Clinical Nursing Research最新文献

{"title":"Influence of mHealth-Based Lifestyle Interventions on Symptoms of Anxiety and Depression of Women With Gestational Diabetes: A Meta-Analysis.","authors":"Rong Liao, Yamin Li, Hui Yang, Yaoyue Luo","doi":"10.1177/10547738241252885","DOIUrl":"10.1177/10547738241252885","url":null,"abstract":"<p><strong>Background: </strong>Symptoms of anxiety and depression are common in women with gestational diabetes mellitus (GDM). Mobile health (mHealth)-based lifestyle interventions have been shown to be effective in improving glycemic control of these women.</p><p><strong>Purpose/objective: </strong>The aim of the study was to evaluate the influence of mHealth-based lifestyle interventions on symptoms of anxiety and depression in women with GDM.</p><p><strong>Design: </strong>A systematic review and meta-analysis or randomized controlled trials.</p><p><strong>Setting: </strong>Clinical or community-based settings.</p><p><strong>Sample: </strong>Nine studies involving 1,168 pregnant women with GDM were included.</p><p><strong>Intervention: </strong>mHealth-based lifestyle interventions.</p><p><strong>Measures: </strong>Symptoms of anxiety and depression quantitatively analyzed in clinical scales.</p><p><strong>Analysis: </strong>A systematic literature search was performed in electronic databases, including PubMed, Cochrane library, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure to obtain relevant randomized controlled studies. A random-effects model was used to pool the results by incorporating the impact of the potential heterogeneity.</p><p><strong>Results: </strong>Findings revealed that when compared to usual care, women who received mHealth-based lifestyle interventions had significant improvements in symptoms of anxiety (standardized mean difference [SMD]: -0.55, 95% CI [-0.77, -0.33], <i>p</i> < .001; <i>I</i>² = 67%) and depression (SMD: -0.51, [-0.72, -0.29], <i>p</i> < .001; <i>I</i>² = 65%). Sensitivity analyses by excluding one study at a time showed consistent results. Subgroup analyses showed similar results in mHealth achieved by phone, websites, and applications, in mHealth targeting diet and exercise with and without psychological support, in mHealth lead by nurse with and without other clinical specialists, and in studies with different evaluating tools for anxiety and depression.</p><p><strong>Conclusions: </strong>mHealth-based lifestyle interventions could significantly improve the symptoms of anxiety and depression in women with GDM.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"448-459"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065944","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":"Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.","authors":"Sandra P Morgan, Bini Thomas, Zoe Morris, Aimee B Klein, Douglas Haladay, Constance Visovsky","doi":"10.1177/10547738241252191","DOIUrl":"10.1177/10547738241252191","url":null,"abstract":"<p><p>Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m²) or nonobese (BMI < 30 kg/m²) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (<i>p</i> = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (<i>r</i> = -.738, <i>p</i> < .001) and in thoracic expansion (<i>r</i> = .544, <i>p</i> = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"440-447"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141069637","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":"Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic.","authors":"Amy Zhang, Siran Koroukian, Cynthia Owusu, Scott E Moore, Hasina Momotaz, Jeffrey M Albert","doi":"10.1177/10547738241252889","DOIUrl":"10.1177/10547738241252889","url":null,"abstract":"<p><p>We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (<i>p</i> = .019) on the Hamilton Depression Rating Scale and improved global health (<i>p</i> = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (<i>p</i> < .001) and crowded living space (<i>p</i> = .001, <i>p</i> = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest <i>p</i> values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (<i>p</i> = .001) and improved global health (<i>p</i> = .029). Increasing access to medicine (<i>p</i> < .01) and satisfaction with telehealth appointments (<i>p</i> < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (<i>p</i> < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"370-383"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077250","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":"Nursing Research on the Social Determinants of Health: Diverse Approaches.","authors":"Candace W Burton, Joachim G Voss","doi":"10.1177/10547738241257294","DOIUrl":"10.1177/10547738241257294","url":null,"abstract":"","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"275-276"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160916","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":"Social Determinants of Health and Cancer Pain in the US: Scoping Review.","authors":"Nayung Youn, Jamie Sorensen, Chelsea Howland, Stephanie Gilbertson-White","doi":"10.1177/10547738241232018","DOIUrl":"10.1177/10547738241232018","url":null,"abstract":"<p><p>Social determinants of health (SDOH) are structural factors that yield health inequities. Within the context of cancer, these inequities include screening rates and survival rates, as well as higher symptom burden during and after treatment. While pain is one of the most frequently reported symptoms, the relationship between SDOHs and cancer pain is not well understood. The purpose of this study is to describe and synthesize the published research that has evaluated the relationships between SDOH and cancer pain. A systematic search of PubMed, CINAHL, and Embase was conducted to identify studies in which cancer pain and SDOH were described. In all, 20 studies met the inclusion criteria. In total, 14 studies reported a primary aim related to SDOH and cancer pain. Demographic variables including education or income were used most frequently. Six specific measurements were utilized to measure SDOH, such as the acculturation scale, the composite measure of zip codes for poverty level and blight prevalence, or the segregation index. Among the five domains of SDOH based on Healthy People 2030, social and community was the most studied, followed by economic stability, and education access and quality. The neighborhood and built environment domain was the least studied. Despite increasing attention to SDOH, the majority of published studies use single-dimension variables derived from demographic data to evaluate the relationships between SDOH and cancer pain. Future research is needed to explore the intersectionality of SDOH domains and their impact on cancer pain. Additionally, intervention studies should be conducted to address existing disparities and to reduce the incidence and impact of cancer pain.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"416-428"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906822","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 Toxic Stress of Racism and Its Relationship to Frailty.","authors":"Julie-Kathryn Graham, Danisha Jenkins, Kalie Iris, Morgan Knudsen, Christina Kelley","doi":"10.1177/10547738241233050","DOIUrl":"10.1177/10547738241233050","url":null,"abstract":"<p><p>Significant morbidity and mortality from COVID-19-related illnesses have been observed among people of color within the United States. While theories involving healthcare inequity and political division have emerged to explain this observation, the role of chronic stress and inflammation is also being explored. Toxic stress is experienced disproportionately by race, ethnicity, and socioeconomic status and increases frailty and vulnerability to diseases such as COVID-19. C-reactive protein (CRP) is a biomarker associated with the inflammatory response that is typically elevated due to exposure to acute or chronic traumatic stress, as well as COVID-19. This study explored the relationship between CRP and Hispanic/non-Hispanic ethnicity among adults hospitalized with COVID-19 via a secondary analysis of retrospective electronic health record (EHR) data collected from a community healthcare system in Southern California. A total of 1,744 cases representing hospitalized adults with COVID-19 were reviewed. Data were extracted from the EHR to reflect demographics, medical diagnoses, medications, CRP, and comorbidity burden. Frequencies, percentages, and measures of central tendency were assessed to understand the distribution of data. Associations were conducted using Pearson's <i>r</i> and the chi-square test of independence. Differences between groups were examined via independent samples <i>t</i>-tests. The sample was 52% Hispanic, 56% male, and the mean age was 62 years (<i>SD</i> = 16.1). The mean age of Hispanic cases was younger than non-Hispanic cases (<i>p</i> < .001, η = 0.289). Serum CRP was significantly higher in the Hispanic cases, with a high degree of association (<i>p</i> < .001, η = 0.472). In addition, higher CRP levels were significantly associated with the need for mechanical ventilation (<i>p</i> < .001, φ_c = 0.216). No significant relationships were found between CRP and age, body mass index (BMI), or comorbidity burden. Findings challenge the assumption that the disproportionate morbidity and mortality suffered by the Hispanic population due to COVID-19 was due to age, BMI, or comorbidities such as metabolic syndrome or heart disease. CRP in the Hispanic population should be further investigated to understand its relationship to chronic stress, frailty, and risk for COVID-19 in this population.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"301-308"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061098","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":"Establishing and Affirming Social Connections: Recruiting Non-Hispanic Black Adults with Type 2 Diabetes.","authors":"Debra A Neblett, Laurie Kennedy-Malone","doi":"10.1177/10547738231216530","DOIUrl":"10.1177/10547738231216530","url":null,"abstract":"<p><p>The underrepresentation of non-Hispanic Black adults in clinical research impacts the generalizability and usefulness of research findings. The purpose of this article is to discuss recruitment strategies used in a research study examining the self-care of diabetes and diabetes distress in non-Hispanic Black adults with type 2 diabetes. In this cross-sectional correlation study, the participants were non-Hispanic Black adults with type 2 diabetes living in North Carolina. A questionnaire collected sociodemographic and clinical characteristics. This study was analyzed using descriptive statistics. In total, 512 individuals accessed the online survey. After data screening, 275 participants were used for data analysis. Sixteen recruitment sites provided letters of support, and 13 were active in the recruitment process. Most participants learned about the research study via social media. Social connections resulting in recruitment partners and using social media supported the successful recruitment. The recruitment strategies implemented can inform researchers of effective evidence-based recruitment strategies to increase the participation of non-Hispanic Black adults in clinical research.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"309-315"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099054","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":"Are We Missing the Mark? Understanding Health Literacy in A Rural-Border Hospital.","authors":"Shiloh A Williams, Mary Martin, Leslie C Hussey, Maria Ojeda, Beverly Carlson, Maria Keckler","doi":"10.1177/10547738231221861","DOIUrl":"10.1177/10547738231221861","url":null,"abstract":"<p><p>Low health literacy (LHL) significantly impacts patients' ability to participate actively in their healthcare. Registered nurses (RNs) play a crucial role in identifying LHL and addressing patient knowledge gaps and skill deficits. This correlational study examined the relationship between RNs' predictions of patients' health literacy levels (HLL) and the actual HLL of a predominately Hispanic patient population. In addition, personal factors (i.e., demographics) were analyzed to determine their influence on the nurse's predictions and patients' HLL. Data were collected from 84 participant patient-nurse couplets admitted to a medical-surgical unit in a rural setting located on the United States-Mexico border. In addition to demographic information collected via survey, RNs were asked to predict their patient's health literacy abilities while the <i>Newest Vital Sign</i>, a health literacy assessment tool, was deployed to determine the actual HLL of patients participating in the study. Data were analyzed using descriptive statistics, <i>t</i>-tests, and chi-square tests while a Spearman correlational model was used to examine the relationship between predicted HLL and actual HLL. Finally, a logistic regression model was used to analyze the relationship between personal factors and HL data for RNs and patients. Analysis of the data revealed that RNs consistently overestimated patients' abilities, as evidenced by the disparity between patients' actual HLL (mean 1.71) and predicted HLL (mean 4.26) by RNs, with a moderately strong positive relationship (<i>r_s</i> = .418). Notably, higher academic preparation and years of experience did not enhance the RNs' ability to identify LHL while the <i>highest level of education completed</i> was the only statistically significant predictor of adequate health literacy in the patient population sampled. These findings emphasize the need to prioritize effective health literacy education in RN academic preparation and clinical practice to support the detection of LHL when a standardized health literacy assessment tool is not utilized in the clinical setting. By recognizing the presence of LHL, healthcare professionals can better support patients' needs and bridge the knowledge gap, ultimately improving patient outcomes.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"326-333"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571995","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":"Unveiling the Strong Black Woman Schema-Evolution and Impact: A Systematic Review.","authors":"Ashley K Parks, Laura L Hayman","doi":"10.1177/10547738241234425","DOIUrl":"10.1177/10547738241234425","url":null,"abstract":"<p><p>The Strong Black Woman (SBW) schema is described as a statue of unrelenting strength, resilience, and self-sufficiency, serving as a shield of protection and cultural adaptation to suppress and control manifestations of racial and gender oppression. Stemming from superwoman syndrome, a conceptual model exploring the multifactorial roles women hold and their impact, the SBW extends beyond gender roles to the sociopolitical context of the Black woman's lived experience. Endorsement of the SBW posits risk for health disparities including stress, anxiety, depression, and obesity. This review was conducted to explore the SBW schema and experiences of Black women who endorse it, to delineate how Black women describe themselves in relation to the SBW persona, and to inform further inquiry, nursing practice, and clinical approaches to improving health outcomes of this population. A systematic review of qualitative studies was conducted with a literature search from CINAHL, APA PsycINFO, MEDLINE, PubMed, and SocINDEX databases yielding seven relevant papers for this analysis. Studies using the superwoman schema and the SBW schema with participants who identified as Black women were included in the review. Consistent with the SBW phenomenon, many participants described examples and consequences of being an SBW. While most women identified with SBW, not all endorsed the persona entirely, challenging its ideal and reinforcing positive self-care. Themes include (a) Strength by nature, not choice, (b) Suppressed emotion, (c) Success over everything, and (d) Prioritizing others over self. Additional emerging themes are also included. Black women increasingly recognize the negative impacts of the SBW schema, pinpointing how their internal feelings manifest in their external world. The conceptual framework itself is an anomaly, incongruently impacting both the mental and physical health of Black women, further contributing to the long-term health and sociopolitical disparities that Black women experience. Simply acknowledging and understanding these experiences by healthcare practitioners are not enough to prevent or eliminate the risks involved with the endorsement of the SBW schema but rather intentionally addressing these as a contributing social determinant of health that predisposes them to long-term chronic conditions.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"395-404"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029435","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":"Understanding Refugees Health Experiences in Host Countries: Three Theoretical Perspectives.","authors":"Yana D Gepshtein, Jung-Ah Lee, Dawn T Bounds, Candace W Burton","doi":"10.1177/10547738241253655","DOIUrl":"10.1177/10547738241253655","url":null,"abstract":"<p><p>Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.</p>","PeriodicalId":50677,"journal":{"name":"Clinical Nursing Research","volume":" ","pages":"292-300"},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180854","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}