American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Maintaining Vital Medical Education Programs Despite the Devastating Effects of the Sudanese War.","authors":"Mamoun Homeida, Suzan Homeida, Arwa Abubaker, Hassan Mukhtar, Charles D Mackenzie","doi":"10.4269/ajtmh.25-0004","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0004","url":null,"abstract":"<p><p>The ongoing civil war in Sudan has had disastrous effects on all aspects of life for the Sudanese, including the essential training of new medical personnel, who are an integral component of health systems in a country in great need of healthcare. The efforts of a leading Khartoum medical university, the University of Medical Sciences and Technology, to sustain the training of medical and allied health personnel after the April civil war in 2023 serve as a unique example of adaptation and inter-country collaboration. Efforts to maintain the educational programs for well over 3,000 medical students, individuals who are desperately needed to provide healthcare in their war-torn country, are described in this report.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling Insecticide Susceptibility and Resistance in Anopheles spp. Populations in Tanzania, 2022.","authors":"Donal Bisanzio, Samwel Lazaro, Shija Joseph Shija, Charles Dismas Mwalimu, Bakari Khatibu, Naomi Serbantez, William Nhandi Kisinza, Stephen Magesa, Nico Govella, Fredros Okumu, Richard Reithinger","doi":"10.4269/ajtmh.24-0821","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0821","url":null,"abstract":"<p><p>Insecticide resistance in anopheline malaria vectors poses a major threat to malaria control and elimination efforts. We conducted spatial analyses using publicly available and published data to document and model the geospatial distribution of Anopheles spp. insecticide resistance in Tanzania at the national, regional, district, and subdistrict levels for the 2012-2021 period. An insecticide resistance map modeled for 2022 predicted that anopheline insecticide susceptibility remained above the 90% susceptibility threshold for all major insecticide classes, except for pyrethroids. We calculate that although resistance to pyrethroids occurs in 99.8% of Tanzania's territory, resistance to carbamates, organophosphates, and organochlorines is present in only 7.4%, 0.2%, and 1.3% of the territory, respectively. These modeled findings indicate that despite widespread pyrethroid resistance in Tanzania, significant opportunities for insecticide-based vector control remain, as major vectors are still broadly susceptible to other insecticide classes. The regular use of this predictive methodology can help malaria program management staff adjust their vector control strategies.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice of Leadership, Governance, and Management Related to Maternal Nutrition Intervention Research Embedded in Antenatal Care in Burkina Faso.","authors":"Ziemlé Clément Méda, Hervé Hien, Robert Karama, Bernard Ilboudo, Zongo Alidou, Seydou Barro, Amadou Koinda, Cheick Ahmed Ouattara, Issiaka Sombié","doi":"10.4269/ajtmh.24-0501","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0501","url":null,"abstract":"<p><p>Maternal nutrition intervention research (MNIR) embedded in antenatal care (ANC) was conducted in Burkina Faso to improve reproductive services. The aim of this study was to understand and document the contributions of leadership and management at various health system levels in improving resource management and maternal nutrition service coverage. It was a qualitative case study conducted from July to December 2022 with 44 participants from the Boucle du Mouhoun and Hauts-Bassins health regions. It consisted of interviews with key managers and document reviews. This study demonstrated that strengthening maternal nutrition through ANC in Burkina Faso was feasible and significantly impacted nutrition practices within a year. Coordination involved national and regional actors, nongovernmental organizations, and the private sector, ensuring effective collaboration. Leadership was shared with the private sector, but not effectively at the central level. Inputs and databases were managed by the private executive association and were not integrated into the National Health Information System. The health system's usual organization was respected, with well-defined roles and effective communication, despite some delays in per diem payments and a lack of implementation tools. Monitoring and follow-up were systematic, involving quarterly and monthly review meetings. The project showed significant improvements in maternal nutrition knowledge, weight gain, ANC visits, anemia management, and early breastfeeding initiation, despite minimal changes in self-efficacy, beliefs, and family support. The MNIR was successfully implemented in four health districts, with private sector involvement improving communication and leadership. The project enhanced the health system's resilience against terrorism and coronavirus disease 2019, demonstrating potential for expansion to national implementation.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Puncture Knowledge and Attitudes among Patients, Caregivers, and Healthcare Workers in Rural Zambia.","authors":"Deanna R Saylor, Melissa Elafros, Charles Mang'ombe, Fridah Chiwanza, Henry Mulonga, Moses Chipoya, Charles Mabeta, Oppah Kufa, Somwe Wa Somwe, Gretchen L Birbeck","doi":"10.4269/ajtmh.24-0749","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0749","url":null,"abstract":"<p><p>Lumbar puncture (LP) is a safe, standard procedure essential in the investigation of a variety of neurological disorders. However, in many regions, LP uptake and performance are low, even when it is strongly indicated. We sought to understand patient, caregiver, and healthcare worker perspectives in rural Zambia. We conducted a cross-sectional survey of adult patients, caregivers of adult and pediatric patients, nurses, doctors, and clinical officers at two rural hospitals in the Southern Province of Zambia. The survey consisted of questions on self-reported LP knowledge, an LP knowledge questionnaire, and open-ended questions about LP perceptions and, for healthcare workers, the LP consent process. Descriptive statistics are reported for quantitative questions, and qualitative responses were thematically coded using an inductive approach. Of 120 total participants, the majority (n = 97; 81%) reported they had previously heard of LPs and indicated having \"a little\" knowledge (n = 71; 59%), with the most common source of knowledge being friends and family members. Scores on LP knowledge questionnaire were low for patients and caregivers (median three out of seven possible points). Healthcare worker knowledge scores were higher than laypersons (mean = 6) but misperceptions about LPs were still common, with half of healthcare workers reporting LPs cause paralysis. This rural cohort essentially demonstrated the same knowledge gaps and misperceptions previously identified in an urban Zambian cohort, further supporting the need for interventions aimed at the community and healthcare workers regardless of urbanicity.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug-Resistant Escherichia coli Isolated from Stool Samples of Healthy Infants in Rural Bangladeshi Communities.","authors":"Fatema-Tuz Johura, Jarin Tasnim, Sahitya Ranjan Biswas, Riajul Islam, Talal Hossain, Hafizur Rahman, Saijuddin Shaikh, Hasmot Ali, Subhra Chakraborty, Alain Labrique, Tahmeed Ahmed, Md Iqbal Hossain, Munirul Alam, Amanda C Palmer","doi":"10.4269/ajtmh.24-0541","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0541","url":null,"abstract":"<p><p>Escherichia coli (E. coli) is a commensal organism in humans and animals. It can serve as a reservoir for antibiotic resistance, thus providing an indicator of drug resistance patterns in a community. We investigated antibiotic resistance in E. coli isolated from nondiarrheal stool samples of 6-month-old infants (n = 110) from northwest Bangladesh. We conducted susceptibility testing using a disc diffusion assay against 20 antibiotics. Resistance was most pronounced for macrolides (98.2% resistant), whereas the most sensitive antibiotics were fosfomycin (100%), gentamicin (99.1%), meropenem (98.2%), mecillinam (97.3%), tigecycline (97.3%), and imipenem (87.3%). Excluding erythromycin, roughly 55% of isolates were multidrug-resistant. Our results likely reflect the burden of drug-resistant E. coli in the guts of infants in rural Bangladesh and the prevailing drug resistance patterns in this community.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Virulence and Host-Specific Fitness of Regionally Distinct Human-Derived Powassan Virus Lineage 2 Strains.","authors":"Rachel E Lange, Julia C Pritchard, Anna S Jaeger, Tyler D Bold, Jennifer L White, Amy B Dean, Rene C Hull, Kirsten St George, Alan P Dupuis, Matthew T Aliota, Alexander T Ciota","doi":"10.4269/ajtmh.24-0776","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0776","url":null,"abstract":"<p><p>Powassan virus (POWV; family Flaviviridae) is a tick-borne encephalitic virus endemic to Canada, the United States, and Russia. In the United States, POWV is transmitted by ixodid ticks, and transmission foci reflect the geographic range of these vectors, primarily Ixodes scapularis. Thus, northeastern and midwestern regions of the United States contain the highest human case burdens and prevalence of infected ticks. Notably, New York (NY) and Minnesota (MN) have a long history of POWV transmission to humans. Over time, genetic divergence has occurred in these regions, giving rise to distinct midwestern and northeastern clades. Despite the established circulation of POWV, increases in reported human cases, and documented genetic distinction, an understanding of strain-specific POWV virulence is limited because of the lack of human isolates. In 2020 and 2021, two POWV strains were isolated from fatal human cases from MN (deer tick virus [DTV] MN-PV320) and NY (DTV NY21-027). Here, we provide the first characterization of geographically distinct, contemporary, human POWV isolates. Comprehensive genetic characterization was completed and phenotypic variability was determined in vitro and in vivo . Although strain fitness was similar in I. scapularis, higher mortality rates were measured in a susceptible POWV mouse model after infection with DTV NY21-027 compared with DTV MN-PV320. Genetic analysis revealed several variable amino acid substitutions, including I2173L in DTV NY21-027, which was selected for in all strains after neurological infection. These data suggest that genetic divergence of POWV strains from regionally distinct transmission foci could contribute to strain-dependent pathogenic potential in humans.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators for Participation in Global Health Research Training Programs Among Underrepresented Minority Groups.","authors":"Usha Ramakrishnan, Monique Hennink, Kofi A Kondwani, Radhika L Sundararajan, Riley Hunt, Donna J Ingles, Dionne Williams, Champagnae Smith, Lan Tran, Teris Taylor, Douglas C Heimburger, Linnie M Golightly","doi":"10.4269/ajtmh.24-0847","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0847","url":null,"abstract":"<p><p>The optimal global health (GH) workforce should be racially and ethnically diverse, yet few persons from historically underrepresented minority (URM) groups in the United States participate in GH training programs. We conducted a study to explore barriers and facilitators for URM individuals to participate in the NIH Fogarty International Center's GH Program for Fellows and Scholars (FGHFS), which offers yearlong international research training opportunities. We used an exploratory sequential mixed methods study design that used qualitative in-depth interviews (n = 18) to inform a subsequent quantitative online survey (n = 82). We assessed URM interest and engagement in GH training at three stages of FGHFS (applicants, alumni, and eligible persons who had not applied). Most participants in both phases were female, Black or African American, aged between 31 and 39 years, and had completed graduate or postgraduate training; a third or less were Hispanic. We identified four principal barriers to participation in GH training programs including lack of exposure to GH, lack of mentorship or support, challenges of global travel and work, and finances. The barriers compounded across training stages. Principal facilitators of training engagement included encouraging mentors and supportive families. Recommendations for increasing the participation of URM individuals in GH research training programs included increased financial support and exposure to GH in academic studies, as well as exposure to role models and mentors who can provide career advising in GH. Our findings suggest that early exposure, mentorship, and sufficient financial support will facilitate URMs' entry into GH.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Opinions from Malawian and Malawi Refugee Camp Residents of Wastewater and Environmental Surveillance.","authors":"Dammy Jeboda, Brandie Banner Shackelford, Petros Chigwechokha, Brighton A Chunga, Ayse Ercumen, Cassandra Workman, Joy L Hart, Ted Smith, Rochelle H Holm","doi":"10.4269/ajtmh.24-0759","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0759","url":null,"abstract":"<p><p>Across low- and middle-income countries, there have been calls to expand wastewater and environmental surveillance to include non-sewered sanitation systems. Considering public opinion, understanding, and acceptance, as well as any related privacy and personal health information concerns, is important in this context. This study used an in-person survey to learn more about the perceptions of Malawian and Malawi refugee camp residents regarding wastewater and environmental surveillance as public health tools, as well as their views on privacy and personal health information. A 15-question survey was conducted from May to July 2024 at three locations in northern, central, and southern Malawi, including a refugee camp (N = 536). Some respondents (n = 30) also completed a board game and a post-game survey. The results indicated high public support for surveilling communicable diseases, deadly diseases, environmental toxicants, healthy eating, illegal drugs, mental illnesses, and prescription drugs. Respondents were less supportive of surveillance that might expose their lifestyle behaviors and alcohol use. Regarding sampling locations, the surveillance of an entire city or of camps and schools had the highest acceptance. Some opposition to surveillance in business and religious organizations was noted. If surveilled, respondents wanted the results of the data analysis to be communicated back to them. Our findings suggested that Malawian and Malawi camp residents supported, with little concern, ongoing wastewater and environmental surveillance for public health. Considering privacy thresholds and participant autonomy regarding public health surveillance tools, along with cultural relevance, is important for future policy development and investment.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-Epidemiological Characteristics of Symptomatic and Asymptomatic Enterotoxigenic and Enteropathogenic Escherichia Coli Diarrhea and Impact on Child Growth.","authors":"Al-Afroza Sultana, Rina Das, Md Nasif Hossain, Rukaeya Amin Sobi, Farina Naz, Soroar Hossain Khan, Sabiha Nasrin, Sharika Nuzhat, Mohammod Jobayer Chisti, Pradip K Bardhan, Protim Sarker, Tahmeed Ahmed, Subhra Chakraborty, Asg Faruque","doi":"10.4269/ajtmh.24-0347","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0347","url":null,"abstract":"<p><p>Enterotoxigenic Escherichia (E.) coli (ETEC) and enteropathogenic E. coli (EPEC) are major bacterial causes of childhood diarrhea. We explored the clinico-epidemiological characteristics of children aged <5 years associated with moderate-to-severe diarrhea (MSD), asymptomatic ETEC or EPEC infections, and subsequent impact on growth reflected by z-score. Data from 9,439 MSD and 13,128 asymptomatic children were extracted from Global Enteric Multicenter Study, conducted between 2007 and 2011. Epidemiological risk factors and clinical characteristics of ETEC and EPEC infection were explored using multivariable logistic regression, and a paired t-test was used to investigate the impact of infection on nutritional status. Children aged 12-23 months were more affected by ETEC-positive MSD compared with 0-11 months, whereas children aged 0-11 months were more vulnerable to EPEC-positive MSD. ETEC- and EPEC-positive MSD children showed more characteristics of clinical dehydration like sunken eyes and loss of skin turgor preservation, and needed more intravenous rehydration than ETEC- and EPEC-negative MSD children. Among the other identified co-pathogen, presence of Campylobacter in the analyzed stool sample had higher likelihood to be associated with symptomatic MSD (adjusted odds ratio [aOR] 1.42, 95% CI 1.17-1.71) and asymptomatic children with ETEC infection (aOR 1.42, 95% CI 1.16-1.73) and asymptomatic EPEC infection (aOR 1.22, 95% CI 1.04-1.43). Significant growth faltering was noted in MSD children with ETEC (mean difference 0.22, 95% CI 0.10-0.34) and EPEC (mean difference 0.15, 95% CI 0.03-0.27) from baseline to ∼60 days (50-90 days). Our findings highlight the need to implement preventative strategies to reduce the risk of diarrheal illnesses.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urogenital Schistosomiasis Is Associated with an Increased Risk of Plasmodium falciparum Infection in Burkina Faso.","authors":"Mireille Ouedraogo, Pytsje T Hoekstra, Youssouf Kabore, Issa Nebie, Stan Hilt, Govert J van Dam, Paul L A M Corstjens, Fabrizio Bruschi, David Modiano, Valentina D Mangano","doi":"10.4269/ajtmh.24-0726","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0726","url":null,"abstract":"<p><p>There is significant overlap in the global distribution of malaria and neglected tropical diseases, with the largest health burden in Sub-Saharan Africa, where areas are co-endemic for malaria and schistosomiasis, soil-transmitted helminths, or lymphatic filariasis. Some studies suggest that helminth infections may increase susceptibility to malaria, but evidence is limited. This study investigated the association between urogenital schistosomiasis and the risk of Plasmodium falciparum (P. falciparum) parasitemia in rural Burkina Faso. A cohort of 424 subjects participated in five cross-sectional malaria surveys. Active Schistosoma hematobium infection was diagnosed at baseline using plasma circulating anodic antigen detection, whereas P. falciparum infection was diagnosed at each survey via blood smear microscopy. Longitudinal analysis assessed the association between baseline urogenital schistosomiasis and P. falciparum parasitemia over time, adjusting for sex, age, village, ethnicity, and hemoglobin genotype. Subjects with active urogenital schistosomiasis had a ∼ 25% increase in the cumulative incidence of P. falciparum infection (incidence rate ratio [IRR] = 1.26; 95% CI = 1.08-1.46; P = 0.004), as well as a nonsignificant trend toward higher parasite density (exponential of the β coefficient [Expβ] = 1.12; 95% CI = 0.96-1.31; P = 0.133) and higher odds of infection over five surveys (odds ratio [OR] = 1.79; 95% CI = 0.89-3.59; P = 0.104). Higher intensity of schistosomiasis increased the cumulative incidence of P. falciparum (IRR = 1.12; 95% CI = 1.05-1.19; P = 0.001) and parasite density (Expβ = 1.08; 95% CI = 1.01-1.15; P = 0.026), and a trend toward increased odds of infection was also observed (OR = 1.28; 95% CI = 0.91-1.80; P = 0.159). This study provides longitudinal evidence that urogenital schistosomiasis is associated with an increased risk of P. falciparum parasitaemia, highlighting the need for integrated control strategies for both diseases, particularly in school-aged children and adolescents.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}