Journal of Public Health Management and Practice最新文献

{"title":"Today's Urgent Leadership Challenge: State-Level Public Health Advocacy.","authors":"Gene W Matthews, Maddy Frey, Quang Dang, Martha Katz, Edward L Baker","doi":"10.1097/PHH.0000000000002134","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002134","url":null,"abstract":"","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":"31 3","pages":"495-497"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Disasters Cross State Borders: Pennsylvania's Public Health Response to the Norfolk Southern Train Derailment in East Palestine, Ohio.","authors":"Matthew Fifolt, Andrew Pickett","doi":"10.1097/PHH.0000000000002095","DOIUrl":"10.1097/PHH.0000000000002095","url":null,"abstract":"<p><p>This case study explores the actions taken by the Pennsylvania Department of Health to address public health concerns related to the Norfolk Southern train derailment in East Palestine, Ohio. Due to the location of the train derailment on the Ohio-Pennsylvania border, the case demonstrates the inherent challenges of addressing disasters that occur across state lines. Furthermore, the train derailment was regarded as an environmental disaster rather than a public health emergency, further complicating response efforts.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"399-405"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competency Gaps Among Governmental Public Health Employees With and Without a Formal Public Health Degree: Where Are We Now?","authors":"MaKenzie Gee, Heather Taylor, Valerie A Yeager","doi":"10.1097/PHH.0000000000002104","DOIUrl":"10.1097/PHH.0000000000002104","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to examine whether differences in self-reported core competency skill gaps among U.S. governmental public health workers with and without a formal degree in public health have changed since the last assessment in 2017.</p><p><strong>Design: </strong>This cross-sectional study utilizes data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting chi-square tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, public health certificate attainment, role type, current employer, and tenure in public health practice constant.</p><p><strong>Setting: </strong>A nationally representative sample of U.S. government public health employees.</p><p><strong>Participants: </strong>36,752 U.S. governmental public health employees across local and state health agencies representing 47 states.</p><p><strong>Main outcome measures: </strong>Self-reported competency skills gaps.</p><p><strong>Results: </strong>In 2021, among both nonsupervisors and supervisors, having a formal public health degree (bachelors, masters, or doctorate) was significantly associated with reduced odds of reporting a skill gap across more than half of the competency skills assessed (14 of 23 skills and 17 of 24 skills, respectively). Nonsupervisors and supervisors with a formal public health degree had fewer skill gaps in 2021 than in 2017. Furthermore, whereas in 2017, when having a public health degree had no effect on executives reporting a skill gap, in 2021, having a public health degree was significantly associated with reduced odds of reporting 2 skill gaps.</p><p><strong>Conclusions: </strong>Overall, across all position levels (ie, nonsupervisory, supervisor, executive), public health workers with a public health degree experienced fewer competency skill gaps in 2021 than in 2017. These findings from PHWINS 2021 illustrate that formal public health education generally decreases competency gaps across numerous competency domains. However, the variability in reported gaps across supervisory levels shows the need for ongoing evaluation and adaptation of formal public health degree programs.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"459-471"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Level Strategies for Addressing Disparities in Healthy People 2030 Leading Health Indicators.","authors":"Rachel Van Vleet, Skyla Chitwood, Victoria Hallman, Megan Heffernan, Catharine Fromknecht, Meghan O'Leary, Yen Lin, Deborah Hoyer","doi":"10.1097/PHH.0000000000002097","DOIUrl":"10.1097/PHH.0000000000002097","url":null,"abstract":"<p><strong>Context: </strong>The Healthy People 2030 Leading Health Indicators (LHIs) offer a select set of measurable objectives to help community-based organizations focus their efforts to improve health equity and reduce health disparities across the lifespan within the populations they serve. Disparities are observed across LHIs, including infant mortality, maternal mortality, and food insecurity, and reducing these disparities is a key strategy for improving health and well-being for all.</p><p><strong>Objective: </strong>This study was designed to answer the following research questions: (1) What programs and initiatives are organizations implementing to address the LHIs of focus - infant mortality, maternal mortality, and food insecurity? (2) How do organizations determine which programs and initiatives they will implement?</p><p><strong>Design: </strong>NORC conducted 9 qualitative interviews with Healthy People 2030 Champions, organizations dedicated to furthering Healthy People goals and objectives, who are working to address disparities within infant mortality, maternal mortality, and food insecurity through a variety of strategies, interventions, and programs.</p><p><strong>Results: </strong>Wraparound services, doula programs, and education and advocacy emerged as common strategies for addressing disparities in maternal and infant mortality. Organizations that are working to reduce household food insecurity and hunger implemented food pharmacies and support participant enrollment in federal food assistance programs. Interviewees shared strategies for determining programs to implement and continued program improvement including assessing community needs, leveraging partnerships, and measuring program success.</p><p><strong>Conclusions: </strong>Healthy People Champion organizations are using several multidimensional strategies to address infant mortality, maternal mortality, and food insecurity in their communities. These strategies, and the community-based organizations that implement them, are critical for addressing disparities in priority health outcomes among the people who have the greatest need. These findings offer insights into how local communities are tackling national priorities and underscore opportunities for more rigorous evaluation to demonstrate progress toward addressing disparities in the LHIs.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"440-446"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic Surveillance of Foodborne Pathogens: Advances and Obstacles.","authors":"Kathleen Gensheimer, Marc W Allard, Ruth E Timme, Eric Brown, Leslie Hintz, Jamie Pettengill, Errol Strain, Sandra M Tallent, Lili F Vélez, Ewa King, Sharon L Shea","doi":"10.1097/PHH.0000000000002090","DOIUrl":"10.1097/PHH.0000000000002090","url":null,"abstract":"<p><strong>Context: </strong>The genomic surveillance of foodborne pathogens in the United States has grown exponentially in the past decade, grounded in a powerful combination of novel sequencing technologies, bioinformatic approaches, data-sharing networks, and metadata harmonization efforts. This practice report examines recent advances in genomic epidemiology as applied to food safety programs and delineates State, Tribal, Local, and Territorial infrastructure necessary for continued life-saving improvements in public health.</p><p><strong>Program: </strong>National databases of foodborne pathogen genomes, along with data sharing and evaluation networks such as GenomeTrakr and PulseNet, have transformed how connections are made among isolates and how root causes of outbreaks are determined, allowing much more timely interventions to protect public health. Freely available bioinformatics tools such as GalaxyTrakr and the National Center for Biotechnology Information Pathogen Detection database have allowed laboratories with limited local computing resources to participate in surveillance efforts and contribute to traceback investigations.</p><p><strong>Implementation: </strong>In this report, we describe advances in genomic epidemiology that have occurred over the past decade and examine obstacles to fully implementing this technology within State, Tribal, Local, and Territorial public health systems.</p><p><strong>Evaluation: </strong>Despite a clear return on investment from governmental expenditures on genomic surveillance of foodborne pathogens, we identify significant obstacles to further sustained progress. These obstacles include workforce gaps, ineffective data sharing, and lack of constitutive and sustained funding.</p><p><strong>Discussion: </strong>Many public health laboratories face major obstacles to widespread and routine adoption of genomic surveillance technologies. While whole genome sequencing has become an integral part of routine public health microbiology, the seamless integration of these protocols into the existing practices, laboratory workflows, and information systems remains challenging. Centralized efforts to address these issues include (1) support through the Food and Drug Administration Laboratory Flexible Funding Model, (2) training and proficiency assessments, (3) open-source, standardized protocols for collecting high-quality genomic data, and (4) open access informatics software.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"351-359"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Typology of US Public Health Work-Education Programs.","authors":"Karen M White, Mari-Lynn Drainoni, Patricia Elliott, Meredith Hurley, Stacey Cunnington, Jacey Greece","doi":"10.1097/PHH.0000000000002079","DOIUrl":"10.1097/PHH.0000000000002079","url":null,"abstract":"<p><strong>Objective: </strong>A pipeline is required to build a qualified and diverse public health workforce. Work-education programs offer public health students experiential learning, training, and a pathway to public health professions. However, there is a gap in the literature to guide public health practice on the types of programs, their components, and their potential impact. By defining and differentiating work-education programs, we aim to provide public health practitioners a useful tool to advance public health careers.</p><p><strong>Design: </strong>We conducted a scoping review of US-based public health work-education programs and performed a content analysis to extract, analyze, and synthesize data to develop a typology of programs in the US. We searched CINAHL, ERIC, PsycInfo, PubMed and Web of Science databases for papers published between January 1, 2012, and December 31, 2022.</p><p><strong>Eligibility criteria: </strong>Inclusion criteria included programs with a description, intervention design, student characteristics, setting characteristics, and program outcomes if available. Exclusion criteria included programs with no description, that focused on the expansion of a specific clinical profession (ie, dentistry), that were implemented outside of the US, and that targeted exclusively high school students.</p><p><strong>Study selection: </strong>The search resulted in 650 references, which yielded 35 articles from 33 interventions.</p><p><strong>Main outcome measures: </strong>The main outcome measures were qualitative and included program design, features, and implementation.</p><p><strong>Results: </strong>We identified 3 types of programs: those that (1) expose students to public health (n = 6), (2) guide students to specific public health professions (n = 12), and (3) connect students with organizations for public health practice (n = 15). Program types were influenced by student participants, setting, and program components.</p><p><strong>Conclusions: </strong>This typology illustrates the spectrum of work-education programs and their variability in design and implementation. The typology has utility for practitioners to identify programmatic aspects that may be feasible and desirable in the context of their practice.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"E134-E143"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of the CDC Preventive Health and Health Services Block Grant to Address Social Determinants of Health to Advance Health Equity.","authors":"Cassandra M Frazier, Karen Mumford, Hannah McMillan, Maggie Carlin, Emily Peterman, Krysia Lindan","doi":"10.1097/PHH.0000000000002073","DOIUrl":"10.1097/PHH.0000000000002073","url":null,"abstract":"<p><strong>Objective: </strong>State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs.</p><p><strong>Design: </strong>Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data.</p><p><strong>Setting: </strong>This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework.</p><p><strong>Participants: </strong>Forty-seven states and the District of Columbia were included in this study.</p><p><strong>Main outcome measures: </strong>Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH.</p><p><strong>Results: </strong>Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs.</p><p><strong>Conclusion: </strong>This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"428-439"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs-United States, 2023.","authors":"Emily W Lankau, Monica Chiang, Julie Dudley, Kimberly Miller, Ann Marie Shields, Jeanne Alongi, Marti Macchi, Katherine H Hohman","doi":"10.1097/PHH.0000000000002083","DOIUrl":"10.1097/PHH.0000000000002083","url":null,"abstract":"<p><strong>Objective: </strong>The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD's 2023 survey outcomes and place those findings into the broader public health policy context.</p><p><strong>Design: </strong>State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size.</p><p><strong>Results: </strong>State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity.</p><p><strong>Conclusions: </strong>During this period of pandemic recovery, turnover, hiring, and training-particularly of the many new public health staff-remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development-particularly workforce development, chronic disease data systems, and tools for addressing health equity-could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"392-398"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Priorities of Local Health Departments in California: A Mixed Methods Study.","authors":"Nimrat K Sandhu, Ana Lucia Mendoza, Mamata Pokhrel, Melissa Renteria, Kim Bristow, Paul M Brown","doi":"10.1097/PHH.0000000000002082","DOIUrl":"10.1097/PHH.0000000000002082","url":null,"abstract":"<p><strong>Objective: </strong>Prioritization is an essential task of local health departments (LHDs). We examined the alignment of priorities reported in Community Health Needs Assessments (CHNA) with priorities in the Community Health Improvement Plans (CHIP). We report factors that influence the choice of priorities and the alignment of the priorities.</p><p><strong>Design: </strong>A mixed method study design.</p><p><strong>Setting: </strong>California.</p><p><strong>Participants: </strong>CHNA and CHIP documents were sought for all 58 counties. Interviews were conducted with 19 state and local public health officials.</p><p><strong>Outcome measures: </strong>The priorities in the CHNA and the CHIP were coded as i) only in the CHNA, ii) only in the CHIP, or iii) in both the CHNA and the CHIP. The interviewees were asked to share their experiences related to issue prioritization and decision-making in public health agencies. The interviews were coded and thematically analyzed to identify barriers and facilitators of the prioritization process.</p><p><strong>Results: </strong>The alignment between the needs prioritized in CHNA and the priorities targeted in CHIP was 35%. The interviews identify reasons for the misalignment, including a need to include priorities in the CHNA even though LHDs are not able to address them, political factors that influence the selection of priorities, and a lack of discretionary funding or capacity/expertise within the agency or its community partners to respond to the needs identified. The lack of discretionary funding was particularly acute for smaller (rural) LHDs (CMSP) and resulted in their often having to focus on priorities where there was state or federal funding.</p><p><strong>Conclusions: </strong>LHDs face numerous challenges in aligning the priorities reported in the CHNA and the priorities they focus upon in the CHIP. LHDs should consider using a formal, transparent, and evidence-based approach to setting aligning. Future research should focus on developing a formal decision-making process that is appropriate for local public health decision-making.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"384-391"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for Patients Seeking Asylum: Early Data From the Safety Net System in New York City.","authors":"Remle Newton-Dame, Laura Jacobson, Andrew B Wallach, Erica Silverman, Benard Dreyer, Theodore Long","doi":"10.1097/PHH.0000000000002106","DOIUrl":"10.1097/PHH.0000000000002106","url":null,"abstract":"<p><strong>Context: </strong>Over 200 000 people seeking asylum have arrived in New York City from 2022 to 2024.</p><p><strong>Program: </strong>As the safety net hospital system for our city, New York City (NYC) Health + Hospitals (H + H) has taken the lead in caring for newly arrived asylum seekers. We used electronic medical record data to gain early insights into utilization and needs among these patients.</p><p><strong>Implementation: </strong>We developed a hybrid definition to identify patients who are asylum seekers and examined their demographics, insurance, utilization, primary billing diagnoses, and immunizations from the Epic EMR. We included data on other patients as a point of comparison and analyzed data separately for adult and pediatric patients.</p><p><strong>Evaluation: </strong>In 2023, 15 233 or 1.4% of H + H patients were asylum seekers. Asylum seekers had fewer visits than other patients in 2023, and utilization was particularly driven by pregnancy and childbirth. Children seeking asylum were engaged in primary care at high rates. Documented childhood vaccinations were higher among asylum-seeking children engaged in primary care compared to those who were not. The majority of adults and children were insured. Adult primary care engagement was low, as were visits for those seeking care for behavioral health issues.</p><p><strong>Discussion: </strong>For adult asylum seekers, pregnancy and childbirth are key needs for adults. Increasing vaccination rates among children is critical and promoting engagement in primary care is a promising way to do so. Coordinated efforts are required to meet the varied needs of migrant arrivals, and safety net hospitals can play a key role in addressing their health care needs.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"477-485"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}