Pub Date : 2024-09-14DOI: 10.1101/2024.09.13.24313629
Jessica Morrel, Michelle Dong, Michael A. Rosario, Devyn L. Cotter, Katherine L. Bottenhorn, Megan Herting
Objectives: Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI). Methods: Using PubMed and Web of Science, we conducted an updated literature search and systematic review of articles published through March 2024, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews informing the World Health Organization Global Air Quality Guidelines. Results: We identified 222 relevant papers, and 14 new studies met our inclusion criteria. Including six studies from our 2019 review, the 20 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old; however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions. Conclusion: Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review, publications doubled - an increase that testifies to the importance of this public health issue. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.
{"title":"A Systematic Review of Air Pollution Exposure and Brain Structure and Function during Development","authors":"Jessica Morrel, Michelle Dong, Michael A. Rosario, Devyn L. Cotter, Katherine L. Bottenhorn, Megan Herting","doi":"10.1101/2024.09.13.24313629","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313629","url":null,"abstract":"Objectives: Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI).\u0000Methods: Using PubMed and Web of Science, we conducted an updated literature search and systematic review of articles published through March 2024, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews informing the World Health Organization Global Air Quality Guidelines. Results: We identified 222 relevant papers, and 14 new studies met our inclusion criteria. Including six studies from our 2019 review, the 20 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old; however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions.\u0000Conclusion: Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review, publications doubled - an increase that testifies to the importance of this public health issue. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257519","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}
Pub Date : 2024-09-14DOI: 10.1101/2024.09.12.24313313
Hannah Sallis, Ilaria Costantini, Tugce Melisa Sau Chuong, Katri Kantojarvi, Robyn E Wootton, Hannah J Jones, Lea Sirignano, Josef Frank, Fabian Streit, Stephanie Witt, Lea Zillich, Maria Gilles, Helga Ask, Alex Siu Fung Kwong, Mark Adams, Kate Tilling, Deborah A. Lawlor, Nicholas J Timpson, Tiina Paunio, Alexandra Havdahl, Andrew M McIntosh, Alan Stein, Deborah James, Rebecca M. Pearson
Disentangling direct and indirect genetic pathways underlying the intergenerational transmission of emotional problems could guide preventative strategies and further the understanding of the role of parental mental health in children's outcomes. This study aimed to estimate the extent to which genetic pathways that are direct (via child genotype) and indirect (e.g., via parental phenotype) explain the well-established association between parent and child emotional problems. We leveraged data from seven European cohort studies with a combined population of Ntrios=15,475. Polygenic scores were calculated for parental and offspring neuroticism, as it represents a dispositional trait underlying emotional problems. Emotional problems in offspring were measured using validated scales across various developmental stages from early childhood to adulthood. We used neuroticism polygenic scores within a structural equation modelling framework to distinguish between direct genetic pathways from parental genotype to offspring outcome (acting through offspring genotype), and indirect genetic pathways (acting through parental phenotype and associated environment). Standard errors for direct genetic, indirect genetic and total effects were bootstrapped and meta-analyses pooled effect estimates at three developmental stages (childhood: 3-4 years, adolescence: 11-13 years, adulthood: 18+ years). We found evidence suggesting an indirect genetic pathway between mothers and child emotional problems during early childhood (pooled estimate, mean difference in child emotional problems score per 1SD increase in maternal PGS for neuroticism=0.04, 95% CI: 0.01, 0.07). This association attenuated over child development, while direct genetic pathways strengthened. High attrition rates, measurement error and low variance explained by polygenic scores may have altered precision of the estimates, influencing the interpretation of the results. However, we provide the first multi-cohort study to provide evidence for an indirect genetic pathway from maternal neuroticism to early child emotional problems. This suggests that there are likely processes other than direct genetic pathways involved in the intergenerational transmission of emotional problems, highlighting the importance of timely support to prevent and reduce emotional issues in mothers as a preventative strategy for emotional difficulties.
{"title":"Direct and indirect genetic pathways between parental neuroticism and offspring emotional problems across development: evidence from 7 cohorts across 5 European nations","authors":"Hannah Sallis, Ilaria Costantini, Tugce Melisa Sau Chuong, Katri Kantojarvi, Robyn E Wootton, Hannah J Jones, Lea Sirignano, Josef Frank, Fabian Streit, Stephanie Witt, Lea Zillich, Maria Gilles, Helga Ask, Alex Siu Fung Kwong, Mark Adams, Kate Tilling, Deborah A. Lawlor, Nicholas J Timpson, Tiina Paunio, Alexandra Havdahl, Andrew M McIntosh, Alan Stein, Deborah James, Rebecca M. Pearson","doi":"10.1101/2024.09.12.24313313","DOIUrl":"https://doi.org/10.1101/2024.09.12.24313313","url":null,"abstract":"Disentangling direct and indirect genetic pathways underlying the intergenerational transmission of emotional problems could guide preventative strategies and further the understanding of the role of parental mental health in children's outcomes. This study aimed to estimate the extent to which genetic pathways that are direct (via child genotype) and indirect (e.g., via parental phenotype) explain the well-established association between parent and child emotional problems. We leveraged data from seven European cohort studies with a combined population of Ntrios=15,475. Polygenic scores were calculated for parental and offspring neuroticism, as it represents a dispositional trait underlying emotional problems. Emotional problems in offspring were measured using validated scales across various developmental stages from early childhood to adulthood. We used neuroticism polygenic scores within a structural equation modelling framework to distinguish between direct genetic pathways from parental genotype to offspring outcome (acting through offspring genotype), and indirect genetic pathways (acting through parental phenotype and associated environment). Standard errors for direct genetic, indirect genetic and total effects were bootstrapped and meta-analyses pooled effect estimates at three developmental stages (childhood: 3-4 years, adolescence: 11-13 years, adulthood: 18+ years). We found evidence suggesting an indirect genetic pathway between mothers and child emotional problems during early childhood (pooled estimate, mean difference in child emotional problems score per 1SD increase in maternal PGS for neuroticism=0.04, 95% CI: 0.01, 0.07). This association attenuated over child development, while direct genetic pathways strengthened. High attrition rates, measurement error and low variance explained by polygenic scores may have altered precision of the estimates, influencing the interpretation of the results. However, we provide the first multi-cohort study to provide evidence for an indirect genetic pathway from maternal neuroticism to early child emotional problems. This suggests that there are likely processes other than direct genetic pathways involved in the intergenerational transmission of emotional problems, highlighting the importance of timely support to prevent and reduce emotional issues in mothers as a preventative strategy for emotional difficulties.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257520","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}
Background: Routine epidemiological data are essential for monitoring the effectiveness of preventive chemotherapy (PC), optimizing resource allocation, and addressing the evolving needs in the elimination of soil-transmitted helminthiasis (STH). This study assesses the prevalence, intensity, and associated risk factors of STH following five rounds of albendazole-based PC in three implementation units (IUs) in Ondo State, Nigeria. Methodology: Fresh stool samples were collected from 2,093 children aged 5–14 years across 45 systematically selected schools in three IUs: Ese-Odo, Irele, and Ile-Oluji. The samples were analyzed using the Kato-Katz technique. Additionally, standardized questionnaires were administered to gather data on demographics and access to water, sanitation, and hygiene (WASH) resources. Data analysis was conducted using R software version 4.3.2, with a 95% confidence interval. Principal Findings/Conclusions: The parasitological data indicated a significant decline in the aggregated prevalence of STH across the three IUs. In Ese-Odo, the prevalence decreased to 25.8% (95% CI: 23.0–29.0) from 39% at baseline (d = -34%, p = 0.00). In Irele, prevalence dropped to 9.7% (95% CI: 7.6–12.0) from 51.3% at baseline (d = -81%, p = 0.00), and in Ile-Oluji, prevalence was reduced to 6.4% (95% CI: 4.6–8.7) from 23% at baseline (d = -72.2%, p = 0.00). The most prevalent STH species was Ascaris lumbricoides, with infection rates of 25.5%, 9.4%, and 6.4% in Ese-Odo, Irele, and Ile-Oluji, respectively, followed by Trichuris trichiura in Ese-Odo (2.7%) and Irele (0.4%), while hookworm infections were detected only in Irele (0.7%). The majority of infections were of low intensity in Ese-Odo (91.0%), Irele (96.8%), and Ile-Oluji (100%). Access to improved sanitation (17.7%, 54.9%, and 58.2%, p < 0.05), improved water sources (24.5%, 66.1%, and 69.8%, p < 0.05), and handwashing facilities (9.0%, 39.6%, and 25.4%) was suboptimal across Ese-Odo, Irele, and Ile-Oluji, respectively. Open defecation rates were high in Ese-Odo (54.2%), Irele (36.3%), and Ile-Oluji (34.3%). In Ese-Odo, significant risk factors for STH infection included the use of hand-pump boreholes (AOR: 2.44, 95% CI: 1.23–4.88, p = 0.01), unprotected dug wells (AOR: 3.25, 95% CI: 0.96–11.36, p = 0.06), ventilated improved pit latrines (AOR: 3.95, 95% CI: 1.13–16.1, p = 0.04), pit latrines without a slab (AOR: 2.19, 95% CI: 1.27–3.8, p = 0.01), and failure to use soap after defecation, both when soap was available (AOR: 12.09, 95% CI: 1.86–112.97, p = 0.01) and when soap was unavailable (AOR: 8.19, 95% CI: 1.73–76.65, p = 0.04). In Irele, access to protected dug wells was marginally significant (AOR: 1.79, 95% CI: 0.96–3.21, p = 0.06), while in Ile-Oluji, access to river water emerged as a significant risk factor (AOR: 7.97, 95% CI: 1.81–58.58, p = 0.02). The use of rainwater was found to be protective across all three IUs. These findings demonstrate significant progress in reducin
{"title":"Prevalence, intensity and risk factors of soil-transmitted helminthiasis after five effective rounds of preventive chemotherapy across three implementation units in Ondo State, Nigeria","authors":"Hammed Mogaji, Francisca Olamiju, Fajana Oyinlola, Ijeoma Achu, Nimota Adekunle, Lydia Etuk Udofia, Ekaette Godwin Edelduok, Clement Ameh Yaro, Olanike Oladipupo, Alice Kehinde, Fatai Oyediran, Moses Aderogba, Louise Makau-Barasa, Uwem Friday Ekpo","doi":"10.1101/2024.09.13.24313604","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313604","url":null,"abstract":"Background: Routine epidemiological data are essential for monitoring the effectiveness of preventive chemotherapy (PC), optimizing resource allocation, and addressing the evolving needs in the elimination of soil-transmitted helminthiasis (STH). This study assesses the prevalence, intensity, and associated risk factors of STH following five rounds of albendazole-based PC in three implementation units (IUs) in Ondo State, Nigeria. Methodology: Fresh stool samples were collected from 2,093 children aged 5–14 years across 45 systematically selected schools in three IUs: Ese-Odo, Irele, and Ile-Oluji. The samples were analyzed using the Kato-Katz technique. Additionally, standardized questionnaires were administered to gather data on demographics and access to water, sanitation, and hygiene (WASH) resources. Data analysis was conducted using R software version 4.3.2, with a 95% confidence interval. Principal Findings/Conclusions: The parasitological data indicated a significant decline in the aggregated prevalence of STH across the three IUs. In Ese-Odo, the prevalence decreased to 25.8% (95% CI: 23.0–29.0) from 39% at baseline (d = -34%, p = 0.00). In Irele, prevalence dropped to 9.7% (95% CI: 7.6–12.0) from 51.3% at baseline (d = -81%, p = 0.00), and in Ile-Oluji, prevalence was reduced to 6.4% (95% CI: 4.6–8.7) from 23% at baseline (d = -72.2%, p = 0.00). The most prevalent STH species was Ascaris lumbricoides, with infection rates of 25.5%, 9.4%, and 6.4% in Ese-Odo, Irele, and Ile-Oluji, respectively, followed by Trichuris trichiura in Ese-Odo (2.7%) and Irele (0.4%), while hookworm infections were detected only in Irele (0.7%). The majority of infections were of low intensity in Ese-Odo (91.0%), Irele (96.8%), and Ile-Oluji (100%). Access to improved sanitation (17.7%, 54.9%, and 58.2%, p < 0.05), improved water sources (24.5%, 66.1%, and 69.8%, p < 0.05), and handwashing facilities (9.0%, 39.6%, and 25.4%) was suboptimal across Ese-Odo, Irele, and Ile-Oluji, respectively. Open defecation rates were high in Ese-Odo (54.2%), Irele (36.3%), and Ile-Oluji (34.3%). In Ese-Odo, significant risk factors for STH infection included the use of hand-pump boreholes (AOR: 2.44, 95% CI: 1.23–4.88, p = 0.01), unprotected dug wells (AOR: 3.25, 95% CI: 0.96–11.36, p = 0.06), ventilated improved pit latrines (AOR: 3.95, 95% CI: 1.13–16.1, p = 0.04), pit latrines without a slab (AOR: 2.19, 95% CI: 1.27–3.8, p = 0.01), and failure to use soap after defecation, both when soap was available (AOR: 12.09, 95% CI: 1.86–112.97, p = 0.01) and when soap was unavailable (AOR: 8.19, 95% CI: 1.73–76.65, p = 0.04). In Irele, access to protected dug wells was marginally significant (AOR: 1.79, 95% CI: 0.96–3.21, p = 0.06), while in Ile-Oluji, access to river water emerged as a significant risk factor (AOR: 7.97, 95% CI: 1.81–58.58, p = 0.02). The use of rainwater was found to be protective across all three IUs. These findings demonstrate significant progress in reducin","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257523","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}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.12.24313469
Anna Strasma, Anisha Gerber, Isabela Agi Maluli, Elizabeth R Blackwood, Sameera Gunasekara, P. Mangala C.S. De Silva, Nivedita Kamath, Marvin Gonzalez-Quiroz, Alison P Sanders, Christina Wyatt, Nishad Jayasundara
Background: Chronic kidney disease of unknown etiology (CKDu) is a tubulointerstitial disease that disproportionately affects young, primarily male, agricultural workers in Mesoamerica and South Asia who lack traditional risk factors for kidney disease. Extensive research in adult populations suggests the etiology is complex and indicates that early childhood exposures could have an integral role. Objectives: To identify, summarize, and compare research in children living in CKDu endemic areas or with relevant CKDu-related exposures. Methods: A systematic literature search was conducted in six databases for studies that report kidney health outcomes of pediatric populations living in proximity to CKDu-affected areas with no limitations on geography or study design. Studies were independently screened for inclusion and underwent quality assessment using the Appraisal Tool for Cross-Sectional Studies (AXIS) or the JBI Critical Appraisal Tool for Cohort Studies based on the study design by at least two authors. Data are compared narratively and graphically. Results: We included twenty peer-reviewed publications and two meeting abstracts from eight different countries. The most common study design involved cross-sectional analysis of biological specimens from children in an established CKDu endemic area. Marked decreases in estimated glomerular filtration rate were generally not identified and prevalence of albuminuria differed widely between countries. Novel urinary biomarkers frequently demonstrated subclinical kidney damage, although the specific biomarker(s) varied between studies. Epidemiologic factors associated with evidence of subclinical kidney damage in children included proximity to agriculture or agrichemicals. Despite heterogenous study outcomes, all studies concluded that there were signs of kidney injury in children living in CKDu endemic areas or with a CKDu-relevant environmental exposure. Conclusion: This systematic review suggests that the pathophysiologic process leading to CKDu may begin prior to adulthood. Future longitudinal research aimed at elucidating the multifaceted factors and exposures impacting entire communities, including children, is imperative for disease prevention strategies.
{"title":"Pediatric Kidney Injury in Communities Impacted by Chronic Kidney Disease of Unknown Etiology (CKDu): A Comprehensive Systematic Review of Epidemiologic Studies","authors":"Anna Strasma, Anisha Gerber, Isabela Agi Maluli, Elizabeth R Blackwood, Sameera Gunasekara, P. Mangala C.S. De Silva, Nivedita Kamath, Marvin Gonzalez-Quiroz, Alison P Sanders, Christina Wyatt, Nishad Jayasundara","doi":"10.1101/2024.09.12.24313469","DOIUrl":"https://doi.org/10.1101/2024.09.12.24313469","url":null,"abstract":"Background: Chronic kidney disease of unknown etiology (CKDu) is a tubulointerstitial disease that disproportionately affects young, primarily male, agricultural workers in Mesoamerica and South Asia who lack traditional risk factors for kidney disease. Extensive research in adult populations suggests the etiology is complex and indicates that early childhood exposures could have an integral role.\u0000Objectives: To identify, summarize, and compare research in children living in CKDu endemic areas or with relevant CKDu-related exposures.\u0000Methods: A systematic literature search was conducted in six databases for studies that report kidney health outcomes of pediatric populations living in proximity to CKDu-affected areas with no limitations on geography or study design. Studies were independently screened for inclusion and underwent quality assessment using the Appraisal Tool for Cross-Sectional Studies (AXIS) or the JBI Critical Appraisal Tool for Cohort Studies based on the study design by at least two authors. Data are compared narratively and graphically.\u0000Results: We included twenty peer-reviewed publications and two meeting abstracts from eight different countries. The most common study design involved cross-sectional analysis of biological specimens from children in an established CKDu endemic area. Marked decreases in estimated glomerular filtration rate were generally not identified and prevalence of albuminuria differed widely between countries. Novel urinary biomarkers frequently demonstrated subclinical kidney damage, although the specific biomarker(s) varied between studies. Epidemiologic factors associated with evidence of subclinical kidney damage in children included proximity to agriculture or agrichemicals. Despite heterogenous study outcomes, all studies concluded that there were signs of kidney injury in children living in CKDu endemic areas or with a CKDu-relevant environmental exposure.\u0000Conclusion: This systematic review suggests that the pathophysiologic process leading to CKDu may begin prior to adulthood. Future longitudinal research aimed at elucidating the multifaceted factors and exposures impacting entire communities, including children, is imperative for disease prevention strategies.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269610","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}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.11.24313500
Alexandra Porras-Ramírez, Alejandro Rico-Mendoza, Maria Fernanda Campos-Maya, Jairo Cardenas-Sanchez, Diego Penagos-Lopez, Ana Maria Gomez-Puentes, Natalia Delgado-Quiroz, Leandro Guarin-Muñoz, Juan Esteban Ortiz-Elejalde
Background Multimorbidity, the coexistence of multiple chronic diseases, poses significant challenges for healthcare systems worldwide. This study aims to assess the situation of multimorbidity in Colombia using structural equation models and to characterize multimorbidity by sex, age group, region, and health insurance regime between 2019 and 2023. Methods We conducted a cross-sectional analytical study utilizing data from the Individual Health Service Provision Registry (RIPS) and other national databases, including the Unit of Payment by Capitation (UPC) Sufficiency Study Database. Structural equation models were employed to identify and analyze multimorbidity clusters among patients with two or more chronic diseases. Results The study revealed a multimorbidity prevalence of 61.5% in the general population. Hypertension emerged as the most prevalent chronic condition, frequently associated with diabetes and chronic kidney disease. Multimorbidity was more common in women and individuals affiliated with the contributory insurance regime. The study also identified significant variations in multimorbidity prevalence across different regions and age groups. Conclusions Multimorbidity is a prevalent issue in Colombia, with substantial variations by sex, age, and insurance regime. These findings underscore the need for tailored healthcare strategies to address the diverse needs of multimorbid patients. The results provide critical insights for health service planning and management, emphasizing the importance of continued research and policy development to mitigate the burden of chronic diseases and multimorbidity in Colombia.
{"title":"Assessing the Impact of COVID-19 on Multimorbidity: Insights from Structural Equation Modeling in Colombia","authors":"Alexandra Porras-Ramírez, Alejandro Rico-Mendoza, Maria Fernanda Campos-Maya, Jairo Cardenas-Sanchez, Diego Penagos-Lopez, Ana Maria Gomez-Puentes, Natalia Delgado-Quiroz, Leandro Guarin-Muñoz, Juan Esteban Ortiz-Elejalde","doi":"10.1101/2024.09.11.24313500","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313500","url":null,"abstract":"Background Multimorbidity, the coexistence of multiple chronic diseases, poses significant challenges for healthcare systems worldwide. This study aims to assess the situation of multimorbidity in Colombia using structural equation models and to characterize multimorbidity by sex, age group, region, and health insurance regime between 2019 and 2023. Methods We conducted a cross-sectional analytical study utilizing data from the Individual Health Service Provision Registry (RIPS) and other national databases, including the Unit of Payment by Capitation (UPC) Sufficiency Study Database. Structural equation models were employed to identify and analyze multimorbidity clusters among patients with two or more chronic diseases. Results The study revealed a multimorbidity prevalence of 61.5% in the general population. Hypertension emerged as the most prevalent chronic condition, frequently associated with diabetes and chronic kidney disease. Multimorbidity was more common in women and individuals affiliated with the contributory insurance regime. The study also identified significant variations in multimorbidity prevalence across different regions and age groups. Conclusions Multimorbidity is a prevalent issue in Colombia, with substantial variations by sex, age, and insurance regime. These findings underscore the need for tailored healthcare strategies to address the diverse needs of multimorbid patients. The results provide critical insights for health service planning and management, emphasizing the importance of continued research and policy development to mitigate the burden of chronic diseases and multimorbidity in Colombia.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257220","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}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.11.24311990
Marie Al Rahmoun, Alexandre Sabaté-Elabbadi, Didier Guillemot, Christian Brun-Buisson, Laurence Watier
Importance Sepsis is a serious medical condition that causes long-term morbidity and high mortality, annually affecting millions of people worldwide. The COVID-19 pandemic may have impacted its burden. Objective To estimate the impact of the COVID-19 pandemic on sepsis incidence, etiology and associated hospitalization costs in metropolitan France. Design, Setting and Participants This retrospective observational study used data drawn from a cohort of hospitalized sepsis patients in France s national healthcare database. Sepsis was identified through both explicit ICD-10 codes (E-sepsis) and implicit codes (I-sepsis). Participants included all patients aged 15 years or older hospitalized with E-sepsis or I-sepsis in metropolitan France between January 1, 2018, and December 31, 2022. Main outcomes and measures Patient and hospital stay characteristics were described by sepsis type (E-sepsis, I-sepsis) and overall. The distribution of sepsis etiology was estimated for each year. Annual incidence rates were estimated overall and by sepsis type and etiology. Total and median per-stay hospitalization costs were calculated. Results The total age- and sex-standardized sepsis incidence rate per 100,000 increased slightly from 2018 (446, 95% CI 444.2 to 447.7) to 2020 (457, 95% CI 455.1 to 458.6) and then decreased in 2022 (382, 95% CI 380.2-383.7) (p <.0001). Incidence rates decreased for both E-sepsis and bacterial sepsis during the pandemic period, whereas I-sepsis incidence increased in 2020 and 2021, associated with a marked increase in viral sepsis and co-infections (p <.0001 for E- and I-sepsis). Viral sepsis represented about 10% of all sepsis cases during the pandemic, but only about 1% prior to the pandemic. Total sepsis-associated hospitalization costs and extra medication costs increased during the pandemic. Characteristics of patients and their hospital stays were overall stable over the five-year study period. Conclusion and Relevance The COVID-19 pandemic led to a higher burden of sepsis in French hospitals and an increase in hospital stay costs. Critically, our study highlights the need for introducing explicit viral sepsis codes within the ICD-11 classification system and for achieving a consensus on its definition in order to robustly estimate sepsis incidence.
重要性 败血症是一种严重的内科疾病，会导致长期发病和高死亡率，每年影响全球数百万人。COVID-19 大流行可能对其负担产生了影响。目的 估计 COVID-19 大流行对法国大都市败血症发病率、病因和相关住院费用的影响。脓毒症通过明确的 ICD-10 编码（E-sepsis）和隐含编码（I-sepsis）进行识别。参与者包括 2018 年 1 月 1 日至 2022 年 12 月 31 日期间在法国本土因 E 败血症或 I 败血症住院的所有 15 岁或以上患者。主要结果和测量方法 根据败血症类型（E-败血症、I-败血症）和总体情况描述患者和住院特征。估计每年败血症病因的分布情况。按败血症类型和病因估算年度总体发病率。结果 每 10 万人中年龄和性别标准化败血症总发病率从 2018 年（446，95% CI 444.2 至 447.7）到 2020 年（457，95% CI 455.1 至 458.6）略有上升，然后在 2022 年有所下降（382，95% CI 380.2-383.7）（p <.0001）。在大流行期间，E-败血症和细菌性败血症的发病率均有所下降，而 I-败血症的发病率在 2020 年和 2021 年有所上升，这与病毒性败血症和合并感染的显著增加有关（E-败血症和 I-败血症的 p <.0001）。在大流行期间，病毒性败血症约占所有败血症病例的 10%，而在大流行之前仅占约 1%。在大流行期间，与败血症相关的住院总费用和额外药物费用都有所增加。在为期五年的研究期间，患者的特征和住院时间总体上保持稳定。重要的是，我们的研究强调，有必要在 ICD-11 分类系统中引入明确的病毒性败血症代码，并就其定义达成共识，以便有力地估计败血症的发病率。
{"title":"Impacts of the COVID-19 pandemic on sepsis incidence, etiology and hospitalization costs in France: a retrospective observational study","authors":"Marie Al Rahmoun, Alexandre Sabaté-Elabbadi, Didier Guillemot, Christian Brun-Buisson, Laurence Watier","doi":"10.1101/2024.09.11.24311990","DOIUrl":"https://doi.org/10.1101/2024.09.11.24311990","url":null,"abstract":"Importance Sepsis is a serious medical condition that causes long-term morbidity and high mortality, annually affecting millions of people worldwide. The COVID-19 pandemic may have impacted its burden. Objective To estimate the impact of the COVID-19 pandemic on sepsis incidence, etiology and associated hospitalization costs in metropolitan France.\u0000Design, Setting and Participants This retrospective observational study used data drawn from a cohort of hospitalized sepsis patients in France s national healthcare database. Sepsis was identified through both explicit ICD-10 codes (E-sepsis) and implicit codes (I-sepsis). Participants included all patients aged 15 years or older hospitalized with E-sepsis or I-sepsis in metropolitan France between January 1, 2018, and December 31, 2022. Main outcomes and measures Patient and hospital stay characteristics were described by sepsis type (E-sepsis, I-sepsis) and overall. The distribution of sepsis etiology was estimated for each year. Annual incidence rates were estimated overall and by sepsis type and etiology. Total and median per-stay hospitalization costs were calculated.\u0000Results The total age- and sex-standardized sepsis incidence rate per 100,000 increased slightly from 2018 (446, 95% CI 444.2 to 447.7) to 2020 (457, 95% CI 455.1 to 458.6) and then decreased in 2022 (382, 95% CI 380.2-383.7) (p <.0001). Incidence rates decreased for both E-sepsis and bacterial sepsis during the pandemic period, whereas I-sepsis incidence increased in 2020 and 2021, associated with a marked increase in viral sepsis and co-infections (p <.0001 for E- and I-sepsis). Viral sepsis represented about 10% of all sepsis cases during the pandemic, but only about 1% prior to the pandemic. Total sepsis-associated hospitalization costs and extra medication costs increased during the pandemic. Characteristics of patients and their hospital stays were overall stable over the five-year study period.\u0000Conclusion and Relevance The COVID-19 pandemic led to a higher burden of sepsis in French hospitals and an increase in hospital stay costs. Critically, our study highlights the need for introducing explicit viral sepsis codes within the ICD-11 classification system and for achieving a consensus on its definition in order to robustly estimate sepsis incidence.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257222","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}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.12.24313561
Tariq Faquih, Kaitlin S Potts, Bing Yu, Robert Kaplan, Carmen R. Isasi, Qibin Qi, Kent Taylor, Peter Y. Liu, Russell Tracy, Craig Johnson, Steve Rich, Clary B Clish, Robert E Gerszten, Jerome Rotter, Susan Redline, Tamar Sofer, Heming Wang
Background Excessive daytime sleepiness (EDS) is a complex sleep problem that affects approximately 33% of the United States population. Although EDS usually occurs in conjunction with insufficient sleep, and other sleep and circadian disorders, recent studies have shown unique genetic markers and metabolic pathways underlying EDS. Here, we aimed to further elucidate the biological profile of EDS using large scale single- and pathway-level metabolomics analyses. Methods Metabolomics data were available for 877 metabolites in 6,071 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and EDS was assessed using the Epworth Sleepiness Scale (ESS) questionnaire. We performed linear regression for each metabolite on continuous ESS, adjusting for demographic, lifestyle, and physiological confounders, and in sex specific groups. Subsequently, gaussian graphical modelling was performed coupled with pathway and enrichment analyses to generate a holistic interactive network of the metabolomic profile of EDS associations. Findings We identified seven metabolites belonging to steroids, sphingomyelin, and long chain fatty acids sub-pathways in the primary model associated with EDS, and an additional three metabolites in the male-specific analysis. The identified metabolites particularly played a role in steroid hormone biosynthesis. Interpretation Our findings indicate that an EDS metabolomic profile is characterized by endogenous and dietary metabolites within the steroid hormone biosynthesis pathway, with some pathways that differ by sex. Our findings identify potential pathways to target for addressing the causes or consequences of EDS and related sleep disorders. Funding Details regarding funding supporting this work and all studies involved are provided in the acknowledgments section.
{"title":"Steroid Hormone Biosynthesis and Dietary Related Metabolites associated with Excessive Daytime Sleepiness","authors":"Tariq Faquih, Kaitlin S Potts, Bing Yu, Robert Kaplan, Carmen R. Isasi, Qibin Qi, Kent Taylor, Peter Y. Liu, Russell Tracy, Craig Johnson, Steve Rich, Clary B Clish, Robert E Gerszten, Jerome Rotter, Susan Redline, Tamar Sofer, Heming Wang","doi":"10.1101/2024.09.12.24313561","DOIUrl":"https://doi.org/10.1101/2024.09.12.24313561","url":null,"abstract":"Background\u0000Excessive daytime sleepiness (EDS) is a complex sleep problem that affects approximately 33% of the United States population. Although EDS usually occurs in conjunction with insufficient sleep, and other sleep and circadian disorders, recent studies have shown unique genetic markers and metabolic pathways underlying EDS. Here, we aimed to further elucidate the biological profile of EDS using large scale single- and pathway-level metabolomics analyses. Methods\u0000Metabolomics data were available for 877 metabolites in 6,071 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and EDS was assessed using the Epworth Sleepiness Scale (ESS) questionnaire. We performed linear regression for each metabolite on continuous ESS, adjusting for demographic, lifestyle, and physiological confounders, and in sex specific groups. Subsequently, gaussian graphical modelling was performed coupled with pathway and enrichment analyses to generate a holistic interactive network of the metabolomic profile of EDS associations. Findings\u0000We identified seven metabolites belonging to steroids, sphingomyelin, and long chain fatty acids sub-pathways in the primary model associated with EDS, and an additional three metabolites in the male-specific analysis. The identified metabolites particularly played a role in steroid hormone biosynthesis. Interpretation\u0000Our findings indicate that an EDS metabolomic profile is characterized by endogenous and dietary metabolites within the steroid hormone biosynthesis pathway, with some pathways that differ by sex. Our findings identify potential pathways to target for addressing the causes or consequences of EDS and related sleep disorders. Funding Details regarding funding supporting this work and all studies involved are provided in the acknowledgments section.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257223","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}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.12.24313524
Zhu Liduzi Jiesisibieke, Io Ieong Chan, Jack Chun Man Ng, C Mary Schooling
Background: Trials of incretins are making it increasingly clear that body mass index (BMI) is linked to several diseases throughout life, but trials cannot provide a comprehensive assessment of the role of BMI in health-related attributes for men and women. To systematically investigate the role of BMI, we conducted a sex-specific Mendelian randomization-phenome-wide association study.
{"title":"A Sex-specific Mendelian Randomization-Phenome-Wide Association Study of Body Mass Index","authors":"Zhu Liduzi Jiesisibieke, Io Ieong Chan, Jack Chun Man Ng, C Mary Schooling","doi":"10.1101/2024.09.12.24313524","DOIUrl":"https://doi.org/10.1101/2024.09.12.24313524","url":null,"abstract":"<strong>Background: </strong>Trials of incretins are making it increasingly clear that body mass index (BMI) is linked to several diseases throughout life, but trials cannot provide a comprehensive assessment of the role of BMI in health-related attributes for men and women. To systematically investigate the role of BMI, we conducted a sex-specific Mendelian randomization-phenome-wide association study.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257221","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}
Pub Date : 2024-09-12DOI: 10.1101/2024.09.11.24313462
Akshay Tiwari, Shreya Chowdhury, Ananthu James, Budhaditya Chatterjee, Narendra M Dixit
Accurate estimates of the prevalence of asymptomatic SARS-CoV-2 infections, ψ, have been important for understanding and forecasting the trajectory of the COVID-19 pandemic. Two-part population-based surveys, which test the infection status and also assess symptoms, have been used to estimate ψ. Here, we identified a widely prevalent confounding effect that compromises these estimates and devised a formalism to adjust for it. The symptoms associated with SARS-CoV-2 infection are not all specific to SARS-CoV-2. They can be triggered by a host of other conditions, such as influenza virus infection. By not accounting for the source of the symptoms, the surveys may misclassify individuals experiencing symptoms from other conditions as symptomatic for SARS-CoV-2, thus underestimating ψ. We developed a rigorous formalism to adjust for this confounding effect and derived a facile formula for the adjusted prevalence, ψadj. We applied it to data from 50 published serosurveys, conducted on the general populations from 28 nations. We found that ψadj was significantly higher than the reported prevalence, ψc (P=3×10-8). The median ψadj was ~60%, whereas the median ψc was ~40%. In several instances, ψadj exceeded ψc by >100%. These findings suggest that asymptomatic infections have been far more prevalent than previously estimated. Our formalism can be readily deployed to obtain more accurate estimates of ψ from standard population-based surveys, without additional data collection. The findings have implications for understanding COVID-19 epidemiology and devising more effective interventions.
{"title":"Adjusting for specificity of symptoms reveals higher prevalence of asymptomatic SARS-CoV-2 infections than previously estimated","authors":"Akshay Tiwari, Shreya Chowdhury, Ananthu James, Budhaditya Chatterjee, Narendra M Dixit","doi":"10.1101/2024.09.11.24313462","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313462","url":null,"abstract":"Accurate estimates of the prevalence of asymptomatic SARS-CoV-2 infections, ψ, have been important for understanding and forecasting the trajectory of the COVID-19 pandemic. Two-part population-based surveys, which test the infection status and also assess symptoms, have been used to estimate ψ. Here, we identified a widely prevalent confounding effect that compromises these estimates and devised a formalism to adjust for it. The symptoms associated with SARS-CoV-2 infection are not all specific to SARS-CoV-2. They can be triggered by a host of other conditions, such as influenza virus infection. By not accounting for the source of the symptoms, the surveys may misclassify individuals experiencing symptoms from other conditions as symptomatic for SARS-CoV-2, thus underestimating ψ. We developed a rigorous formalism to adjust for this confounding effect and derived a facile formula for the adjusted prevalence, ψ<sub>adj</sub>. We applied it to data from 50 published serosurveys, conducted on the general populations from 28 nations. We found that ψ<sub>adj</sub> was significantly higher than the reported prevalence, ψ<sub>c</sub> (P=3×10<sup>-8</sup>). The median ψ<sub>adj</sub> was ~60%, whereas the median ψ<sub>c</sub> was ~40%. In several instances, ψ<sub>adj</sub> exceeded ψ<sub>c</sub> by >100%. These findings suggest that asymptomatic infections have been far more prevalent than previously estimated. Our formalism can be readily deployed to obtain more accurate estimates of ψ from standard population-based surveys, without additional data collection. The findings have implications for understanding COVID-19 epidemiology and devising more effective interventions.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213600","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}
Pub Date : 2024-09-12DOI: 10.1101/2024.09.10.24312897
Louisa R Moorhouse, Simon Gregson, Jeffrey W Imai-Eaton, Justin Mayini, Tawanda Dadirai, Phyllis Magoge-Mandizvidza, Rufurwokuda Maswera, Simbarashe Mabaya, Rachel Baggaley, Daniel Low-Beer, Constance Nyamukapa, Shona Dalal
Background Differentiating risk for HIV infection is important for providing focussed prevention options to individuals. We conducted a longitudinal study to validate a risk-differentiation tool for predicting HIV or HSV-2 acquisition among HIV-negative youth. Setting Population-based household survey in east Zimbabwe. Methods HIV and HSV-2 status and HIV behavioural risk factors were assessed in two surveys conducted 12 months apart among young people. Associations between risk-behaviours and combined HIV/HSV-2 incident infection were estimated using proportional hazards models. We calculated the sensitivity and specificity of risk-differentiation questions in predicting HIV/HSV-2 acquisition and quantified changes between surveys among low, medium, and high-risk categories. Results In total, 44 HIV/HSV-2 seroconversions were observed in 1812 person-years of follow up (2.43/100PY, 95%CI: 1.71-3.15); 50% of incident cases reported never having had sex at baseline. Risk of HIV/HSV-2 acquisition was higher for those reporting non-regular partners (women: HR=2.71, 95% CI:1.12-6.54, men: HR=1.37, 95%CI: 0.29-6.38) and those reporting having a partner with a sexually transmitted infection (STI) (HR=7.62 (1.22-47.51). Adding a question on non-regular partnerships increased tool sensitivity from 18.2% to 38.6%, and further to 77.3% when restricted to those who had ever had sex. Individual risk category increased for 28% of men and 17% of women over 12-months. Conclusion The refined risk differentiation tool identified a high proportion of youth at risk of HIV acquisition. Despite this, half of incident infections were among individuals who reported no prior sexual activity. The shifting patterns of risk behaviours underscore the need for dynamic prevention engagement strategies in high HIV prevalence or incidence settings.
{"title":"Dynamic HIV risk differentiation among youth: Validation of a tool for prioritization of prevention in East Zimbabwe","authors":"Louisa R Moorhouse, Simon Gregson, Jeffrey W Imai-Eaton, Justin Mayini, Tawanda Dadirai, Phyllis Magoge-Mandizvidza, Rufurwokuda Maswera, Simbarashe Mabaya, Rachel Baggaley, Daniel Low-Beer, Constance Nyamukapa, Shona Dalal","doi":"10.1101/2024.09.10.24312897","DOIUrl":"https://doi.org/10.1101/2024.09.10.24312897","url":null,"abstract":"Background\u0000Differentiating risk for HIV infection is important for providing focussed prevention options to individuals. We conducted a longitudinal study to validate a risk-differentiation tool for predicting HIV or HSV-2 acquisition among HIV-negative youth.\u0000Setting\u0000Population-based household survey in east Zimbabwe.\u0000Methods\u0000HIV and HSV-2 status and HIV behavioural risk factors were assessed in two surveys conducted 12 months apart among young people. Associations between risk-behaviours and combined HIV/HSV-2 incident infection were estimated using proportional hazards models. We calculated the sensitivity and specificity of risk-differentiation questions in predicting HIV/HSV-2 acquisition and quantified changes between surveys among low, medium, and high-risk categories. Results In total, 44 HIV/HSV-2 seroconversions were observed in 1812 person-years of follow up (2.43/100PY, 95%CI: 1.71-3.15); 50% of incident cases reported never having had sex at baseline. Risk of HIV/HSV-2 acquisition was higher for those reporting non-regular partners (women: HR=2.71, 95% CI:1.12-6.54, men: HR=1.37, 95%CI: 0.29-6.38) and those reporting having a partner with a sexually transmitted infection (STI) (HR=7.62 (1.22-47.51). Adding a question on non-regular partnerships increased tool sensitivity from 18.2% to 38.6%, and further to 77.3% when restricted to those who had ever had sex. Individual risk category increased for 28% of men and 17% of women over 12-months.\u0000Conclusion The refined risk differentiation tool identified a high proportion of youth at risk of HIV acquisition. Despite this, half of incident infections were among individuals who reported no prior sexual activity. The shifting patterns of risk behaviours underscore the need for dynamic prevention engagement strategies in high HIV prevalence or incidence settings.","PeriodicalId":501071,"journal":{"name":"medRxiv - Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213597","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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