Journal of multimorbidity and comorbidity最新文献

{"title":"Synergistic interactions of obesity with sex, education, and smoking and accumulation of multi-morbidity (MM) across the lifespan.","authors":"Jennifer L St Sauver,&nbsp;Brandon R Grossardt,&nbsp;Alanna M Chamberlain,&nbsp;Ekta Kapoor,&nbsp;Walter A Rocca","doi":"10.1177/26335565231160139","DOIUrl":"https://doi.org/10.1177/26335565231160139","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity is a potentially modifiable risk factor that has been consistently associated with the development and progression of multi-morbidity (MM). However, obesity may be more problematic for some persons compared to others because of interactions with other risk factors. Therefore, we studied the effect of interactions between patient characteristics and overweight and obesity on the rate of accumulation of MM.</p><p><strong>Methods: </strong>We studied 4 cohorts of persons ages 20-, 40-, 60-, and 80-years residing in Olmsted County, Minnesota between 2005 and 2014 using the Rochester Epidemiology Project (REP) medical records-linkage system. Body mass index, sex, race, ethnicity, education, and smoking status were extracted from REP indices. The rate of accumulation of MM was calculated as the number of new chronic conditions accumulated per 10 person years through 2017. Poisson rate regression models were used to identify associations between characteristics and rate of MM accumulation. Additive interactions were summarized using relative excess risk due to interaction, attributable proportion of disease, and the synergy index.</p><p><strong>Results: </strong>Greater than additive synergistic associations were observed between female sex and obesity in the 20- and 40-year cohorts, between low education and obesity in the 20-year cohort (both sexes), and between smoking and obesity in the 40-year cohort (both sexes).</p><p><strong>Conclusions: </strong>Interventions targeted at women, persons with lower education, and smokers who also have obesity may result in the greatest reduction in the rate of MM accumulation. However, interventions may need to focus on persons prior to mid-life to have the greatest effect.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231160139"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/26/10.1177_26335565231160139.PMC9969451.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9512946","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":"Enhanced Care Planning Study: Patient Needs, Care Plan Topics, and Health-Related Quality of Life","authors":"Kristen O’Loughlin, Alicia Richards, Roy T. Sabo, J. Hinesley, Jacqueline B. Britz, Paulette Kashiri, Benjamin Webel, A. Huebschmann, A. Krist","doi":"10.1370/afm.21.s1.4058","DOIUrl":"https://doi.org/10.1370/afm.21.s1.4058","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84985587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the variability of multiple daily symptoms over time among individuals with multiple long-term conditions (MLTC-M/multimorbidity): An exploratory analysis of a longitudinal smartwatch feasibility study.","authors":"Khalid Kazi,&nbsp;Syed Mustafa Ali,&nbsp;David A Selby,&nbsp;John McBeth,&nbsp;Sabine van der Veer,&nbsp;William G Dixon","doi":"10.1177/26335565221150129","DOIUrl":"https://doi.org/10.1177/26335565221150129","url":null,"abstract":"<p><strong>Introduction: </strong>People living with multiple long-term conditions (MLTC-M) (multimorbidity) experience a range of inter-related symptoms. These symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices, and then summarised to provide useful clinical insight.</p><p><strong>Aim: </strong>We aimed to perform an exploratory analysis to summarise the extent and trajectory of multiple symptom ratings tracked via a smartwatch, and to investigate the relationship between these symptom ratings and demographic factors in people living with MLTC-M in a feasibility study.</p><p><strong>Methods: </strong>'Watch Your Steps' was a prospective observational feasibility study, administering multiple questions per day over a 90 day period. Adults with more than one clinician-diagnosed long-term condition rated seven core symptoms each day, plus up to eight additional symptoms personalised to their LTCs per day. Symptom ratings were summarised over the study period at the individual and group level. Symptom ratings were also plotted to describe day-to-day symptom trajectories for individuals.</p><p><strong>Results: </strong>Fifty two participants submitted symptom ratings. Half were male and the majority had LTCs affecting three or more disease areas (N = 33, 64%). The symptom rated as most problematic was fatigue. Patients with increased comorbidity or female sex seemed to be associated with worse experiences of fatigue. Fatigue ratings were strongly correlated with pain and level of dysfunction.</p><p><strong>Conclusion: </strong>In this study we have shown that it is possible to collect and descriptively analyse self reported symptom data in people living with MLTC-M, collected multiple times per day on a smartwatch, to gain insights that might support future clinical care and research.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565221150129"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9588276","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":"Multimorbidity transitions and the associated healthcare cost among the Finnish adult population during a two-year follow-up.","authors":"Katja Wikström,&nbsp;Miika Linna,&nbsp;Eeva Reissell,&nbsp;Tiina Laatikainen","doi":"10.1177/26335565231202325","DOIUrl":"https://doi.org/10.1177/26335565231202325","url":null,"abstract":"<p><strong>Background: </strong>Ageing of the population increases the prevalence and coexistence of many chronic diseases; a condition called multimorbidity. In Finland, information on the significance of multimorbidity and its relation to the sustainability of healthcare is scarce.</p><p><strong>Aim: </strong>To assess the prevalence of multimorbidity, the transitions between patient groups with and without multiple diseases and the associated healthcare cost in Finland in 2017-2019.</p><p><strong>Methods: </strong>A register-based cohort study covering all adults (<i>n</i> = 3,326,467) who used Finnish primary or specialised healthcare services in 2017. At baseline, patients were classified as 'non-multimorbid', 'multimorbid' or 'multimorbid at risk' based on the recordings of a diagnosis of interest. The costs were calculated using the care-related patient grouping and national standard rates. Transition plots were drawn to observe the transition of patients and costs between groups during the two-year follow-up.</p><p><strong>Results: </strong>At baseline, 62% of patients were non-multimorbid, 23% multimorbid and 15% multimorbid at risk. In two years, the proportion of multimorbid patients increased, especially those at risk. Within the multimorbid at-risk group, total healthcare costs were greatest (€5,027 million), accounting for 62% of the total healthcare cost of the overall patient cohort in 2019. Musculoskeletal diseases, cardiometabolic diseases and tumours were the most common and expensive chronic diseases contributing to the onset of multimorbidity.</p><p><strong>Conclusion: </strong>Multimorbidity is causing a heavy burden on Finnish healthcare. The estimates of its effect on healthcare usage and costs should be used to guide healthcare planning.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231202325"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10260658","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":"Putting Patients’ Goals First: Learnings from Primary Care Stakeholders","authors":"Dagje Boeykens","doi":"10.1370/afm.21.s1.3900","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3900","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81300584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Care Fragmentation with Polypharmacy and Inappropriate Medication Among Older Adults with Multimorbidity","authors":"T. Ando, Yukiko Abe, Y. Arai, Takashi Sasaki, Seitarou Fujishima","doi":"10.1370/afm.21.s1.3570","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3570","url":null,"abstract":"Context: Fragmentation of care is associated with worse prognosis and higher health care costs in several conditions such as malignancy. Caring for older adults with multimorbidity often requires the involvement of multiple specialists, but the impact of fragmentation of care in older adults with multimorbidity remains unclear. In Japan, the healthcare insurance system guarantees free access, allowing patients to freely see specialists, which can easily lead to fragmentation of care. Objective: To determine how the fragmentation of care is associated with polypharmacy, potentially inappropriate prescribing, and health care costs in older adults. Study Design: An observational cross-sectional study using the baseline survey and claims data of the Cohort study. (The Kawasaki Aging and Wellbeing Project ） Setting or Dataset: Community-dwelling people. Population studied: Independent elderly aged 85-89 living in Kawasaki city, Japan. Outcome Measures: The primary outcome was the number of regularly prescribed drugs extracted from claims data. The number of potentially inappropriate drugs for the elderly and the outpatient medical care cost were used as secondary outcomes. Results: There were a total of 1026 study participants, with a 1:1 sex ratio; the mean age was 86.6 years. 650(63.4%) participants regularly visited two or more outpatient clinics. The average number of prescribed drugs was 5.3, and the more clinics a patient visited, the more drugs were prescribed. The odds ratio for polypharmacy, defined as six or more regular prescribed medications, tended to be significantly higher with more visiting clinics, even after adjusted with the number of comorbid chronic illnesses. The number of potentially inappropriate drug prescriptions for the elderly increased with the number of clinics visited. When adjusted for the number of chronic conditions, there was no significant correlation between the fragmentation of care and the number of potentially inappropriate","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79608457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The multidisciplinary team in diagnosing and treatment of patients with diabetes and comorbidities: A scoping review.","authors":"Jonas Dahl Andersen,&nbsp;Morten Hasselstrøm Jensen,&nbsp;Peter Vestergaard,&nbsp;Vigga Jensen,&nbsp;Ole Hejlesen,&nbsp;Stine Hangaard","doi":"10.1177/26335565231165966","DOIUrl":"https://doi.org/10.1177/26335565231165966","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary Teams (MDTs) has been suggested as an intervention to overcome some of the complexities experienced by people with diabetes and comorbidities in terms of diagnosis and treatment. However, evidence concerning MDTs within the diabetes field remains sparse.</p><p><strong>Objective: </strong>This review aims to identify and map available evidence on key characteristics of MDTs in the context of diagnosis and treatment in people with diabetes and comorbidities.</p><p><strong>Methods: </strong>This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and CINAHL were systematically searched for studies assessing any type of MDT within the context of diagnosis and treatment in adult people (≥ 18 years) with diabetes and comorbidities/complications. Data extraction included details on study characteristics, MDT interventions, digital health solutions, and key findings.</p><p><strong>Results: </strong>Overall, 19 studies were included. Generally, the MDTs were characterized by high heterogeneity. Four overall components characterized the MDTs: Both medical specialists and healthcare professionals (HCPs) of different team sizes were represented; interventions spanned elements of medication, assessment, nutrition, education, self-monitoring, and treatment adjustment; digital health solutions were integrated in 58% of the studies; MDTs were carried out in both primary and secondary healthcare settings with varying frequencies. Generally, the effectiveness of the MDTs was positive across different outcomes.</p><p><strong>Conclusions: </strong>MDTs are characterized by high diversity in their outline yet seem to be effective and cost-effective in the context of diagnosis and treatment of people with diabetes and comorbidities. Future research should investigate the cross-sectorial collaboration to reduce care fragmentation and enhance care coordination.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231165966"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/65/10.1177_26335565231165966.PMC10031602.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9191336","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":"Convergence of four measures of multi-morbidity.","authors":"Brandon R Grossardt,&nbsp;Alanna M Chamberlain,&nbsp;Cynthia M Boyd,&nbsp;William V Bobo,&nbsp;Jennifer L St Sauver,&nbsp;Walter A Rocca","doi":"10.1177/26335565221150124","DOIUrl":"https://doi.org/10.1177/26335565221150124","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the agreement between percentile ranks from 4 multi-morbidity scores.</p><p><strong>Design: </strong>Population-based descriptive study.</p><p><strong>Setting: </strong>Olmsted County, Minnesota (USA).</p><p><strong>Participants: </strong>We used the medical records-linkage system of the Rochester Epidemiology Project (REP; http://www.rochesterproject.org) to identify all residents of Olmsted County, Minnesota who reached one or more birthdays between 1 January 2005 and 31 December 2014 (10 years).</p><p><strong>Methods: </strong>For each person, we calculated 4 multi-morbidity scores using readily available diagnostic code lists from the US Department of Health and Human Services, the Clinical Classifications Software, and the Elixhauser Comorbidity Index. We calculated scores using diagnostic codes received in the 5 years before the index birthday and fit quantile regression models across age and separately by sex to transform unweighted, simple counts of conditions into percentile ranks as compared to peers of same age and of same sex. We compared the percentile ranks of the 4 multi-morbidity scores using intra-class correlation coefficients (ICCs).</p><p><strong>Results: </strong>We assessed agreement in 181,553 persons who reached a total of 1,075,433 birthdays at ages 18 years through 85 years during the study period. In general, the percentile ranks of the 4 multi-morbidity scores exhibited high levels of agreement in 6 score-to-score pairwise comparisons. The agreement increased with older age for all pairwise comparisons, and ICCs were consistently greater than 0.65 at ages 50 years and older.</p><p><strong>Conclusions: </strong>The assignment of percentile ranks may be a simple and intuitive way to assess the underlying trait of multi-morbidity across studies that use different measures.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565221150124"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/f6/10.1177_26335565221150124.PMC9813979.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540556","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 DynAIRx Project Protocol: Artificial Intelligence for dynamic prescribing optimisation and care integration in multimorbidity.","authors":"Lauren E Walker, Aseel S Abuzour, Danushka Bollegala, Andrew Clegg, Mark Gabbay, Alan Griffiths, Cecil Kullu, Gary Leeming, Frances S Mair, Simon Maskell, Samuel Relton, Roy A Ruddle, Eduard Shantsila, Matthew Sperrin, Tjeerd Van Staa, Alan Woodall, Iain Buchan","doi":"10.1177/26335565221145493","DOIUrl":"10.1177/26335565221145493","url":null,"abstract":"<p><strong>Background: </strong>Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Plan for medicines optimisation in people living with multiple long-term conditions and polypharmacy. It is challenging to gather the information needed for these reviews due to poor integration of health records across providers and there is little guidance on how to identify those patients most urgently requiring review.</p><p><strong>Objective: </strong>To extract information from scattered clinical records on how health and medications change over time, apply interpretable artificial intelligence (AI) approaches to predict risks of poor outcomes and overlay this information on care records to inform SMRs. We will pilot this approach in primary care prescribing audit and feedback systems, and co-design future medicines optimisation decision support systems.</p><p><strong>Design: </strong>DynAIRx will target potentially problematic polypharmacy in three key multimorbidity groups, namely, people with (a) mental and physical health problems, (b) four or more long-term conditions taking ten or more drugs and (c) older age and frailty. Structured clinical data will be drawn from integrated care records (general practice, hospital, and social care) covering an ∼11m population supplemented with Natural Language Processing (NLP) of unstructured clinical text. AI systems will be trained to identify patterns of conditions, medications, tests, and clinical contacts preceding adverse events in order to identify individuals who might benefit most from an SMR.</p><p><strong>Discussion: </strong>By implementing and evaluating an AI-augmented visualisation of care records in an existing prescribing audit and feedback system we will create a learning system for medicines optimisation, co-designed throughout with end-users and patients.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221145493"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9761229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10785864","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":"Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults.","authors":"Ana R Quiñones, Corey L Nagel, Anda Botoseneanu, Jason T Newsom, David A Dorr, Jeffrey Kaye, Stephen M Thielke, Heather G Allore","doi":"10.1177/26335565221143012","DOIUrl":"10.1177/26335565221143012","url":null,"abstract":"<p><strong>Background: </strong>Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.</p><p><strong>Methods: </strong>We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.</p><p><strong>Results: </strong>We identified four distinct multidimensional trajectory groups: (1) <i>Minimal Impairment with Low Multimorbidity</i> (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) <i>Minimal Impairment with High Multimorbidity</i> (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) <i>Multidomain Impairment with Intermediate Multimorbidity</i> (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) <i>Multidomain Impairment with High Multimorbidity</i> (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two <i>Multidomain Impairment</i> classes.</p><p><strong>Conclusions: </strong>There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221143012"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/eb/10.1177_26335565221143012.PMC9720836.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10260374","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}