Childhood Obesity最新文献

{"title":"A Scale-Out Study of an Evidence-Based Family Meals Program Delivered in the Head Start Setting: Results, Challenges, and Opportunities.","authors":"Carolyn Gunther, Chyongchiou J Lin, Heather Schier, Miriam Knopp, Mei-Wei Chang, Julie Kennel, Amy R Sharn, Miranda Westrick, Sanja Ilic, Susan M Breitenstein, Joyce Grimes, Kyra Foster, Sierra Schwierking, Leah May","doi":"10.1089/chi.2024.0370","DOIUrl":"https://doi.org/10.1089/chi.2024.0370","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is need to identify evidence-based early childhood obesity prevention programs that are feasible and demonstrate cost-effectiveness for a broader health impact. This scale-out study leveraged community-engaged principles to compare the feasibility and cost-effectiveness of three delivery modes of a childhood obesity prevention family meals program (Simple Suppers) that demonstrated positive impacts on child and caregiver diet/nutritional health-related outcomes in a previous experimental trial tested among elementary-aged children. <b><i>Methods:</i></b> This three-arm (in-person, online, hybrid) pre-(T0) and post-(T1)-test study included families recruited from Head Start. Forty-five families (45 caregivers; 55 children) completed the study. The program was adapted to families with younger children (3-5 years). During the 8-week program, participants received weekly group education and meals through in-person, online, or hybrid format. Feasibility outcomes were attendance, acceptability (post-test survey; focus groups), fidelity, and cost (food; staff). Participant outcomes were related to diet/nutritional health. Kruskal-Wallis test was used to compare T0 to T1 differences in participant outcomes across delivery modes. Qualitative data were analyzed using thematic analysis. Cost-effectiveness was calculated as the net-cost of the program by changes in outcomes. <b><i>Results:</i></b> Overall attendance was 51.2%, and higher for in-person (72.0%) and hybrid (59.7%). Program satisfaction rate was highest for hybrid (93.0%), as well as program fidelity (96.7%). Focus group results revealed areas of program improvement, behavior change, and program approval. Cost was lowest for hybrid ($17.09/family). Children in the hybrid group had a reduced waist circumference (<i>p</i> = 0.02) versus in-person and online groups. <b><i>Conclusion:</i></b> The hybrid mode of Simple Suppers demonstrated the greatest scaling potential for a broader public health impact.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957247","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":"Relationships Between Gonadotropins, Sex Hormones, and Vascular Health in Adolescents with Normal Weight or Obesity.","authors":"William T Juckett, Nicholas G Evanoff, Aaron S Kelly, Eric M Bomberg, Donald R Dengel","doi":"10.1089/chi.2024.0325","DOIUrl":"https://doi.org/10.1089/chi.2024.0325","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Relationships between gonadotropins, sex hormones, and vascular structure and function in adolescents of varying weight statuses have not been fully investigated. In the present study, we examined associations among these in female and male adolescents with normal weight or obesity. <b><i>Methods:</i></b> We performed a cross-sectional analysis of adolescents (<i>n</i> = 58; 12-<18 years) grouped according to BMI percentile (BMI%) into normal weight (5th-<85th BMI%; <i>n</i> = 25) and obesity (≥95th BMI%; <i>n</i> = 33) categories. Fasting blood samples were collected to measure follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol. Vascular function was measured via ultrasonography for measures of carotid artery diameter compliance (cDC), incremental elastic modulus (cIEM), and brachial artery flow mediated dilation (FMD). <b><i>Results:</i></b> Females with obesity had a significantly (<i>p</i> = 0.009) greater mean FMD compared with those with normal weight. FSH, LH, testosterone, and estradiol did not differ between normal weight and obesity groups in either sex. After adjusting for age and multiple comparisons, higher testosterone was associated with decreased cDC (<i>R</i>² = 0.189; <i>p</i> = 0.018) and increased cIEM (<i>R</i>² = 0.346; <i>p</i> = 0.002) across all females. In all males, higher estradiol was associated with decreased cDC (<i>R</i>² = 0.404; <i>p</i> = 0.006) and increased cIEM (<i>R</i>² = 0.411; <i>p</i> = 0.003). <b><i>Conclusion:</i></b> We found that testosterone and estradiol were associated with vascular measures in female and male adolescents, respectively. Future studies are needed to confirm these relationships in larger cohorts and among those with BMIs in the overweight (85th-<95th BMI%) and severe obesity (BMI ≥120% of the 95th percentile and/or ≥35 kg/m²) categories.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957249","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":"Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.","authors":"Md Mozaharul Mottalib, Thao-Ly T Phan, Carolyn T Bramante, Christopher G Chute, Lee A Pyles, Rahmatollah Beheshti","doi":"10.1089/chi.2024.0256","DOIUrl":"10.1089/chi.2024.0256","url":null,"abstract":"<p><p><b><i>Background:</i></b> The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. <b><i>Methods:</i></b> Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results {<i>n</i> = 11,474, 53% male, mean [standard deviation (SD)] age 5.57 [±3.29] years, 54% White, mean [SD] 5.2 [±2.9] BMI observations per participant} were matched with COVID-19-negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19-positive and COVID-19-negative cohorts, with further evaluation performed on COVID-19-positive patients stratified by hospitalization status. <b><i>Results:</i></b> COVID-19-positive patients had a greater increase in <math><mi>%</mi><mi>B</mi><mi>M</mi><mrow><msub><mrow><mi>I</mi></mrow><mrow><mi>p</mi><mn>95</mn></mrow></msub></mrow></math> than COVID-19-negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), <i>p</i> < 0.0005). COVID-19-positive patients gained more weight after their diagnosis of COVID-19 than before. Nonhospitalized children gained more weight than hospitalized children [average increase in <math><mi>%</mi><mi>B</mi><mi>M</mi><mrow><msub><mrow><mi>I</mi></mrow><mrow><mi>p</mi><mn>95</mn></mrow></msub></mrow></math> of 2.38 (±7.65) compared to 1.87 (±8.54)]. Mixed-effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline <math><mi>%</mi><mi>B</mi><mi>M</mi><mrow><msub><mrow><mi>I</mi></mrow><mrow><mi>p</mi><mn>95</mn></mrow></msub></mrow></math>. <b><i>Conclusions:</i></b> Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980121","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":"Differences in Geographical Location and Health Behaviors of Participants in a Family-Based Lifestyle Intervention for Children and Adolescents Living with Obesity.","authors":"Alexandra J Heidl, Madelaine Gierc, Stephanie Saputra, Thumri Waliwitiya, Eli Puterman, Tamara R Cohen","doi":"10.1089/chi.2024.0374","DOIUrl":"https://doi.org/10.1089/chi.2024.0374","url":null,"abstract":"<p><p>It is unknown if children and youth who live in rural or \"less rural\" locations who enroll in the provincially funded Generation Health Clinic (British Columbia, Canada), a family-based lifestyle program for weight management, present with different health behaviors at baseline. Thus, we assessed sociodemographic and health behavior (diet, physical activity, and sleep) collected between 2015 and 2019. Data were stratified by age (children: ≤12 years; adolescents: ≥13 years) and geographical location (\"less urban\" and urban) based on Statistics Canada definitions and then analyzed using independent <i>t</i>-tests and chi<i>-</i>square tests. We found that more \"urban\" children consumed more daily family meals (<i>p</i> < 0.001), ate out weekly (<i>p</i> = 0.02), ate \"other\" vegetables (<i>p</i> = 0.002), and had less frequent sports drink consumption (<i>p</i> < 0.001) compared with less urban children. No significant differences in health behaviors were seen in adolescents. These findings suggest that a participant's geographical location should be considered when developing family-based interventions for weight management.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933228","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":"Barriers and Facilitators for Healthy Eating and Physical Activity: Interviews with Family Child Care Educators and Organization Staff.","authors":"Lieke Vorage, Lisa Vincze, Lucy Tudehope, Neil Harris","doi":"10.1089/chi.2024.0350","DOIUrl":"https://doi.org/10.1089/chi.2024.0350","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Family child care (FCC) offers a promising setting for obesity prevention, yet interventions have had varied success, potentially due to insufficient stakeholder input. This study aimed to explore barriers, facilitators, and preferences for healthy eating and physical activity interventions among Australian FCC educators and organization staff. <b><i>Methodology:</i></b> Semi-structured interviews were conducted with 15 FCC educators and 6 staff members, using the framework method for data analysis. <b><i>Results:</i></b> Findings were organized according to the socioecological model. At the public policy level, regulations were seen as prioritizing risk avoidance over health benefits. At the community level, educators cited community programs and facilities as supportive of physical activity, noting that cultural and socioeconomic factors influence healthy eating. At the organizational level, adequate space promoted physical activity, but financial limitations impacted food provision and access to physical activity equipment. Some FCC organizations did not provide support for healthy practices. At the interpersonal level, educators and staff struggled to address unsupportive parental choices. Lastly, at the individual level, nutrition knowledge and education were deemed important for promoting healthy eating, with picky eating as a common obstacle. <b><i>Conclusion:</i></b> To enhance healthy eating and physical activity in FCC, recommended strategies include training safety assessors, educators, and parents on risky play; adapting regulations to the FCC context; reimbursing food provision; enhancing opportunities for excursions and outdoor play spaces; improving communication between educators and parents and expanding educators' knowledge of nutrition and physical activity.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933227","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":"Resting Energy Expenditure Equations Have Lower Accuracy for Adolescents with Overweight/Obesity Versus Healthy-Weight Adolescents.","authors":"Paige M Posson, Paul R Hibbing, Anthony Damiot, Aaron F Carbuhn, David A White, Valentina Shakhnovich, Debra Sullivan, Robin P Shook","doi":"10.1089/chi.2024.0226","DOIUrl":"10.1089/chi.2024.0226","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The objectives of the study were (1) to assess whether resting energy expenditure (REE) equations have comparable validity for adolescents with overweight/obesity vs. adolescents with healthy weight and (2) to examine determinants of measured REE in adolescents with overweight/obesity vs. adolescents with healthy weight. <b><i>Methods:</i></b> Ten equations were used to predict REE for 109 adolescents (70% males; 36.7% with overweight/obesity); 95% equivalence testing was used to assess how well each equation agreed with the criterion measure of indirect calorimetry. Linear regression models were fitted to examine how much REE variance was accounted for by age, sex, race, fat-free mass (FFM), and fat mass. <b><i>Results:</i></b> For adolescents with healthy weight, all ten equations were significantly equivalent to the criterion measure within ±8.4% (<i>p</i> < 0.05), whereas for participants with overweight/obesity, only three equations were equivalent within the same range (<i>p</i> < 0.05). Controlling for age, sex, race, fat mass, and FFM accounted for 74% of REE variance. FFM explained the greatest amount (26%) of variance in REE, while weight status itself explained an additional 22%. <b><i>Conclusions:</i></b> Prediction equations tend to be more accurate for adolescents with healthy weight than adolescents with overweight/obesity unless the original sample specifically included participants with overweight/obesity. Determinants of REE are similar regardless of weight status.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":"30-38"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761951","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":"Medical Home Access Among Children with Obesity: The Role of Family-Centered Communication.","authors":"Coleman R Hayes, Olasunkanmi Kehinde, Dmitry Tumin, Shaundreal D Jamison","doi":"10.1089/chi.2024.0303","DOIUrl":"10.1089/chi.2024.0303","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The American Academy of Pediatrics recommends all children receive care in a patient-centered medical home. With weight stigma potentially hampering family-centered communication in the care of children with overweight or obesity, we aimed to determine how children's weight status was associated with access to a medical home and its components. <b><i>Methods:</i></b> We analyzed 2016-2021 data on children age 10-17 years in the National Survey of Children's Health. Children's weight status was classified as underweight/normal weight, overweight, or obese, based on caregiver-reported height and weight. Outcomes included receiving care in a medical home and each category of the medical home definition (personal health care provider, usual source of health care, family/patient-centered care, care coordination, and assistance with referrals). <b><i>Results:</i></b> Based on the study sample (<i>n</i> = 105,111), we estimated that 16% of children were overweight and 16% were obese, while 42% had access to a patient-centered medical home. On multivariable analysis, obesity compared to normal weight was associated with lower access to a medical home (odds ratio: 0.87; 95% confidence intervals: 0.80, 0.95; <i>p</i> = 0.003) and, specifically, with lower access to family-centered care and assistance with care coordination. <b><i>Conclusions:</i></b> Children with obesity encounter barriers to accessing care meeting medical home criteria, with one plausible mechanism being that weight stigma disrupts family-centered communication. Lower access to care coordination among children with obesity may also indicate a need to improve the integration of obesity-related specialty care with pediatric primary care services.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":"84-91"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299219","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":"Moving Beyond Research to Public Health Practice: Spread And Scale of Interventions that Support Healthy Childhood Growth.","authors":"Alyson B Goodman, Eileen Bosso, Ruth Petersen, Heidi M Blanck","doi":"10.1089/chi.2024.0255","DOIUrl":"10.1089/chi.2024.0255","url":null,"abstract":"<p><p>Equitable access to affordable, effective, and safe obesity prevention and treatment remains a problem for many children and families in the U.S. In 2023, the American Academy of Pediatrics (AAP) published its first Clinical Practice Guideline (CPG) for pediatric obesity evaluation and treatment, aiding the field's awareness of effective approaches. CDC has supported the adapting and packaging of existing, effective Family Healthy Weight Programs that deliver CPG-recommended intensive behavioral treatment for kids. Currently, at least six family-centered programs are recognized by CDC and can be implemented in clinical and community settings to support child health. CDC and other national partners are coordinating the movement of these research-tested FHWPs into public health practice. This work includes implementing FHWPs in over 60 US communities and supporting national-level infrastructure improvements. CDC is committed to engaging with stakeholders to help scale proven strategies that ensure all children receive the care they need to thrive.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":"1-2"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113813","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":"High BMI z-Scores from Different Growth References Are Not Comparable: An Example from a Weight Management Trial with an Anti-Obesity Medication in Pubertal Adolescents with Obesity.","authors":"Craig M Hales, Cynthia L Ogden, David S Freedman, Kushal Sahu, Paula M Hale, Rashmi K Mamadi, Aaron S Kelly","doi":"10.1089/chi.2024.0248","DOIUrl":"10.1089/chi.2024.0248","url":null,"abstract":"<p><p><b><i>Background:</i></b> The BMI z-score is a standardized measure of weight status and weight change in children and adolescents. BMI z-scores from various growth references are often considered comparable, and differences among them are underappreciated. <b><i>Methods:</i></b> This study reanalyzed data from a weight management clinical study of liraglutide in pubertal adolescents with obesity using growth references from CDC 2000, CDC Extended, World Health Organization (WHO), and International Obesity Task Force. <b><i>Results:</i></b> BMI z-score treatment differences varied 2-fold from -0.13 (CDC 2000) to -0.26 (WHO) overall and varied almost 4-fold from -0.05 (CDC 2000) to -0.19 (WHO) among adolescents with high baseline BMI z-score. <b><i>Conclusions:</i></b> Depending upon the growth reference used, BMI z-score endpoints can produce highly variable treatment estimates and alter interpretations of clinical meaningfulness. BMI z-scores cited without the associated growth reference cannot be accurately interpreted.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":"22-29"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601982","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 Scoping Review of Tailoring in Pediatric Obesity Interventions.","authors":"Emily S Fu, Cady Berkel, James L Merle, Sara M St George, Andrea K Graham, Justin D Smith","doi":"10.1089/chi.2024.0214","DOIUrl":"10.1089/chi.2024.0214","url":null,"abstract":"<p><p><b><i>Background:</i></b> Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term \"tailor\" in pediatric obesity interventions and propose a uniform definition. <b><i>Methods:</i></b> We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. <b><i>Results:</i></b> The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. <b><i>Conclusions:</i></b> We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.</p>","PeriodicalId":48842,"journal":{"name":"Childhood Obesity","volume":" ","pages":"3-21"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621253","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}