{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:37:09Z","timestamp":1764175029410,"version":"3.46.0"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Men who have sex with men (MSM) with perianal condyloma face compounded health care challenges within structural inequities. Current research poorly characterizes their medical experiences, including barriers to care, psychosocial stressors, and policy-driven exclusion. Human papillomavirus (HPV)\u2013related perianal condyloma in MSM is associated with high recurrence, diagnostic delays, and limited preventive access, underscoring the need to address systemic disparities.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore health care experiences of MSM with perianal condyloma, identify multilevel care barriers, and characterize structural oppression affecting clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This qualitative study used semistructured interviews and qualitative analysis. Twenty MSM with confirmed perianal condyloma acuminatum were purposively sampled via clinician referrals. Inclusion criteria included age of 18 years or older and the capacity to provide informed consent. The study was conducted at a tertiary hospital (First Affiliated Hospital of China Medical University, Northeast China). Data were collected from January 1 to March 31, 2025, and analyzed from March 31 to June 30, 2025.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Thematic analysis and grounded theory were used to identify barriers across 4 levels (individual, clinical, societal, and policy) and reflect how multiple barriers contribute to structural oppression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty MSM (mean [SD] age, 23.95 [4.36] years) participated in the study. Of the 20 MSM, 10 (50%) were students, 17 (85%) had a bachelor\u2019s degree or higher, 13 (65%) identified as gay, and 9 (45%) engaged in exclusive anal-receptive intercourse. The mean (SD) monthly income was \u00a54725 (\u00a52573). Regarding health care visits, 8 (40%) visited for active disease, 5 (25%) used private health care, and 1 (5%) had HIV coinfection. Participants faced synergistic barriers: (1) gaps in HPV knowledge, reliance on unverified online information, and risky sexual behaviors (individual level); (2) fragmented care pathways, privacy violations, and postoperative trauma (clinical level); (3) stigma-driven identity concealment, social isolation, and relationship strain (societal level); and (4) exclusion from HPV vaccination, lack of male-adapted screening tools, and inadequate sexual health education (policy level). Together, these barriers reflect how clinical neglect and structural oppression emerge and how their intersection perpetuates health care disparities among MSM with perianal condyloma.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this qualitative study of MSM with perianal condyloma, the findings suggest that privacy-protected care, standardized protocols, inclusive prevention strategies, and practitioner cultural competency training are required. These findings also emphasize the urgent need for equity-focused sexual health policies to address the needs of marginalized populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.45768","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:31:25Z","timestamp":1764174685000},"page":"e2545768","source":"Crossref","is-referenced-by-count":0,"title":["Multilevel Barriers to Perianal Condyloma Care Among Men Who Have Sex With Men in Northeast China"],"prefix":"10.1001","volume":"8","author":[{"given":"Fangxiao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases II, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingting","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyun","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingqi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yalun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"issue":"4","key":"zoi251242r1","first-page":"198","article-title":"The prevalence, incidence, persistence and transmission ways of human papillomavirus infection (HPV) [in Czech].","volume":"66","author":"Sehnal","year":"2017","journal-title":"Epidemiol Mikrobiol Imunol"},{"issue":"2","key":"zoi251242r2","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.idc.2023.02.008","article-title":"Sexually transmitted human papillomavirus: update in epidemiology, prevention, and management.","volume":"37","author":"Plotzker","year":"2023","journal-title":"Infect Dis Clin North Am"},{"issue":"2","key":"zoi251242r3","first-page":"156","article-title":"Genital warts: rapid evidence review.","volume":"111","author":"Temple","year":"2025","journal-title":"Am Fam Physician"},{"issue":"1","key":"zoi251242r4","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2025.2490440","article-title":"A systematic review and thematic synthesis exploring how gay, bisexual and other men who have sex with men (GBMSM) experience HPV and HPV vaccination.","volume":"21","author":"Pow","year":"2025","journal-title":"Hum Vaccin Immunother"},{"issue":"5","key":"zoi251242r5","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1002\/ijc.28431","article-title":"Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men.","volume":"134","author":"Berry","year":"2014","journal-title":"Int J Cancer"},{"issue":"4","key":"zoi251242r6","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1097\/DCR.0000000000003247","article-title":"Anal condyloma and human papillomavirus: recognition, treatment, and prevention.","volume":"67","author":"Unruh","year":"2024","journal-title":"Dis Colon Rectum"},{"issue":"5","key":"zoi251242r7","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1097\/QAI.0000000000003450","article-title":"Prevalence of anal human papillomavirus infection and anal high-grade squamous intraepithelial lesions among men who have sex with men 50 years and older living with or without HIV.","volume":"96","author":"Hernandez","year":"2024","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"zoi251242r8","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-025-13980-w","article-title":"Barriers and facilitators to anal cancer screening among men who have sex with men: a systematic review with narrative synthesis.","volume":"25","author":"Sam","year":"2025","journal-title":"BMC Cancer"},{"issue":"2","key":"zoi251242r9","doi-asserted-by":"publisher","first-page":"e97","DOI":"10.1016\/S2352-3018(22)00368-X","article-title":"Effect of the introduction of screening for cancer precursor lesions on anal cancer incidence over time in people living with HIV: a nationwide cohort study.","volume":"10","author":"van der Zee","year":"2023","journal-title":"Lancet HIV"},{"issue":"4","key":"zoi251242r10","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.70274","article-title":"The burden of HPV infections and HPV-related diseases among people with HIV: a systematic literature review.","volume":"97","author":"Tadese","year":"2025","journal-title":"J Med Virol"},{"issue":"1","key":"zoi251242r11","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1037\/hea0001131","article-title":"Social support and HIV prevention behaviors among urban HIV-negative gay, bisexual, and other men who have sex with men.","volume":"41","author":"Skakoon-Sparling","year":"2022","journal-title":"Health Psychol"},{"issue":"11","key":"zoi251242r12","doi-asserted-by":"publisher","first-page":"3768","DOI":"10.1007\/s10461-024-04460-6","article-title":"Intersecting stigma and the HIV care cascade: qualitative insights from sex workers, men who have sex with men, and transgender women living with HIV in Jamaica.","volume":"28","author":"Logie","year":"2024","journal-title":"AIDS Behav"},{"issue":"1","key":"zoi251242r13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s41256-025-00418-w","article-title":"Mpox-related stigma and healthcare-seeking behavior among men who have sex with men.","volume":"10","author":"Liu","year":"2025","journal-title":"Glob Health Res Policy"},{"issue":"1","key":"zoi251242r14","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12939-025-02417-2","article-title":"Health conditions, health literacy, access to care, and health care experiences among lesbian, gay, bisexual, transgender and queer adults in Lebanon.","volume":"24","author":"Daoud Khatoun","year":"2025","journal-title":"Int J Equity Health"},{"key":"zoi251242r15","doi-asserted-by":"publisher","DOI":"10.1177\/23779608241251632","article-title":"Enhancing nursing education to address LGBTQ+ healthcare needs: perspectives from the Philippines.","volume":"10","author":"Alibudbud","year":"2024","journal-title":"SAGE Open Nurs"},{"issue":"2","key":"zoi251242r16","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s40670-021-01227-9","article-title":"Obstetrics and gynecology resident physician experiences with lesbian, gay, bisexual, transgender and queer healthcare training.","volume":"31","author":"Guerrero-Hall","year":"2021","journal-title":"Med Sci Educ"},{"issue":"6","key":"zoi251242r17","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1037\/ort0000756","article-title":"Toward transgender health: analysis of current barriers and theorizing interventions.","volume":"94","author":"Murano-Kinney","year":"2024","journal-title":"Am J Orthopsychiatry"},{"issue":"4","key":"zoi251242r18","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1007\/s10620-025-08921-3","article-title":"An Education intervention in gastrointestinal healthcare workers improves knowledge of sexual and gender minority digestive health.","volume":"70","author":"Goldowsky","year":"2025","journal-title":"Dig Dis Sci"},{"issue":"5","key":"zoi251242r19","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1111\/1753-6405.13029","article-title":"Disparities in characteristics in accessing public Australian sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men.","volume":"44","author":"Walia","year":"2020","journal-title":"Aust N Z J Public Health"},{"issue":"10279","key":"zoi251242r20","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1016\/S0140-6736(21)00395-0","article-title":"Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses.","volume":"397","author":"Sullivan","year":"2021","journal-title":"Lancet"},{"issue":"1","key":"zoi251242r21","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2024.2440956","article-title":"Uptake and service preferences of human papillomavirus vaccination in men who have sex with men.","volume":"21","author":"Zhang","year":"2025","journal-title":"Hum Vaccin Immunother"},{"issue":"5","key":"zoi251242r22","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1007\/s40615-022-01396-2","article-title":"Factors that predict HPV vaccination behavior among young men-who-have-sex-with-men in the Greater Philadelphia Region.","volume":"10","author":"Mann-Barnes","year":"2023","journal-title":"J Racial Ethn Health Disparities"},{"key":"zoi251242r23","doi-asserted-by":"publisher","DOI":"10.2196\/66702","article-title":"A comparison of mobile social media promotion and volunteer-driven strategies for community organizations recruiting men who have sex with men for HIV testing in Zhejiang Province, China: cross-sectional study based on a large-scale survey.","volume":"27","author":"He","year":"2025","journal-title":"J Med Internet Res"},{"key":"zoi251242r24","doi-asserted-by":"publisher","DOI":"10.2196\/63114","article-title":"Adolescent youth survey on HIV prevention and sexual health education in Alabama: protocol for a web-based survey with fraud protection study.","volume":"14","author":"Budhwani","year":"2025","journal-title":"JMIR Res Protoc"},{"issue":"1","key":"zoi251242r25","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2024.2348845","article-title":"Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France.","volume":"20","author":"Cogordan","year":"2024","journal-title":"Hum Vaccin Immunother"},{"issue":"1","key":"zoi251242r26","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12981-022-00497-6","article-title":"Multi-dimensional mismatch and barriers for promoting PrEP among men who have sex with men in China: a cross sectional survey from the Demand-side.","volume":"20","author":"Guan","year":"2023","journal-title":"AIDS Res Ther"},{"issue":"2","key":"zoi251242r27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1001\/jama.2016.18977","article-title":"Revised CIOMS international ethical guidelines for health-related research involving humans.","volume":"317","author":"van Delden","year":"2017","journal-title":"JAMA"},{"issue":"(2)","key":"zoi251242r28","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology.","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"6","key":"zoi251242r30","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"9","key":"zoi251242r31","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1001\/jamasurg.2021.0525","article-title":"SRQR and COREQ reporting guidelines for qualitative studies.","volume":"156","author":"Dossett","year":"2021","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi251242r32","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2024.2364984","article-title":"Developing an interactive reproductive health equity session for pre-clerkship medical students.","volume":"29","author":"Tiako","year":"2024","journal-title":"Med Educ Online"},{"issue":"2","key":"zoi251242r33","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.jadohealth.2024.10.009","article-title":"How racism and discrimination impacts black young women\u2019s sexual health: the influence of racial and sexual stereotypes on educational access.","volume":"76","author":"Hill","year":"2025","journal-title":"J Adolesc Health"},{"key":"zoi251242r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2024.104459","article-title":"Acceptability of integrating mental health and substance use care within sexual health services among young sexual and gender minority men in Vancouver, Canada.","volume":"128","author":"Coulaud","year":"2024","journal-title":"Int J Drug Policy"},{"key":"zoi251242r35","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1190007","article-title":"Incidence, persistence, and clearance of anogenital human papillomavirus among men who have sex with men in Taiwan: a community cohort study.","volume":"14","author":"Zhou","year":"2023","journal-title":"Front Immunol"},{"issue":"1","key":"zoi251242r36","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1186\/s12874-022-01752-0","article-title":"\u201cThe problem is that our culture is just so messed up about aging.\u201d Recruiting older men who have sex with men (MSM) into research studies: an example from a study of aging, HIV, and anal HPV.","volume":"22","author":"Hernandez","year":"2022","journal-title":"BMC Med Res Methodol"},{"issue":"13","key":"zoi251242r37","doi-asserted-by":"publisher","first-page":"2804","DOI":"10.3390\/jcm10132804","article-title":"Predictors of oral infection by mucosal and cutaneous human papillomaviruses in HIV-infected and uninfected men who have sex with men of the OHMAR study.","volume":"10","author":"Giuliani","year":"2021","journal-title":"J Clin Med"},{"issue":"4","key":"zoi251242r39","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1080\/15546128.2020.1832009","article-title":"Sex education in school, are gender and sexual minority youth included? a decade in review.","volume":"15","author":"Rabbitte","year":"2020","journal-title":"Am J Sex Educ"},{"key":"zoi251242r40","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.jsp.2023.02.005","article-title":"Effects of identity disclosure on school victimization and long-term educational outcomes among lesbian, gay, bisexual, transgender, and intersex students in China.","volume":"98","author":"Chan","year":"2023","journal-title":"J Sch Psychol"},{"issue":"4","key":"zoi251242r41","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1080\/00224499.2024.2355564","article-title":"Sexual health education experiences and recommendations from the perspective of LGBTQ+ youth.","volume":"62","author":"Hobaica","year":"2025","journal-title":"J Sex Res"},{"issue":"5","key":"zoi251242r42","doi-asserted-by":"publisher","first-page":"445","DOI":"10.3390\/vaccines13050445","article-title":"The role of internet information on anti-HPV vaccines: a comprehensive overview of a double-edged sword.","volume":"13","author":"Giannella","year":"2025","journal-title":"Vaccines (Basel)"},{"issue":"9","key":"zoi251242r43","doi-asserted-by":"publisher","DOI":"10.2196\/38449","article-title":"Social media use and health and well-being of lesbian, gay, bisexual, transgender, and queer youth: systematic review.","volume":"24","author":"Berger","year":"2022","journal-title":"J Med Internet Res"},{"key":"zoi251242r44","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1546166","article-title":"Epidemiologic evaluation of human papillomavirus type competition in unvaccinated women from Xiamen, China.","volume":"16","author":"Chen","year":"2025","journal-title":"Front Microbiol"},{"issue":"1","key":"zoi251242r45","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12985-023-01959-7","article-title":"Prevalence and genotype distribution of human papillomavirus infections in Beijing, China between 2016 and 2020.","volume":"20","author":"Zhang","year":"2023","journal-title":"Virol J"},{"issue":"7","key":"zoi251242r46","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.3390\/v13071342","article-title":"Multiple human papilloma virus (HPV) infections are associated with HSIL and persistent HPV infection status in Korean patients.","volume":"13","author":"Kim","year":"2021","journal-title":"Viruses"},{"key":"zoi251242r47","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.857410","article-title":"Detection of five types of HPV genotypes causing anogenital warts (condyloma acuminatum) using PCR-Tm analysis technology.","volume":"13","author":"Wu","year":"2022","journal-title":"Front Microbiol"},{"issue":"4","key":"zoi251242r48","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1007\/s13178-019-00418-9","article-title":"Sexual minority people\u2019s perspectives of sexual health care: understanding minority stress in sexual health settings.","volume":"17","author":"Gessner","year":"2020","journal-title":"Sex Res Social Policy"},{"key":"zoi251242r49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104331","article-title":"Factors associated with providers\u2019 culturally competent care for sexual and gender minority older adults in Taiwan: a qualitative study applying the social ecological model.","volume":"135","author":"Wang","year":"2022","journal-title":"Int J Nurs Stud"},{"key":"zoi251242r50","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2024.108007","article-title":"Menopause experiences in sexual minority women and non-binary people.","volume":"185","author":"Sobel","year":"2024","journal-title":"Maturitas"},{"issue":"6","key":"zoi251242r51","doi-asserted-by":"publisher","first-page":"865","DOI":"10.14309\/ajg.0000000000001804","article-title":"Digestive health in sexual and gender minority populations.","volume":"117","author":"V\u00e9lez","year":"2022","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"zoi251242r52","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.7115","article-title":"Mental and physical health among danish transgender persons compared with cisgender persons.","volume":"8","author":"Glintborg","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi251242r53","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1093\/infdis\/jiad485","article-title":"High risk of new HPV infection acquisition among unvaccinated young men.","volume":"229","author":"Giuliano","year":"2024","journal-title":"J Infect Dis"},{"issue":"10","key":"zoi251242r54","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.3390\/vaccines11101614","article-title":"HPV infection profiles among people living with HIV and HPV vaccine acceptance among individuals with different HIV infection statuses in China: a systematic meta-analysis.","volume":"11","author":"Yuan","year":"2023","journal-title":"Vaccines (Basel)"},{"issue":"2","key":"zoi251242r55","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s40618-023-02192-3","article-title":"HPV-related diseases in male patients: an underestimated conundrum.","volume":"47","author":"Garolla","year":"2024","journal-title":"J Endocrinol Invest"},{"issue":"8","key":"zoi251242r56","doi-asserted-by":"publisher","DOI":"10.1093\/jambio\/lxae184","article-title":"Comparative evaluation of two clinical sampling techniques for HPV detection in male genital sites: a randomized controlled study.","volume":"135","author":"Zhang","year":"2024","journal-title":"J Appl Microbiol"},{"issue":"2","key":"zoi251242r57","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/OLQ.0000000000000226","article-title":"Male human papillomavirus vaccine acceptance is enhanced by a brief intervention that emphasizes both male-specific vaccine benefits and altruistic motives.","volume":"42","author":"Bonafide","year":"2015","journal-title":"Sex Transm Dis"},{"issue":"2","key":"zoi251242r58","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1080\/07317115.2018.1544955","article-title":"Care and LGBT aging in Canada: a focus group study on the educational gaps among care workers.","volume":"42","author":"Kortes-Miller","year":"2019","journal-title":"Clin Gerontol"},{"key":"zoi251242r29","volume-title":"Basics of Qualitative Research: Grounded Theory Procedures and Techniques","author":"Strauss","year":"1990"},{"key":"zoi251242r38","first-page":"1","article-title":"The prevalence of high carcinogenic risk of HPV genotypes among HIV-positive and HIV-negative MSM from Russia.","volume-title":"Can J Infect Dis Med Microbiol","author":"Beliakov","year":"2021"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2842061\/zhang_2025_oi_251242_1763583126.92563.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:31:26Z","timestamp":1764174686000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2842061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":58,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.45768","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]}}}