Journal of multimorbidity and comorbidity最新文献

{"title":"The association between social care expenditure and multiple-long term conditions: A population-based area-level analysis.","authors":"Emeka Chukwusa,&nbsp;Paulino Font-Gilabert,&nbsp;Jill Manthorpe,&nbsp;Andrew Healey","doi":"10.1177/26335565231208994","DOIUrl":"https://doi.org/10.1177/26335565231208994","url":null,"abstract":"<p><strong>Background: </strong>Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure.</p><p><strong>Aim: </strong>To estimate the prevalence of MTLCs and association with English social care expenditure.</p><p><strong>Methods: </strong>Our study population included those aged ≥ 65 who died in England in the year 2018 with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (≥ 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics.</p><p><strong>Results: </strong>Of the 409551 deaths reported, 19.9% (n = 81395) had ≥ 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure.</p><p><strong>Conclusion: </strong>Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231208994"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415811","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":"Improving person-centered care for people with multimorbidity: the potential of participatory learning and action research.","authors":"Anne MacFarlane,&nbsp;Marianne McCallum,&nbsp;Moira Stewart","doi":"10.1177/26335565231207075","DOIUrl":"https://doi.org/10.1177/26335565231207075","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207075"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415810","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":"Self-concept in Adolescents with Physical-Mental Comorbidity.","authors":"Mark A Ferro,&nbsp;Megan Dol,&nbsp;Karen A Patte,&nbsp;Scott T Leatherdale,&nbsp;Lilly Shanahan","doi":"10.1177/26335565231211475","DOIUrl":"10.1177/26335565231211475","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept.</p><p><strong>Methods: </strong>Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures.</p><p><strong>Results: </strong>Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p < .001), but this association was not found among younger adolescents (B = -0.29, p = .680). A similar effect was found for SPPC among older (B = -0.48, p = .001) and younger adolescents (B = 0.03, p = .842). Adolescent sex was not found to be a moderator.</p><p><strong>Conclusions: </strong>Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age-differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231211475"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/5f/10.1177_26335565231211475.PMC10594959.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50164023","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":"Self-regulatory coping among community dwelling older adults with multiple chronic conditions.","authors":"Ayomide Okanlawon Bankole, Sara L Gill, Jenny McSharry, Carole L White, Chidinma Aniemeke, Sherrie Flynt Wallington, Dorothy Ewurabena Addo-Mensah, Carrie Jo Braden","doi":"10.1177/26335565231207538","DOIUrl":"10.1177/26335565231207538","url":null,"abstract":"<p><strong>Objectives: </strong>Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC.</p><p><strong>Methods: </strong>A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study.</p><p><strong>Results: </strong>Three themes were developed from the analysis: (1) <i>\"I don't think about it unless something happens\":</i> coping in the absence of a health event, (2) <i>\"doing what I am supposed to do\"</i>: coping during a health event, and (3) <i>\"How do I know if what I did works?\":</i> appraisal of coping success.</p><p><strong>Discussion: </strong>Self-regulatory coping was influenced by individual beliefs and experiences (<i>illness representations</i>), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207538"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/fa/10.1177_26335565231207538.PMC10588418.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694884","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 and the need to rethink Medical Education.","authors":"Cara Bezzina,&nbsp;Lindsey Pope","doi":"10.1177/26335565231207811","DOIUrl":"10.1177/26335565231207811","url":null,"abstract":"The prevalence of patients experiencing multimorbidity is increasing year on year, accompanied by an expanding knowledge base in this field. Perhaps once considered the domain of geriatricians and general practitioners, all healthcare professionals are now likely to encounter, assess and manage patients living with multimorbidity as part of their daily practice. Despite our recognition and understanding of this changing profile of our patients, the evidence on how best to educate our healthcare workforce to meet the population’s needs lags behind.We propose that all healthcare education and training must give due consideration to the positioning of multimorbidity in their curricula and assessments. Furthermore, expertise from both educationalists and multimorbidity researchers will be required to inform key decisions.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207811"},"PeriodicalIF":0.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241826","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":"Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa.","authors":"Diego F Cuadros, Claudia M Moreno, Andrew Tomita, Urisha Singh, Stephen Olivier, Alison Castle, Yumna Moosa, Johnathan A Edwards, Hae-Young Kim, Mark J Siedner, Emily B Wong, Frank Tanser","doi":"10.1177/26335565231204119","DOIUrl":"10.1177/26335565231204119","url":null,"abstract":"<p><strong>Introduction: </strong>Several low-and middle-income countries are undergoing rapid epidemiological transition with a rising burden of non-communicable diseases (NCDs). South Africa (SA) is a country with one of the largest HIV epidemics worldwide and a growing burden of NCDs where the collision of these epidemics poses a major public health challenge.</p><p><strong>Methods: </strong>Using data from a large nationally representative survey, the South Africa Demographic and Health Survey (SADHS 2016), we conducted a geospatial analysis of several diseases including HIV, tuberculosis (TB), cardiovascular, respiratory, and metabolic diseases to identify areas with a high burden of co-morbidity within the country. We explored the spatial structure of each disease and associations between diseases using different spatial and visual data methodologies. We also assessed the individual level co-occurrence of HIV and the other diseases included in the analysis.</p><p><strong>Results: </strong>The spatial distribution for HIV prevalence showed that this epidemic is most intense in the eastern region of the country, mostly within the Gauteng, Mpumalanga, and Kwazulu-Natal provinces. In contrast, chronic diseases had their highest prevalence rates the southern region of the country, particularly in the Eastern and Western Cape provinces. Individual-level analyses were consistent with the spatial correlations and found no statistically significant associations between HIV infection and the presence of any NCDs.</p><p><strong>Conclusions: </strong>We found no evidence of geospatial overlap between the HIV epidemic and NCDs in SA. These results evidence the complex epidemiological landscape of the country, characterized by geographically distinct areas exhibiting different health burdens. The detailed description of the heterogenous prevalence of HIV and NCDs in SA reported in this study could be a useful tool to inform and direct policies to enhance targeted health service delivery according to the local health needs of each community.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231204119"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/5e/10.1177_26335565231204119.PMC10540575.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175027","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":"Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) - protocol for a research collaboration.","authors":"Simon Ds Fraser,&nbsp;Sebastian Stannard,&nbsp;Emilia Holland,&nbsp;Michael Boniface,&nbsp;Rebecca B Hoyle,&nbsp;Rebecca Wilkinson,&nbsp;Ashley Akbari,&nbsp;Mark Ashworth,&nbsp;Ann Berrington,&nbsp;Roberta Chiovoloni,&nbsp;Jessica Enright,&nbsp;Nick A Francis,&nbsp;Gareth Giles,&nbsp;Martin Gulliford,&nbsp;Sara Macdonald,&nbsp;Frances S Mair,&nbsp;Rhiannon K Owen,&nbsp;Shantini Paranjothy,&nbsp;Heather Parsons,&nbsp;Ruben J Sanchez-Garcia,&nbsp;Mozhdeh Shiranirad,&nbsp;Zlatko Zlatev,&nbsp;Nisreen Alwan","doi":"10.1177/26335565231204544","DOIUrl":"https://doi.org/10.1177/26335565231204544","url":null,"abstract":"<p><strong>Background: </strong>Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as 'early onset'). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled 'MELD-B' to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions.</p><p><strong>Aim: </strong>Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses.</p><p><strong>Design: </strong>We will develop deeper understanding of 'burdensomeness' and 'complexity' through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential 'preventable moments', defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231204544"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10521301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41179740","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":"Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study.","authors":"Glenn Simpson, Beth Stuart, Marisza Hijryana, Ralph Kwame Akyea, Jonathan Stokes, Jon Gibson, Karen Jones, Leanne Morrison, Miriam Santer, Michael Boniface, Zlatko Zlatev, Andrew Farmer, Hajira Dambha-Miller","doi":"10.1177/26335565231194552","DOIUrl":"10.1177/26335565231194552","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions.</p><p><strong>Methods: </strong>A three-round online Delphi study was conducted in England with health and social care professionals, data scientists, researchers, people living with multimorbidity and their carers.</p><p><strong>Results: </strong>Our findings suggest a care system which is still predominantly single condition focused. 'Person-centred and holistic care' and 'coordinated and joined up care', were highly rated determinants in relation to improved care for multimorbidity. We further identified a range of non-medical determinants that are important to providing holistic care for this cohort.</p><p><strong>Conclusions: </strong>Further progress towards a holistic and patient-centred model is needed to ensure that care more effectively addresses the complex range of medical and non-medical needs of people living with multimorbidity. This requires a move from a single condition focused biomedical model to a person-based biopsychosocial approach, which has yet to be achieved.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231194552"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10569899","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":"A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity.","authors":"Sebastian Stannard, Ann Berrington, Shantini Paranjothy, Rhiannon Owen, Simon Fraser, Rebecca Hoyle, Michael Boniface, Becky Wilkinson, Ashley Akbari, Sophia Batchelor, William Jones, Mark Ashworth, Jack Welch, Frances S Mair, Nisreen A Alwan","doi":"10.1177/26335565231193951","DOIUrl":"10.1177/26335565231193951","url":null,"abstract":"<p><strong>Objective: </strong>Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity.</p><p><strong>Method: </strong>This work was conducted as part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) study. The conceptualisation of multimorbidity lifecourse determinant domains was shaped by a review of existing research evidence and policy, and co-produced with public involvement via two workshops.</p><p><strong>Results: </strong>Early-life risk factors incorporate personal, social, economic, behavioural and environmental factors, and the key domains discussed in research evidence, policy, and with public contributors included adverse childhood experiences, socioeconomics, the social and physical environment, and education. Policy recommendations more often focused on individual-level factors as opposed to the wider determinants of health discussed within the research evidence. Some domains highlighted through our co-production process with public contributors, such as religion and spirituality, health screening and check-ups, and diet, were not adequately considered within the research evidence or policy.</p><p><strong>Conclusions: </strong>This co-produced conceptualisation can inform research directions using primary and secondary data to investigate the early-life characteristics of population groups at risk of future multimorbidity, as well as policy directions to target public health prevention scenarios of early-onset multimorbidity.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231193951"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305798","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":"Quantifying care delivery team influences on the hospitalization outcomes of patients with multimorbidity: Implications for clinical informatics.","authors":"Tremaine B Williams, Taiquitha Robins, Jennifer L Vincenzo, Riley Lipschitz, Ahmad Baghal, Kevin Wayne Sexton","doi":"10.1177/26335565231176168","DOIUrl":"10.1177/26335565231176168","url":null,"abstract":"<p><p>The primary objective was to quantify the influences of care delivery teams on the outcomes of patients with multimorbidity. Electronic medical record data on 68,883 patient care encounters (i.e., 54,664 patients) were extracted from the Arkansas Clinical Data Repository. Social network analysis assessed the minimum care team size associated with improved care outcomes (i.e., hospitalizations, days between hospitalizations, and cost) of patients with multimorbidity. Binomial logistic regression further assessed the influence of the presence of seven specific clinical roles. When compared to patients without multimorbidity, patients with multimorbidity had a higher mean age (i.e., 47.49 <i>v.</i> 40.61), a higher mean dollar amount of cost per encounter (i.e., $3,068 <i>v.</i> $2,449), a higher number of hospitalizations (i.e., 25 <i>v.</i> 4), and a higher number of clinicians engaged in their care (i.e., 139,391 <i>v.</i> 7,514). Greater network density in care teams (i.e., any combination of two or more Physicians, Residents, Nurse Practitioners, Registered Nurses, or Care Managers) was associated with a 46-98% decreased odds of having a high number of hospitalizations. Greater network density (i.e., any combination of two or more Residents or Registered Nurses) was associated with 11-13% increased odds of having a high cost encounter. Greater network density was not significantly associated with having a high number of days between hospitalizations. Analyzing the social networks of care teams may fuel computational tools that better monitor and visualize real-time hospitalization risk and care cost that are germane to care delivery.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231176168"},"PeriodicalIF":0.0,"publicationDate":"2023-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/5d/10.1177_26335565231176168.PMC10184258.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290167","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}