Journal of Developmental and Behavioral Pediatrics最新文献

{"title":"Care Coordination for Children with Neurodevelopmental Disorders and Medical Complexity: Is Child Behavioral Health a Key Mediator of Caregiver Stress?","authors":"Myka Estes, Genevieve Currie, Dercia Materula, Cathy Richard, Karen Taylor, Greta Heathcote, Suzanne Deliscar, Nadine Gall, W Ben Gibbard, Jennifer D Zwicker, Sarah MacEachern","doi":"10.1097/DBP.0000000000001348","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001348","url":null,"abstract":"<p><strong>Introduction: </strong>Children with neurodevelopmental disorders and medical complexity experience care that is fragmented, costly, and ineffective, causing health disparities and harm. The Neurodevelopmental Disorders Care Coordination (NDD-CC) program addresses these issues by connecting families with support across medical and social services. While NDD-CC has improved outcomes in several areas, many families continue to experience challenges.</p><p><strong>Objective: </strong>Using data from a longitudinal study, we investigated patterns of change across child health and behavior and caregiver stress during care coordination (CC).</p><p><strong>Methods: </strong>We performed an exploratory analysis of prospectively collected data from 67 caregivers of children with a neurodevelopmental disorder aged 2 to 17 years referred for CC. We examined changes in child health states (EQ-5D-Y), care-related quality of life (CarerQoL), and parenting stress (Parental Stress Index-Short Form) to assess impacts of CC over time and within subgroups.</p><p><strong>Results: </strong>Most caregivers who reported CarerQoL scores in the bottom half of the distribution at baseline saw improvements at 3 (89%) and 12 months (71%). Gains were strongly associated with improvements in mental health at both time points. Similarly, child health states in the bottom half of the distribution improved the most. The difficult child domain of the parenting stress index was the key contributor to clinically significant stress scores, and changes in the difficult child score were negatively associated with changes in CarerQoL, explaining 36% of the variance.</p><p><strong>Conclusion: </strong>Findings show that CC has the most impact on those with the greatest need; yet clinically significant child behavior may prevent sustained improvements if left unaddressed.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Orofacial Dyskinesia With Transdermal Methylphenidate.","authors":"Carson Rogge, Elizabeth Barnhardt","doi":"10.1097/DBP.0000000000001356","DOIUrl":"10.1097/DBP.0000000000001356","url":null,"abstract":"<p><strong>Background: </strong>Methylphenidate transdermal systems are a generally safe and effective treatment option for individuals with attention deficit hyperactivity disorder (ADHD).</p><p><strong>Case presentation: </strong>A 9-year-old boy with a history of autism spectrum disorder, insomnia, ADHD combined type, and historical global developmental delays with high suspicion for intellectual disability presented to a developmental and behavioral pediatrics clinic for medication management related to his diagnosis of ADHD. Other pertinent medical history includes a history of pica, a branchial cleft cyst that has since been removed, intermittent constipation and early childhood trauma, resulting in permanent placement with his maternal grandparents. His birth history is notable for a presumed history of in utero exposure to marijuana. He has a family history of substance use disorder, depression, autism and ADHD. A chromosomal microarray and testing for Fragile X were completed in the past and unremarkable. Shortly after a first-time application of a starting dose methylphenidate transdermal system, he was noted to demonstrate involuntary lip puckering, tongue thrusting, and repetitive jaw opening and closing. Upon immediate discontinuation of the patch, the dyskinesia subsided with no persistent remaining symptoms.</p><p><strong>Conclusion: </strong>To inform medication management for ADHD in children with comorbidities, it is valuable to define specific risk factors for adverse effects and intolerability of medication. Identifying if patient age, weight, comorbidities, previous antipsychotic or stimulant use, and concurrent medication use are demonstrable risk factors for dyskinesia can help practitioners develop a more individualized medication treatment plan for children with ADHD.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e309-e311"},"PeriodicalIF":1.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopmental and Mental Health Outcomes in a National Clinical Sample of Youth With Sex Chromosome Trisomies Compared With Matched Controls.","authors":"Adriana Hall, Anna Furniss, Nicole N Tartaglia, Jennifer Janusz, Rebecca Wilson, Caitlin Middleton, Sydney Martin, Jacqueline Frazier, Michele Martinez-Chadrom, Jennifer Hansen-Moore, Chijioke Ikomi, Judith Ross, Maria G Vogiaski, Leela Morrow, Dimitri A Christakis, Rachel E Lean, Natalie Nokoff, Laura Pyle, Shanlee M Davis","doi":"10.1097/DBP.0000000000001342","DOIUrl":"10.1097/DBP.0000000000001342","url":null,"abstract":"<p><strong>Objective: </strong>To compare the prevalence of neurodevelopmental and mental health diagnoses in a national sample of youth with sex chromosome trisomies (SCTs) with matched controls.</p><p><strong>Methods: </strong>Patients in PEDSnet and a diagnosis code mapping to 47,XXY/Klinefelter syndrome (n = 1171), 47,XYY/Double Y syndrome (n = 243), or 47,XXX/Trisomy X syndrome (n = 262) were matched with controls using propensity scores. Generalized estimating equations computed odds ratios (OR) with 95% confidence intervals (CI) for the prevalence of diagnoses within the neurodevelopmental and mental health composites, psychotropic medication prescriptions, and encounters with behavioral health and therapy providers. Alpha was set at 0.0025 to account for multiple comparisons.</p><p><strong>Results: </strong>Patients with SCTs had higher odds of diagnoses within the neurodevelopmental (OR 6.3, 95% CI, 5.7-7.2) and mental health composites (OR 2.7, 95% CI, 2.3-3.2) compared with matched controls. All neurodevelopmental diagnoses were more prevalent among all SCT groups compared with controls. Within the mental health composite, only the prevalence of anxiety and mood disorder was higher in all SCT groups. A higher proportion of patients with SCTs had psychotropic prescriptions compared with controls (stimulants 13.1% vs 5.2%, selective serotonin reuptake inhibitors 8.7% vs 2.8%, antipsychotics 6.5% vs 2.4%, p < 0.0001 for all). Overall, 48% of patients with SCTs had a clinical encounter with a behavioral health provider vs 16.6% of controls (OR 5.6, 95% CI, 4.1-5.1).</p><p><strong>Conclusion: </strong>Compared with matched controls, youth with SCTs receiving care at US tertiary care pediatric centers have disproportionately high rates of neurodevelopmental and mental health conditions, emphasizing the need for appropriate screening and intervention in these populations.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents' Experiences and Views About Use of Wearable Technology for Research and Treatment Monitoring of Children with Neurodevelopmental Disorders.","authors":"Rachel Xifaras, David J Amor, Erin Turbitt, Claudine M Kraan","doi":"10.1097/DBP.0000000000001337","DOIUrl":"10.1097/DBP.0000000000001337","url":null,"abstract":"<p><strong>Objective: </strong>Wearable technology has potential benefits for clinical measurement with children who have neurodevelopmental disorders (NDDs). However, this cohort may experience sensory processing disorder, behavioral dysregulation, and cognitive challenges. For effective and considerate implementation, the experiences and views of parents of children with NDDs on this topic need in-depth investigation.</p><p><strong>Method: </strong>This qualitative semi-structured interview study used purposeful sampling of families with experience with wearable technology in a research setting. The cohort included 12 parents of 14 children with a diagnosis of Fragile X (n = 6), Prader-Willi (n = 4), or Angelman (n = 4) syndromes. The data were processed using NVivo software (QSR International Ltd. 1999-2013). Data analysis was conducted using reflexive thematic analysis.</p><p><strong>Results: </strong>Theme 1: Parents are willing to use wearable technology in the home or community if it is feasible. Aspects of feasibility were the ease of embedding technology into existing routines, device robustness, and device invasiveness. Theme 2: Parents are guided by previous healthcare and research experiences. Wearables were considered low burden in the context of everything else their child experiences through health care. Theme 3: Early engagement with families in the design and research process of new technologies is important. Parents had strong views on how to introduce a wearable to their child. In this article, parents stressed that the child's behavioral phenotype needs to be considered early in the design and rollout phases.</p><p><strong>Conclusion: </strong>A shared decision-making approach between researchers and parents will improve the uptake and success of NDD-focused research adopting wearable technology approaches for clinical measurement.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glutathione, Vitamin C, and Cysteine Use in Autistic Children With Disruptive Behavior: A Double-Blind, Placebo-Controlled Crossover Pilot Study.","authors":"Patricia Gail Williams, Lonnie Sears, Walter H Watson, Bakeerathan Gunaratnam, Yana Feygin, Stephen P Wright, Janice E Sullivan","doi":"10.1097/DBP.0000000000001334","DOIUrl":"10.1097/DBP.0000000000001334","url":null,"abstract":"<p><strong>Objective: </strong>Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication differences and restricted interests. One proposed biologic mechanism underlying ASD is oxidative stress, leading to the clinical use of glutathione based on anecdotal reports of improved behavior in autistic children. In this pilot study, we tested this observation using a randomized clinical trial format to collect preliminary data on glutathione safety and efficacy.</p><p><strong>Methods: </strong>Glutathione and glutathione in combination with vitamin C and N-acetylcysteine (Trio) were tested. Both treatments were administered in double-blind placebo-controlled randomized crossover studies. In total, 24 children between the ages of 5 and 16 years with ASD and severe behavior disorders were randomized to receive weekly intravenous injections of either placebo or 1 of the 2 interventions (glutathione or Trio) for 8 weeks. After a 1-week washout period, participants were crossed over for the subsequent 8 weeks. Behavioral measures and plasma levels of glutathione were obtained at baseline, during the washout period, and at the end of the study.</p><p><strong>Results: </strong>No differences between treatment groups in behavioral or biologic measures were found. No significant adverse side effects attributable to the treatments were observed. Small improvements in specific glutathione and behavioral measures occurred over the study period for all groups.</p><p><strong>Conclusion: </strong>Treatment with glutathione or glutathione in combination with vitamin C and N-acetylcysteine did not result in improvements in behavior or biologic measures. The positive trends over the course of the study were likely due to the placebo effect or decreased anxiety associated with the study routine.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding Universal Language Promotion in Pediatric Primary Care to Optimize Early Child Development and Reduce Long-Term Health Disparities.","authors":"Brenda Salley, Heather von Bevern, Nicolette Grasley-Boy, Kandace Fleming, Kirsten Weltmer, Judith Carta","doi":"10.1097/DBP.0000000000001344","DOIUrl":"10.1097/DBP.0000000000001344","url":null,"abstract":"<p><strong>Objective: </strong>To report on the feasibility and outcomes of universal language promotion intervention (Talk With Me Baby [TWMB]) embedded within routine well-child care for children from birth to 3-years old.</p><p><strong>Methods: </strong>Across 2 primary care clinics, 29 health care team members participated in a 12-month trial to deliver TWMB within well-child care visits. Feasibility was based on clinician feedback during the trial, clinician knowledge assessments, and clinic data. Sixty-three parents and their infant/toddlers were enrolled to provide feedback on TWMB and to assess parent language promotion behaviors, specifically, parents' self-reported use of their language-building interactions during daily activities with their child.</p><p><strong>Results: </strong>Clinician feedback and clinic data support TWMB as an acceptable and feasible intervention that can be used successfully within standard of care well-child visits by health care teams. Initial outcome data show positive changes for increasing parent-child language promoting interactions during daily activities.</p><p><strong>Conclusion: </strong>Results support the promise of leveraging primary care as a low-cost, scalable way to deliver universal language promotion intervention to optimize the developmental potential of all young children.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glutathione, Vitamin C, and Cysteine Use in Autistic Children With Disruptive Behavior: A Double-Blind, Placebo-Controlled Crossover Pilot Study.","authors":"Patricia Gail Williams, Lonnie Sears, Walter H Watson, Bakeerathan Gunaratnam, Yana Feygin, Stephen P Wright, Janice E Sullivan","doi":"10.1097/DBP.0000000000001334","DOIUrl":"10.1097/DBP.0000000000001334","url":null,"abstract":"<p><strong>Objective: </strong>Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication differences and restricted interests. One proposed biologic mechanism underlying ASD is oxidative stress, leading to the clinical use of glutathione based on anecdotal reports of improved behavior in autistic children. In this pilot study, we tested this observation using a randomized clinical trial format to collect preliminary data on glutathione safety and efficacy.</p><p><strong>Methods: </strong>Glutathione and glutathione in combination with vitamin C and N-acetylcysteine (Trio) were tested. Both treatments were administered in double-blind placebo-controlled randomized crossover studies. In total, 24 children between the ages of 5 and 16 years with ASD and severe behavior disorders were randomized to receive weekly intravenous injections of either placebo or 1 of the 2 interventions (glutathione or Trio) for 8 weeks. After a 1-week washout period, participants were crossed over for the subsequent 8 weeks. Behavioral measures and plasma levels of glutathione were obtained at baseline, during the washout period, and at the end of the study.</p><p><strong>Results: </strong>No differences between treatment groups in behavioral or biologic measures were found. No significant adverse side effects attributable to the treatments were observed. Small improvements in specific glutathione and behavioral measures occurred over the study period for all groups.</p><p><strong>Conclusion: </strong>Treatment with glutathione or glutathione in combination with vitamin C and N-acetylcysteine did not result in improvements in behavior or biologic measures. The positive trends over the course of the study were likely due to the placebo effect or decreased anxiety associated with the study routine.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 1","pages":"e17-e24"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Demographic Description of Children and Adolescents With Concomitant Autism and Anxiety Along With a Comparison of Receipt of Psychological Services.","authors":"Elizabeth Salt, Amanda T Wiggins, David N Toupin, Emma Parks, Chizimuzo Okoli, Mary Kay Rayens","doi":"10.1097/DBP.0000000000001321","DOIUrl":"10.1097/DBP.0000000000001321","url":null,"abstract":"<p><strong>Objective: </strong>(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism.</p><p><strong>Methods: </strong>Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ 2 tests of association, and logistic regression.</p><p><strong>Results: </strong>Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively ( p < 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White.</p><p><strong>Conclusion: </strong>We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e33-e39"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Posters and Research Platform Accepted for Presentation at the 2024 Annual Meeting of the Society for Developmental and Behavioral Pediatrics.","authors":"","doi":"10.1097/DBP.0000000000001339","DOIUrl":"10.1097/DBP.0000000000001339","url":null,"abstract":"","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 1","pages":"e97-e153"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Opportunities for Intervening Early in Preschoolers with Developmental Concern: Perspectives From Head Start Parents, Teachers, and Healthcare Providers.","authors":"Karen Burkett, Courtney M Brown, Rita Pickler, Tina Stanton-Chapman, Phyllis Sharps, Farrah Jacquez, Teresa Smith, Amy Holland, Anna Heeman, Tanya Froehlich","doi":"10.1097/DBP.0000000000001327","DOIUrl":"10.1097/DBP.0000000000001327","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to discover the care meanings of facilitators and barriers to detection and intervention for developmental delay among Head Start preschool-aged children, as viewed by parents, teachers, and primary care providers.</p><p><strong>Methods: </strong>We used a qualitative focus group design and broad cultural lens to understand similarities and differences in family and professional care, as Head Start programs educate preschoolers living in poverty who are disproportionately from ethno-racial minoritized groups. We sought the perspectives of 15 Head Start parents equally representing Black, Latino(a), and White parents, 17 teachers, and 11 healthcare providers to discover facilitators and barriers to adherence with professional recommendations.</p><p><strong>Results: </strong>We found that silos in professional communications, parent distrust, knowledge deficits, and stigma were barriers to obtaining developmental recommendations. Participants also identified missed opportunities to facilitate interagency coordination, parental advocacy of a child's developmental needs, and professional alliances to take collaborative actions for early identification and treatment. Furthermore, a subculture of poverty adversely influenced adherence to developmental recommendations, and ethno-racial biases affected Black and Latino(a) families' follow-through.</p><p><strong>Conclusion: </strong>Our findings highlight how the lack of coordination between sectors resulted in the dismissal of parental concerns or denial of services by 1 system or the other, thus, at the very least reducing the child's chances for earlier intervention and treatment. We also identified potential benefits to children when the barriers of poverty and ethnoracial bias are addressed by professionals with coordinated actions, and new systems are developed for sharing developmental screening results and partnering to coordinate care across the preschool and primary healthcare settings.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e45-e55"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}