African Journal of Primary Health Care & Family Medicine最新文献

{"title":"Optimising neonatal bubble continuous positive airway pressure: A Somaliland quality initiative.","authors":"Hawa D Mahmoud, Sarah C Kent, Fatima E Ibrahim, Najma Mohamed, Fatima A Abdulahi, Meagan N O'Neal, Priya Kanajam, Ellen K Diego","doi":"10.4102/phcfm.v17i1.4742","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4742","url":null,"abstract":"<p><strong>Background: </strong> Continuous positive airway pressure (CPAP) therapy is the standard of care for neonatal respiratory distress and improves survival when implemented in low-resource settings. Clinical audits at the Borama Regional Hospital (BRH) Neonatal Intensive Care Unit (NICU) revealed multiple barriers to effective CPAP, including insufficient pressure, a lack of neonatal-sized nasal prongs, and patient interface challenges.</p><p><strong>Aim: </strong> Improve respiratory distress by increasing effective CPAP delivery for neonates 30 days of age from 52% to 90% in 6 months.</p><p><strong>Setting: </strong> Single-centre referral hospital in the Awdal region of Somaliland.</p><p><strong>Methods: </strong> Quality improvement (QI) initiative with outcomes displayed using statistical process control (SPC) charts.</p><p><strong>Results: </strong> Eleven residents, three medical interns and seven NICU nurses completed the educational training. Forty-five patients were initiated on the locally designed bubble CPAP (bCPAP) device with a 47% (122/261) CPAP safety checklist completion rate for the three daily nursing shifts. We achieved our study aim by increasing the adherence rate to the 7-item bCPAP device set up from a baseline of 52% to 91%. The rate of infants weaned or discontinued from bCPAP for improved respiratory severity score (RSS) increased from 0% to 18% but did not demonstrate process change. There was no increase in adverse event rates (air leak, nasal columella breakdown and nasal irritation).</p><p><strong>Conclusion: </strong> We demonstrated increased effective bCPAP delivery and decreased respiratory distress.Contribution: This study outlines low-cost, customisable QI strategies to address commonly encountered gaps for effective bCPAP delivery in low-resource settings without access to commercially available CPAP devices or speciality-trained providers.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e14"},"PeriodicalIF":1.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050160","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":"Psychological insulin resistance among patients with diabetes mellitus in Botswana.","authors":"Engemadzo Bitsang, Billy M Tsima, Keneilwe Motlhatlhedi","doi":"10.4102/phcfm.v17i1.4752","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4752","url":null,"abstract":"<p><strong>Background: </strong> Timely initiation of insulin therapy is vital in patients with type 2 diabetes mellitus. However, insulin initiation may be delayed because of psychological insulin resistance (PIR).</p><p><strong>Aim: </strong> This study aims to determine the prevalence of PIR and factors that contribute to PIR in adults with type 2 diabetes mellitus at a diabetes clinic in Botswana.</p><p><strong>Setting: </strong> The study was conducted in a diabetes clinic, one of the two large centres in the country that manage diabetes mellitus. It is situated on the south eastern part of Botswana.</p><p><strong>Methods: </strong> This was a cross-sectional study among patients with type 2 diabetes mellitus. We included participants aged between 18 and 80 years old and diagnosed with type 2 diabetes mellitus for more than 1 year. Patients' attitudes towards insulin therapy were assessed using the Insulin Treatment Appraisal Scale (ITAS).</p><p><strong>Results: </strong> The prevalence of PIR was 82.9% (95% confidence interval [CI]: 78.0 - 87.8) out of the 228 respondents. Factors significantly associated with PIR were gender (odds ratio [OR] adjusted 0.44; 95% confidence interval 0.211 - 0.921; p = 0.029) and treatment type (OR adjusted 1.58; 95% confidence interval 1.067 - 2.341; p = 0.023).</p><p><strong>Conclusion: </strong> Significant factors associated with psychological insulin resistance were patient and health system-related. It is therefore pivotal to improve patient and healthcare provider communication and to ensure that patient education is thoroughly performed at the diagnosis of disease.Contribution: This study highlights the importance of patient education at diagnosis and during treatment continuum of diabetes mellitus.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e7"},"PeriodicalIF":1.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057458","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":"Prevalence of hypertension in community members in a low-income community in Windhoek, Namibia.","authors":"Zelda Janse van Rensburg, Craig Vincent-Lambert","doi":"10.4102/phcfm.v17i1.4735","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4735","url":null,"abstract":"<p><strong>Background: </strong> Hypertension remains a significant risk factor for the development of several non-communicable diseases such as stroke, myocardial infarction and renal failure. In many African countries, undiagnosed and unmanaged hypertension within the population remains a challenge. Proactive screening and health education therefore become important interventions.</p><p><strong>Aim: </strong> This study aimed to investigate the prevalence of hypertension among community members in a low-income, peri-urban community.</p><p><strong>Setting: </strong> The study was conducted in Otjomuise township, Windhoek, Namibia.</p><p><strong>Methods: </strong> A quantitative, cross-sectional design with a survey method was followed. A pre-validated health screening instrument was used to record the presence of hypertension in a sample of 358 community members who presented for screening over 2 days. A purposive sampling method was employed. Systolic and diastolic blood pressure reading were recorded, analysed and categorised using the American Heart Association classification scale. Blood pressures were classified as being either normal, elevated, hypertension stage 1 or hypertension stage 2. The data were analysed by a statistician using SPSS version 27 statistical software program and presented in tables.</p><p><strong>Results: </strong> A total of 210/358 (59%) of participants were found to have blood pressures within normal limits. Moreover, 57/358 (16%) had elevated blood pressures, 52/358 (14%) were in hypertension stage 1 and 39/358 (11%) were in hypertension stage 2.</p><p><strong>Conclusion: </strong> The 41% prevalence of abnormally elevated blood pressures found in our study is in line with the findings of other studies and confirms that hypertension in the Namibian population remains an ongoing public health concern. Larger scale and more regular screening exercises with appropriate referral are recommended.Contribution: Our study give insight on the prevalence of hypertension in a community in Namibia.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e6"},"PeriodicalIF":1.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044789","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":"Lower back pain prevalence and experiences in civil service workers, Botswana.","authors":"David Damba, Sonti I Pilusa","doi":"10.4102/phcfm.v17i1.4629","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4629","url":null,"abstract":"<p><strong>Background: </strong> Lower back pain (LBP) is a global problem contributing to both disability and an increased demand for rehabilitation services. Studies on the prevalence and impact on work performance in Botswana are scarce.</p><p><strong>Aim: </strong> We investigated the prevalence of LBP among civil workers in Botswana and their experiences.</p><p><strong>Setting: </strong> The study setting comprised physiotherapy practice, Gaborone, Botswana.</p><p><strong>Methods: </strong> Concurrent explanatory mixed methods were employed. A total of 339 medical files for civil service workers were reviewed to identify the prevalence of LBP and associated risk factors such as age, gender, body mass index, working duration and type of work. Descriptive statistics were performed. In addition, 20 civil service workers were interviewed. The interviews were transcribed verbatim and coded inductively.</p><p><strong>Results: </strong> A total of 339 files were reviewed and the prevalence of LBP was 49%. There was no association between the risk factors and LBP (p  0.05). The experience of LBP was expressed in terms of the characteristics of LBP; the effects of LBP on all life domains and how LBP was managed. Our findings were that LBP affected work life and work performance.</p><p><strong>Conclusion: </strong> The high prevalence of LBP in civil service workers is concerning because it affects all the domains of life including work performance. Workplace health and wellness interventions are recommended.Contribution: Workplace health and wellness interventions are recommended.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e6"},"PeriodicalIF":1.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053049","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":"Maximising contributions of midwives in Africa towards achieving MNH targets: Lessons learned.","authors":"Doreen K Kaura, Jemima A Dennis-Antwi, Frances D Ganges, Sarah N Ngoma","doi":"10.4102/phcfm.v17i1.4851","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4851","url":null,"abstract":"<p><p>African midwives are pivotal in enhancing continuity and care coordination throughout healthcare systems. They are a critical human resource in mitigating near misses, morbidities and mortality in Maternal and Neonatal Health (MNH). Thus, achieving the sustainable development goals (SDGs) necessitates robust midwifery policies and system strengthening across Africa. Given the critical role of midwives, this report reflects on the need for a coordinated regional approach to unify midwifery across the continent as a strategy towards impactful SDG achievements. The reflections are based on insights from a Ghana meeting aimed at unifying African midwives. Globalisation and Africanisation are both crucial for developing a harmonised sexual, reproductive, maternal, newborn and adolescent health system that improves the quality of life for African women and their families. Despite significant healthcare improvements, Africa faces challenges such as a shortage of skilled birth attendants, leading to high maternal and neonatal mortality rates. Achieving SDGs requires local solutions and fully integrating midwives into health systems. It also requires that midwives are purposefully and regularly engaged in global, regional and local policy discussions and decisions. To support this goal, the authors present an approach to ensure midwives in Africa are not only represented in these forums but also actively engaged in shaping, advocating for, and advancing relevant actions. We therefore recommend establishing a regional midwifery body to lead and coordinate these efforts.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e3"},"PeriodicalIF":1.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988010","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":"What is the role of family medicine in providing palliative care in Africa?","authors":"Jennie Morgan, Maggie De Swardt, Nuhamin T Gebre, Mohja K Marhoom, Edwina B Opare-Lokko, Liz Gwyther","doi":"10.4102/phcfm.v17i1.4879","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4879","url":null,"abstract":"<p><p>Although palliative care is known to effectively relieve serious health-related suffering (SHS), it is not yet widely available, particularly in Africa. Primary health care has been recognised as an effective means to enhance access to palliative care and achieve universal health coverage. As family physicians play an important role in the delivery of primary health care, this article seeks to illustrate how the family medicine speciality is contributing to efforts to ensure palliative care services are provided throughout the African continent. The World Health Organization recommends three tiers of training for healthcare providers to enhance competencies in palliative care. This training has played out differently in various African countries. This article focuses on the countries represented by the authors, namely South Africa, Ethiopia, Sudan and Ghana. In providing continuous, coordinated, holistic care to patients along the life course, family physicians can anticipate and relieve suffering in a timely manner in ways that no other specialities have been trained to do. We propose that all family physicians' training programmes in Africa prioritise palliative care training along with other leading clinical areas, to ensure that the significant numbers of people dying from SHS receive holistic care and die with dignity.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e3"},"PeriodicalIF":1.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004307","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":"Self-reported knowledge, attitude and mental health status of in-school adolescents in Nigeria.","authors":"Atinuke O Olowe, Amme M Tshabalala, Judith C Bruce","doi":"10.4102/phcfm.v17i1.4858","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4858","url":null,"abstract":"<p><strong>Background: </strong> The global rise in adolescent mental health conditions highlights the need for preventive interventions particularly in schools for timely access to young people, building on inherent strengths and competencies.</p><p><strong>Aim: </strong> The study aims to determine the knowledge, attitude, mental health status and the predictors of mental health status of in-school adolescents.</p><p><strong>Setting: </strong> The study was conducted in government-owned secondary schools in Lagos State, Nigeria. Simple random sampling was used to select one of three senatorial districts; one junior and one senior secondary school with a nurse-led school clinic were purposively selected from the sampled district.</p><p><strong>Methods: </strong> Within a cross-sectional survey design, a self-administered questionnaire was used to obtain data from a sample of in-school adolescents aged 10-19 years (n = 148), enrolled in junior and senior classes.</p><p><strong>Results: </strong> Most in-school adolescents reported poor knowledge (62.2%; n = 92) and poor attitude (54.7%; n = 81) towards mental health; 37.2% (n = 55) reported being substantially at risk of conduct problems. A high proportion (79.7%) indicated normal prosocial behaviours. Level of knowledge (odds ratio [OR] = 3.25; p  0.05; 95% confidence interval [CI] = 1.34-7.86) as well as third or higher birth order (OR = 3.46; p  0.05; 95% CI = 1.34-8.94) were significant predictors of mental health status.</p><p><strong>Conclusion: </strong> Most in-school adolescents lack knowledge, have a poor attitude towards mental health and are more likely to display conduct problems impacting their mental health status.Contribution: The study provides baseline evidence for designing in-school programmes with a mental wellness focus to promote the mental health of adolescents, leveraging professional and parental networks.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040828","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":"Optimising clinical governance and risk management in resource-limited hospitals: A family medicine model.","authors":"Mergan Naidoo, Kimera T Suthiram","doi":"10.4102/phcfm.v17i1.4876","DOIUrl":"https://doi.org/10.4102/phcfm.v17i1.4876","url":null,"abstract":"<p><p>In resource-constrained healthcare settings, clinical governance and risk management are critical to improving patient outcomes and efficiently using limited resources. This article describes an innovative strategy implemented at a South African district hospital led by family physicians to optimise admissions and care prioritisation. The protocol established a designated high-care unit and admissions ward, ensuring that all new admissions were seen by a family physician, allowing family physicians to focus on the sickest patients requiring immediate intervention. This structured approach improved clinical oversight, reduced medical errors, and decreased morbidity and mortality. By efficiently allocating the expertise of family physicians, the intervention demonstrated measurable improvements in care delivery and patient safety. This model highlights the leadership role of family physicians in clinical governance and presents a scalable solution for similar resource-limited healthcare settings.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e5"},"PeriodicalIF":1.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018060","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":"Reducing prescribing cascades.","authors":"Aaron M Tejani, Thomas L Perry","doi":"10.4102/phcfm.v17i1.4929","DOIUrl":"10.4102/phcfm.v17i1.4929","url":null,"abstract":"<p><p>Prescribing cascades contribute to the increasing prevalence of polypharmacy and its associated risks, where a drug-induced adverse event is misinterpreted as a new condition and treated with additional medications. Notable cascades include the use of anticholinergics leading to cognitive impairment, dyspepsia or constipation, which then prompt prescriptions for dementia medications, proton pump inhibitors or laxatives, respectively. Similarly, calcium channel blockers and gabapentinoids often induce oedema, resulting in unnecessary diuretic use. Strategies for prevention include careful review of adverse effects, deprescribing where appropriate and clinician education to improve symptom interpretation and prescribing practices. Recognising these cascades can mitigate unnecessary interventions and improve patient outcomes.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e4"},"PeriodicalIF":1.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764979","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":"Factors associated to hypertension knowledge and control in Kimpese, Democratic Republic of the Congo.","authors":"Vainqueur N Diakengua, Ernest K Sumahili, Patrick N Ntontolo, Aliocha N Nkodila, James Ibuaku, Pieter Van den Hombergh, Meena Hariharan, Louis S Jenkins, Philippe L Ngwala","doi":"10.4102/phcfm.v17i1.4721","DOIUrl":"10.4102/phcfm.v17i1.4721","url":null,"abstract":"<p><strong>Background: </strong> Worldwide, the proportion of hypertensive patients with controlled blood pressure is poor. Knowledge on hypertension has been recognised as a major determinant of uncontrolled hypertension.</p><p><strong>Aim: </strong> This study aimed to determine factors associated with knowledge and control of hypertension among hypertensive patients in Kimpese Health Zone, in the Democratic Republic of the Congo (DRC).</p><p><strong>Setting: </strong> Six health facilities of the Kimpese Health Zone were selected.</p><p><strong>Methods: </strong> This study was an analytical cross-sectional study from May 2021 to December 2021. Information on socio-demographic characteristics, clinical data and knowledge on hypertension was collected. Factors associated with knowledge and control of hypertension were determined using logistic regression analysis.</p><p><strong>Results: </strong> A total of 301 participants with a sex ratio of 1:3 (F M) and a mean age of 60.5 ± 12.1 years were included in the study. Poor knowledge on hypertension (79.1%) and a treatment failure (84.3%) were common. Low educational level (p = 0.024; adjusted odds ratio [aOR] = 2.64 [1.72-3.73]), rural residence (p = 0.02; aOR = 3.34 [1.24-8.52]) and a lack of information by a health professional (physician or nurse) (p ≤ 0.001; aOR = 3.34 [1.24-8.52]) were significantly associated with poor knowledge. In addition, high cardiovascular risk (p = 0.009; aOR = 2.75 [1.29-5.84]), subclinical atherosclerosis (p = 0.000, AOR = 9.26 [3.54-24.23]) and absence of knowledge on hypertension (p = 0.042, AOR = 1.96 [1.49-2.23]) were significantly associated with uncontrolled hypertension.</p><p><strong>Conclusion: </strong> There was propensity of uncontrolled hypertension and poor knowledge among the study participants. Poor socio-demographic conditions and a lack of accurate information on hypertension increased odds of poor knowledge of the disease. In addition, insufficient knowledge on hypertension and comorbidities were associated with uncontrolled hypertension.Contribution: Education on hypertension and screening; managing comorbidities in integrating approach to non-communicable diseases are key components of managing hypertension in our setting to improve health outcomes.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"17 1","pages":"e1-e7"},"PeriodicalIF":1.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765372","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}