Health Policy最新文献

{"title":"“That’s a tricky question”: perceptions of mandatory vaccination among parents and paediatricians in Austria","authors":"Nora Hansl,&nbsp;Katharina T. Paul","doi":"10.1016/j.healthpol.2025.105331","DOIUrl":"10.1016/j.healthpol.2025.105331","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic and recurrent outbreaks of vaccine-preventable diseases highlight the need to improve vaccine uptake. Vaccine mandates constitute prominent policy instruments that promise a quick increase in coverage. Yet mandates are difficult to implement and bear the potential to increase resistance and polarisation, while diminishing trust. Against this background, studying perceptions towards mandates of groups directly affected by mandates is key to sustainable vaccination governance</div></div><div><h3>Objective</h3><div>In this paper, we study parents as decision-makers for childhood immunisation and paediatricians who administer vaccination and mitigate reactance. We explore how these two groups perceive vaccine mandates</div></div><div><h3>Methods</h3><div>Our study builds on 42 qualitative interviews with parents and paediatricians. We draw on the case of Austria, which is characterised by a fragmented vaccination system and recent experiences with mandates</div></div><div><h3>Results</h3><div>Perceptions overall are ambivalent, with both cohorts weighing positive and negative aspects. We find four lines of reasoning that relate to perceptions of vaccine mandates: <em>political and societal impact, epidemiological reasoning, ethical considerations,</em> and <em>impact on vaccine uptake</em>. Both cohorts show considerable alignment in their perceptions. Crucially, we find that perceptions of mandates are formed in contextual, concrete experiences with the healthcare system</div></div><div><h3>Conclusions</h3><div>Our findings have critical implications for vaccination policy in Austria and beyond, especially concerning the distribution of responsibility in vaccination systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105331"},"PeriodicalIF":3.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895668","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":"Availability of primary care and avoidable attendance at English emergency departments: A regression analysis","authors":"Timothy Jamieson ,&nbsp;Hugh Gravelle ,&nbsp;Rita Santos","doi":"10.1016/j.healthpol.2025.105330","DOIUrl":"10.1016/j.healthpol.2025.105330","url":null,"abstract":"<div><div>Attendances at emergency departments (EDs) by patients who could have been treated in primary care increase waiting times and costs in EDs and may reduce quality of care. This study examines whether the probability that a patient’s ED attendance is avoidable is associated with their characteristics and the quality, staffing, and availability of their general practice, particularly its extended hours provision. We estimate ED attendance level linear probability and logistic regressions using data on 10.16 M attendances at 144 major EDs by patients aged 16 or over from 6668 English practices. We use two definitions of avoidable ED attendance: the NHS definition (non-urgent) and a new wider definition (clinically inappropriate).</div><div>9.3 % of attendances were avoidable according to the NHS definition and 21.8 % with our definition. The probability of avoidable attendance was lower for older, female patients, those living in more socioeconomically deprived or sparsely populated areas, or those closer to their practice than to the ED attended. Attendances from practices where a higher proportion of patients get same-day GP appointments, or were aware of early morning extended hours, were less likely to be avoidable. The probability that an ED attendance was clinically inappropriate was about 0.5 % smaller during weekends or evenings when the practice had extended hours but was not associated with the overall provision of extended hours by the practice.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"157 ","pages":"Article 105330"},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901978","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":"Common institutional ownership and the erosion of competition in the American health insurance market: A quantitative analysis","authors":"Kevin Smith","doi":"10.1016/j.healthpol.2025.105316","DOIUrl":"10.1016/j.healthpol.2025.105316","url":null,"abstract":"<div><h3>Background</h3><div>Empirical studies have shown that when large institutional investors and private equity funds own a significant stake in multiple publicly traded firms within an industry, this common ownership may lead to anti-competitive behavior. In 2010, the Affordable Care Act (ACA) was passed. This law created health insurance exchanges that allowed for Americans to purchase health insurance plans directly on a marketplace. The insurers on this marketplace have common institutional owners, that could influence the level of competition in these markets.</div></div><div><h3>Objective</h3><div>To assess the causal effects of common ownership on competition in the US health insurance market.</div></div><div><h3>Methods</h3><div>To identify the causal impact of common ownership, I use two empirical strategies: the Arellano-Bond Dynamic Panel Model and Bartik-style Instruments. Data on firm ownership came the paper, “Common Ownership Data: Scraped SEC form 13F filings for 1999-2017” by Matthew Backus, Christopher Conlon, and Michael Sinkinson.</div></div><div><h3>Results</h3><div>The results show that a one standard deviation increase in common ownership leads to a 7.7 % increase in monthly premiums charged for certain health insurance plans. This finding is robust to different model specifications and suggests that common ownership reduces competition in the health insurance exchanges.</div></div><div><h3>Conclusions</h3><div>The results from this paper indicate that policymakers and regulators need to formulate policies that limit the amount that institutional investors and private equity funds can own of companies in the health insurance industry in the US. Additionally, policymakers need to make more data on firm ownership available, as the data that is available has quality issues.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105316"},"PeriodicalIF":3.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824152","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":"Making integrated care happen: Middle managers' views on leadership for promoting multidisciplinary collaboration at the early stage of the Finnish social and healthcare reform.","authors":"Soila Karreinen, Satu Paatela, Henna Paananen, Moona Huhtakangas, Markku Satokangas, Harri Jalonen, Liina-Kaisa Tynkkynen","doi":"10.1016/j.healthpol.2025.105320","DOIUrl":"https://doi.org/10.1016/j.healthpol.2025.105320","url":null,"abstract":"<p><p>Different forms of health and social care integration are promoted in many countries to address the complex needs of the population. This qualitative study explores integrative leadership from the perspective of middle managers. The study examines how national and regional integration aspirations are converted into micro-level multidisciplinary collaborations through leadership actions in primary health and social services. The study was conducted at the early stages of major social and health services reform in Finland. The data forms a cross-section of 11 interviews with middle-level managers from different sectors in a new wellbeing services county. Thematic analysis revealed that managers view integrated care positively, considering it efficient and useful. Their main goal is to create public value, including cost-efficiency. The managers believe that their task is to promote multidisciplinary collaboration by developing visions, structures and processes that support professionals in implementing changes in daily work. Many aspects of integrative leadership, such as shared goals and collaborative processes, were identified. More contradictory issues, such as tensions and conflicts between stakeholders, complex accountabilities, legitimacy and power imbalances, were almost absent in the data. These issues should be addressed in organisations, and their role should be studied further as a potential barrier to the successful implementation of integrated care.</p>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":" ","pages":"105320"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026198","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":"Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022","authors":"Qing Xia ,&nbsp;Steven M McPhail ,&nbsp;Clifford Afoakwah ,&nbsp;Linh K Vo ,&nbsp;Megumi Lim ,&nbsp;David Brain ,&nbsp;John Paul Kuwornu ,&nbsp;Hannah E. Carter","doi":"10.1016/j.healthpol.2025.105319","DOIUrl":"10.1016/j.healthpol.2025.105319","url":null,"abstract":"<div><h3>Background</h3><div>Since the introduction of cost-utility analysis (CUA) in the 1990s, its methodologies and applications have evolved significantly in Australia.</div></div><div><h3>Objectives</h3><div>To provide a comprehensive overview of the volume, trends, and characteristics of the application of CUA in healthcare decision-making.</div></div><div><h3>Methods</h3><div>Bibliometric analysis of published CUAs identified from the Cost-Effectiveness Analysis Registry, a `1comprehensive source of CUA data between 1992 and 2022. Multinomial logistic regression models were conducted to explore the associations between ICERs and variables including sponsorship, perspective, and discount rate.</div></div><div><h3>Results</h3><div><em>N</em> = 484 unique Australian-based CUAs were analysed. Over the last three decades, the volume and quality of CUAs in Australia have steadily increased. Commonly evaluated interventions included pharmaceuticals (21.5 %), health education/behaviour (18.0 %), and models of care (16.6 %), while diseases of circulatory system, cancers, and metabolic diseases were the most studied health conditions. Only nine CUAs involved First Nations people. Most CUAs (72.9 %) were conducted from a healthcare payer perspective, with only 19.0 % adopting a societal perspective. Approximately half of studies applied a 5 % discount rate, and 50.4 % used a $50,000 WTP threshold. 14.7 % CUAs were sponsored by industry. Regression analyses showed that industry sponsorship, societal perspective, and lower discount rate were positively associated with lower ICERs.</div></div><div><h3>Conclusions</h3><div>The increasing volume of CUAs underscores the importance of efficient allocation of scare resources in Australian health system. However, gaps remain, particularly in the inclusion of First Nations populations and the societal costs. Further research is needed to address these gaps and to evaluate the impact of sponsorship and discounting on CUA outcomes.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105319"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826300","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":"Contact time in GP Care: Descriptive patterns and a scoping review of the literature","authors":"Simon Reif ,&nbsp;Jan Köhler ,&nbsp;Sabrina Schubert ,&nbsp;Benedikt Stelter","doi":"10.1016/j.healthpol.2025.105315","DOIUrl":"10.1016/j.healthpol.2025.105315","url":null,"abstract":"<div><h3>Background</h3><div>Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations.</div></div><div><h3>Objective</h3><div>To study the determinants and consequences of the length of consultations in GP care.</div></div><div><h3>Method</h3><div>We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters.</div></div><div><h3>Results</h3><div>We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies.</div></div><div><h3>Conclusion</h3><div>Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105315"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864002","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":"The ethics of behaviour-based insurance models: Solidarity-based concerns in Germany's statutory health insurance","authors":"Carl Justus Bredthauer ,&nbsp;Eva Kuhn ,&nbsp;Alena Buyx","doi":"10.1016/j.healthpol.2025.105318","DOIUrl":"10.1016/j.healthpol.2025.105318","url":null,"abstract":"<div><div>Sickness funds have begun to harness digital behavioural data to incentivise physical activity in their members. This ethical and societal effects of this phenomenon remain largely unclear, especially in solidarity-based insurance systems. Therefore, this study analysed the risks and benefits of such programmes with respect to solidarity against the background of recent efforts by German statutory health insurance funds to integrate digital tracking data into their bonus programmes. Key, potential benefits include new forms of solidarity that may emerge based on sharing personal health data. The incentives introduced by these reward programmes could lead to efficiency gains used to benefit society. However, three conceptual pitfalls have been identified: First, the data gathering method may penalise certain vulnerable groups. Such discrimination could, however, be avoided by minimising barriers to participation. Second, digitally mediated bonus programmes may create deadweight effects, i.e. beneficiaries are likely to already be healthy and active. Consequently, behavioural targets should be designed to consider individual prerequisites. Lastly, linking premiums to behaviour might diminish solidarity with poor risks within statutory health insurances and between statutory and private health insurance. Hence, this study aimed to stimulate debate on the ethical and societal implications of the systemic integration of eHealth innovations into healthcare systems.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105318"},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837919","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":"Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe","authors":"Brigitte Michelsen ,&nbsp;Mikkel Østergaard ,&nbsp;Michael John Nissen ,&nbsp;Adrian Ciurea ,&nbsp;Burkhard Möller ,&nbsp;Lykke Midtbøll Ørnbjerg ,&nbsp;Pavel Horák ,&nbsp;Bente Glintborg ,&nbsp;Alan MacDonald ,&nbsp;Karin Laas ,&nbsp;Tuulikki Sokka-Isler ,&nbsp;Bjorn Gudbjornsson ,&nbsp;Florenzo Iannone ,&nbsp;Pasoon Hellamand ,&nbsp;Tore Kristian Kvien ,&nbsp;Ana Maria Rodrigues ,&nbsp;Catalin Codreanu ,&nbsp;Ziga Rotar ,&nbsp;Isabel Castrejón ,&nbsp;Johan Karlsson Wallman ,&nbsp;Merete Lund Hetland","doi":"10.1016/j.healthpol.2025.105311","DOIUrl":"10.1016/j.healthpol.2025.105311","url":null,"abstract":"<div><h3>Background</h3><div>Studies on national policies for biologics are warranted.</div></div><div><h3>Objectives</h3><div>To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries’ socio-economic status.</div></div><div><h3>Methods</h3><div>An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.</div></div><div><h3>Results</h3><div>National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.</div></div><div><h3>Conclusion</h3><div>The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105311"},"PeriodicalIF":3.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833693","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":"What are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries","authors":"Matthew Tracey ,&nbsp;Katharine Schulmann ,&nbsp;Florian Tille ,&nbsp;Thomas Rice ,&nbsp;Julien Mercille ,&nbsp;Rob Timans ,&nbsp;Sara Allin ,&nbsp;Alexis Dottin ,&nbsp;Sanna Syrjälä ,&nbsp;Tiia Sotamaa ,&nbsp;Ilmo Keskimäki ,&nbsp;Bernd Rechel","doi":"10.1016/j.healthpol.2025.105312","DOIUrl":"10.1016/j.healthpol.2025.105312","url":null,"abstract":"<div><div>Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent — and how — subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"156 ","pages":"Article 105312"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837920","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":"Time to completion of conditions required by Health Canada after approving new drugs: A cohort study","authors":"Joel Lexchin","doi":"10.1016/j.healthpol.2025.105314","DOIUrl":"10.1016/j.healthpol.2025.105314","url":null,"abstract":"<div><h3>Background</h3><div>To ensure that promising drugs for serious illnesses reach Canadians in a timely manner, Health Canada can approve them conditionally provided companies commit to conducting confirmatory studies to verify the benefits.</div></div><div><h3>Objective</h3><div>To determine how long it takes until the conditions are fulfilled and if certain factors affect that length of time.</div></div><div><h3>Methods</h3><div>A list of conditional approvals for new drugs and new indications for existing drugs to the end of 2024 was compiled from Health Canada databases. Orphan drug status was determined from the US Food and Drug Administration databases. Kaplan-Meier survival curves were constructed to determine how long it took to complete the studies.</div></div><div><h3>Results</h3><div>There were 153 conditional approvals: 91 were fulfilled, 45 have not been fulfilled as of January 18, 2025 and 17 were withdrawn. The median time for fulfillment was 1200 (IQR 777, 1852) days. Orphan drug status and whether the conditional approval was for a new drug or a new indication for an existing drug did not affect the time to completion.</div></div><div><h3>Conclusions</h3><div>Some NOC/c take considerable time to be fulfilled. Health Canada should require studies to be underway at the time that a NOC/c is granted except in exceptional circumstances and it should be transparent about the completion date for confirmatory studies and provided detailed reports about any delays. In the case of delays that cannot be justified it should be given the power to impose significant financial penalties on manufacturers through the NOC/c pathway being converted from a policy into legislation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"155 ","pages":"Article 105314"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799349","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}