Journal of Appalachian health最新文献

{"title":"Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents.","authors":"Brittany L Smalls, Oluwatosin Leshi, Suraksha Khanal, Grejika E Abram-Erby","doi":"10.13023/jah.0801.06","DOIUrl":"10.13023/jah.0801.06","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.</p><p><strong>Purpose: </strong>To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program's effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed. Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, tailored educational intervention, this study used linear mixed models to assess the associations with clinical outcomes, knowledge, self-care, attitudes, and social support post intervention.</p><p><strong>Results: </strong>Eighteen respondents consented to participate in the study (mean age: 58.3 years). Diabetes knowledge and attitudes improved significantly at six months post intervention. Positive changes in social support were also noted in that time frame. Self-care behaviors remained consistent post intervention, yet key metabolic outcomes (e.g., HbA1c, triglycerides, and BMI) decreased significantly.</p><p><strong>Implications: </strong>Few studies have examined the effectiveness of a self-management intervention tailored for older, rural-dwelling Kentuckians living with T2D. With these promising results, tailored interventions that incorporate social support and social determinants of health hold the potential to improve the health and quality of life of adults with diabetes, paving the way for innovative and sustainable approaches to diabetes care.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"69-84"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Covid-19 Vaccination Rates Among Pregnant Tennessee Women by Month of Conception and Urbanization Level: March 2021 - November 2021.","authors":"Claudia Valenzuela, Anne K Driscoll, Elizabeth Harvey, Heather Wingate","doi":"10.13023/jah.0801.07","DOIUrl":"10.13023/jah.0801.07","url":null,"abstract":"<p><strong>Introduction: </strong>Throughout the pandemic, COVID-19 vaccination coverage was lower for the general population living in rural counties than in urban counties. In Tennessee (TN), COVID-19 vaccinations became available to pregnant women in March 2021. Little is known about rates of COVID-19 vaccination in pregnancy during the pandemic, or whether these rates changed or differed by urbanization level.</p><p><strong>Purpose: </strong>The purpose of this study is to describe COVID-19 vaccination rates among pregnant women in TN by month of conception and urbanization level.</p><p><strong>Methods: </strong>COVID-19 vaccination data from the TN Immunization Information System and the TN Surveillance for Emerging Threats to Mothers and Babies Network for women who conceived between March - November 2021 were linked to birth data from the National Center for Health Statistics. Women were categorized based on the urbanization level of their county of residence.</p><p><strong>Results: </strong>Vaccination rates during pregnancy were highest for women in large central metropolitan counties and lowest for women in rural counties. Among women who conceived in March 2021, those living in urban counties were 1.5 - 2 times as likely to be vaccinated as those living in rural counties. From March - November 2021, declines in vaccination rates were observed for all urbanization levels with larger declines in urban counties. There was no significant difference in vaccination rates across all urbanization levels among women who conceived in November 2021.</p><p><strong>Implications: </strong>Differences noted in vaccination rates, particularly at the beginning of an outbreak, can help inform decision-makers on where and how to direct vaccination resources.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"85-95"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Systemic Challenges in the Western North Carolina Dental Safety Net: A Qualitative Analysis.","authors":"Blaire Mirmow, Bill Milner, Nadia Laniado","doi":"10.13023/jah.0801.04","DOIUrl":"10.13023/jah.0801.04","url":null,"abstract":"<p><strong>Introduction: </strong>Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.</p><p><strong>Purpose: </strong>This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 17 oral health stakeholders involved in the WNC dental safety-net system between June - August 2024. Interviews explored challenges to meeting community oral health needs and potential solutions. Data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Three major themes emerged: (1) workforce challenges involving dentists, hygienists, and dental assistants, (2) fragmentation between dental providers and the broader health care system, and (3) financial instability. Proposed solutions corresponding to each theme included streamlined credentialing and expanded allied health training programs to address workforce shortages, skills-based continuing education for public health dentists to reduce specialty referral gaps and fragmentation, and increased Medicaid reimbursement rates paired with coordinated policy advocacy to strengthen financial sustainability across the safety net.</p><p><strong>Implications: </strong>These findings suggest structural challenges facing rural safety-net programs and highlight opportunities to strengthen their capacity to meet growing community oral health needs.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"42-59"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Starting with Story, Not Symptom: Narrative Collapse and Cultural Repair in Appalachia.","authors":"Wayne Coombs","doi":"10.13023/jah.0801.01","DOIUrl":"10.13023/jah.0801.01","url":null,"abstract":"<p><p>Appalachia's opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, and restore belonging.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Hurricane Helene on Mental Health and Physical Activity.","authors":"Hunter Smathers, Robyn York, Jarrett Walbolt","doi":"10.13023/jah.0801.02","DOIUrl":"10.13023/jah.0801.02","url":null,"abstract":"<p><strong>Introduction: </strong>Hurricane Helene brought widespread damage to Southern Appalachia, disrupting utilities, health care, and recreation. While natural disasters are linked to declines in mental and physical health, few studies have examined their effects on distinct types of physical activity (PA).</p><p><strong>Purpose: </strong>This study evaluated the effects of Hurricane Helene on perceived stress, depressive symptoms, post-traumatic stress disorder (PTSD) symptomology, and intentional (exercise for health benefits) and incidental (physical labor or transportation) PA. Evacuation status influence was also explored.</p><p><strong>Methods: </strong>Twenty participants completed assessments four weeks before (BASE), immediately after (0POST), and four weeks after landfall (4POST). Measures included the Perceived Stress Scale (PSS), Patient Health Questionnaire-9 (PHQ-9), and the Impact of Event Scale-Revised (IES-R). PA was assessed via activity recalls.</p><p><strong>Results: </strong>PSS and PHQ-9 increased from BASE to 4POST (<i>p</i> = 0.002, <i>p</i> = 0.017; respectively). Overall PA levels remained stable, but incidental PA increased at 0POST among non-evacuated individuals (<i>p</i> = 0.002). Time evacuated negatively predicted hyperarousal (<i>p</i> = 0.007) and PSS change (<i>p</i> = 0.006). Baseline stress positively predicted intentional exercise at 0POST (<i>p</i> = 0.008), while higher PQH-9 at 4POST predicted reduced intentional exercise (<i>p</i> = 0.038).</p><p><strong>Implications: </strong>Hurricane Helene increased psychological distress in a rural Appalachian population. While incidental PA increased immediately post-Helene in non-evacuated individuals, it may have exposed them to ongoing stressors. Evacuation status influenced mental health outcomes, suggesting non-evacuated individuals may face greater psychological risks. Recovery efforts in Appalachian communities should prioritize mental health support, promote exercise behaviors, and ensure infrastructure for safe evacuation.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"8-21"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infective Endocarditis Hospitalizations in Kentucky, 2008-2018: Spatial and Temporal Trends.","authors":"Meera Marji, Steve Browning, W Jay Christian, Richard Charnigo, Steve W Leung, Anna Kucharska-Newton","doi":"10.13023/jah.0801.03","DOIUrl":"10.13023/jah.0801.03","url":null,"abstract":"<p><strong>Introduction: </strong>Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid epidemic. In 2016, Kentucky (KY) ranked among the top ten states for opioid-related overdose deaths, but limited data exist on IE trends in KY.</p><p><strong>Purpose: </strong>This study seeks to examine county-level spatial and temporal trends in IE hospitalization rates in KY.</p><p><strong>Methods: </strong>Hospital inpatient discharge data from 2008-2018 for KY residents aged 18 and older were analyzed. IE admissions and drug use status were identified using ICD-9 & 10 diagnosis codes. U.S. Census data calculated yearly IE hospitalization rates per 100,000 residents. Joinpoint regression identified periods with significant rate changes and calculated annual percent change (APC). Poisson modeling in SaTScan conducted spatiotemporal cluster analysis at the county level and calculated the relative risk (RR) of IE hospitalizations within identified clusters.</p><p><strong>Results: </strong>During 2008-2018, we observed 17,787 IE hospital admissions, including 3,577 associated with intravenous drug use (IDU-IE). Medicaid patients were more prevalent in the IDU-IE group compared to the non-IDU-IE group (75% vs. 15%). IDU-IE hospitalization rates increased from 1.2 to 27.3 per 100,000 residents between 2008 - 2018. Joinpoint regression for IDU-IE identified a significant upward trend from 2013-2018 with an APC of 71.3% (95% CI: 47.8, 98.5). The spatiotemporal analysis identified seven significant IE hospitalization clusters, with the largest (RR=2.06, p.</p><p><strong>Implications: </strong>IDU-IE hospitalization rates increased significantly from 2013-2018, while non-IDU-IE rates decreased over the study period.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"22-41"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Community Perspectives on Hurricane Helene in Western North Carolina.","authors":"Jennifer A Horney, Lilly Moreau, Search Wnc","doi":"10.13023/jah.0801.05","DOIUrl":"10.13023/jah.0801.05","url":null,"abstract":"<p><strong>Introduction: </strong>After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm's direct impacts.</p><p><strong>Purpose: </strong>The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.</p><p><strong>Methods: </strong>A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access to food, shelter, transportation, and health care as well as the successes and challenges to the coordination of multiple groups around hurricane response and recovery. Key informants in the two counties were invited to participate in an in-person interview. Recordings were inductively coded to identify themes.</p><p><strong>Results: </strong>Five themes were identified through analysis of 16 interview transcripts. These included (1) housing issues exacerbated by the storm, (2) challenges with communication during and after the storm, (3) challenges with transportation, (4) mental health impacts, and (5) food insecurity.</p><p><strong>Implications: </strong>As inland flooding associated with wetter tropical cyclones becomes more severe, the populations at risk of health and other impacts of this flooding will grow. Even in areas well-prepared and well-resourced for emergency response, the failure of essential infrastructure such as communications and transportation will limit effectiveness of response and recovery. Rural areas are at particular risk due to limited alternatives such as public transportation, affordable short-term housing, and limited access to broadband and Wi-Fi.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"8 1","pages":"60-68"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Breastfeeding Practices in Tennessee: Goals, Duration, and Reasons for Discontinuation.","authors":"Amir Alakaam, Chia-Lin Chang, Hannah Jeffery","doi":"10.13023/jah.0704.01","DOIUrl":"10.13023/jah.0704.01","url":null,"abstract":"<p><strong>Introduction: </strong>Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.</p><p><strong>Purpose: </strong>The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).</p><p><strong>Methods: </strong>A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June - September 2021. The data were entered and analyzed from September 2022 - March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.</p><p><strong>Results: </strong>About 32% of the participants did not meet their goal to exclusively breastfeed for six months. Most participants reported that they chose to breastfeed due to benefits for the child (78.4%) and woman (62.1%). About 44% of the participants indicated that their healthcare provider promoted milk formula, and 41% did not feel comfortable breastfeeding in public. More than half of the participants reported not receiving education on the benefits of breastfeeding from their healthcare provider. Findings showed a significant relationship between discontinuing exclusive breastfeeding early and not receiving support from hospital maternity staff (X2 (1, N = 403) = 7.7, <i>p</i> < 0.05) and not feeling comfortable breastfeeding in public (X2 (1, N = 372) = 15.5, <i>p</i> < 0.001).</p><p><strong>Implications: </strong>Enhanced education and support from healthcare providers, along with efforts to normalize breastfeeding in public, are essential to improve breastfeeding outcomes and support individuals in achieving their breastfeeding goals.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"7 4","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Workshop on Rural Healthcare Delivery on Medical Student Attitudes.","authors":"Robert L Snedegar, Ryan Hayes, Jun Xiang, Treah Haggerty, Kendra Unger, Jason Oreskovich, Amie M Ashcraft","doi":"10.13023/jah.0704.06","DOIUrl":"10.13023/jah.0704.06","url":null,"abstract":"<p><strong>Introduction: </strong>Rural residents in the United States (U.S.) experience significant health disparities due to social determinants such as poverty, geographic isolation, and limited healthcare access. Physician shortages in rural areas further exacerbate these challenges.</p><p><strong>Purpose: </strong>This study evaluates the impact of an educational workshop on medical students' attitudes toward rural healthcare barriers, aiming to determine whether targeted education can enhance their understanding and interest in rural practice.</p><p><strong>Methods: </strong>Third-year medical students at the West Virginia University School of Medicine participated in a workshop that included a 20-minute pre-recorded lecture and a 90-minute interactive virtual session. Pre- and post-surveys assessed students' attitudes toward rural healthcare challenges. Responses were analyzed using paired t-tests with Bonferroni correction (p < 0.0017), stratified by rural background.</p><p><strong>Results: </strong>Of 97 students who completed the baseline survey, 67 completed both pre- and post-surveys (69% completion rate). After applying Bonferroni correction, four significant changes emerged: students reported greater confidence in addressing rural patient concerns (4.07 v 2.99, p < 0.0001), increased support for exempting rural patients from strict appointment timing rules (4.15 v 3.42, p < 0.0001), greater flexibility regarding follow-up scheduling (2.30 v 2.84, p < 0.0001), and enhanced recognition of financial strain from travel to Morgantown (4.70 v 4.43, p < 0.0001). Students from non-rural backgrounds demonstrated the most pronounced improvements in understanding rural-specific healthcare barriers.</p><p><strong>Implications: </strong>The workshop effectively improved medical students' understanding of rural healthcare barriers, with particularly strong effects among students lacking prior rural exposure. These findings suggest that integrating structured educational experiences into medical curricula may enhance students' preparedness for rural practice and help address physician shortages in underserved areas. Future research should explore the long-term impact of such interventions on career choices.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"7 4","pages":"100-115"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hurricane Helene, One Year Later: Lived Experience.","authors":"Geraldine A Miller","doi":"10.13023/jah.0704.09","DOIUrl":"https://doi.org/10.13023/jah.0704.09","url":null,"abstract":"<p><p>Ashe County is located in the northwestern corner of North Carolina (NC), bordered by Virginia and Tennessee. The county is isolated, mountainous, and historically has lacked good highway access. Hurricane Helene, a category 4 hurricane at landfall, struck Western NC on September 27, 2024, resulting in flooding and wind damage that destroyed local communities in terms of land, homes, bridges, water, electricity, etc. with a damage of $59.6 billion.6 One year later, the recovery from the hurricane continues draining individuals and communities of their time, energy, and money. Geri Miller reflects on her hurricane impact experiences a year later. She is a psychologist that responded to 9/11 in New York as an American Red Cross (ARC) Disaster Mental Health Counselor (DMHC). At 70 years old, she lives in Ashe County along the New River.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"7 4","pages":"137-142"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}