevalence of caesarean deliveries and maternal infections and slightly increased the prevalence of primary and secondary postpartum haemorrhage. Our results were similar to those of studies among live birth cohorts.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150417","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":"Identifiability and Interpretation of Estimands Under Selection in Perinatal Research.","authors":"Louisa H Smith","doi":"10.1111/ppe.70073","DOIUrl":"https://doi.org/10.1111/ppe.70073","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131535","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":"Ending Pregnancy Ends Risks. Consistent Questions, Estimands, Estimates, and Interpretation in the Presence of Competing Events.","authors":"Jeremy P Brown, Sonia Hernández-Díaz","doi":"10.1111/ppe.70076","DOIUrl":"https://doi.org/10.1111/ppe.70076","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131545","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":"Periconceptional Hormonal Contraception Use and Autism Spectrum Disorder in the Study to Explore Early Development.","authors":"Michelle T Delahanty, Stephanie Engel, Dani Fallin, Tanya Garcia, Christine Ladd-Acosta, Anne Steiner, Mollie Wood, Julie L Daniels","doi":"10.1111/ppe.70049","DOIUrl":"https://doi.org/10.1111/ppe.70049","url":null,"abstract":"<p><strong>Background: </strong>Prior studies report associations between periconceptional exposure to natural and synthetic oestrogen and progesterone and autism spectrum disorder (ASD). Hormonal contraception contains synthetic forms of one or both hormones. Although hormonal contraception is highly effective when consistently used, unintended pregnancy can occur with irregular use. Given the popularity of hormonal contraception, foetal exposure in utero is possible, yet the potential consequences are unknown.</p><p><strong>Objectives: </strong>We investigated the association between periconceptional hormonal contraception use and the development of ASD in offspring.</p><p><strong>Methods: </strong>We analysed data from the Study to Explore Early Development (SEED), a population-based case-control study conducted in select US states, from 2007 to 2020. Children with and without ASD were identified from clinical/education sources and vital records, respectively, and enrolled at ages 2.5-5 years. We confirmed the ASD case status by in-person developmental assessment. We assessed hormonal contraception via a structured interview. We assessed the associations between ASD and hormonal contraception exposure separately for contraception discontinued in the 3 months prior to pregnancy and contraception continued during pregnancy using logistic models to estimate odds ratios (OR) adjusted for biological mother age, education, parity, pre-pregnancy body mass index (BMI), and presence of gynaecologic conditions and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 5210 participants, 9.9% reported discontinuing hormonal contraception use before pregnancy and 2.3% reported continuing use during pregnancy. A suggestive association was found between ASD and hormonal contraception use during pregnancy (aOR 1.38,95% CI 0.93, 2.05). There was no association with use prior to pregnancy (aOR 1.02, 95% CI 0.84, 1.25).</p><p><strong>Conclusions: </strong>Discontinuation of hormonal contraception prior to conception was not associated with ASD. The prevalence of hormonal contraception use during pregnancy was low. Results were imprecise and may be impacted by recall bias and unmeasured confounding by indication and health behaviours related to planning pregnancy.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125718","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":"Considerations When Generalising Using Survey Sampling Weights.","authors":"Michael Webster-Clark, Asma M Ahmed","doi":"10.1111/ppe.70078","DOIUrl":"https://doi.org/10.1111/ppe.70078","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125730","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":"Estimating Causal Effects of Third-Stage Management on Postpartum Haemorrhage in a Midwifery Context: An Evidence Synthesis Approach for Constructing Directed Acyclic Graphs.","authors":"Vanessa Hébert, Irina I Oltean, Giulia M Muraca, Nancy Santesso, Elizabeth K Darling","doi":"10.1111/ppe.70072","DOIUrl":"https://doi.org/10.1111/ppe.70072","url":null,"abstract":"<p><strong>Background: </strong>Estimating the causal effect of third-stage management approaches on preventing postpartum haemorrhage (PPH) in the context of physiologic birth using observational data requires conditioning on specific variables, with selection relying on assumptions about their roles in the exposure-outcome pathway that are rarely made explicit.</p><p><strong>Objectives: </strong>To apply the evidence synthesis for constructing DAGs approach, incorporating findings from a systematic review, to develop a causal directed acyclic graph (DAG) that clarifies these assumptions and identifies the minimum set of variables needed to reduce bias in estimating the causal effects of physiologic third-stage care versus oxytocin prophylaxis on PPH.</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials (to December 15, 2023), ClinicalTrials.gov (to July 8, 2024), and reference lists of eligible studies.</p><p><strong>Study selection and data extraction: </strong>The systematic review included randomised and non-randomised studies involving individuals with physiologic birth or minimal obstetric interventions. Two authors independently screened studies. DAG development was based on the subset of non-randomised studies. For each, one reviewer extracted outcome, exposure, control variables and mediators.</p><p><strong>Synthesis: </strong>Eligible studies were analysed in three stages: (i) mapping each study's saturated implied graph; (ii) translating each posited connection using causal criteria to create study-specific DAGs; (iii) synthesising individual DAGs into an integrated DAG. The assumptions underlying this process were specific to the midwifery context in Ontario, Canada and translation was guided by midwifery expertise and existing literature.</p><p><strong>Results: </strong>Four non-randomised studies were included. Expert consultation identified 20 factors influencing third-stage management. The integrated DAG comprised 339 directed edges connecting 35 covariates, yielding four minimal sufficient adjustment sets.</p><p><strong>Conclusions: </strong>The integrated DAG and minimal sufficient adjustment sets are valuable tools for informing future study design and analysis, helping to minimise bias in estimating the causal effect of physiologic third-stage care versus oxytocin prophylaxis on PPH in the context of physiologic birth, while also exposing the assumptions about causal relationships between variables to scrutiny.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081002","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":"Psychotropic Medication Exposure via Breast Milk: A Population-Based Descriptive Study in Denmark.","authors":"Xiaoqin Liu, Kathrine Bang Madsen, Jin Liang Zhu, Trine Munk-Olsen, Per Damkier, Angela Lupattelli, Helga Zoega, Hedvig Nordeng, Mette-Marie Zacher Kjeldsen, Merete Lund Mægbæk, Malene Galle Madsen, Veerle Bergink, Mette Bliddal","doi":"10.1111/ppe.70074","DOIUrl":"https://doi.org/10.1111/ppe.70074","url":null,"abstract":"<p><strong>Background: </strong>There is limited data on the extent of psychotropic medication exposure through breast milk in infants. This information is essential for identifying research gaps and informing clinical practice.</p><p><strong>Objectives: </strong>To examine the prevalence and trend of psychotropic medication exposure among exclusively breastfed infants.</p><p><strong>Methods: </strong>A population-based descriptive study among exclusively breastfed infants during 2012-2022, using Danish nationwide registers. Psychotropic prescriptions (Anatomical Therapeutic Chemical Classification System codes N05-N06) filled by mothers during the recorded breastfeeding period were identified in the Prescription Registry. We calculated the prevalence of potential exposure to any psychotropic medication (expressed per 1000 infants), categorised by drug class and stratified by maternal demographic and clinical factors.</p><p><strong>Results: </strong>Among 446,573 exclusively breastfed infants, 7882 (17.6 per 1000 infants, 95% confidence interval [CI]: 17.2, 18.1) were exposed to at least one, and 699 (1.6 per 1000 infants, 95% CI: 1.5, 1.7) to two different psychotropic medications via breastfeeding. The most frequent exposure was antidepressants, with a prevalence of 15.0 per 1000 infants (95% CI: 14.6, 15.4), primarily sertraline. This was followed by hypnotics and sedatives, at 1.3 per 1000 infants (95% CI: 1.2, 1.4), predominantly zopiclone, and antipsychotics, at 1.1 per 1000 infants (95% CI: 1.0, 1.2), mainly quetiapine. Psychotropic medication exposure in exclusively breastfed infants increased 1.39-fold, from 15.7 per 1000 infants (95% CI: 14.5, 17.1) in 2012 to 21.8 per 1000 infants (95% CI: 20.3, 23.4) in 2022. This increase was observed for all drug classes except anxiolytics. The prevalence of psychotropic medication exposure varied by maternal demographic and clinical factors.</p><p><strong>Conclusions: </strong>Approximately 2% of exclusively breastfed infants are potentially exposed to psychotropic medications through breast milk in Denmark. The prevalence has shown an upward trend over time, especially for psychostimulants.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033840","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}