Health Equity最新文献

{"title":"Respectful Patient-Provider Communication and Patient Portal Usage in Pregnant People of Color.","authors":"Amy H Goh, Christopher Lee, Chisolum Nkenke, Joyce K Edmonds","doi":"10.1089/heq.2024.0177","DOIUrl":"10.1089/heq.2024.0177","url":null,"abstract":"<p><strong>Background: </strong>Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.</p><p><strong>Methods: </strong>A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on the association between portal usage and PPC.</p><p><strong>Results: </strong>A total of 130 self-identified pregnant POC participated in the study. Participants who did not use the portal had 68% lower odds of rating higher quality PPC (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.12-0.86, <i>p</i> = 0.02). Participants with public versus private insurance had 62% lower odds of rating high-quality PPC (OR = 0.38, 95% CI = 0.14-0.99, <i>p</i> = 0.04). For portal users, DHL moderated the association between PPC and portal use - eHealth Literacy Scale (adjusted OR [aOR] = 1.06, 95% CI = 1.01-1.12, <i>p</i> = 0.02) and DHLI (aOR = 2.36, 95% CI = 1.12-4.95, <i>p</i> = 0.02). The moderation effect of DHLI was also significant among limited portal users (aOR = 2.32, 95% CI = 1.04-5.19, <i>p</i> = 0.04).</p><p><strong>Conclusion: </strong>Addressing the digital divide for pregnant POC requires further investigation into portal non-users with consideration to insurance type, DHL, and social determinants of health.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"343-353"},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Binary: Advancing Gender-Inclusive Data Policy for Health Equity in the US National Provider Identifier System.","authors":"Jeremy W Jacobs, Shazia S Khan, Laura D Stephens, Garrett S Booth","doi":"10.1089/heq.2025.0059","DOIUrl":"https://doi.org/10.1089/heq.2025.0059","url":null,"abstract":"<p><p>Achieving health equity requires data systems that recognize and reflect provider diversity. The National Provider Identifier (NPI) system underpins United States health care administration, yet its gender data standards remain outdated, conflating sex and gender and lacking inclusive options. These deficiencies undermine research, equity initiatives, and the visibility of transgender and nonbinary providers. In an era of growing political hostility to diversity, administrative neutrality is insufficient. The National Plan and Provider Enumeration System must establish itself as a model of gender-inclusive policy by separating sex and gender variables, expanding identity categories, and implementing transparent, regularly updated standards grounded in science.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"339-342"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethno-Racial Differences in Age and Symptom Severity Among Pre-Menopausal Women Commencing Treatment for Benign Gynecological Conditions with a Levonorgestrel-Releasing Intrauterine Device.","authors":"Michael J Green, Kemi M Doll, Mollie E Wood, Annie G Howard, Lauren G Anderson, Joacy G Mathias, Natalie A Rivadeneira, Erin T Carey, Timothy S Carey, Wanda Nicholson, Til Stürmer, Evan R Myers, Whitney R Robinson","doi":"10.1089/heq.2024.0238","DOIUrl":"10.1089/heq.2024.0238","url":null,"abstract":"<p><strong>Introduction: </strong>Levonorgestrel-releasing intrauterine devices (LNG-IUDs) can be effective treatments for benign gynecological conditions, but there may be ethno-racial differences in how patients receive treatment.</p><p><strong>Methods: </strong>Data were from a health care system in the U.S. South (April 2014-September 2019). We identified 783 female patients aged 18-44 years with an LNG-IUD for a benign gynecological condition (455 White, 208 Black, and 120 Hispanic patients). Abstraction of medical notes preceding insertion gave symptom severity scores for uterine bleeding, pelvic pain, and uterine bulk. Linear and negative binomial regression models assessed differences in patients' age and symptom severity scores, respectively. Covariates included insurance status, parity, prior treatments, and fibroid and endometriosis diagnoses.</p><p><strong>Results: </strong>White patients' mean age was 32.4 years. Black patients were similarly aged (+0.9 years [95% confidence interval: -0.4 to 2.1]), whereas Hispanic patients were older (+3.4 years [2.0-4.9]), and adjustment attenuated this difference (+0.7 [-0.7 to 2.0]). Estimated ratios indicated more severe bleeding and bulk symptoms for Black and Hispanic than White patients (bleeding: Black: 1.7[1.5-2.0], Hispanic: 1.7[1.4-2.1]; bulk: Black: 1.5[1.3-1.9], Hispanic: 1.5[1.2-1.9]). Adjustment for covariates attenuated estimates, especially for Hispanic patients (bleeding: Black: 1.4[1.2-1.6], Hispanic: 1.2[1.0-1.4]; bulk: Black: 1.3[1.1-1.6], Hispanic: 1.2[1.0-1.6]).</p><p><strong>Discussion: </strong>At the time of LNG-IUD insertion, Hispanic patients were older than White patients. Black and Hispanic patients had more severe symptoms than White patients. Differences in age and symptom severity were associated with lack of insurance coverage, higher parity, presence of fibroids, and prior medical management, potentially indicating barriers to early LNG-IUD treatment for Black and Hispanic patients.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"326-338"},"PeriodicalIF":2.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Implementation of Informational Toolkits to Address Inequities in COVID-19 Testing.","authors":"Sunasia Mims, Jessica Rhinehart, Melissa Ryan, Susan Driggers, Travaé Hardaway Griffith, Grace Okoro, Tiffany Osborne, Lori Brand Bateman, Janet M Turan, Raegan H Durant, Barbara Hansen, Gabriela R Oates","doi":"10.1089/heq.2025.0043","DOIUrl":"10.1089/heq.2025.0043","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disproportionately affected African American communities. Informational toolkits have emerged as a strategy to address such inequities. Community-driven approaches to toolkit design may enhance their relevance and impact in underserved communities.</p><p><strong>Methods: </strong>Using a human-centered design approach, we developed COVID-19 testing toolkits tailored to health care, faith-based, and public housing settings in rural and urban communities. A group of community stakeholders representing each setting was recruited to co-create the toolkits. The design process began with an intensive two-day workshop to deliberate on content, format, and dissemination channels, followed by virtual meetings and iterative prototyping cycles that incorporated stakeholder feedback. Given the complexity of implementing such toolkits in health care settings, additional measures were taken to support and assess implementation at the participating health facility sites.</p><p><strong>Results: </strong>The toolkits included core resources, such as training modules, testing guidelines, and maps, and setting-specific content, such as appointment reminders, pulpit announcements, and emergency contact sheets. Materials were provided in both digital and print formats. Onboarding and technical training facilitated implementation in health care settings. Pre/post implementation surveys showed high perceived usefulness and feasibility of the health care toolkits. Implementation patterns favored print resources, with appointment reminders being most utilized. Leadership support enhanced toolkit credibility and adoption. Implementation challenges included COVID-19 fatigue, technology limitations, and leadership transitions.</p><p><strong>Conclusion: </strong>Informational toolkits co-developed with community stakeholders provide a model for translating research into solutions that enhance health equity. Prioritizing community perspectives can improve preparedness for future crises. Successful implementation requires adaptability, multimodal delivery, and sustained leadership buy-in.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"316-325"},"PeriodicalIF":2.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Review of Organizational COVID-19 Communications and Guidance for Pregnant and Postpartum People Who Are Incarcerated.","authors":"Ingie Osman, Abaki Beck, Ashley N Watson, Carolyn Sufrin, Rebecca J Shlafer","doi":"10.1089/heq.2024.0235","DOIUrl":"10.1089/heq.2024.0235","url":null,"abstract":"<p><strong>Background: </strong>Each year, thousands of pregnant or postpartum women enter prison and jails across the U.S. During the COVID-19 pandemic, pregnant people who were incarcerated were at increased risk of infection and health complications. Little is known about the role of national public health, medical, and carceral organizations in promoting the health and well-being of pregnant and postpartum people who are incarcerated during the COVID-19 pandemic. The objectives of this study were to assess publicly available COVID-19 communications and guidance from national organizations to better understand guidance for pregnant and postpartum people who were incarcerated during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This study used documentary qualitative analysis to review publicly available COVID-19 guidance and communications from public health agencies and professional organizations. A total of 27 documents were reviewed, coded, and analyzed across eight organizations.</p><p><strong>Results: </strong>In the 338 pages reviewed, \"pregnancy/postpartum\" was coded just 17 times among four organizations. Our review found that mentions of the unique needs of pregnant and postpartum people during the COVID-19 pandemic were mostly absent from organizational guidance.</p><p><strong>Conclusion: </strong>This analysis calls attention to the gaps in the consideration for pregnant and postpartum people who are incarcerated, particularly in the context of the COVID-19 pandemic. We conclude with a series of recommendations to strengthen the care of pregnant and postpartum people who are incarcerated and promote health equity.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"305-315"},"PeriodicalIF":2.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations and Recommendations for Humanizing Immigrant Language in Health Equity Data Collection, Reporting, and Measurement.","authors":"Andrea Thoumi, Olurotimi Kukoyi, Kamaria Kaalund, Yazmin Garcia Rico, Rosa M Gonzalez-Guarda, Jay Pearson, Viviana Martinez-Bianchi","doi":"10.1089/heq.2024.0127","DOIUrl":"10.1089/heq.2024.0127","url":null,"abstract":"<p><p>Collecting accurate and consistent sociodemographic data is needed to improve health measurement and public health interventions. Missing or inaccurate data hinders the adequate assessment of the state of access, quality, and coverage in the overall population and communities experiencing social marginalization. Health measurement requires data labels that humanize all populations living, working, and residing across the United States and territories. Humanization is fundamentally grounded in the concepts of human dignity and ethical identity integrity. An often-overlooked form of exclusion in health care is the long-standing use of dehumanizing language, including its use in health measurement and data collection efforts, to refer to immigrant populations. In this perspective, we delineate ethical concerns regarding the use of dehumanizing language when referring to immigrant populations. We provide recommendations for health providers, researchers, and policy makers in improving humanizing language in health equity data collection and reporting through engagement of community experts, use of alternative language, implementation, and monitoring.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"281-289"},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of Community-Based Participatory Research in High-Impact Medical Journals.","authors":"Michelle Doughtery, Yesmina Salib, Mylynda Massart, Jaime E Sidani, Jean L Raphael, Felicia Savage Friedman, Jason Beery, Monica Ruiz, Elizabeth Miller, Maya I Ragavan","doi":"10.1089/heq.2024.0151","DOIUrl":"10.1089/heq.2024.0151","url":null,"abstract":"<p><p>Community-based participatory research (CBPR) is essential for addressing health care inequities; however, it is unclear to what extent articles published in high-impact medical journals use CPBR. We reviewed original research articles in nine journals across 4 years to determine how frequently CBPR was used and, for articles using CBPR, details about partnerships. Of 5,624 articles, only 6 (0.1%) used CBPR. Five identified community partners and whether partners were involved in research planning/implementation, one reported that partners were involved in dissemination, and none reported adherence to CBPR principles. Improving integration of CBPR is an urgent priority for funders, institutions, journals, and researchers.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"290-295"},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial, Ethnic, and Color-Based Discrimination and Pre-Pregnancy Risk Factors for Preeclampsia Among Nulliparous Patients.","authors":"Alexa I K Campbell, Maria J Small, Sarahn M Wheeler, Jerome J Federspiel","doi":"10.1089/heq.2024.0173","DOIUrl":"10.1089/heq.2024.0173","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity and chronic hypertension are well-known risk factors for maternal morbidity and mortality. Evidence suggests racism contributes to the development of these chronic conditions.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes: monitoring mothers-to-be (nuMoM2b) cohort, which recruited nulliparous pregnant participants in the United States in 2010-2013. Using logistic regression, we assessed the relationship between experiences of racial, ethnic, and color-based (REC) discrimination (categorized as high, low, or no REC discrimination) and prevalence of a composite outcome of obesity and/or chronic hypertension.</p><p><strong>Results: </strong>Among 8,554 participants, the composite outcome was unequally distributed by race and ethnicity (<i>p</i> < 0.001), present in 19.9% of non-Hispanic White, 23.1% of Hispanic, and 39.0% of non-Hispanic Black participants. Self-reported REC discrimination was similarly unequally distributed (<i>p</i> < 0.001), with high REC discrimination reported by 17.5% of non-Hispanic Black, 10.6% of Hispanic, and 2.1% of and non-Hispanic White participants. In multivariable analyses, high self-reported REC discrimination was associated with a 1.75 adjusted odds ratio (95% confidence interval: 1.43-2.14) of the composite outcome compared with those reporting no REC discrimination. When stratified by race and ethnicity, the odds ratios for the composite outcome among those reporting high REC discrimination were only statistically significant among the Hispanic subgroup.</p><p><strong>Conclusion: </strong>We observed a positive, dose-dependent association between self-reported REC discrimination and our outcome of obesity and/or chronic hypertension. By demonstrating this relationship in an obstetric cohort, we aim to highlight the role of racism over the life course in contributing to chronic health conditions and associated maternal outcomes.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"270-280"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demystifying Traumatic Experiences and Complex Effects in People with HIV and Post-Traumatic Stress Disorder in Tennessee.","authors":"L Lauren Brown, Almariana J Acuña, Amna Osman, Lloyda B Williamson, Carolyn M Audet, Megan L Wilkins, Jessica M Sales, Samantha V Hill, Jill Foster, April C Pettit, Latrice C Pichon","doi":"10.1089/heq.2023.0251","DOIUrl":"10.1089/heq.2023.0251","url":null,"abstract":"<p><strong>Background: </strong>Compared with the general public, people with HIV (PWH) experience more psychological trauma and higher rates of post-traumatic stress disorder (PTSD), yet limited research explores how PWH may uniquely experience trauma. The primary goal of this study was to investigate trauma exposure typologies and sequelae among PWH to inform trauma screening and interventions.</p><p><strong>Methods: </strong>Qualitative interviews were conducted with a convenience sample of 20 PWH with PTSD, receiving services from an urban, Tennessee-based HIV Service Organization. Interview guides were conducted to gain a rich understanding of exposure types from the Life Events Checklist-5 (LEC-5), explore potential social determinants of trauma, and uncover effects of chronic trauma or traumata. Thematic content analysis was used to examine typologies and effects.</p><p><strong>Results: </strong>Exposure typologies appeared as social determinants of trauma, including molestation as the most common followed by racial trauma, community violence, incarceration, addiction, interpersonal violence, poverty cycles, and stigma. Standard PTSD symptoms were reported in addition to emerging effects of complexity, synergism, and resilience. Complex effects spanned socioecological contexts and included sequelae of affective dysregulation, negative self-concept/self-organization, and disturbances in relationships.</p><p><strong>Conclusion: </strong>Many typologies were not well accounted for in the LEC-5, underscoring the potential to miss exposure types and thus treatment indication. Similarly, effects expanded beyond standard PTSD symptoms, suggesting that nuanced treatment needs may also be overlooked. Findings are consistent with literature indicating the need for updated trauma screening and assessment measures to most comprehensively and accurately direct treatment needs.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"131-141"},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Equity and <i>BRCA1/2</i> Testing.","authors":"Steven Sorscher","doi":"10.1089/heq.2024.0167","DOIUrl":"10.1089/heq.2024.0167","url":null,"abstract":"<p><p>Although most cancers are sporadic, a significant proportion are related to inherited cancer-causing genes called pathogenic germline variants (PGVs). There are recommended measures for prevention and earlier diagnosis of cancers in patients identified as <i>BRCA1</i> and <i>BRCA2</i> PGV carriers, which are the most common cancer-predisposing PGVs. For example, published guidelines recommend that patients with <i>BRCA1/2</i> PGVs undergo bilateral oophorectomies to prevent ovarian cancer and regular magnetic resonance imaging to screen for breast cancer. Also, those same measures are recommended for family members identified by cascade testing as <i>BRCA1/2</i> carriers. Here, reports of the significant disparities between groups in which patients diagnosed with breast cancer are offered and undergo testing for <i>BRCA1/2</i> PGVs are reviewed. Expanding the current standard of care guidelines for <i>BRCA1/2</i> testing to all patients diagnosed with breast cancer and enacting the Cancer Moonshot 2.0 Initiative measures that should mitigate these disparities are discussed as well.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"127-130"},"PeriodicalIF":2.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}