Lancet Regional Health-Americas最新文献

{"title":"Economic burden of Chagas disease in Latin American countries: a population-based cost-of-illness analysis from the RAISE study","authors":"Mônica Viegas Andrade ,&nbsp;Kenya Valeria Micaela de Souza Noronha ,&nbsp;Aline de Souza ,&nbsp;Nayara Abreu Julião ,&nbsp;André Soares Motta-Santos ,&nbsp;Paulo Estevão Franco Braga ,&nbsp;Henrique Bracarense ,&nbsp;André Batista Alves do Santos ,&nbsp;Bruno Ramos Nascimento ,&nbsp;Ísis Eloah Machado ,&nbsp;Francisco Rogerlândio Martins-Melo ,&nbsp;Israel Molina ,&nbsp;Pablo Perel ,&nbsp;Yvonne Geissbühler ,&nbsp;Caroline Demacq ,&nbsp;Hector Eduardo Castro Jaramillo ,&nbsp;Luis Eduardo Echeverría ,&nbsp;Mario Bruno Principato ,&nbsp;Luisa Fernanda Aguilera Mora ,&nbsp;Marisa Liliana Fernandez ,&nbsp;Antonio Luiz Pinho Ribeiro","doi":"10.1016/j.lana.2025.101340","DOIUrl":"10.1016/j.lana.2025.101340","url":null,"abstract":"<div><h3>Background</h3><div>Chagas disease (ChD) remains a public health concern in Latin America. Despite a decline in overall prevalence, the chronic symptomatic forms still impose a substantial epidemiological and economic burden. This study undertakes a comprehensive, population-based cost analysis of chronic Chagas disease (CCD) from a societal perspective in seven endemic Latin American countries for 2010 and 2023.</div></div><div><h3>Methods</h3><div>A Markov model with one-year cycles and six states was employed. Direct medical and indirect costs, converted to 2024 purchasing power parity US dollars, were estimated using prevalence data from the Global Burden of Disease Study 2023. Based on a previous Brazilian Markov model, parameters were adjusted using healthcare coverage and per capita health expenditure ratios for each country, further validated by national experts.</div></div><div><h3>Findings</h3><div>In 2010, Brazil (US$252 billion) and Argentina (US$164 billion) had the highest lifetime burdens. As a percentage of annual Gross Domestic Product, Bolivia (0·9%) and Argentina (0·8%) were most affected. CCD accounted for 6% of total health expenditures in both countries. Between 2010 and 2023, most countries experienced a decline in economic burden due to decreased CCD prevalence, despite an increased proportion of patients with cardiac conditions, reflecting population aging and disease progression.</div></div><div><h3>Interpretation</h3><div>CCD imposes substantial economic burden across Latin American countries. Epidemiological shift to older populations with severe cardiac forms signals increased healthcare demands. Findings inform policymakers for resource allocation and tailored interventions.</div></div><div><h3>Funding</h3><div>Funding was provided by <span>Novartis Pharma AG</span> as part of a research collaboration with the <span>World Heart Federation</span> (project number CLCZ696D2010R).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101340"},"PeriodicalIF":7.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of eggs on Maya child development and growth: the Saqmolo’ Project randomized clinical trial","authors":"Gabriela Montenegro-Bethancourt ,&nbsp;Gabriela V. Proaño ,&nbsp;Elizabeth Yakes Jimenez ,&nbsp;Taylor C. Wallace ,&nbsp;Alison Steiber ,&nbsp;Xingya Ma ,&nbsp;Ming Ji ,&nbsp;Peter Rohloff","doi":"10.1016/j.lana.2025.101339","DOIUrl":"10.1016/j.lana.2025.101339","url":null,"abstract":"<div><h3>Background</h3><div>There is worldwide interest in determining whether frequent egg provision during complementary feeding enhances child development and growth in low-resource settings. We evaluated effects of adding one whole egg per day to local standard nutrition care on infant outcomes.</div></div><div><h3>Methods</h3><div>The Saqmolo’ Project individually randomized, partially blinded, comparative effectiveness clinical trial was conducted in rural Guatemala from 2021 to 2023. Maya infants aged 6–9 months were randomized to standard nutrition care alone (growth monitoring, complementary and responsive feeding education, deworming medication, multiple micronutrient powders, and referrals for medical care) versus standard care plus one whole egg per day for 6 months. Mixed linear or logistic regression models were used to estimate between-group differences in primary (global development score) and secondary (growth, anemia status, and diet quality) outcomes.</div></div><div><h3>Findings</h3><div>This trial included 1200 Maya infants (51.3% male). After adjustment for baseline values and participant characteristics, there was no significant between-group difference in global development score (β −0.08 points [95% CI −0.22 to 0.06]). There were also no significant between-group differences for most secondary outcomes. Intervention participants did have significantly higher odds of stunting (odds ratio [OR] 1.42 [95% CI 1.10–1.82]; p = 0.007) and of meeting minimum dietary diversity (OR 1.41 [95% CI 1.20–1.65]; p &lt; 0.001) and minimum adequate diet (OR 1.44 [95% CI 1.26–1.64]; p &lt; 0.001) benchmarks than standard care participants.</div></div><div><h3>Interpretation</h3><div>Provision of one whole egg per day in addition to standard care improved diet quality but did not benefit development, growth, or anemia status among Maya infants.</div></div><div><h3>Funding</h3><div><span>Academy of Nutrition and Dietetics Foundation</span> via an <span>Egg Nutrition Center investigator-initiated research</span> grant.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101339"},"PeriodicalIF":7.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing real-world evidence in Brazil: regulatory gaps and global lessons","authors":"Nélio Cézar de Aquino ,&nbsp;Cadiele Oliana Reichert ,&nbsp;Luis Alberto de Padua Covas Lage ,&nbsp;Hebert Fabricio Culler ,&nbsp;Felipe Santa Rosa Roitberg ,&nbsp;Vanderson Rocha ,&nbsp;Flávia Neves Rocha Alves ,&nbsp;Juliana Pereira","doi":"10.1016/j.lana.2025.101344","DOIUrl":"10.1016/j.lana.2025.101344","url":null,"abstract":"<div><div>Regulatory agencies are increasingly incorporating real-world data (RWD) and real-world evidence (RWE) into decision-making frameworks to complement randomized clinical trials. While some regions, such as the U.S. and EU, have developed structured approaches for RWE use, Brazil's regulatory environment remains comparatively limited. This study examines the status of RWE regulatory integration in Brazil through an analysis of normative documents, institutional publications, and selected case studies, using a comparative policy perspective. Although advances have been made in data standardization and the publication of technical guidelines, such as ANVISA's Guidance No. 64/2023, the practical use of RWE in regulatory processes is still nascent. Key challenges include fragmented data infrastructure, and limited intersectoral coordination. Addressing these gaps will require improved interoperability across health information systems, convergence of methodological standards, and sustained collaboration among regulatory authorities, academia, and data holders to enable consistent and scientifically robust use of RWE in the Brazilian context and, potentially, in other low- and middle-income countries.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101344"},"PeriodicalIF":7.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of urgent gastrointestinal-related procedures in Latin America (LATAM-URG): a prospective multicentre study","authors":"Latam Collaborative Colorectal Surgery Consortium","doi":"10.1016/j.lana.2025.101336","DOIUrl":"10.1016/j.lana.2025.101336","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Urgent abdominal operations represent a large proportion of surgical care and are associated with substantial morbidity and mortality. Evidence is scarce from low- and middle-income countries (LMICs), including Latin America (LA). The lack of regionally representative outcomes data hinders quality-improvement efforts and understanding of modifiable risk factors that could be targeted to improve urgent care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We present results from a prospective, multicenter observational cohort study of urgent abdominal surgery conducted in 14 countries across Latin America between February and December 2024. Eligible participants were consecutive adults (≥18 years) undergoing urgent gastrointestinal operations at each site during a 6-week inclusion window. The primary outcome was 30-day mortality. Secondary outcomes were reoperation, readmission, time to discharge, and prolonged intensive care unit (ICU) stay (defined as &gt;72 h). Bayesian time-to-event models and Bayesian logistic regression were used to estimate associations between the outcomes and pre-specified covariates (age, sex, obesity, center volume, Charlson Comorbidity Index, SOFA score, surgical approach, operative time, prior abdominal surgery, intraoperative complications).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 1015 patients were included from 89 hospitals (mean age 58.3 years; 50.4% female and 49.6% male). The most common indications for surgery were intestinal obstruction (46.8%), perforation (23.4%), and abdominal abscess (9.6%). Overall 30-day mortality was 12.6% (128/1015) and one in three of these deaths occurred within 24 h of the index operation. Prolonged ICU stay occurred in 27.9% of patients, reoperation was required in 18.4% and readmission in 4.9%. Across all models, we consistently found an association between Charlson Comorbidity Index &gt;3, SOFA score &gt;3, and open surgical approach with higher odds or hazard of adverse postoperative outcomes, including death. Patients with SOFA &gt;3 had substantially increased odds of prolonged ICU stay and higher hazard of reoperation and death. In contrast, open surgery was associated with longer hospitalization and more reoperations, as well as higher mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This large multi-country cohort provides the first region-wide estimates of outcomes after urgent abdominal surgery in Latin America. Mortality remains high, with almost one-third of all deaths occurring in the first 24 h after surgery. Patients’ comorbidity burden, physiological derangement at presentation, and operative approach are all key determinants of outcome after urgent abdominal surgery. This evidence provides a baseline for quality-improvement efforts and highlights the urgent need for region-specific guidelines and protocols to standardize urgent surgical care across Latin America.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study received no external f","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101336"},"PeriodicalIF":7.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health and economic burden of insomnia medications among older Americans: findings from the future elderly model","authors":"Christopher N. Kaufmann ,&nbsp;Adam P. Spira ,&nbsp;Chien-Yu Tseng ,&nbsp;Emerson M. Wickwire","doi":"10.1016/j.lana.2025.101333","DOIUrl":"10.1016/j.lana.2025.101333","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101333"},"PeriodicalIF":7.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The right to health: indigenous data sovereignty in Canada during and beyond the COVID-19 pandemic","authors":"Alya Govorchin ,&nbsp;Maëve Leduc ,&nbsp;Clifford G. Atleo ,&nbsp;Dawn Hoogeveen ,&nbsp;Irina Borgos ,&nbsp;Lyana Patrick","doi":"10.1016/j.lana.2025.101335","DOIUrl":"10.1016/j.lana.2025.101335","url":null,"abstract":"<div><div>The COVID-19 pandemic disproportionately impacted Indigenous Peoples in Canada, highlighting preexisting health inequities. These disparities were exacerbated by inadequate data management policies across Canadian governments, which contribute to inaccurate health information and access challenges for Indigenous Nations. Indigenous data sovereignty, which recognizes the right of Indigenous Peoples to govern their own data, has been identified as essential for achieving self-determination and improving health outcomes. We focus on British Columbia (BC) given its unique health and data governance structure with First Nations. This policy paper examines the challenges related to health data management that arose during COVID-19 in BC, and the regulatory barriers hindering Indigenous health equity. We present four policy recommendations that address data issues as a promising avenue to reducing health inequities in Canada. This includes supporting research by and with Indigenous Peoples, promoting ethical responsibilities of non-Indigenous researchers, implementing anti-racism policies, and adopting Indigenous data management frameworks.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101335"},"PeriodicalIF":7.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomised, double-blind, sham-controlled, 2×2 factorial trial of aerobic vs. non-aerobic exercise and motor cortex transcranial direct current stimulation in fibromyalgia: effects on clinical outcomes and descending pain modulation","authors":"Felipe Fregni ,&nbsp;Luis Castelo-Branco ,&nbsp;Alejandra Cardenas-Rojas ,&nbsp;Marianna Daibes ,&nbsp;Fernanda MQ. Silva ,&nbsp;Kevin Pacheco-Barrios ,&nbsp;Guilherme J.M. Lacerda ,&nbsp;Lucas Camargo ,&nbsp;Anna Carolyna Gianlorenco ,&nbsp;Wolnei Caumo","doi":"10.1016/j.lana.2025.101314","DOIUrl":"10.1016/j.lana.2025.101314","url":null,"abstract":"<div><h3>Background</h3><div>Exercise is first-line therapy for fibromyalgia, but the superiority of aerobic vs. non-aerobic modalities is uncertain. Motor-cortex transcranial direct current stimulation (tDCS) may enhance descending pain inhibition. We tested the effects of exercise modality and tDCS on conditioned pain modulation (CPM) and clinical outcomes.</div></div><div><h3>Methods</h3><div>Double-blind, randomised 2 × 2 factorial trial in Boston, USA (2019–2024; allocation 1:1:1:1). Adults with fibromyalgia were assigned to aerobic + active tDCS, aerobic + sham, non-aerobic + active, or non-aerobic + sham. Participants completed 16 in-person sessions over 4 weeks, combining concurrent tDCS and exercise. The non-aerobic condition involved light treadmill walking matched for duration but below aerobic threshold (&lt;40% HRmax). Primary outcomes were changes in CPM and temporal summation of pain (TSP) at week 6; secondary outcomes were pain, fatigue, sleep, quality of life, and depressive symptoms.</div></div><div><h3>Findings</h3><div>Of 116 participants (mean age 47.1 ± 11.9 years), 88.8% were female. Active tDCS improved CPM vs. sham (Cohen's d = 0.66; p = 0.015), independent of exercise modality, and showed a small, nonsignificant improvement in TSP (mean change −0.19 [95% CI –0.90, 0.51]). All groups showed moderate-to-large improvements in pain, fatigue, and quality of life (Cohen's d 0.60–0.92), with no added benefit from tDCS. Non-aerobic and aerobic exercise produced comparable symptom improvements. Greater age and lower body mass index (BMI) were associated with enhanced response. Changes in pain modulation were not mediated by short-term clinical changes.</div></div><div><h3>Interpretation</h3><div>Supervised aerobic and non-aerobic exercise produced meaningful short-term clinical improvements. Motor-cortex tDCS enhanced descending pain inhibition but did not add clinical benefit beyond exercise over 6 weeks.</div></div><div><h3>Funding</h3><div>National Institutes of health (R01 1R01AT009491-01A1).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101314"},"PeriodicalIF":7.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency growth in Mexico: expansion and alignment challenges","authors":"Mauricio Gonzalez-Urquijo","doi":"10.1016/j.lana.2025.101337","DOIUrl":"10.1016/j.lana.2025.101337","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101337"},"PeriodicalIF":7.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the expressions and impacts of racism on health in Brazil: a scoping review","authors":"Priscila de Morais Sato ,&nbsp;Fernanda Lopes ,&nbsp;Sonora English ,&nbsp;Silvana Oliveira da Silva ,&nbsp;James Berson Lalane ,&nbsp;Thilagawathi Abi Deivanayagam ,&nbsp;Rute Ramos da Silva Costa ,&nbsp;Elizângela Baré ,&nbsp;Indira Ramos Gomes ,&nbsp;Delan Devakumar","doi":"10.1016/j.lana.2025.101323","DOIUrl":"10.1016/j.lana.2025.101323","url":null,"abstract":"<div><div>We conducted a scoping review to examine how racism affects the health of minoritized populations in Brazil. A comprehensive search was carried out, and identified articles underwent independent double screening. The 145 included studies consistently highlighted structural health inequities, with White advantage functioning as a protective factor. Institutional racism restricts healthcare access and availability, exacerbating minoritized populations’ vulnerability to violence and disease through discrimination and substandard care. Spatial segregation further exposes minoritized populations to harmful environmental conditions and limited infrastructure, while traditional and migrant communities experience marginalization, social isolation, increased disease exposure, and poorer livelihoods. Interpersonal racism negatively impacts mental and physical health across the lifespan, with gender and socioeconomic conditions intersecting and shaping these experiences. The study provides critical insights for practice, policy, and research by demonstrating how racism at multiple levels shapes health inequities in Brazil and by emphasizing the need for human rights-centred, redistributive interventions that promote justice, equity, and inclusive care for minoritized populations.</div><div>Funding: This publication was funded by Edital 02/2025—PRPPG/UFBA (<span>Scientific Publications Support Program</span>) and by the <span>CNPq Productivity in Research Scholarship</span> (process number 306359/2024-3).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101323"},"PeriodicalIF":7.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a health system resilience framework: national, state, regional, and local perspectives","authors":"Marco Antonio Catussi Paschoalotto ,&nbsp;Eduardo Alves Lazzari ,&nbsp;Rudi Rocha ,&nbsp;Adriano Massuda ,&nbsp;Marcia C. Castro","doi":"10.1016/j.lana.2025.101334","DOIUrl":"10.1016/j.lana.2025.101334","url":null,"abstract":"<div><div>Health system resilience (HSR) is essential to sustaining equitable essential functions under acute and chronic stressors in decentralized systems. We developed and validated a Brazil-tailored HSR framework that distinguishes steady-state performance from resilience-specific capacities and assigns responsibilities across federal, state, regional, and municipal levels. Using a three-phase qualitative deductive–inductive approach with 48 international and national experts, we identified nine dimensions, 18 subdimensions, and 65 indicators that prioritise governance coherence, surge workforce strategies, emergency regulation, real-time monitoring, and access to critical technologies. The framework clarifies boundaries between general health system performance and adaptive, absorptive, and transformative functions, and specifies how managers can apply it in practice through structured scoping, mapping, scoring, prioritisation, planning, and monitoring steps. Although designed for Brazil's Unified Health System (SUS), the development logic generalises to other decentralised contexts with appropriate re-allocation of responsibilities and calibration to national financing rules. This policy-facing tool supports actionable resilience strengthening in complex, multi-level systems.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101334"},"PeriodicalIF":7.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}