BMJ Global Health最新文献

{"title":"Socioeconomic health and impact of sickle cell disease and vaso-occlusive crises in India: results from B-VOCAL study.","authors":"Dipty Jain, Tulika Seth, Shashank Udupi, Suman Jain, Seema Bhatwadekar, Nandakumar Menon, Rabindra Jena, Ravindra Kumar, Bharat Parmar, Anil Goel, Ashvin Vasava, Anupam Dutta, Priyanka Samal, Riya Ballikar, Deepa Bhat, Tuphan Kanti Dolai, Jina Bhattacharyya, Disha Shetty, Manish Mistry, Shomik Ray","doi":"10.1136/bmjgh-2024-017887","DOIUrl":"10.1136/bmjgh-2024-017887","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) has a major impact on healthcare resource utilisation and poses a significant financial burden for the patients. This study examines the economic implications of managing VOC in individuals with SCD in India, from the perspectives of patients, healthcare system and society.</p><p><strong>Methods: </strong>This cross-sectional, observational study included 1000 patients with SCD across 14 centres enrolled from November 2021 to June 2022. Data were collected systematically using a structured electronic case record form. Employing a cost-of-illness approach, the study assessed the economic impact of SCD and VOC management, including assessing patient/caregiver costs, healthcare provider costs and societal burdens extrapolated to the larger SCD population in India.</p><p><strong>Findings: </strong>Patients incurred substantial out-of-pocket expenses, with a median (IQR) annual expenditure of INR 22 080/US$267 (IQR: INR 36 990/US$447.7), representing 14.65% (26.53) of their annual household income. Overall, catastrophic healthcare expenditure (CHE) for total annual average SCD care with VOC management was experienced by 624 patients (62.40%). Moreover, 334 patients (33.4%) experienced CHE of >25% of the annual household income. Patients with SCD with VOC had significantly higher median annual healthcare expenditures and used a higher median percentage of their yearly household income on healthcare compared with those without VOC (19.82% vs 6.08%; p<0.001). Cost incurred by healthcare providers for VOC management in different healthcare facilities (outpatient department/emergency department/intensive care unit) was similar across different reimbursed facilities (government tertiary care hospitals, non-governmental organisation-operated healthcare centres and government-subsidised healthcare setups). The estimated societal burden for VOC management in 1 year for 1000 patients visiting different healthcare facilities was around INR 35 119 074 (~US$0.42 million).</p><p><strong>Interpretation: </strong>These findings highlight the considerable economic strain on both patients and healthcare providers in SCD and VOC management, which is similar to the other non-communicable diseases emphasising the urgent need for targeted interventions to improve financial hardships among patients.</p><p><strong>Funding: </strong>The study was funded by Novartis Healthcare Private Limited.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131923","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}

{"title":"Navigating independence: the short-term and long-term impacts of USAID dismantling on Somalia's humanitarian and development landscape.","authors":"Abdirahman Moallim Ibrahim, Mohamed Osman Mohamed","doi":"10.1136/bmjgh-2025-019330","DOIUrl":"10.1136/bmjgh-2025-019330","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131851","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}

{"title":"Exploring global health diplomacy in Iran: insights from experts in health and foreign policy.","authors":"Sanaz Taghizade, Amirhossein Takian, Mohsen Asadi-Lari, Mohammad Javad Zarif, Ebrahim Jaafaripooyan, Jalal Arabloo","doi":"10.1136/bmjgh-2024-017797","DOIUrl":"10.1136/bmjgh-2024-017797","url":null,"abstract":"<p><strong>Introduction: </strong>The literature on global health diplomacy (GHD) is scarce, particularly in the context of low- and middle-income countries (LMICs). This study thus explores the GHD concept, content, policy-making process and influencing factors in Iran from the perspectives of key health and foreign policy-makers.</p><p><strong>Methods: </strong>This is a qualitative study using conventional content analysis. We conducted in-depth, semi-structured interviews with 29 experts from the health and diplomatic sectors in Iran, supplemented by five focus group discussions. We used purposeful and snowball sampling techniques to identify key informants and continued data collection until saturation was achieved. Data analysis was facilitated by MAXQDA V.12 software.</p><p><strong>Results: </strong>A lack of consensus emerged among the health and foreign policy-makers regarding the definition and importance of GHD, and the varying interpretations of the concept were influenced by the level of knowledge, personal experiences and professional backgrounds, values and belief systems of participants. GHD was found under a relative influence of-both explicit and implicit-ideological and political challenges in Iran. The excessive emphasis on the ideological aspects and the dominance of political, security and military considerations over other foreign policy objectives have been identified as a major barrier to achieving the desired policy goals. Health integration into foreign policy has often been reactive and crisis-driven, rather than planned and proactive, failing to adequately identify or optimise available domestic and international opportunities. Additionally, participants singled out the lack of an inter-sectoral institution or steering council to improve policy coherence and enhance coordination across and within sectors.</p><p><strong>Conclusion: </strong>A common understanding of GHD is expected to pave the way for the implementation and effective achievement of broader foreign and health policy goals in LMICs, such as Iran.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126687","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}

{"title":"Reflections on 50 years of immunisation programmes in the WHO African region: an impetus to build on the progress and address the unfinished immunisation business.","authors":"Amos Petu, Balcha Masresha, Charles S Wiysonge, Jason Mwenda, Kwasi Nyarko, Ado Bwaka, Sarah Wanyoike, Franck Mboussou, Benido Impouma, Abdulmumini Usman, Olushayo Oluseun Olu, Alex Ntale Gasasira, Joseph Waogodo Cabore, Matshidiso R Moeti","doi":"10.1136/bmjgh-2024-017982","DOIUrl":"10.1136/bmjgh-2024-017982","url":null,"abstract":"<p><p>Immunisation is crucial to achieving the Sustainable Development Goals for maternal and child mortality reduction. As Africa marks the 50th anniversary of implementing immunisation programmes, it is imperative to review progress, address challenges and strategise for the future. Using available programme data, this article examines the progress made in achieving the immunisation milestones in the region, describes the success factors and lessons learnt and makes recommendations on how to immunise every African child in the coming years. The article concludes that despite significant improvements in childhood immunisation coverage, the region still falls short of global targets, with disparities across countries. Contributing factors include, among others, weak health systems, rapid population growth without corresponding increases in service delivery, vaccine hesitancy, inadequate sustainable financing and disruptions caused by the COVID-19 pandemic. Moving forward, efforts to attain the global immunisation coverage milestones should focus on building on the past progress, addressing the COVID-19 setbacks, leveraging new technologies and securing sustainable immunisation funding. This can be achieved by accelerating the implementation of the Immunization Agenda 2030 and the Addis Ababa Declaration on Immunization commitments. The support of all stakeholders including political leaders, public health professionals, the vaccine industry, regional organisations, academia, donors and healthcare workers is essential for this noble endeavour.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118797","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}

{"title":"The red thread: stakeholder perspectives on menstrual health and hygiene in Ghana.","authors":"Sitsofe Gbogbo, Israel Wuresah, Priscilla Klutse, Sarah Odi Mantey, Ishmael Boateng, Paramount Eli Nelson, Veronica Okwuchi Charles-Unadike, Darline El Reda, Constance Currier","doi":"10.1136/bmjgh-2025-019124","DOIUrl":"10.1136/bmjgh-2025-019124","url":null,"abstract":"<p><strong>Background: </strong>Menstrual hygiene management is a challenge for girls and women in Ghana due to a lack of access to affordable menstrual products; water, sanitation and hygiene (WASH) facilities; inadequate menstrual health education; and social stigma surrounding menstruation. This study aimed to explore the experiences and perspectives of various stakeholders and identify strategies for improving menstrual health and hygiene (MHH) among adolescent girls.</p><p><strong>Methods: </strong>We recruited stakeholders for focus group discussions (FGDs) from basic schools (primary and junior high, grades 1-9) in Hohoe, Volta Region, Ghana. We conducted FGDs with adolescent boys (n=60), parents (n=48) and gatekeepers (n=19). Semi-structured guides were developed and used during FGDs, recorded and supplemented by field notes. Transcripts were thematically analysed using MAXQDA 2024 software.</p><p><strong>Results: </strong>Adolescent boys demonstrated a willingness to learn and support menstrual health of peers, challenging the assumption that they primarily contribute to stigma. The study also indicated a shift in perceptions and practices related to menstruation among parents; whereas, gatekeepers highlighted government commitments on MHH infrastructure and material provision for schoolgirls. Based on the findings, the following strategies were identified: (1) the need for adequate WASH facilities, (2) the need to address stigma associated with MHH, (3) the need to reduce the cost of sanitary materials and (4) the need for improved menstrual health education.</p><p><strong>Conclusion: </strong>These results confirm that cultural stigmas, inadequate facilities and financial constraints still exist. These act as key barriers to MHH for schoolgirls in Hohoe, Ghana. To support girls' health, dignity and education, recommendations include inclusive education programmes, improved WASH facilities and affordable and/or sustainable menstrual products.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118802","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}

{"title":"Clustering and visualisation of the GABRIEL network expertise in the field of infectious diseases.","authors":"Cécile Chauvel, Philippe Vanhems, Marie-Charlotte Quemin, Marianne Abifadel, Shally Awasthi, Sayera Banu, Silvia Figueiredo Costa, Sara Eyangoh, Monzer Hamze, Zakir Hossain, Bourema Kouriba, Daniel Mukadi-Bamuleka, Francine Ntoumi, Abdoul-Salam Ouedraogo, Phimpha Paboriboune, Jean William Pape, Chan Leakhena Phoeung, Firdausi Qadri, Ana Tereza Ribeiro Vasconcelos, Graciela Russomando, Luc Samison, Marilda Agudo Mendonça Siqueira, Nestani Tukvadze, Jianwei Wang, Florence Komurian Pradel","doi":"10.1136/bmjgh-2024-017595","DOIUrl":"10.1136/bmjgh-2024-017595","url":null,"abstract":"<p><strong>Introduction: </strong>The Global Approach to Biology Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL) network is an international scientific network of 21 centres coordinated by the Merieux Foundation (Lyon, France). Mapping and characterising the similarities and differences in expertise and activities across four major infectious diseases (tuberculosis, antimicrobial-resistant infections, acute respiratory infections and emerging pathogens) among these centres would help to provide a better understanding of the network's capacity. It will also highlight how the applied methodology can enhance information sharing within research networks.</p><p><strong>Methods: </strong>Each centre responded to a questionnaire on their core activities and research themes. An advanced multivariate analysis was performed to relate all items together and highlight new synergies among members of the GABRIEL network. Similarities were found using a clustering algorithm and data were visualised using alluvial plots.</p><p><strong>Results: </strong>This strategy enabled to find new patterns in the GABRIEL network for the implementation of new projects on global health, regardless of geographical proximity or historical connections. Five clusters based on core activities, consisting of 6, 1, 3, 9 and 2 research units, respectively, have been identified, with clusters 1 and 4, including the majority of the units. Four clusters have been defined based on the four major infectious diseases, comprising 7, 3, 5 and 6 research units, respectively.</p><p><strong>Conclusions: </strong>The same methodology could also be applied to identify proximities on other networks of experts or between members of different networks for more efficient research or surveillance global programmes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085612","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}

{"title":"Confronting global inequities in palliative care.","authors":"Anna Peeler, Oladayo Ayobami Afolabi, Katherine E Sleeman, Maha El Akoum, Nahla Gafer, Asmus Hammerich, Richard Harding","doi":"10.1136/bmjgh-2024-017624","DOIUrl":"10.1136/bmjgh-2024-017624","url":null,"abstract":"<p><p>The number of people dying with preventable, serious health-related suffering is rapidly increasing, and international calls for the expansion of palliative care services have been made, such as the World Health Assembly Resolution 67.19, which named palliative care as an essential component of Universal Health Coverage. Despite this, only about 14% of all palliative care need globally is met today, and health systems around the world are unprepared to meet the growing need. Palliative care has been shown to improve patient, caregiver and health-system outcomes and reduce costs for many populations and contexts. Geographic, social, cultural and health-literacy related inequities in access to and quality of palliative care services persist. We provide evidence-based recommendations which require immediate, coordinated action to improve progress towards achieving equitable access to high-quality palliative care for all. These include but are not limited to ensuring every country has palliative care codified into national health policy; providing evidence-based, basic palliative care education and training for all non-specialist healthcare workers; empowering and facilitating community action in research and service development; and ensuring that all essential palliative care medicines are available for those who need them. Unless urgent, evidence-based, coordinated action is taken, countries, health systems, and communities will fail to meet the growing palliative care demand, and millions of people around the world will experience preventable suffering.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085795","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}

{"title":"A methodological review of patient healthcare-seeking journeys from symptom onset to receipt of care.","authors":"Charity Oga-Omenka, Angelina Sassi, Nathaly Aguilera Vasquez, Namrata Rana, Mohammad Yasir Essar, Darryl Ku, Hanna Diploma, Lavanya Huria, Kiran Saqib, Rishav Das, Guy Stallworthy, Madhukar Pai","doi":"10.1136/bmjgh-2024-016978","DOIUrl":"10.1136/bmjgh-2024-016978","url":null,"abstract":"<p><strong>Background: </strong>For many diseases, early diagnosis and treatment are more cost-effective, reduce community spread of infectious diseases and result in better patient outcomes. However, healthcare-seeking and diagnoses for several diseases are unnecessarily delayed. For example, in 2022, 3 million and 5.6 million people living with tuberculosis (TB) and HIV, respectively, were undiagnosed. Many patients never access appropriate testing, remain undiagnosed after testing or drop out shortly after treatment initiation. This underscores challenges in accessing healthcare for many individuals. Understanding healthcare-seeking obstacles can expose bottlenecks in healthcare delivery and promote equity of access. We aimed to synthesise methodologies used to portray healthcare-seeking trajectories and provide a conceptual framework for patient journey analyses.</p><p><strong>Design/methods: </strong>We conducted a literature search using keywords related to \"patient/care healthcare-seeking/journey/pathway analysis\" AND \"TB\" OR \"infectious/pulmonary diseases\" in PubMed, CINAHL, Web of Science and Global Health (OVID). From a preliminary scoping search and expert consultation, we developed a conceptual framework and honed the key data points necessary to understand patients' healthcare-seeking journeys, which then served as our inclusion criteria for the subsequent expanded review. Retained papers included at least three of these data points.</p><p><strong>Results: </strong>Our conceptual framework included five data points and seven related indicators that contribute to understanding patients' experiences during healthcare-seeking. We retained 66 studies that met our eligibility criteria. Most studies (56.3%) were in Central and Southeast Asia, explored TB healthcare-seeking experiences (76.6%), were quantitative (67.2%), used in-depth, semistructured or structured questionnaires for data collection (73.4%). Healthcare-seeking journeys were explored, measured and portrayed in different ways, with no consistency in included information.</p><p><strong>Conclusions: </strong>We synthesised various methodologies in exploring patient healthcare-seeking journeys and found crucial data points necessary to understand challenges patients encounter when interacting with health systems and offer insights to researchers and healthcare practitioners. Our framework proposes a standardised approach to patient journey research.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085860","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}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjgh-2025-020389","DOIUrl":"10.1136/bmjgh-2025-020389","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075949","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}

{"title":"Conceptualisation of critical health literacy-insights from Western and East Asian perspectives: a scoping review.","authors":"Cindy Yue Tian, Clement Cheuk Wai Ng, Luyao Xie, Phoenix K H Mo, Dong Dong, Don Nutbeam, Eliza L Y Wong","doi":"10.1136/bmjgh-2024-018232","DOIUrl":"10.1136/bmjgh-2024-018232","url":null,"abstract":"<p><p>This article describes a scoping review of components of critical health literacy (CHL) and examines how these components have been conceptualised, highlighting fundamental differences from the Western and East Asian perspectives. The review includes 23 studies, with the majority (n=19) from Western countries and only two from East Asia. Three primary components of CHL were identified: 'information appraisal', 'understanding of social determinants of health (SDH)' and 'actions to address SDH'. The findings indicate that these prevailing components of CHL are largely grounded in Western social structures, while East Asian studies primarily focused on the first component. Given the distinct social and cultural norms in these regions, this study explored the potential differences in how social factors influencing health are understood and prioritised in Western versus East Asian contexts. From a Western universalistic perspective, actions to address SDH often involve political and social movements aimed at improving individual and community health. However, such actions may not be feasible or relevant for many East Asian population groups, who may have more limited opportunities to engage in Western-style social movements, and culturally, have a stronger focus on family and local community. Furthermore, building on the theory of 'distributed health literacy', we argued that interpersonal-level actions to address SDH are also crucial and can serve as a stepping stone to social-level actions, which have been more extensively discussed in Western literature. We conclude that CHL is a context-specific concept, and its definition and practical application need further examination across different contexts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085587","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}