{"title":"The future of moral injury and its treatment","authors":"B. Litz","doi":"10.3138/jmvfh.9.2.ed","DOIUrl":"https://doi.org/10.3138/jmvfh.9.2.ed","url":null,"abstract":"","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"22 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83819966","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}
LAY SUMMARY Most research on military family health has involved talking to spouses, but what do military personnel think? Personnel may identify different issues that have not had the attention of research or armed forces. This study used the “Any other comments?” question in a military family survey to get their thoughts. Australian Defence Force regular and reserve personnel who were in the army, navy, or air force completed the survey. There were 264 personnel who talked about families, and key issues and views were identified from their responses. These included the challenge of living away from families for service reasons and a feeling of “talk, not action” on work and family balance. Responses revealed that non-family-friendly practices affected the health of families. They also caused personnel to leave regular service or the military altogether. Armed forces should work to match practices with policies. This study also shows how open-ended-comment questions in surveys are useful for research and give military personnel a chance to have their say.
{"title":"Australian military personnel perspectives on family, service, and deployment: An analysis of open-ended survey data","authors":"C. Runge, K. Moss, J. Dean, Michael Wallera","doi":"10.3138/jmvfh-2022-0054","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0054","url":null,"abstract":"LAY SUMMARY Most research on military family health has involved talking to spouses, but what do military personnel think? Personnel may identify different issues that have not had the attention of research or armed forces. This study used the “Any other comments?” question in a military family survey to get their thoughts. Australian Defence Force regular and reserve personnel who were in the army, navy, or air force completed the survey. There were 264 personnel who talked about families, and key issues and views were identified from their responses. These included the challenge of living away from families for service reasons and a feeling of “talk, not action” on work and family balance. Responses revealed that non-family-friendly practices affected the health of families. They also caused personnel to leave regular service or the military altogether. Armed forces should work to match practices with policies. This study also shows how open-ended-comment questions in surveys are useful for research and give military personnel a chance to have their say.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"6 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78834423","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}
L. King, Doreen Campbell, Marie Finkbeiner, Jesse T Gallimore, Jill Kennedy, Emily McCarthy, F. Ketcheson
LAY SUMMARY Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.
{"title":"The mySELF group: Recreation- and art-based group therapy as adjunct treatment for posttraumatic stress disorder","authors":"L. King, Doreen Campbell, Marie Finkbeiner, Jesse T Gallimore, Jill Kennedy, Emily McCarthy, F. Ketcheson","doi":"10.3138/jmvfh-2022-0062","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0062","url":null,"abstract":"LAY SUMMARY Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"23 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81638122","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}
H. Burdett, Marie-Louise Sharp, Danai Serfioti, Margaret Jones, D. Murphy, L. Hull, D. Pernet, S. Wessely, N. Fear
LAY SUMMARY This article examines how employment status changed for working-age UK ex-military personnel in the early period of the COVID-19 pandemic and how this relates to their mental health. Overall, the unemployment rate among ex-military personnel was not worse than that in the general population; however, because ex-military personnel generally have a lower unemployment rate than the general population, this suggests they were worse hit by the pandemic. Part-time and self-employed personnel were more likely to experience negative changes to their employment situation. Both becoming unemployed and being furloughed were correlated with negative changes in mental health. However, it should be noted that the mental health data used for this comparison predate the onset of the pandemic; hence, other factors related to both change in employment status and change in mental health could be the cause of this apparent relationship.
{"title":"Employment and mental health among UK ex-service personnel during the initial period of the COVID-19 pandemic","authors":"H. Burdett, Marie-Louise Sharp, Danai Serfioti, Margaret Jones, D. Murphy, L. Hull, D. Pernet, S. Wessely, N. Fear","doi":"10.3138/jmvfh-2022-0064","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0064","url":null,"abstract":"LAY SUMMARY This article examines how employment status changed for working-age UK ex-military personnel in the early period of the COVID-19 pandemic and how this relates to their mental health. Overall, the unemployment rate among ex-military personnel was not worse than that in the general population; however, because ex-military personnel generally have a lower unemployment rate than the general population, this suggests they were worse hit by the pandemic. Part-time and self-employed personnel were more likely to experience negative changes to their employment situation. Both becoming unemployed and being furloughed were correlated with negative changes in mental health. However, it should be noted that the mental health data used for this comparison predate the onset of the pandemic; hence, other factors related to both change in employment status and change in mental health could be the cause of this apparent relationship.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"10 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85599223","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}
Natasha Benfer, M. B. N. Vannini, Breanna Grunthal, B. Darnell, G. Zerach, Y. Levi-Belz, B. Litz
LAY SUMMARY Both moral injury (MI) and posttraumatic stress disorder (PTSD) can result from adverse experiences (potentially morally injurious events [PMIEs] for the former and Criterion A events for the latter) and may lead to similar symptoms. Thus, debate is ongoing as to whether MI and PTSD are distinct. Depressive symptoms can also follow these events and may also overlap with symptoms of MI and PTSD. This study investigated how distinct MI is from PTSD and depression by examining networks composed of MI-related outcomes (trust violation, shame, functioning), PTSD symptom clusters, and depression for participants who reported experiencing a PMIE and those who did not. This study is the first of its kind to use MI outcomes with PTSD and depression in a network analysis. The results suggest that MI, PTSD, and depression are distinct but related phenomena, with more connections between these phenomena present particularly among those who experienced a PMIE. Moreover, the negative alterations in cognition and mood cluster of PTSD and MI-related functioning appears to explain some of the co-occurrence among constructs.
{"title":"Moral injury symptoms and related problems among service members and Veterans: A network analysis","authors":"Natasha Benfer, M. B. N. Vannini, Breanna Grunthal, B. Darnell, G. Zerach, Y. Levi-Belz, B. Litz","doi":"10.3138/jmvfh-2022-0040","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0040","url":null,"abstract":"LAY SUMMARY Both moral injury (MI) and posttraumatic stress disorder (PTSD) can result from adverse experiences (potentially morally injurious events [PMIEs] for the former and Criterion A events for the latter) and may lead to similar symptoms. Thus, debate is ongoing as to whether MI and PTSD are distinct. Depressive symptoms can also follow these events and may also overlap with symptoms of MI and PTSD. This study investigated how distinct MI is from PTSD and depression by examining networks composed of MI-related outcomes (trust violation, shame, functioning), PTSD symptom clusters, and depression for participants who reported experiencing a PMIE and those who did not. This study is the first of its kind to use MI outcomes with PTSD and depression in a network analysis. The results suggest that MI, PTSD, and depression are distinct but related phenomena, with more connections between these phenomena present particularly among those who experienced a PMIE. Moreover, the negative alterations in cognition and mood cluster of PTSD and MI-related functioning appears to explain some of the co-occurrence among constructs.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"44 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88492446","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}
Heather A. King, Kathleen R Perry, Stephanie Ferguson, Bret L. Hickene, G. Jackson, Chanee Lynch, S. Woolson, J. Wortmann, Jason A. Nieuwsma, Kimber J Parry
LAY SUMMARY Current conceptualizations of potentially morally injurious events (PMIEs) emphasize war atrocities (e.g., killing of children or civilians, witnessing abuse of prisoners of war). Additional research on PMIEs could inform provision of patient-centred care in pursuit of healing for those experiencing moral injury. The field would benefit from an operationalization of PMIEs that is not only grounded in empirical data and meaningful to clinicians but also accounts for the perspectives of the Veterans who experienced PMIEs. This study sought to gain a more in-depth understanding of and explore Veterans’ experiences surrounding PMIEs.
{"title":"Identifying potentially morally injurious events from the Veteran perspective: A qualitative descriptive study","authors":"Heather A. King, Kathleen R Perry, Stephanie Ferguson, Bret L. Hickene, G. Jackson, Chanee Lynch, S. Woolson, J. Wortmann, Jason A. Nieuwsma, Kimber J Parry","doi":"10.3138/jmvfh-2022-0049","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0049","url":null,"abstract":"LAY SUMMARY Current conceptualizations of potentially morally injurious events (PMIEs) emphasize war atrocities (e.g., killing of children or civilians, witnessing abuse of prisoners of war). Additional research on PMIEs could inform provision of patient-centred care in pursuit of healing for those experiencing moral injury. The field would benefit from an operationalization of PMIEs that is not only grounded in empirical data and meaningful to clinicians but also accounts for the perspectives of the Veterans who experienced PMIEs. This study sought to gain a more in-depth understanding of and explore Veterans’ experiences surrounding PMIEs.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"11 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83289149","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}
LAY SUMMARY Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one’s moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations.
{"title":"Clinical utility of moral injury in a treatment-seeking military-Veteran mental health population","authors":"J. Richardson, Maya Roth, J. Liu","doi":"10.3138/jmvfh-2022-0053","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0053","url":null,"abstract":"LAY SUMMARY Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one’s moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"57 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87555104","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}
Stefanie T LoSavio, W. Hale, C. Straud, J. S. Wachen, J. Mintz, S. Young-McCaughan, Sarah Vacek, Jeffrey S. Yarvis, D. Sloan, Donald D. McGeary, Daniel J Taylor, T. Keane, A. Peterson, P. Resick
LAY SUMMARY Military personnel frequently report actions taken by themselves or others that violate deeply held moral beliefs, which can be experienced as a kind of moral injury. Some have questioned whether existing treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy, are effective for those who have been exposed to a morally injurious traumatic event. These analyses demonstrate that active duty service members and Veterans seeking treatment for PTSD who reported potentially morally injurious trauma had PTSD and depression outcomes that were as good as those whose traumas were not primarily seen as morally injurious, suggesting that cognitive processing therapy is an efficacious treatment for PTSD in the context of morally injurious trauma.
{"title":"Impact of morally injurious traumatic event exposure on cognitive processing therapy outcomes among Veterans and service members","authors":"Stefanie T LoSavio, W. Hale, C. Straud, J. S. Wachen, J. Mintz, S. Young-McCaughan, Sarah Vacek, Jeffrey S. Yarvis, D. Sloan, Donald D. McGeary, Daniel J Taylor, T. Keane, A. Peterson, P. Resick","doi":"10.3138/jmvfh-2022-0048","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0048","url":null,"abstract":"LAY SUMMARY Military personnel frequently report actions taken by themselves or others that violate deeply held moral beliefs, which can be experienced as a kind of moral injury. Some have questioned whether existing treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy, are effective for those who have been exposed to a morally injurious traumatic event. These analyses demonstrate that active duty service members and Veterans seeking treatment for PTSD who reported potentially morally injurious trauma had PTSD and depression outcomes that were as good as those whose traumas were not primarily seen as morally injurious, suggesting that cognitive processing therapy is an efficacious treatment for PTSD in the context of morally injurious trauma.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73878355","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}
N. Ein, Stephanie A Houle, J. Liu, B. Easterbrook, Clara Baker, Marianela Fuertes, Richard Benjamin Turner, Caleb MacDonald, Kathryn Reeves, E. Deda, Ken Hoffer, Catherine Baillie Abidi, A. Nazarov, J. Richardson
LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual’s deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.
{"title":"The potentially morally injurious nature of encountering children during military deployments: A call for research","authors":"N. Ein, Stephanie A Houle, J. Liu, B. Easterbrook, Clara Baker, Marianela Fuertes, Richard Benjamin Turner, Caleb MacDonald, Kathryn Reeves, E. Deda, Ken Hoffer, Catherine Baillie Abidi, A. Nazarov, J. Richardson","doi":"10.3138/jmvfh-2022-0044","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0044","url":null,"abstract":"LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual’s deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"70 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85337080","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}
LAY SUMMARY With the concept of moral injury being adopted as a way of understanding psychological distress experienced by Veterans, there is a growing interest in what role religion or spirituality might play as a factor in the risk of, or resilience against, experiencing this form of trauma. There is also interest in how religion and spirituality might be used to help treat moral injuries. However, most of the research to date has been conducted with American Christian Veterans and military service members. What is in question is whether these ideas work in the context of Veterans and service members of the Canadian Armed Forces. This article presents a critical warning about how the use of religion and spirituality might possibly cause harm instead of helping as intended.
{"title":"Critical intercession for non-religious Canadian Veterans on the intersections of moral injury, religion, and spirituality","authors":"W. Callaghan","doi":"10.3138/jmvfh-2022-0046","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0046","url":null,"abstract":"LAY SUMMARY With the concept of moral injury being adopted as a way of understanding psychological distress experienced by Veterans, there is a growing interest in what role religion or spirituality might play as a factor in the risk of, or resilience against, experiencing this form of trauma. There is also interest in how religion and spirituality might be used to help treat moral injuries. However, most of the research to date has been conducted with American Christian Veterans and military service members. What is in question is whether these ideas work in the context of Veterans and service members of the Canadian Armed Forces. This article presents a critical warning about how the use of religion and spirituality might possibly cause harm instead of helping as intended.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83817599","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}
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