Age and ageing最新文献

{"title":"2796 Improving physical health care in older people in mental health settings: the ImPreSs-care qualitative study","authors":"B Hickey, B Desai, F Davies, D Chari, R Evley, C Clegg, A Donovan, AP Rajkumar, T Dening, H Subramaniam, E Mukaetova-Ladinska, T Robinson, C Tarrant, L Beishon","doi":"10.1093/ageing/afae277.129","DOIUrl":"https://doi.org/10.1093/ageing/afae277.129","url":null,"abstract":"Background The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community). Methods 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n = 28), patients (n = 7), carers (n = 19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged >65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE). Results Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience. Conclusions The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"30 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of 15-year transitions across living and care settings in a population of Swedish older adults","authors":"Susanna Gentili, Amaia Calderón-Larrañaga, Debora Rizzuto, Adam Lee Gordon, Janne Agerholm, Carin Lennartsson, Åsa Hedberg Rundgren, Laura Fratiglioni, Davide Liborio Vetrano","doi":"10.1093/ageing/afaf006","DOIUrl":"https://doi.org/10.1093/ageing/afaf006","url":null,"abstract":"Objective We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings. Methods Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions. Results Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06–1.08) and being a woman compared with being a man (HR range 1.35–4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14–1.23) and slow gait speed (HR range 1.11–1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99–2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57–3.07). Conclusions Accounting for older adults’ whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults’ needs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"119 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mobile interactive cognitive self-assessment scale for screening cognitive impairment due to Alzheimer’s disease","authors":"Kexin Xie, Juan Huang, Ting Chen, Dan Li, Tianxinyu Xia, Min Chu, Yue Cui, Mei Tang, Dantao Peng, Jingtong Wang, Jianling Liu, Xiaojuan Chen, Weiwei Cui, Li Liu, Yingtao Wang, Jianbing Liu, Fang Li, Liyong Wu","doi":"10.1093/ageing/afae293","DOIUrl":"https://doi.org/10.1093/ageing/afae293","url":null,"abstract":"Background A mobile cognition scale for community screening in cognitive impairment with rigorous validation is in paucity. We aimed to develop a digital scale that overcame low education for community screening for mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) and AD. Methods A mobile cognitive self-assessment scale (CogSAS) was designed through the Delphi process, which is feasible for the older population with low education. In Phase 1, 518 clinically diagnosed participants were subjected to optimise the items. In Phase 2, the scale was validated in 358 participants with cognitively unimpaired and 396 participants of clinically diagnosed MCI and dementia for reliability, validity and diagnostic accuracy. In Phase 3, specificity and sensitivity were tested for biologically diagnosed participants of 38 with cognitively unimpaired and 45 with MCI and dementia due to AD according to the amyloid, tau, neurodegeneration classification system. Results The CogSAS was a three-task mobile scale testing memory and executive function. In Phase 2, the internal consistency was 0.81, and the test–retest reliability was 0.82. The construct validity was 0.74, and the criterion validity was 0.77. The sensitivity and specificity for discriminating clinically diagnosed participants with MCI and dementia from cognitively unimpaired were 0.90 and 0.67, respectively. For discriminating biologically diagnosed MCI and dementia due to AD from cognitively unimpaired, the sensitivity and specificity were 1.00 and 0.78, respectively. Conclusions The CogSAS has good reliability, validity and feasibility, showing a high sensitivity and specificity both in the community and the clinic, identifying biologically diagnosed MCI and dementia due to AD.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"87 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional survey of healthcare professionals’ perceptions of bedrails as a measure of physical restraint in the hospital setting","authors":"César Gálvez-Barrón, Ana González-De Luna, Carlos Pérez-López, Oscar Macho-Perez","doi":"10.1093/ageing/afaf002","DOIUrl":"https://doi.org/10.1093/ageing/afaf002","url":null,"abstract":"Objective Although bedrails are considered a restraint measure under the legal regulations in Spain, no data on the related perceptions of healthcare professionals (HCPs) are available. Thus, this study aimed to calculate the proportion of HCPs in the hospital setting that consider bedrails to be a restraint measure. Methods Between June and December 2022, a cross-sectional online survey was conducted among the HCPs at our institution. Basal information was collected in the first section, and seven questions related to bedrails were included in the second. The perception of bedrails as a restraint measure was evaluated with a multiple-choice question in which devices that can be considered restraint measures were listed. Results A total of 246 HCPs participated in the survey, 201 of whom passed quality control and were analysed. The mean age was 42.2 years old, and 85% of the participants were women. The proportion of HCPs who considered bedrails as a restraint measure was 54.2% (95% confidence interval [CI]: 47.3–61.1) in the total group and 54.5% (95% CI: 44.1–65.0) in the intermediate care subgroup. These proportions were significantly lower for HCPs who worked night shifts and among those who believed that bedrails do not limit patient mobility. Conclusions There is a considerable difference between what is established in legal regulations and the perceptions of HCPs in terms of bedrails being considered a restraint measure. Our results can help improve the content of training programs on the use of restraint measures by HCPs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"9 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive reserve and its impact on cognitive and functional abilities, physical activity and quality of life following a diagnosis of dementia: longitudinal findings from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) study","authors":"Laura D Gamble, Linda Clare, Carol Opdebeeck, Anthony Martyr, Roy W Jones, Jennifer M Rusted, Claire Pentecost, Jeanette M Thom, Fiona E Matthews","doi":"10.1093/ageing/afae284","DOIUrl":"https://doi.org/10.1093/ageing/afae284","url":null,"abstract":"Background The concept of cognitive reserve may explain inter-individual differences in susceptibility to neuropathological changes. Studies suggest that experiences over a lifetime impact on cognitive reserve, and it is hypothesised that following a dementia diagnosis, greater reserve levels are linked to accelerated disease progression. Objective To investigate the longitudinal impact of cognitive reserve on cognitive and functional abilities, physical activity and quality of life in people with dementia. Design Longitudinal cohort design. Setting and participants Participants were 1537 people with mild-to-moderate dementia at baseline, 1183 at 12 months follow-up and 851 at 24 months follow-up, from the IDEAL study. Methods A comprehensive latent measure of cognitive reserve incorporated domains from all stages of life: education, occupational attainment and later-life engagement in leisure activities. The impact of cognitive reserve on cognition, functional abilities, physical activity and quality of life at baseline and over time was investigated using latent growth curve modelling. Results Higher cognitive reserve was associated with better cognition, fewer functional difficulties, more physical activity and better quality of life at baseline but was associated with accelerated cognitive decline and greater dependence over time. After 2 years, those with higher initial reserve were estimated to still have better cognition than those with low reserve. Conclusions Cognitive reserve may be important in initially delaying dementia progression but is linked with accelerated deterioration once dementia becomes clinically evident, likely because of the more advanced neuropathological stage of the condition. Engagement in leisure activities is a potentially modifiable domain of cognitive reserve warranting further investigation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"30 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outreach acute care for nursing homes: an observational study on the quality and cost-effectiveness of the Mobile Hospital","authors":"Kontunen Perttu, Leppänen Roope, Linna Miika, Castrén Maaret, Torkki Paulus","doi":"10.1093/ageing/afae287","DOIUrl":"https://doi.org/10.1093/ageing/afae287","url":null,"abstract":"Background The global trend of emergency department (ED) crowding can be mitigated with outreach care. The Mobile Hospital is an outreach acute care service in Espoo, Finland. This study describes the results of the Mobile Hospital intervention to nursing homes in a pre–post study setting with benchmarking validation data. Methods We compared Emergency Medical Services (EMS) missions, ED visits, hospitalisations and their estimated costs from two 6-month periods in 2018–2019 (1325 nursing home beds). Benchmarking control data for ED visits were obtained from health records of the 10 largest Finnish cities. Results The number of EMS missions to nursing homes decreased by 16% (720 vs 604), ED visits decreased by 22% (801 vs 622), there was no significant difference in specialised inpatient episodes (178 vs 162) and primary hospital inpatient episodes were fewer (285 vs 178, decreased 38%). Annual estimated savings per resident were 686 euros (decreased 14%). Annual estimated total savings were 934 908 euros. In the benchmarking analysis, the number of ED visits and acute hospitalisations amongst the older population decreased in Espoo, while in the other cities it increased. Conclusions The Mobile Hospital seems to reduce nursing home residents’ ED visits, hospitalisations and overall costs. Advance care planning and on-call physician telephone consultations may be useful components of the service. Implications to practice: This study adds to the growing evidence that outreach care to nursing homes is cost-effective in suburban areas with universal healthcare funding, at least as part of other developments in the acute care pathway.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"77 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the evidence-practice gap in dementia: two new national guidelines.","authors":"J Simon Bell, Sue Brennan, Alli Patterson, Velandai Srikanth","doi":"10.1093/ageing/afaf005","DOIUrl":"https://doi.org/10.1093/ageing/afaf005","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between sarcopenic obesity and risk of frailty in older adults: a systematic review and meta-analysis.","authors":"Yao Gengxin, Ma Xuehan, Wan Xinyu, Yang Yali, Xu Yiran, Zheng Lishuang, Qiu Yiming, Li Guichen, Chen Li","doi":"10.1093/ageing/afae286","DOIUrl":"10.1093/ageing/afae286","url":null,"abstract":"<p><strong>Background: </strong>Age-related changes in body composition such as muscle loss can lead to sarcopenia, which is closely associated with frailty. However, the effect of body fat accumulation on frailty in old age remains unclear. In particular, the association between the combination of these two conditions, known as sarcopenic obesity, and frailty in older adults is unclear.</p><p><strong>Objective: </strong>To synthesise the association between sarcopenic obesity and the risk of frailty and to investigate the role of obesity in the risk of frailty in old age.</p><p><strong>Methods: </strong>Six databases were searched from inception to 29 September 2024. Two reviewers independently extracted the data and assessed the risk of bias for the included observational studies using the adapted Newcastle-Ottawa scale. The control groups consisted of robust, obese and sarcopenic individuals. Meta-analyses were performed to examine the risk of frailty due to sarcopenic obesity and the role of obesity in frailty amongst sarcopenic older adults.</p><p><strong>Results: </strong>Sixteen eligible studies were included in meta-analyses from 1098 records. Compared to robust individuals, older adults with sarcopenic obesity were more vulnerable to frailty [odds ratio (OR), 3.76; 95% confidence interval (CI), 2.62 to 5.39; I2 = 79.3%; P < .0001]. Obesity was not associated with the risk of frailty (OR, 1.23; 95% CI, 0.99 to 1.53; I2 = 0.0%; P = .501) in sarcopenic older adults.</p><p><strong>Conclusions: </strong>Sarcopenic obesity is associated with a high risk of frailty. Sarcopenia and obesity may have synergistic effects on frailty in older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated digit in noise test (iDIN) for rapid hearing and cognitive screening: a preliminary exploration.","authors":"Shangqiguo Wang, Lena L N Wong, Tsz Y Pan","doi":"10.1093/ageing/afaf009","DOIUrl":"https://doi.org/10.1093/ageing/afaf009","url":null,"abstract":"<p><strong>Background: </strong>Hearing and cognitive impairments are common amongst older adults, both affecting communication and are not easy to distinguish from each other.</p><p><strong>Objective: </strong>To preliminarily evaluate the efficacy of the integrated Digit in Noise Test (iDIN) for rapid screening of hearing and cognitive functions in older adults.</p><p><strong>Design: </strong>This cross-sectional cohort study was conducted at multiple clinical sites.</p><p><strong>Setting: </strong>Data collection occurred in sound-treated booths and quiet rooms at several outpatient clinics and elderly community centres.</p><p><strong>Subjects: </strong>The study included 107 older adults, aged 58-96, who were long-term residents of Hong Kong and native Cantonese speakers. Participants were selected through convenience sampling.</p><p><strong>Methods: </strong>Primary outcomes were the speech reception thresholds (SRTs) for 2-, 3- and 5-digit sequences with forward and 3-digit sequences with backward recall measured on iDIN. Hearing level was assessed using pure-tone audiometry. Cognitive function was assessed using the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA).</p><p><strong>Results: </strong>The 2-digit and 3-digit SRTs effectively distinguished participants with hearing loss, demonstrating high sensitivity (0.815 and 0.908, respectively) and specificity (0.905 and 0.853, respectively). The SRT3b-3f index effectively discriminated between participants who passed or failed the MoCA, with sensitivities of 0.727 and 0.781, and specificities of 0.885 and 0.787 using the two MoCA scoring methods. No significant correlation was found between SRT3b-3f and hearing levels after adjustment for educational background.</p><p><strong>Conclusions: </strong>iDIN demonstrates significant promise for rapid and effective screening of both hearing and cognitive impairments in older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.","authors":"Nicosha De Souza, Bruce Guthrie, Suzanne Grant, Fabiana Lorencatto, Jane Dickson, Aleksandra Herbec, Carmel Hughes, Jacqueline Sneddon, Peter T Donnan, Charis A Marwick","doi":"10.1093/ageing/afae288","DOIUrl":"10.1093/ageing/afae288","url":null,"abstract":"<p><strong>Background: </strong>There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance.</p><p><strong>Objective: </strong>To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics.</p><p><strong>Design: </strong>Population-based analyses using administrative data.</p><p><strong>Setting and subjects: </strong>148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices.</p><p><strong>Methods: </strong>Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression.</p><p><strong>Results: </strong>For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus <80 years old] and comorbidity (1.88 [1.71 to 2.06] for Charlson Comorbidity Index 3+ versus 0), and the care-home's sampling rate for microbiological culture (1.53 [1.28 to 1.84] for >7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]).</p><p><strong>Conclusion: </strong>Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}