Health Services Research最新文献

{"title":"Recruitment and Retention of Rural Health Professionals in Minnesota.","authors":"Hannah MacDougall, Selam Woldegerima, Carrie Henning-Smith, Teri Fritsma, Andrew P J Olson","doi":"10.1111/1475-6773.14453","DOIUrl":"https://doi.org/10.1111/1475-6773.14453","url":null,"abstract":"<p><strong>Objective: </strong>To qualitatively explore the reasons health professionals decide to practice in rural areas.</p><p><strong>Study setting and design: </strong>Exploratory, cross-sectional, semi-structured qualitative interview and focus group study using thematic analysis with a convenience sample of health professionals in rural Minnesota. Interviews and focus groups were conducted virtually and in person, respectively, between August 2023 and March 2024.</p><p><strong>Data sources and analytic sample: </strong>Primary interview and focus group data were collected from 19 individual interviews and 3 focus groups (n = 16) with health professionals in rural Minnesota. Interview and focus group recordings were transcribed, deductively coded, and analyzed using constant comparison.</p><p><strong>Principal findings: </strong>Rural health professionals cited autonomy and breadth of practice and patient connection as rewarding and challenging components of practice that were distinctly rural. Barriers to recruitment and retention of rural health professionals included lack of housing (especially rental and short-term) and accessible childcare. Potentially promising considerations when recruiting and retaining health professionals include loan forgiveness programs, the appeal of increasing racial and ethnic diversity in rural areas, and the ease of community health advocacy efforts.</p><p><strong>Conclusion: </strong>Our findings suggest that to recruit and retain rural health professionals, stakeholders could highlight autonomy and patient connection, reduce childcare and housing barriers, and explore community strengths such as racial/ethnic diversity and opportunities for advocacy.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14453"},"PeriodicalIF":3.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated health systems and medical care quality during the COVID-19 pandemic.","authors":"Kaushik Ghosh, Nancy D Beaulieu, Maurice Dalton, Zakaria El Amrani, Helene Machado, David M Cutler","doi":"10.1111/1475-6773.14433","DOIUrl":"https://doi.org/10.1111/1475-6773.14433","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences between patients treated in integrated systems of care and patients treated outside of such systems during the COVID pandemic in the use of primary and preventive care, emergency services, inpatient services, and mortality.</p><p><strong>Data sources and study setting: </strong>Data are used from all enrollees in traditional Medicare aged 66 and older.</p><p><strong>Study design: </strong>Difference-in-differences estimates are calculated from the pre-COVID time period (January 2019-February 2020) to the initial COVID time period (March-May 2020) and the ongoing COVID time period (June 2020-December 2021) for patients treated by primary care physicians working in a health system versus not, and by the type of health system.</p><p><strong>Data collection/extraction methods: </strong>Medicare claims data are used to measure monthly claims for office and telehealth visits, mammography, colon cancer screening, inpatient/emergency department visits, and death. Patients are assigned to primary care physicians using common algorithms. Physician membership in a health system is determined from a previously generated dataset.</p><p><strong>Principal findings: </strong>Relative to the pre-COVID period, patients treated in health systems fared no better in maintaining primary care access than patients treated outside of such systems (DID estimate on receipt of office care or telehealth visit = -4%; p < 0.001). In the ongoing COVID time period, non-COVID mortality rose by less in health systems (DID estimate = -0.9%; p < 0.001) and health system patients experienced a greater decline in the use of the emergency department (DID estimate = -1.2%; p < 0.001) and emergency/urgent inpatient care for non-COVID conditions less (DID estimate = -0.7%; p < 0.001).</p><p><strong>Conclusion: </strong>Health systems were associated with reduced occurrence of death and adverse medical events, although the effect magnitudes are modest. This reduction appears unrelated to the use of primary care and should be considered in the context of our evolving understanding of the advantages and disadvantages of health systems.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14433"},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Barriers to Being Offered and Accepting a Telehealth Visit for Cancer Care: Unpacking the Multi-Levels of Documented Racial Disparities in Telehealth Use.","authors":"Matthew R Dunn, Ilona Fridman, Alan C Kinlaw, Christine Neslund-Dudas, Samantha Tam, Jennifer Elston Lafata","doi":"10.1111/1475-6773.14461","DOIUrl":"https://doi.org/10.1111/1475-6773.14461","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate patient- and area-level factors in relation to telehealth visit use in cancer care.</p><p><strong>Study setting and design: </strong>We surveyed a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central North Carolina and one in southeast Michigan) and their community affiliates. Black adults and those with a scheduled telehealth visit were purposively oversampled during recruitment. We linked respondent residential addresses to area-level measures, including broadband access. The two patient-reported outcomes of interest were (1) whether a choice in visit type (virtual or in-person) was offered and (2) scheduled visit type.</p><p><strong>Data sources and analytic sample: </strong>We assembled a cohort of 773 adults (response rate = 15%). After excluding nonrecall for being offered a choice, the analytic sample was 725 adults.</p><p><strong>Principal findings: </strong>The sample was 46% aged < 65 years, 42% Black, and 67% women. Black respondents were less likely than non-Black respondents to be offered a choice, 15% versus 23%, prevalence difference (PD) and 95% CI = (-8.7%, CI: -14.4, -3.0) and if offered a choice, less likely to accept a telehealth visit (20% vs. 67%; PD = -47.0%, CI: -62.0, -32.0). Compared to men, women had a lower frequency of visit choice (16% vs. 27%; PD = -10.9%. CI: -17.4, -4.4) and accepted telehealth visits (42% vs. 63%; PD = -20.8%, CI: -36.8, -4.7). Respondents who expressed technology-related worries were less likely to accept a telehealth visit. Lower area-level technology access (e.g., broadband ownership) and higher poverty were nonsignificantly associated with less offering and less scheduling of telehealth visits.</p><p><strong>Conclusions: </strong>Interventions to improve access to telehealth in cancer care and mitigate structural inequities (namely racism and sexism) should consider patient- and area-level barriers to being offered a choice in visit type and the ability to accept a telehealth visit.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14461"},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Staffing Shortages in Nursing Homes: Does Relaxing Training and Licensing Requirements Increase Nurse Aide Staffing?","authors":"Gulrukh Mehboob, Hari Sharma","doi":"10.1111/1475-6773.14455","DOIUrl":"https://doi.org/10.1111/1475-6773.14455","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether COVID-19-related nurse aide training and licensing relaxation policies improved staffing shortages in nursing homes.</p><p><strong>Study setting and design: </strong>Staffing shortages have been a long-standing concern in nursing homes, and states are experimenting with different approaches to enhance nurse aide staffing. We use the latest quasi-experimental difference-in-differences methods to evaluate the effect of relaxing training and licensing requirements in 19 states (treatment group) relative to the 31 states that did not implement such policies (control group). We analyze the combined effect of relaxing both training and licensing requirements, as well as the impact of relaxing each policy separately.</p><p><strong>Data sources and analytic sample: </strong>We obtain quarterly data on nursing home characteristics, including adjusted nurse aide hours per resident day (HPRD) from 2019 to 2023 from Care Compare, a federal website with quality information on all Medicare/Medicaid-certified nursing homes. After excluding outliers of staffing data (nurse aide HPRD > 5.25, or nurse aide HPRD = 0), our final analytical sample had 278,170 observations.</p><p><strong>Principal findings: </strong>The average nurse aide HPRD is 2.30 in the treatment group and 2.26 in the control group. Using the difference-in-differences regression analyses, we find no significant effect of the relaxation of training and licensing requirements on nurse aide levels (average treatment effect: -0.0001; p = 0.99). Similarly, separate analyses of training and licensing relaxation policies suggest that neither policy significantly impacts nurse aide staffing. Results are consistent when we adjust for staffing requirements, wage increase policies, and nursing home characteristics.</p><p><strong>Conclusions: </strong>Our findings suggest that the relaxation of training and licensing requirements may not lead to improved nurse aide staffing levels in nursing homes. Policymakers need to consider other strategies to address persistent staffing shortages in nursing homes.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14455"},"PeriodicalIF":3.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Integration and Oncologists' Adoption of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer.","authors":"Xin Hu, Changchuan Jiang, K Robin Yabroff, Joseph Lipscomb, Ilana Graetz","doi":"10.1111/1475-6773.14436","DOIUrl":"https://doi.org/10.1111/1475-6773.14436","url":null,"abstract":"<p><strong>Objective: </strong>To examine the trend in Immune Checkpoint Inhibitor (ICI) use before and after FDA approval in 2015 for patients with metastatic non-small cell lung cancer (NSCLC), and whether vertical integration of oncologists affected ICI use.</p><p><strong>Study setting and design: </strong>We conducted a retrospective cohort study of patients with metastatic NSCLC from 21 population-based cancer registries in the United States. We measured whether patients' treating oncologists were vertically integrated based on ≥ 10% of total services billed through hospital outpatient departments. We described the percentage of ICI recipients annually in 2010-2019, stratified by oncologists' integration status each year. In the post-FDA approval period (2015-2019), we used difference-in-differences (DID) modeling to compare the probability of patients' receiving ICI before and after oncologists became integrated relative to those whose oncologists remained non-integrated.</p><p><strong>Data sources and analytic sample: </strong>Using the SEER-Medicare linkage, we identified Medicare Fee-For-Service beneficiaries aged ≥ 65.5 years diagnosed with metastatic NSCLC in 2010-2019 and followed them from diagnosis until ICI receipt, death, or end of 2019.</p><p><strong>Principal findings: </strong>The overall percentage of patients receiving ICI increased from 0% before 2015 to 4.0% in 2015, and further increased to 29.2% in 2019. The percent of ICI recipients was higher among integrated (6.9%) than non-integrated oncologists (2.0%, p < 0.001) in 2015, but by 2017 adoption rates converged (19.8% vs. 19.8%, p = 0.91). DID analysis showed non-significant changes in the probability of ICI use after oncologists became integrated (1.7 percentage points, 95% CI = -1.0 to 4.4) relative to oncologists who remained non-integrated.</p><p><strong>Conclusions: </strong>Integrated oncologists were quicker to adopt ICIs in the first year after FDA approval, but this lead was not sustained over time. Vertically integrating into health systems was not associated with significant changes in ICI use. Further research is needed on the factors influencing equitable dissemination of novel cancer therapies across practice settings.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14436"},"PeriodicalIF":3.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 Pandemic and the Gender Mental Health Gap.","authors":"Ayesha Jamal","doi":"10.1111/1475-6773.14450","DOIUrl":"https://doi.org/10.1111/1475-6773.14450","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between the COVID-19 pandemic and the preexisting gender mental health gap in symptoms as well as service utilization.</p><p><strong>Study setting and design: </strong>Using repeated cross-sectional data, the study compares the gender mental health gap between American female and male college students before and after the start of the COVID-19 pandemic. Adjustments are made for preexisting trends. The study constructs an overall index of poor mental health, based on self-reported symptoms and service utilization related to anxiety, depression, and eating disorders. The gender mental health gap is also broken into the gender symptoms gap and the gender service utilization gap; each is analyzed separately by race, ethnicity, and sexuality.</p><p><strong>Data sources and analytic sample: </strong>The study draws on secondary data from the National College Health Assessment Surveys from fall 2015 to fall 2022 and focuses on young American college students, ages 18-25 years old.</p><p><strong>Principal findings: </strong>The gender mental health gap, measured using the overall index of poor mental health, increased by 15.6% [95% CI: 5.67-25.6]. The gender symptom gap in eating disorders increased by 38.8% [95% CI: 24.4-53.1] and is consistently observed across race, ethnicity, and sexuality, except among non-Hispanic Asian students. Minimal to no long-term significant differences are observed for the gender symptom gap in anxiety and depression. The gender service utilization gap, on the other hand, increased for all illnesses, with slight increases for anxiety and depression.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was accompanied by an exacerbation of the already existing rise in eating disorders among female college students. In symptoms of anxiety and depression, the gap between women and men stayed constant during the pandemic. Action is required to understand and address the factors that led to a rise in the symptoms of eating disorders among women.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14450"},"PeriodicalIF":3.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editor's Desk: Publishing in HSR in 2023.","authors":"Austin Frakt, Chris Tachibana","doi":"10.1111/1475-6773.14454","DOIUrl":"https://doi.org/10.1111/1475-6773.14454","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14454"},"PeriodicalIF":3.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting Inside Closed-Loop Referrals: Exploring the Patient Experience of Finding and Connecting to Social Care With a Community Resource Referral System Using a Community-Based Participatory Approach.","authors":"Anthony W Olson, Nik Allen, Ardem Elmayan, Kim Green, Melissa L Harry, Jenny Kempfert, Emily Kuenstler, Heath Maki, Sarah Nelson, Mary Rapps, Rose St John, Salaam Witherspoon, Shawandala Brown, Ashlie Castaldo, Melissa Grimes, Treasure Jenkins, Kennedy Mosher","doi":"10.1111/1475-6773.14451","DOIUrl":"https://doi.org/10.1111/1475-6773.14451","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences of patients who found and/or connected to social care via a community resource referral system named \"Resourceful\" (linked with FindHelp.org) linked to a health system's electronic health record.</p><p><strong>Study setting and design: </strong>The mixed-methods study was co-designed and conducted using community-based participatory processes by a team of researchers at a multi-state health system (Minnesota, North Dakota, Wisconsin) and community members with lived experience addressing unmet social needs. Study participants were individuals referred to, connected to, or delivered social care through Resourceful in the health system's service area. Quantitative surveys were emailed to 780 patients and 38 healthcare workers (HCWs) tied to closed-loop referrals between 8/2022 and 2/2023. Qualitative interview invites were emailed to 19 patient survey respondents wanting to interview, and the five HCWs and 12 community-based organizations (CBOs) involved in their social care experience. Descriptive statistics analyzed sociodemographic and patient experience variables developed via the participatory process. We coded qualitative data using thematic analysis, extracting thematic factors informing survey responses.</p><p><strong>Data sources and analytic sample: </strong>We collected primary data from online surveys and semi-structured phone interviews.</p><p><strong>Principal findings: </strong>Usable survey responses from 62 patients and 14 HCWs were analyzed. Most respondents agreed on some level that their experience using Resourceful strengthened patient trust (patients:66%, HCWs:86%), improved communication about what patients need to be healthy (patients:61%, HCWs:57%), provided \"helpful help\" reducing social care barriers (patients:56%, HCWs:93%), and enhanced person-centeredness (patients:60%, HCWs:79%). Qualitative analysis yielded six thematic factors corresponding to 23 actionable takeaways potentially important for using CRRS to improve the seeker experience of social care: resource/service environment; platform access/usability/utilization; helper integration/coordination/continuity; helpful help; reliable sources/partnerships; responsive relationships.</p><p><strong>Conclusions: </strong>Differences in the perceptions of patient experiences involving resourceful were observed between patients and HCWs/CBOs. Thematic factors clarified these differences and how to improve patient experiences with closed-loop referrals.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14451"},"PeriodicalIF":3.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Medicaid Coverage for School-Based Health Services on the Supply of School-Based Healthcare Clinics: Evidence From the \"Free Care Rule\" Reversal and FQHCs.","authors":"Lindsey Rose Bullinger, Scarlette Jiajing Shi","doi":"10.1111/1475-6773.14452","DOIUrl":"https://doi.org/10.1111/1475-6773.14452","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether Medicaid coverage of healthcare services provided within schools affects the supply of school-based health clinics.</p><p><strong>Data sources and study setting: </strong>We combine nationwide data spanning 2012-2020 on Federally Qualified Health Centers delivering health services within school settings with state policy information on Medicaid expansion to school-based healthcare.</p><p><strong>Study design: </strong>Until 2014, the federal \"Free Care Rule\" restricted school-based health centers from using Medicaid funding to provide health services unless these services were part of the student's Individual Education Plan. In 2014, the Centers for Medicare & Medicaid Services reversed the free care rule, allowing states to opt in to authorizing Medicaid reimbursement for comprehensive health services delivered in schools to Medicaid-enrolled students. We compared the number of federally qualified school-based health centers in states that expanded their Medicaid policies in response to the free care rule reversal to that of states that did not expand their Medicaid programs to reimburse for school-based health services in a staggered difference-in-differences analysis. We also adjusted the analysis for other important measures that may independently affect school-based healthcare provision and funding decisions.</p><p><strong>Data collection: </strong>The number of health centers delivering services in schools comes from the Health Resources & Services Administration. State Medicaid coverage policy information comes from the Healthy Schools Campaign.</p><p><strong>Principal findings: </strong>Expanding Medicaid coverage to comprehensive school-based healthcare increased the number of Federally Qualified Health Centers providing services in school settings by about 13.42 (p = 0.035, 95% CI: 0.94, 25.90). This increase represents a relative rise of 39%. However, these results are sensitive to specifications.</p><p><strong>Conclusions: </strong>Local educational entities, school health providers, and public health professionals are responsive to financial incentives to provide services to Medicaid-enrolled children within schools. Recent federal legislation has the potential to increase financial incentives and offer complementarities to prior state-level policy changes.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14452"},"PeriodicalIF":3.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criminal Justice, Arrests Data, and Structural Racism Measurement for Health Equity Research: Promises and Pitfalls.","authors":"Carmen Mitchell, Julia Stantoznik, Shekinah Fashaw-Walters, Odichinma Akosionu, Rachel Hardeman, Michelle Ko","doi":"10.1111/1475-6773.14449","DOIUrl":"https://doi.org/10.1111/1475-6773.14449","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14449"},"PeriodicalIF":3.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}