Lancet Public Health最新文献

{"title":"Three decades of population health changes in Japan, 1990–2021: a subnational analysis for the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s2468-2667(25)00044-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00044-1","url":null,"abstract":"<h3>Background</h3>Given Japan's rapidly ageing demographic structure, comprehensive and long-term evaluations of its national and subnational health progress are important to inform public health policy. This study aims to assess Japan's population health, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to analyse the country's evolving disease patterns.<h3>Methods</h3>GBD 2021 used Japanese data from 1474 sources, covering 371 diseases, including COVID-19, and 88 risk factors. The analysis included estimates of life expectancy, mortality, and disability-adjusted life-years (DALYs). Estimates were generated using the standardised GBD methodology, which incorporates various data sources through statistical modelling, including the Cause Of Death Ensemble Model for mortality, Bayesian Meta-Regression Disease Model for non-fatal outcomes, and risk factor estimation frameworks to quantify attributable burdens. Life expectancy decomposition by cause of death and annualised rates of change of age-standardised mortality and DALYs were calculated for 1990–2005, 2005–15, and 2015–21.<h3>Findings</h3>Between 1990 and 2021, life expectancy in Japan rose from 79·4 years (95% uncertainty interval 79·3–79·4) to 85·2 years (85·1–85·2), with prefecture-level disparities widening. Gains were primarily driven by reduced mortality from stroke (adding 1·5 years to life expectancy), ischaemic heart disease (1·0 years), and neoplasms, particularly stomach cancer (0·5 years), with variation across prefectures. Leading causes of death in 2021 were Alzheimer's disease and other dementias (135·3 deaths [39·5–312·3] per 100 000 population), stroke (114·9 [89·8–129·3] per 100 000), ischaemic heart disease (96·5 [77·7–106·7] per 100 000), and lung cancer (72·1 [61·8–77·5] per 100 000). Age-standardised mortality for major non-communicable diseases declined, but the pace of this decline has slowed. All-cause annualised rate of change in mortality rate decreased from –1·6% for 2005–15 to –1·1% for 2015–21. Age-standardised COVID-19 mortality rates were 0·8 deaths (0·7–0·9) per 100 000 population (accounting for 0·3% of all deaths) in 2020 and 3·0 (2·5–3·7) per 100 000 population in 2021 (1·0% of deaths). Age-standardised DALY rates for diabetes worsened, with annualised rate of change increasing from 0·1% for 2005–15 to 2·2% for 2015–21. This change parallels worsening trends in major risk factors, particularly high fasting plasma glucose (annualised rate of change of attributable DALYs –0·8% for 2005–15 and 0·8% for 2015–21) and high BMI (0·2% and 1·4%, respectively). Age-standardised DALYs attributable to other major risk factors continued to decrease, albeit slower.<h3>Interpretation</h3>Japan's health gains over the past 30 years are now stalling, with rising regional disparities. The increasing burdens of Alzheimer's disease and other dementias and diabetes, alongside high fasting plasma glucose and high BMI, highlight areas needing focus","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"1 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion care in Alberta, Canada, from 2012 to 2023: a population-based, cross-sectional analysis of use and geographical access","authors":"Erin A Brennand, Beili Huang, Natalie V Scime, Jadine Paw, Erin L Nelson","doi":"10.1016/s2468-2667(25)00010-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00010-6","url":null,"abstract":"<h3>Background</h3>Equitable access to abortion care remains a challenge in public health. Current Canadian abortion reporting overlooks modern practices such as mifepristone medication abortion and has no access and equity metrics. We aimed to comprehensively analyse abortion care provision in Alberta (the fourth largest province in Canada, home to more than 4 million people) focusing on temporal trends in annual abortion rates and access disparities.<h3>Methods</h3>In this population-based, repeated cross-sectional study using linked administrative databases (Practitioner Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, and Pharmaceutical Information Network) in Alberta, Canada, we examined abortion use across the province over a 10-year period. Our data included all females of reproductive age (12–49 years) who received abortion care from Jan 1, 2012, to June 30, 2023. The primary outcome was abortion rate, calculated as the annual number of abortions per 1000 females of reproductive age (15–49 years), trimming data for those younger than 15 years. We descriptively analysed abortions (procedural, medication, and induction of labour) using temporal and geospatial analysis by Alberta's five geographical zones and 35 subzones.<h3>Findings</h3>During the study period, 130 755 abortions occurred in Alberta, of which 120 326 (92·0%) were procedural (118 063 [98·1%] of 120 326 first trimester; 2263 [1·9%] second trimester), 7395 (5·7%) were medication abortions, and 3034 (2·3%) were induction of labour. Abortion declined steadily between 2012 and 2023, with a change of –0·42 abortions per 1000 reproductive-aged females per year (95% CI –0·49 to –0·36). Medication abortion increased following the introduction of mifepristone and comprised 1489 (13·8%) of 10 765 abortions by 2022. Nearly all (8440 [99·7%] of 8462) procedural abortions in 2022 were provided in Edmonton and Calgary. 14 882 (11·5%) of 129 527 individuals accessing abortion in Alberta travelled more than 3 h from home to receive care; 18 864 (14·6%) travelled more than 200 km.<h3>Interpretation</h3>Our findings suggest that annual rates of abortion in Alberta are declining; however, overall access to abortion care has minimally improved in the past decade. Abortion in Alberta remains highly procedural and concentrated in Alberta's two major cities, resulting in poor access outside metropolitan centres. Mismatch between use of abortion care and local provision of care results in substantial travel. Policy should focus on expansion of patient-preferred, evidence-based medication abortion services.<h3>Funding</h3>Canadian Institutes of Health Research; Women and Gender Equality Canada","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"49 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to tackle obesogenic environments","authors":"","doi":"10.1016/s2468-2667(25)00049-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00049-0","url":null,"abstract":"March 4th is <span><span>World Obesity Day</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, a unified day of action calling for a response to the obesity crisis. Obesity is one of the most concerning public health crises globally. According to <span><span>WHO</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, since 1990, obesity has more than doubled in adults and quadrupled in adolescents. In 2022, 2·5 billion adults had overweight, including 890 million with obesity, and 390 million children and adolescents aged 5–19 years had overweight, including 160 million with obesity. Overweight and obesity are associated with other major chronic diseases such as type 2 diabetes, coronary heart disease, stroke, hypertension, and cancer. 1·9 billion people are projected to be living with obesity by 2035, including a doubling of childhood obesity from 2020 levels by 2035. Urgent response and action by stakeholders needs to be prioritised to prevent this worsening health crisis.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"28 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The responsibility of health: shifting the focus from individuals to systems","authors":"Sandy Tubeuf, Alejandro Valdivia, Lara Tavoschi, Jean-Philippe Empana, Eivind Engebretsen","doi":"10.1016/s2468-2667(25)00013-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00013-1","url":null,"abstract":"Social determinants of health, although widely acknowledged, tend to be poorly translated into policy. Health programme initiatives too often underline individual accountability, which reinforces a flawed narrative that overlooks structural barriers—poverty, inequitable access to resources, unsafe environments, and harmful commercial practices—which shape health behaviours.<span><span>¹</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"34 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to abortion in Canada","authors":"Martha Jane Paynter","doi":"10.1016/s2468-2667(25)00041-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00041-6","url":null,"abstract":"The study in <em>The Lancet Public Health</em> by Erin Brennand and colleagues<span><span>¹</span></span> looking at abortion care in Alberta, Canada, tests an optimistic hypothesis held by many, that the 2017 implementation and deregulation of mifepristone for medication abortion would substantially improve access to care. Until 2017, abortion in Canada was almost exclusively available through procedures carried out by physicians in urban centres.<span><span>²</span></span> Using Ontario population-based administration data from 2012 to 2020, Schummers and colleagues<span><span>³</span></span> found that after its introduction, medication abortion increased rapidly as a proportion of abortion overall. In 2019, Renner and colleagues<span><span>⁴</span></span> surveyed Canada's abortion workforce and found 83% of the 465 respondents reported providing first-trimester medication abortion. Furthermore, nurse practitioners constituted 6% of respondents, and 44% of abortion in rural areas was through medication abortion. These studies pointed to the effect that medication abortion was swiftly making on practice. By 2022, the Canadian Institute of Health Information reported that 39·5% of abortion across the country was by medication.<span><span>⁵</span></span> But was that effect equal across populations? Brennand and colleagues provide an overview of changing abortion care in Alberta specifically.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"29 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health in Germany: structures, dynamics, and ways forward","authors":"Hajo Zeeb, Julika Loss, Dagmar Starke, Thomas Altgeld, Susanne Moebus, Karin Geffert, Ansgar Gerhardus","doi":"10.1016/s2468-2667(25)00033-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00033-7","url":null,"abstract":"Despite Germany's robust economy, comprehensive social welfare system, and the country ranking third among Organisation for Economic Co-operation and Development countries in terms of per-capita health spending, its health indicators still lag behind those of other European nations. Germany also has one of the highest prevalences of major modifiable risk factors for non-communicable diseases within the EU. This Health Policy provides an overview of the development, structures, and actors in public health in Germany, highlighting possible explanations for the country's underperforming health indicators and suggesting a way forward. This Health Policy is structured along the essential public health operations. We identify the absence of a strong central institution for public health, inadequate funding for disease prevention and health promotion, and little interoperability in data collection as major challenges. The country's decentralised governance structure allows flexibility, especially at the community level, but leads to scattered responsibilities and little coordination between sectors. We also note the absence of a public health strategy. The current system's focus on curative care and individualised medicine has led to a neglect of disease prevention and health promotion. Furthermore, the country's strong economic interests and powerful lobbies have hindered the implementation of effective public health policies. To address these challenges, we recommend developing a public health identity, creating a comprehensive public health strategy, fostering a culture of health promotion and disease prevention that encompasses all areas and does not shy away from tackling the commercial determinants of health, and strengthening the connection between medicine, public health practice, and research.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"6 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer screening inequities and people with intellectual disabilities—what should we do to close the gaps?","authors":"Hannah Kuper, Luthfi Azizatunnisa’","doi":"10.1016/s2468-2667(25)00037-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00037-4","url":null,"abstract":"Evidence from electronic health records is transforming what we know about the health inequalities experienced by people with disabilities. In <em>The Lancet Public Health</em>, Amina Banda and colleagues produced another excellent example of this approach, using large-scale data from the Netherlands to demonstrate that participation in cancer screening programmes is around 20% lower for people with intellectual disabilities than in the general population.<span><span>¹</span></span> The inequities were remarkably similar across the breast, cervical, and colon cancer screening programmes, even though the programmes are different in terms of targeted age and gender, and the demands placed on the participant. The findings are also consistent with reports from elsewhere, despite the divergence in how the screening programmes operate and target participants in different countries.<span><span>²</span></span> This Article also adds a piece to the puzzle of explaining why people with intellectual disabilities are dying earlier than the general population.<span><span>³</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"190 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer screening participation and outcomes among people with an intellectual disability in the Netherlands: a cross-sectional population-based study","authors":"Amina Banda, Maarten Cuypers, Jenneken Naaldenberg, Aura Timen, Geraline Leusink","doi":"10.1016/s2468-2667(25)00011-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00011-8","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;People with an intellectual disability face diverse health disparities, including challenges accessing cancer care. In the Netherlands, as in many other countries, there are national screening programmes for early detection of breast, cervical, and colon cancer. These programmes were, however, initially introduced for the general population, and they often fail to meet the needs of the population with intellectual disability. This study aimed to assess participation rates and screening outcomes of these screening programmes for the population with intellectual disability compared with the general population.&lt;h3&gt;Methods&lt;/h3&gt;In this cross-sectional population-based study, we identified adults (age &gt;18 years) with intellectual disability and matched them at a 1:4 ratio to individuals from the general population from Jan 1, 2015, to Dec 31, 2021, in the Netherlands. National long-term care and supportive databases were used to identify people with an intellectual disability, which were matched to the database for the national cancer screening programmes based on age and gender. The primary outcome was to assess the participation rates for the national breast cancer, cervical cancer, and colon cancer screening programmes. We also assessed whether the screening outcomes were favourable or not in the group with intellectual disability compared with the general population.&lt;h3&gt;Findings&lt;/h3&gt;We identified 187 149 people with intellectual disability and 760 907 individuals from the general population, of whom 100 204 individuals with intellectual disability and 480 103 individuals from the general population were invited at least once for cancer screening during follow-up. Individuals with intellectual disability, compared with the general population, have significantly lower participation rates for cervical cancer screening (45·2% &lt;em&gt;vs&lt;/em&gt; 68·1%; adjusted odds ratio 0·38 [95% CI 0·38–0·39], p&lt;0·0001), breast cancer screening (55·5% &lt;em&gt;vs&lt;/em&gt; 76·0%; 0·40 [0·39–0·41], p&lt;0·0001), and colon cancer screening (51·7% &lt;em&gt;vs&lt;/em&gt; 72·7%; 0.40 [0·41–0·42], p&lt;0·0001). Although cancer screening outcomes are similar for people in both cohorts, the prevalence of invalid (insufficient sample) outcomes was higher among people with intellectual disability than the general population for breast cancer screening (0·9% &lt;em&gt;vs&lt;/em&gt; &lt;0·1%, 41·90 [30·35–57·92], p&lt;0·0001) and cervical cancer screening (0·2% &lt;em&gt;vs&lt;/em&gt; &lt;0·1%, 5·43 [3·59–8·19], p&lt;0·0001). Additionally, unreliable screening outcomes for colon cancer were more frequent in the population with intellectual disability than the general population (unreliable favourable outcomes 4·90 [4·55–5·83], p&lt;0·0001; unreliable unfavourable outcomes 2·79 [2·37–3·39], p&lt;0·0001).&lt;h3&gt;Interpretation&lt;/h3&gt;For all three cancer screening programmes, participation is significantly lower, with more invalid screening outcomes among individuals with intellectual disability. This finding indi","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"9 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in public health: promises, challenges, and an agenda for policy makers and public health institutions","authors":"Dimitra Panteli, Keyrellous Adib, Stefan Buttigieg, Francisco Goiana-da-Silva, Katharina Ladewig, Natasha Azzopardi-Muscat, Josep Figueras, David Novillo-Ortiz, Martin McKee","doi":"10.1016/s2468-2667(25)00036-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00036-2","url":null,"abstract":"Artificial intelligence (AI) can rapidly analyse large and complex datasets, extract tailored recommendations, support decision making, and improve the efficiency of many tasks that involve the processing of data, text, or images. As such, AI has the potential to revolutionise public health practice and research, but accompanying challenges need to be addressed. AI can be used to support public health surveillance, epidemiological research, communication, the allocation of resources, and other forms of decision making. It can also improve productivity in daily public health work. Core challenges to its widespread adoption span equity, accountability, data privacy, the need for robust digital infrastructures, and workforce skills. Policy makers must acknowledge that robust regulatory frameworks covering the lifecycle of relevant technologies are needed, alongside sustained investment in infrastructure and workforce development. Public health institutions can play a key part in advancing the meaningful use of AI in public health by ensuring their staff are up to date regarding existing regulatory provisions and ethical principles for the development and use of AI technologies, thinking about how to prioritise equity in AI design and implementation, investing in systems that can securely process the large volumes of data needed for AI applications and in data governance and cybersecurity, promoting the ethical use of AI through clear guidelines that align with human rights and the public good, and considering AI's environmental impact.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"86 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards opioid access without excess","authors":"William E Rosa, Felicia Marie Knaul, Michael Touchton, Afsan Bhadelia, Keith Humphreys, Lukas Radbruch, M R Rajagopal","doi":"10.1016/s2468-2667(25)00035-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00035-0","url":null,"abstract":"A decade after World Health Assembly Resolution 67.19 recognised palliative care as a component of comprehensive care and universal health coverage throughout the life course, a balanced approach to opioid access remains elusive. Disparities in the alleviation of serious health-related suffering persist, characterised by two parallel opioid-related public health crises: a pandemic of unrelieved pain and an opioid addiction epidemic. The pain pandemic is largely driven by the opioid access abyss and primarily affects over 50 million people with serious health-related suffering living in low-income and middle-income countries. Conversely, several high-income countries have been affected by an opioid addiction epidemic. An estimated 39·5 million people struggle with opioid use disorder worldwide, the vast majority living in North America. In this Viewpoint, we describe these parallel crises, argue for pain relief as a global public good, and identify stewardship roles of WHO member states and local actors to use a balanced approach in galvanising the global health system to simultaneously close the global pain divide and move towards opioid access without excess in alignment with Sustainable Development Goal targets focused on the prevention of substance abuse (3.5) and universal health coverage (3.8).","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"185 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}