Journal of Public Health Management and Practice最新文献

{"title":"Experiences and Lessons Learned From Surging the Governmental Public Health Workforce During the COVID-19 Pandemic.","authors":"Katie Morrison Lee, Alyssa Bosold, Cindy Alvarez, Oluwatosin O Dada, Deborah S Porterfield","doi":"10.1097/PHH.0000000000002051","DOIUrl":"10.1097/PHH.0000000000002051","url":null,"abstract":"<p><strong>Context: </strong>During the COVID-19 pandemic, the United States relied on the public health workforce to control the spread of COVID-19 while continuing to provide foundational public health services. Facing longstanding staffing shortages, state, tribal, local, and territorial (STLT) public health agencies (PHAs) used various strategies and supports to surge the workforce in response to the pandemic.</p><p><strong>Objectives: </strong>The study explored (1) the types of strategies and supports STLT PHAs used to surge the public health workforce during the pandemic, (2) assessments of surge strategies and supports, and (3) approaches to using the range of surge strategies available.</p><p><strong>Design: </strong>We conducted 27 semi-structured interviews in 2023 and performed thematic analysis.</p><p><strong>Participants: </strong>Interviewees included STLT public health officials, leaders of organizations that directly supported the COVID-19 workforce surge, and public health workforce experts indirectly involved in the workforce surge.</p><p><strong>Results: </strong>To surge the workforce, interviewees relied on partnerships, staffing agencies, the National Guard, the Centers for Disease Control and Prevention Foundation's COVID-19 Corps, the Medical Reserve Corps, and other strategies. Interviewees valued strategies that rapidly engaged staff and volunteers at no cost to their PHA and flexible funding from the federal government to support surge efforts but noted shortcomings in the strategies and supports available. Interviewees described using multiple strategies simultaneously but noted challenges in implementing these strategies due to inadequate planning and insufficient staff and resources.</p><p><strong>Conclusion: </strong>The study underscores the need for STLT PHAs to establish mechanisms to surge the workforce as part of ongoing planning for emergency preparedness. Focus areas include building administrative and hiring capacity within STLT PHAs and sustaining partnerships and contractual agreements that helped fill staffing gaps during the pandemic. To support efforts to build workforce capacity to meet future surge management needs, STLT PHAs should consider creative solutions to attract and retain staff, as well as opportunities to engage students in public health work.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"283-290"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156372","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":"Local Supports to Break the Cycle: A Description of Intersectional Interventions to Address Adverse Childhood Experiences and Drug Overdose.","authors":"Amie C Myrick, Camille A Adams, Laura J Cremer, Nicole Filion, Stephanie Haddad, Caroline Snyder, April Wisdom","doi":"10.1097/PHH.0000000000002042","DOIUrl":"10.1097/PHH.0000000000002042","url":null,"abstract":"<p><strong>Context: </strong>Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues.</p><p><strong>Program: </strong>This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities.</p><p><strong>Implementation: </strong>From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18 months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose.</p><p><strong>Evaluation: </strong>Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle.</p><p><strong>Discussion: </strong>It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"227-233"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548303","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":"National Public Health Accreditation: Now Is the Time.","authors":"Paul Kuehnert, Kaye Bender","doi":"10.1097/PHH.0000000000002099","DOIUrl":"10.1097/PHH.0000000000002099","url":null,"abstract":"","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"155-156"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886313","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":"How Business and Public Health Can Work Better Together.","authors":"Emma Dewhurst, Bethany Kuerten","doi":"10.1097/PHH.0000000000002116","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002116","url":null,"abstract":"","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":"31 2","pages":"337-338"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025310","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":"Leveraging Communities of Practice to Support Translation of Knowledge Into Action Among State, Tribal, Local, and Territorial Public Health Agencies: Lessons Learned From the COVID-19 Pandemic.","authors":"Alyssa Bosold, Rachel Machta, Jackie Brenner, Deborah S Porterfield","doi":"10.1097/PHH.0000000000002114","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002114","url":null,"abstract":"<p><strong>Context: </strong>During the COVID-19 pandemic, communities of practice (CoPs) supported state, Tribal, local, and territorial (STLT) public health agencies. No studies have examined the collective role of these CoPs in helping STLT public health agencies translate guidance into practice.</p><p><strong>Objectives: </strong>This qualitative study examines the types of CoPs that supported STLT public health agencies during the COVID-19 response, how CoPs assisted in translating guidance into practice, and the characteristics of CoPs that made them valuable to STLT public health members. We report lessons for future public health emergencies (PHEs) for STLT public health agencies and membership organizations that represent them.</p><p><strong>Design: </strong>We conducted 21 in-depth interviews with CoP leaders, STLT public health participants, and federal agency sponsors and collaborators.</p><p><strong>Participants: </strong>We interviewed 9 CoP leads, 6 STLT participants, and 6 federal agency representatives.</p><p><strong>Results: </strong>Three types of CoPs, each with unique advantages, supported STLT public health agencies during the COVID-19 pandemic: (1) CoPs led by federal agencies, (2) CoPs led by membership organizations or associations that represent STLT public health agencies, and (3) CoPs led by other nonfederal organizations, such as philanthropic organizations and academic institutions. The most valuable CoPs to STLT public health agencies had a clear focus on issues of significance to their members, strong connections between members, and a structure tailored to the group's goals. STLT public health agencies valued CoP support with implementing guidance-based policies and practices and facilitating bidirectional communication with federal agencies. STLT public health agencies also benefitted from tailored and implementation-focused resources developed through CoPs.</p><p><strong>Conclusion: </strong>Our study affirms the importance of CoPs in facilitating collaboration and information-sharing among multiple actors during PHEs. During the COVID-19 pandemic, CoPs helped STLT public health agencies implement guidance, tailor approaches to specific contexts, and generate practice-based discoveries to advance the field.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256974","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":"Exploring the Impact of COVID-19 on a Child Maltreatment Prevention Network.","authors":"Patricia L Kohl, Jenine K Harris, Mary Katherine Shires, Caren Bacon, Sanaria Sulaima, Melissa Jonson-Reid","doi":"10.1097/PHH.0000000000002107","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002107","url":null,"abstract":"<p><strong>Objective: </strong>Child maltreatment is a complex and preventable public health problem that cannot be effectively addressed by a single organization or sector. We examined a network of organizations working to prevent childhood maltreatment before and during COVID-19, including members of the Parents and Children Together-St. Louis Collaborative. The Collaborative is an initiative with the purpose of strengthening ties among service agencies and was new when the COVID-19 shutdowns began.</p><p><strong>Design and participants: </strong>In September 2020, we surveyed 62 agencies working on childhood maltreatment prevention in the public health, health, or social service sectors. We asked about frequency of contact between organizations before (pre-COVID) and during COVID (in-COVID). We used descriptive and inferential network methods to examine network properties and changes.</p><p><strong>Results: </strong>There were 360 ties among organizations in the pre-COVID network (density = 0.19) and 321 ties among organizations (density = 0.17) during COVID. The median number of ties per organization decreased from pre- to in-COVID for most organizations and most notably for smaller and newer organizations and mental health care organizations. The only organization type that increased connections was substance abuse organizations. Pre- and in-COVID odds of connection were significantly higher for mental health care, substance abuse, health care, child welfare, and legal-advocacy organizations compared to multisector organizations. Odds of a connection between 2 organizations were significantly higher pre-COVID and in-COVID if one or both organizations were Collaborative members.</p><p><strong>Conclusions: </strong>Disruptions during COVID-19 coincided with fewer connections among organizations. Collaborative members had higher odds of connection before and during COVID-19, suggesting a potential strategy for building and maintaining a cross-sector service network. Understanding network structure and change in the early stages of COVID-19 provides an opportunity to work on building and sustaining inter-organizational connections essential in violence prevention and child well-being and other areas of public health.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256970","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 Systems Perspective of How Community-Engaged Public Health Addresses Social Determinants of Health: A Case Study of a Population-Based COVID-19 Testing Program.","authors":"Leah Frerichs, Ann-Marie Akiwumi, Lia Kaz, Doyoung Kim, Laura Florick, Valerie Lucas, Marcus Layer, Brandy Farrar, Gaurav Dave, Kristen Hassmiller Lich","doi":"10.1097/PHH.0000000000002089","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002089","url":null,"abstract":"<p><strong>Context: </strong>Despite the recognition that social determinants of health (SDOH) are key to improving the health of all communities, the causality and specific mechanisms through which SDOH impacts health behaviors and outcomes are often ambiguous.</p><p><strong>Objective: </strong>The aim of this study was to use systems thinking to document pathways through which SDOH affected health-seeking behaviors and identify how community engagement strategies intervened to address SDOH barriers.</p><p><strong>Design: </strong>We leveraged the case context of a large federal initiative (Rapid Acceleration of Diagnostics-Underserved Populations [RADx-UP]) designed to improve COVID-19 testing for underserved populations through community-engaged and participatory approaches. First, we used structured sessions with RADx-UP partners to create causal maps that documented relationships between factors relevant to SDOH, a health-seeking behavior (COVID-19 testing), and community engagement strategies. Second, we searched, reviewed, and tied evidence from RADx-UP peer-reviewed literature to contextualize the causal maps.</p><p><strong>Results: </strong>We identified 17 unique pathways that linked SDOH to COVID-19 testing. The map also highlighted 3 mechanisms through which the community engagement addressed SDOH: (1) improving access to testing, (2) addressing health and digital literacy, and (3) conducting social needs screening and assistance.</p><p><strong>Conclusions: </strong>Our findings highlighted the complexity of public health issues such as COVID-19 and how community engagement is critical to addressing SDOH and health equity. Importantly, dedicating resources to community engagement created positive reinforcing dynamics to improve the health of communities; however, as COVID-19 became better managed, funding also diminished and decreased the capacity for community-engaged efforts. Research in public health needs to focus on understanding and reshaping systems that better support community-engaged efforts.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256963","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":"https://doi.org/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":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","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":"Public Health Travel Restrictions Implemented for Persons at Risk of Transmitting SARS-CoV-2 Infection-United States, January 1, 2020-April 6, 2022.","authors":"Amethyst Clare A Surpris, M Robynne Jungerman, Leigh Ellyn Preston, Alida M Gertz, Krista K Duong, Sheila Roy, Mayra Morales, John Olmstead, Kristin Delea, Francisco Alvarado-Ramy, Clive Brown, Tai-Ho Chen","doi":"10.1097/PHH.0000000000002105","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002105","url":null,"abstract":"<p><strong>Context: </strong>Federal public health travel restrictions (FPHTR) in the United States are implemented for persons who meet specific criteria to prevent spread of communicable diseases of public health concern. FPHTR can mitigate the risk of disease transmission during air travel and mitigating disease translocation between geographic areas.</p><p><strong>Objective: </strong>To characterize and determine the extent of FPHTR implementation during the COVID-19 pandemic.</p><p><strong>Design: </strong>Secondary data analysis.</p><p><strong>Setting and participants: </strong>This report reviewed the U.S. public health response for 3010 persons traveling within, into, and out of, the U.S. who were placed on federal public health travel restrictions during the COVID-19 outbreak from January 1, 2020 to April 6, 2022.</p><p><strong>Main outcome measure: </strong>Total number and characteristics of persons with SARS-CoV-2 infection or high-risk exposure added to FPHTR.</p><p><strong>Results: </strong>During this period, FPHTR were implemented for 3010/5460 (55%) persons who were reported to CDC as having tested positive for SARS-CoV-2, or being identified as close contacts of a person with COVID-19, with intention to travel. Of those added to FPHTR lists, 2023/3010 (67%) had confirmed SARS-CoV-2 infection, 975/3010 (32%) were close contacts, and 12/3010 (0.4%) were reasonably believed to have COVID-19 but later confirmed to have another diagnosis and removed. Twenty-six percent (793/3010) of SARS-CoV-2-related FPHTR were for persons reported to CDC after testing positive for SARS-CoV-2 at a testing site located within a U.S. airport.</p><p><strong>Conclusions: </strong>The extensive application of FPHTR for more than 3000 persons over a period of 29 months during the COVID-19 pandemic was unprecedented. The additional use of FPHTR required extraordinary effort and collaboration among CDC staff and local/state public health agencies for case investigation, reporting, exchange of information, and communication with travelers for case management. Use of this tool should be considered within the context current transmission risk and disease severity.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034350","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":"Senility-Related Mortality in the United States During the COVID-19 Pandemic.","authors":"Sabrina Soin, Rama Mouhaffel, Hoang Nhat Pham, Enkhtsogt Sainbayar, Mahmoud Abdelnabi, Ramzi Ibrahim","doi":"10.1097/PHH.0000000000002122","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002122","url":null,"abstract":"<p><strong>Context: </strong>Senility has been shown to negatively impact health outcomes. While national stressors have altered death trajectories for numerous diseases, little is known about the impact of the COVID-19 pandemic on senility-related outcomes.</p><p><strong>Objective: </strong>To evaluate the impact of the COVID-19 pandemic on senility-related mortality in the United States.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective analysis of US decedents with documented senility-related death using the CDC WONDER database. We estimated annual trends in senility-related age-adjusted mortality rates (AAMR) from 1999 to 2020 using log-linear regression models. Calculation of excess deaths attributable to the COVID-19 pandemic was completed by comparison of actual 2020 mortality rates and estimated 2020 mortality using average annual percentage changes.</p><p><strong>Results: </strong>A total of 510 819 senility-related deaths were identified. AAMR declined by 9.76%, from 7.48 in 1999 to 6.75 deaths per 100 000 in 2020. Year 2020 showed a marked increase in mortality, with 1.13 excess deaths per 100 000 population attributable to the COVID-19 pandemic. The COVID-19 pandemic contributed to an additional burden of mortality across both sexes, resulting in an estimated 1.18 and 0.99 per 100 000 excess deaths among females and males, respectively. The excess death rates per 100 000 for Black, White, Asian/Pacific Islander, and American Indian/Alaska Native populations were 1.84, 1.05, 0.99, and 1.16, respectively. The impact on US census regions was reflected in excess death rates, with the Northeastern, Midwestern, Southern, and Western regions seeing 1.27, 1.27, 1.39, and 0.31 excess deaths per 100 000, respectively.</p><p><strong>Conclusions: </strong>These findings suggest that the pandemic had an association with excess senility-related mortality. Further investigation is warranted to identify factors that impact senility-related outcomes.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014031","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}