Lee-Wen Pai , Chin-Tun Hung , Li-Li Chen , Ro-Lin Lin , Craig Lockwood
{"title":"Efficacy of a health education technology program in improving adherence to self-management behaviors and quality of life among adults with type 2 diabetes: A randomized controlled trial","authors":"Lee-Wen Pai , Chin-Tun Hung , Li-Li Chen , Ro-Lin Lin , Craig Lockwood","doi":"10.1016/j.pcd.2024.08.003","DOIUrl":"10.1016/j.pcd.2024.08.003","url":null,"abstract":"<div><h3>Aim</h3><p>This study examined the efficacy of a health education technology program on self-management adherence behavior and quality of life among people with type 2 diabetes (T2D).</p></div><div><h3>Methods</h3><p>A randomized experimental study design was employed. A total of 110 subjects was recruited. The experimental group received a novel technology education program plus routine shared care. The control group received routine shared care alone. Quality of life and adherence to self-management behavior questionnaires were used to measure outcomes. A linear mixed-effects model was used to analyze changes in quality of life after controlling for pre-test effects. The odds ratio was calculated for differences in adherence behavior between the two groups.</p></div><div><h3>Results</h3><p>The between-group mean difference in quality of life scores and adherence to physical activity comparing pre-test at 3 months follow-up showed significant progress at 3 months post-test compared with the control group. However, the increase in mean quality of life scores and adherence behavior at 6 months did not demonstrate a sustained between-group difference.</p></div><div><h3>Conclusion</h3><p>The results showed adherence to physical activity and improved quality of life in patients with T2D at 3 months post intervention. Therefore, the program can be used as an intensive model for diabetes shared care.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 5","pages":"Pages 479-485"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121473","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}
Johan Røikjer , Anne-Marie Wegeberg , Amar Nikontovic , Christina Brock , Peter Vestergaard
{"title":"Prevalence of painful and painless diabetic peripheral neuropathy in the Northern Danish Region: A population-based study","authors":"Johan Røikjer , Anne-Marie Wegeberg , Amar Nikontovic , Christina Brock , Peter Vestergaard","doi":"10.1016/j.pcd.2024.08.006","DOIUrl":"10.1016/j.pcd.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, yet varying estimates of its prevalence exist. The present study aimed to estimate a questionnaire-centered prevalence of painful and painless DPN in the Northern Danish Region, examine its geographical distribution within the region, and investigate associations between DPN and potential risk factors.</div></div><div><h3>Methods</h3><div>A questionnaire-based survey was sent to all persons living with diabetes in the Northern Danish Region using electronic mail. Persons with diabetes were identified using The National Health Insurance Service Registry. The survey included information on demographics, socioeconomics, municipality, diabetes type, duration, and treatment, as well as the validated questionnaires Michigan Neuropathy Screening Instrument-questionnaire (MNSIq) and the Douleur Neuropathique en 4 Questions (DN4)-interview. Possible DPN was defined as an MNSIq-score ≥ 4, while possible painful DPN was defined as pain in both feet and a DN4-interview score ≥ 3.</div></div><div><h3>Results</h3><div>A total of 23,206 eligible people were identified as having diabetes and approximately 33 % answered all questionnaires. The prevalence of possible DPN was 23.3 % (95 % CI: 22.4–24.3 %), while the prevalence of possible painful DPN was 18.0 % (17.1–18.8 %). The prevalence of possible DPN ranged from 22.1 % to 35.0 % between municipalities, while the prevalence of possible painful DPN ranged from 15.6 % to 20.0 %. High body-mass index, long diabetes duration, insulin use, glucagon-like-peptide-1-analogue use, and low income were associated with increased risk of DPN.</div></div><div><h3>Conclusion</h3><div>The high prevalence of possible painless and painful DPN emphasizes the need for better prevention and careful screening even in high-income countries.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 606-611"},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116644","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":"The effect of training to diabetes patients according to planned behavior theory on self-efficacy and patient empowerment: A randomized study","authors":"Seda Göger , Şenay Şener , Dilek Ci̇ngi̇l","doi":"10.1016/j.pcd.2024.08.002","DOIUrl":"10.1016/j.pcd.2024.08.002","url":null,"abstract":"<div><h3>Aim</h3><p>To examine the effect of training provided to type 2 diabetes patients according to the theory of planned behavior on self-efficacy and patient empowerment.</p></div><div><h3>Methods</h3><p>This study, pre-test-post-test active control group single-blind experimental design, was conducted in the internal medicine outpatient clinic of a state hospital between April and October 2023. Participants were randomly assigned to the intervention group (IG; n = 45) and control group (CG; n = 47). The intervention group received a theory-based training program consisting of 5 sessions lasting approximately 40 min. each. Diabetes Management Self-Efficacy Scale, Patient Empowerment Scale and the patient's laboratory results were used for data collection.</p></div><div><h3>Results</h3><p>In the study, while the posttest self-efficacy and patient empowerment scores of the intervention group increased compared to the pretest, there was an decrease in HbA1C level. On the post-test measurements between groups, self-efficacy and patient empowerment scores were higher and effect sizes were higher in the intervention group, while no difference was found in HbA1C values.</p></div><div><h3>Conclusion</h3><p>The training program provided according to the theory of planned behavior in diabetes patients provides positive contributions to disease management.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 5","pages":"Pages 486-492"},"PeriodicalIF":2.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057628","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}
Lucianne Righeti Monteiro Tannus , Hermelinda Cordeiro Pedrosa , Cejana Hamu Aguiar , Karla Guerra Drummond , André Pinheiro , Franz Schubert Leal , Carlos Antonio Negrato , Marilia Brito Gomes
{"title":"Prevalence of cardiovascular autonomic neuropathy in an admixed population of patients with type 1 diabetes. Lessons from a pioneer multicentre study in Brazil","authors":"Lucianne Righeti Monteiro Tannus , Hermelinda Cordeiro Pedrosa , Cejana Hamu Aguiar , Karla Guerra Drummond , André Pinheiro , Franz Schubert Leal , Carlos Antonio Negrato , Marilia Brito Gomes","doi":"10.1016/j.pcd.2024.08.001","DOIUrl":"10.1016/j.pcd.2024.08.001","url":null,"abstract":"<div><h3>AIMS</h3><p>To evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) and its associated factors in Brazilian patients with type 1 diabetes (T1D).</p></div><div><h3>Methods</h3><p>This cross-sectional, multicentre study was conducted in 14 public clinics in ten Brazilian cities. From 1760 patients, 1712 were included (97.3 %): 953 females (55.7 %), 930 (54.3 %) Caucasians, aged 29.9 ±11.9 years and with diabetes duration of 15.4 ± 9.2 years. CAN was evaluated using cardiovascular autonomic reflex tests.</p></div><div><h3>Results</h3><p>The prevalence of CAN was 23.4 %. Multivariable hierarchical logistic regression showed CAN associated with age, smoking, lower socioeconomic status, higher yearly medical appointments, insulin therapeutic regimens, higher levels of HbA1c, total cholesterol, uric acid, diastolic blood pressure and heart rate, presence of retinopathy, diabetic kidney disease and a tendency to be associated with severe hypoglycemia. Lower health-related quality of life was also found in univariate analysis in these patients.</p></div><div><h3>Conclusions</h3><p>Patients with T1D presented an important prevalence of CAN that was associated with other diabetes-related chronic complications, and also with demographic, clinical and laboratorial traditional risk factors. Considering lack of formal policy, our data could be used for guiding public health approach to awareness and CAN’s screening, diagnosis and clinical management in patients with T1D in Brazil.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 5","pages":"Pages 539-546"},"PeriodicalIF":2.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997153","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}
Alaa Alshehri , Dawei Guan , Piaopiao Li , Yichen Zhang , Hans K. Ghayee , Tianze Jiao , Hui Shao
{"title":"Trends in utilization patterns of newer glucose-lowering drugs in US adults with type 2 diabetes and a history of coronary heart disease or heart failure: 2005–2019","authors":"Alaa Alshehri , Dawei Guan , Piaopiao Li , Yichen Zhang , Hans K. Ghayee , Tianze Jiao , Hui Shao","doi":"10.1016/j.pcd.2024.07.003","DOIUrl":"10.1016/j.pcd.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>The newer glucose-lowering drugs (GLDs), including Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), have demonstrated superior cardio- and renal protective benefits compared to older GLDs in individuals with type 2 diabetes (T2D) at high risk for cardiovascular disease (CVD).</p></div><div><h3>Objective</h3><p>This study examined the trends of the newer GLDs use in people with T2D who had a history of coronary heart disease or heart failure in the United States.</p></div><div><h3>Method</h3><p>We used 2005–2019 data from the Medical Expenditure Panel Survey (MEPS). Individuals with self-reported diabetes and CVD history were identified.</p></div><div><h3>Results</h3><p>There was a steady increase in the use of GLP-1RA only from 2008 (3 %) to 2019 (21 %) and SGLT2i only from 2014 (5 %) to 2019 (12 %). Individuals with dual use of both newer GLD classes increased from 0.62 % in 2015 to 6 % in 2019. The overall uptake of these two newer drugs in 2019 was less than 40 %. In other words, 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments.</p></div><div><h3>Conclusion</h3><p>The use of GLP-1RA and SGLT2i among individuals with T2D and a history of CVD was low and varied by insurance type. Policy-level interventions are needed to improve the use of these newer treatments further.</p></div><div><h3>Summary</h3><p>We examined how newer glucose-lowering drugs are used among individuals with type 2 diabetes and at high risk for coronary heart disease or heart failure in the US. We found that 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments due to the variation of insurance type.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 5","pages":"Pages 561-563"},"PeriodicalIF":2.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879996","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":"Modifiable self-management practices impact nocturnal and morning glycaemia in type 1 diabetes","authors":"","doi":"10.1016/j.pcd.2024.06.007","DOIUrl":"10.1016/j.pcd.2024.06.007","url":null,"abstract":"<div><h3>Aims</h3><p>To identify risk factors for nocturnal/morning hypo- and hyperglycaemia in type 1 diabetes.</p></div><div><h3>Methods</h3><p>Data on self-management practices were obtained from 3-day records. We studied the associations between self-management practices on the first recording day and the self-reported blood glucose (BG) concentrations on the subsequent night/morning.</p></div><div><h3>Results</h3><p>Of the 1025 participants (39 % men, median age 45 years), 4.4 % reported nocturnal hypoglycaemia (<3.9 mmol/l), 9.8 % morning hypoglycaemia, 51.5 % morning euglycaemia, and 34.3 % morning hyperglycaemia (≥8.9 mmol/l). Within hypoglycaemic range, insulin pump use was associated with higher nocturnal BG concentration (B=0.486 [95 % Confidence Interval=0.121–0.852], p=0.009). HbA<sub>1c</sub> was positively (0.046 [0.028–0.065], p<0.001), while antecedent fibre intake (-0.327 [-0.543 – -0.111], p=0.003) and physical activity (PA) (-0.042 [-0.075 – -0.010], p=0.010) were inversely associated with morning BG concentration. The odds of morning hypoglycaemia were increased by previous day hypoglycaemia (OR=2.058, p=0.002) and alcohol intake (1.031, p=0.001). Previous day PA (0.977, p=0.031) and fibre intake (0.848, p=0.017) were inversely, while HbA<sub>1c</sub> (1.027, p<0.001) was positively associated with the risk of morning hyperglycaemia.</p></div><div><h3>Conclusions</h3><p>Alcohol avoidance may prevent nocturnal hypoglycaemia, while PA and fibre intake may reduce hyperglycaemia risk. Avoidance of daytime hypoglycaemia and keeping HbA<sub>1c</sub> in control may help maintain normoglycaemia also at night-time.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 4","pages":"Pages 435-440"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824001189/pdfft?md5=611d391362a1490a094ba2dc4e8f6b96&pid=1-s2.0-S1751991824001189-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294099","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":"Self-reported smoking, urine cotinine, and risk of type 2 diabetes: Findings from the PREVEND prospective cohort study","authors":"","doi":"10.1016/j.pcd.2024.04.004","DOIUrl":"10.1016/j.pcd.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Smoking is a major risk factor for type 2 diabetes (T2D), but the evidence has mostly relied on self-reports. We aimed to compare the associations of smoking exposure as assessed by self-reports and urine cotinine with T2D.</p></div><div><h3>Methods</h3><p>Using the PREVEND prospective study, smoking status was assessed at baseline by self-reports and urine cotinine in 4708 participants (mean age, 53 years) without a history of diabetes. Participants were classified as never, former, light current and heavy current smokers according to self-reports and analogous cut-offs for urine cotinine. Hazard ratios (HRs) with 95% CIs were estimated for T2D.</p></div><div><h3>Results</h3><p>During a median follow-up of 7.3 years, 259 participants developed T2D. Compared with self-reported never smokers, the multivariable adjusted HRs (95% CI) of T2D for former, light current, and heavy current smokers were 1.02 (0.75–1.4), 1.41 (0.89–2.22), and 1.30 (0.88–1.93), respectively. The corresponding adjusted HRs (95% CI) were 0.84 (0.43–1.67), 1.61 (1.12–2.31), and 1.58 (1.08–2.32), respectively, as assessed by urine cotinine. Urine cotinine-assessed but not self-reported smoking status improved T2D risk prediction beyond established risk factors.</p></div><div><h3>Conclusion</h3><p>Urine cotinine assessed smoking status may be a stronger risk indicator and predictor of T2D compared to self-reported smoking status.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 4","pages":"Pages 414-421"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824000767/pdfft?md5=2f27f9e4d3fd789a4094ea3e3aa5fb1d&pid=1-s2.0-S1751991824000767-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909652","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":"Glucagon-like peptide receptor agonists and risk for depression","authors":"","doi":"10.1016/j.pcd.2024.05.005","DOIUrl":"10.1016/j.pcd.2024.05.005","url":null,"abstract":"<div><h3>Aims</h3><p>Package labeling for weight loss formulations of semaglutide<span> and liraglutide<span> include a warning for suicidal thoughts and behaviors. The objective was to examine the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) and incident depression.</span></span></p></div><div><h3>Methods</h3><p>This retrospective cohort study compared Veterans Health Administration patients initiated on a GLP-1RA versus a dipeptidyl peptidase-4 inhibitor (DPP-4i) between June 1, 2013 and June 30, 2020. The primary outcome was incident depression, defined as a new diagnosis of depression or new antidepressant prescription, within 1 year following drug initiation. Multivariable log-binomial regression was used to estimate relative risk, adjusted for confounding factors including patient demographics, comorbid conditions, and prior medication.</p></div><div><h3>Results</h3><p>Of 34,130 patients initiated on a GLP-1RA and 105,478 initiated on a DPP-4i, incident depression occurred in 7.7 % (n= 2263) and 6.3 % (n= 6602), respectively. After adjustment, the relative risk was 1.02 (95 % CI: 0.97 – 1.07), thus failing to demonstrate a significant increase in risk for incident depression following initiation of a GLP-1RA compared to DPP-4i. Relative risk estimates in all sensitivity analyses were also non-significant.</p></div><div><h3>Conclusions</h3><p>This study did not demonstrate a significant increase in risk for incident depression following GLP-1RA initiation.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 4","pages":"Pages 422-426"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294098","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 effect of different times of day for exercise on blood glucose fluctuations","authors":"","doi":"10.1016/j.pcd.2024.06.004","DOIUrl":"10.1016/j.pcd.2024.06.004","url":null,"abstract":"<div><h3>Aims</h3><p>This study aims to explore blood glucose variations before and after short-term intensive exercise in the morning or afternoon of a day and the trend of blood glucose fluctuations during exercise in patients with T2DM (type 2 diabetes, T2DM).</p></div><div><h3>Methods</h3><p>Blood glucose variations of Fouty during morning exercise 8:00–12:00 hours and twenty during afternoon exercise 14:30–18:30 hours). Patients with T2DM discharged from the hospital were analyzed retrospectively, with the baseline data checked through the medical record system before intervention. We were asked to perform seven times of treadmill aerobic exercise, which lasted for 30 minutes with incremental intensity for each time, for two weeks under the supervision of the Continuous Glucose Monitor (CGM) and the heart rate armband. The exercise intensity has been adjusted by the clinicians and specialist nurses from the Department of Diabetes Mellitus according to the blood glucose levels and heart rate curves during exercise; data including the height, weight, body mass index (BMI), waist-to-hip ratio, fasting blood glucose, glycosylated hemoglobin, in-exercise CGM-measured blood glucose value/min, and after-exercise fingertip blood glucose value of patients with T2DM were collected after the intensive exercise (2 weeks). SPSS 22.0 and GraphPad Prism 7 were adopted for statistical analysis using the T-test and ANOVA.</p></div><div><h3>Result</h3><p>No difference was observed in the baseline data between the morning and afternoon exercise groups before intervention; compared to the morning exercise group, the fasting C-peptide value (2.15±0.97 <em>vs.</em> 1.53±0.46) in the afternoon exercise group was higher than that in the morning exercise group, with a superior (<em>p</em>=0.029) effect after two weeks of intervention, exhibiting a significant difference in the results. According to the results of repeated variance ANOVA analysis, the time for the appearance of significant improvement in blood glucose in the afternoon exercise group was 5 minutes earlier (11th minute <em>vs</em> 1 minute)than that in the morning exercise group (15th minute <em>vs</em> 1 min); significant differences were observed in both time (<em>p</em>=0.048 <em>vs p</em><0.01) between the two groups on exercise days, as revealed by the results of bivariate ANOVA; in comparison to the morning exercise group (7.42±1.68), there was a significant difference (<em>p</em>=0.049)in the mean blood glucose between the two groups 25 min after patients with T2DM in the afternoon exercise group (6.25±1.53) started to exercise; in addition, a significant statistical difference (<em>p</em>=0.021) was revealed in the CGM-measured hourly the mean blood glucose on exercise days between the morning(8.18±1.88) and afternoon exercise (6.75±1.40)groups at 4:00 pm in week one and two w.</p></div><div><h3>Conclusions</h3><p>Glycaemic improvement in the short-term intensive afternoon exercise group may","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 4","pages":"Pages 427-434"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824001165/pdfft?md5=aa1f6bedd01913488dc777fcd9373705&pid=1-s2.0-S1751991824001165-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428555","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}