{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:22:01Z","timestamp":1772119321701,"version":"3.50.1"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"the Samaritan Foundation for Pediatric Research"},{"name":"the Swedish Heart Child foundation"},{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>More adolescents with congenital heart disease (CHD) are reaching adulthood and reproductive age. They face challenges transitioning from pediatric to adult health care and need to manage their health and developmental goals. The 2030 Agenda emphasizes a holistic approach to sexual and reproductive health rights (SRHR), aiming to provide accessible information to adolescents. Healthcare providers (HCPs) must offer appropriate information about CHD and SRHR issues. This study aimed to describe HCPs\u2019 experiences of informing adolescents with heart disease about SRH. An explorative study with a descriptive design using semi-structured interviews. The qualitative content analysis method by Graneheim and Lundman was used to analyze the data. The interviews provided a wealth of data, revealing different opinions and experiences. The analysis resulted in four main categories: (1) organizational culture, (2) health care professionals\u2019 perception of adolescents\u2019 needs, (3) skills and ability are essential, and (4) parents\u2019 influence on conversation<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : Discussing SRH is universally accepted among HCPs, but prioritization varies. HCPs must customize information, consider the timing and setting of the conversation. Enhanced knowledge and skills in SRH are essential, including strategies to overcome barriers and respectfully involve parents. Crucially, adolescents\u2019 rights to SRH information must always be upheld.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>There are challenges in the transition from pediatric to adult care in managing adolescents\u2019 health and developmental goals. Health professionals need to provide appropriate information to adolescents about their sexual and reproductive health.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>This information needs to be tailored to the time and setting of the counselling session. Health professionals need to know more about how to provide this information and are looking for more knowledge on the subject.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06357-5","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:01:55Z","timestamp":1754028115000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["\u201cNot just about the pump\u201d\u2014providing sexual and reproductive health information to adolescents with heart disease"],"prefix":"10.1007","volume":"184","author":[{"given":"Annika","family":"Bay","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harpa","family":"Vidarsdottir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Jangsten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c5sa","family":"Burstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"issue":"22","key":"6357_CR1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017704","volume":"9","author":"Z Mandalenakis","year":"2020","unstructured":"Mandalenakis Z, Giang KW, Eriksson P, Liden H, Synnergren M, Wahlander H et al (2020) Survival in children with congenital heart disease: have we reached a peak at 97%? J Am Heart Assoc 9(22):e017704","journal-title":"J Am Heart Assoc"},{"issue":"6","key":"6357_CR2","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1161\/CIRCRESAHA.116.309302","volume":"120","author":"BJ Bouma","year":"2017","unstructured":"Bouma BJ, Mulder BJ (2017) Changing landscape of congenital heart disease. Circ Res 120(6):908\u2013922","journal-title":"Circ Res"},{"issue":"10036","key":"6357_CR3","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.1016\/S0140-6736(16)00579-1","volume":"387","author":"GC Patton","year":"2016","unstructured":"Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB et al (2016) Our future: a Lancet commission on adolescent health and wellbeing. Lancet 387(10036):2423\u20132478","journal-title":"Lancet"},{"key":"6357_CR4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab388","author":"P Moons","year":"2021","unstructured":"Moons P, Bratt EL, De Backer J, Goossens E, Hornung T, Tutarel O et al (2021) Transition to adulthood and transfer to adult care of adolescents with congenital heart disease: a global consensus statement of the ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP), the ESC Working Group on Adult Congenital Heart Disease (WG ACHD), the Association for European Paediatric and Congenital Cardiology (AEPC), the Pan-African Society of Cardiology (PASCAR), the Asia-Pacific Pediatric Cardiac Society (APPCS), the Inter-American Society of Cardiology (IASC), the Cardiac Society of Australia and New Zealand (CSANZ), the International Society for Adult Congenital Heart Disease (ISACHD), the World Heart Federation (WHF), the European Congenital Heart Disease Organisation (ECHDO), and the Global Alliance for Rheumatic and Congenital Hearts (Global ARCH). Eur Heart J. https:\/\/doi.org\/10.1093\/eurheartj\/ehab388","journal-title":"Eur Heart J"},{"issue":"13","key":"6357_CR5","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1161\/CIR.0b013e3182107c56","volume":"123","author":"C Sable","year":"2011","unstructured":"Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM et al (2011) Best practices in managing transition to adulthood for adolescents with congenital heart disease: the transition process and medical and psychosocial issues: a scientific statement from the American Heart Association. Circulation 123(13):1454\u20131485","journal-title":"Circulation"},{"issue":"12","key":"6357_CR6","first-page":"1640","volume":"35","author":"AS Mackie","year":"2019","unstructured":"Mackie AS, Fournier A, Swan L, Marelli AJ, Kovacs AH (2019) Transition and transfer from pediatric to adult congenital heart disease care in Canada: call for strategic implementation. Can J Cardiol 35(12):1640\u20131651","journal-title":"Can J Cardiol"},{"key":"6357_CR7","unstructured":"WHO (2024) Adolescents health WWW: World Health Organization. Available from: https:\/\/www.who.int\/health-topics\/adolescent-health#tab=tab_1. Accessed 28 Jun 2025"},{"issue":"10140","key":"6357_CR8","doi-asserted-by":"publisher","first-page":"2642","DOI":"10.1016\/S0140-6736(18)30293-9","volume":"391","author":"AM Starrs","year":"2018","unstructured":"Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R et al (2018) Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 391(10140):2642\u20132692","journal-title":"Lancet"},{"key":"6357_CR9","unstructured":"Skolverket (2024) Curricululm for compulsory school, preschool class and school-age Educare-LGR. In: Skolverket (ed). https:\/\/www.skolverket.se\/sok-publikationer\/publikationsserier\/styrdokument\/2024\/curriculum-for-compulsory-school-preschool-class-and-school-age-educare---lgr222024. Accessed 28 Jun 2025"},{"issue":"4","key":"6357_CR10","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1111\/chd.12778","volume":"14","author":"LX Deng","year":"2019","unstructured":"Deng LX, Gleason LP, Awh K, Khan AM, Drajpuch D, Fuller S et al (2019) Too little too late? Communication with patients with congenital heart disease about challenges of adult life. Congenital Heart Disease 14(4):534\u2013540","journal-title":"Congenital Heart Disease"},{"key":"6357_CR11","unstructured":"Skolverket (2024) Sexuality, consent and relationships in the Swedish Curricula. In: Skolverket (ed). https:\/\/www.skolverket.se\/sok-publikationer\/publikationsserier\/ovrigt-material\/2024\/sexuality-consent-and-relationships-in-the-swedish-curricula2024. Accessed 28 Jun 2025"},{"issue":"5","key":"6357_CR12","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1177\/10598405211029252","volume":"39","author":"M Silivri","year":"2023","unstructured":"Silivri M, Wirf T, Hodges EA, Fredholm YS, Bj\u00f6rk M (2023) Conversations about sexual and reproductive health and rights-from a school nurse perspective. J Sch Nurs 39(5):406\u2013414","journal-title":"J Sch Nurs"},{"key":"6357_CR13","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1348","author":"CC Breuner","year":"2016","unstructured":"Breuner CC, Mattson G (2016) Sexuality education for children and adolescents. Pediatrics. https:\/\/doi.org\/10.1542\/peds.2016-1348","journal-title":"Pediatrics"},{"issue":"3","key":"6357_CR14","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1007\/s00246-022-02951-8","volume":"44","author":"N Stokes","year":"2023","unstructured":"Stokes N, Stransky OM, West SC, Hoskoppal A, Talabi MB, Kazmerski TM (2023) Sexual and reproductive health care experiences and perceptions of women with congenital heart disease. Pediatr Cardiol 44(3):564\u2013571","journal-title":"Pediatr Cardiol"},{"issue":"4","key":"6357_CR15","doi-asserted-by":"publisher","first-page":"e1257","DOI":"10.1542\/peds.2014-2300","volume":"134","author":"MA Ott","year":"2014","unstructured":"Ott MA, Sucato GS (2014) Contraception for adolescents. Pediatrics 134(4):e1257\u2013e1281","journal-title":"Pediatrics"},{"issue":"6","key":"6357_CR16","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s00246-005-0950-3","volume":"26","author":"A Hargrove","year":"2005","unstructured":"Hargrove A, Penny DJ, Sawyer SM (2005) Sexual and reproductive health in young people with congenital heart disease: a systematic review of the literature. Pediatr Cardiol 26(6):805\u2013811","journal-title":"Pediatr Cardiol"},{"issue":"12","key":"6357_CR17","first-page":"1652","volume":"35","author":"K Haberer","year":"2019","unstructured":"Haberer K, Silversides CK (2019) Congenital heart disease and women\u2019s health across the life span: focus on reproductive issues. Can J Cardiol 35(12):1652\u20131663","journal-title":"Can J Cardiol"},{"issue":"4","key":"6357_CR18","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.jpag.2020.02.005","volume":"33","author":"RA Parry","year":"2020","unstructured":"Parry RA, Sayner R, Davis SA, Beznos BY, Carpenter DM, Sleath BL (2020) Communication about contraception with adolescent females with asthma in pediatric visits. J Pediatr Adolesc Gynecol 33(4):372\u2013376","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"6357_CR19","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0000000000000838","author":"A Burstrom","year":"2021","unstructured":"Burstrom A, Acuna Mora M, Sparud-Lundin C, Moons P, Bratt EL (2021) Adolescents with congenital heart disease: what do they know about reproductive health and risks? J Cardiovasc Nurs. https:\/\/doi.org\/10.1097\/JCN.0000000000000838","journal-title":"J Cardiovasc Nurs"},{"issue":"3","key":"6357_CR20","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.jpag.2021.12.013","volume":"35","author":"AJ Katz","year":"2022","unstructured":"Katz AJ, Lyon S, Farrell AG, Srivastava N, Wilkinson TA, Shew ML (2022) Adolescent women with congenital heart disease: self-reported reproductive health discussions with health care providers. J Pediatr Adolesc Gynecol 35(3):299\u2013304","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"6357_CR21","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1016\/j.pedn.2017.11.003","volume":"38","author":"M Nakamura","year":"2018","unstructured":"Nakamura M, Kita S, Kikuchi R, Hirata Y, Shindo T, Shimizu N et al (2018) A qualitative assessment of adolescent girls\u2019 perception of living with congenital heart disease: focusing on future pregnancies and childbirth. J Pediatr Nurs 38:e12\u2013e18","journal-title":"J Pediatr Nurs"},{"issue":"25","key":"6357_CR22","first-page":"e533","volume":"142","author":"SR Ommen","year":"2020","unstructured":"Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P et al (2020) 2020 AHA\/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines. Circulation 142(25):e533\u2013e557","journal-title":"Circulation"},{"issue":"5","key":"6357_CR23","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/JCN.0000000000000288","volume":"31","author":"A Burstr\u00f6m","year":"2016","unstructured":"Burstr\u00f6m A, Ojmyr-Joelsson M, Bratt EL, Lundell B, Nisell M (2016) Adolescents with congenital heart disease and their parents: needs before transfer to adult care. J Cardiovasc Nurs 31(5):399\u2013404","journal-title":"J Cardiovasc Nurs"},{"issue":"20","key":"6357_CR24","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"WM Association","year":"2013","unstructured":"Association WM (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20):2191\u20132194","journal-title":"JAMA"},{"issue":"2","key":"6357_CR25","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1002\/nur.4770180211","volume":"18","author":"M Sandelowski","year":"1995","unstructured":"Sandelowski M (1995) Sample size in qualitative research. Res Nurs Health 18(2):179\u2013183","journal-title":"Res Nurs Health"},{"key":"6357_CR26","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.nedt.2017.06.002","volume":"56","author":"UH Graneheim","year":"2017","unstructured":"Graneheim UH, Lindgren BM, Lundman B (2017) Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today 56:29\u201334","journal-title":"Nurse Educ Today"},{"issue":"8","key":"6357_CR27","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27087","volume":"65","author":"NN Frederick","year":"2018","unstructured":"Frederick NN, Campbell K, Kenney LB, Moss K, Speckhart A, Bober SL (2018) Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: the clinician perspective. Pediatr Blood Cancer 65(8):e27087","journal-title":"Pediatr Blood Cancer"},{"issue":"2","key":"6357_CR28","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1089\/jwh.2018.7186","volume":"29","author":"AE Brown","year":"2020","unstructured":"Brown AE, Bradbrook KE, Casey FE (2020) A survey of adult and pediatric cardiology fellows on training received in family planning counseling. J Womens Health (Larchmt) 29(2):237\u2013241","journal-title":"J Womens Health (Larchmt)"},{"key":"6357_CR29","doi-asserted-by":"crossref","unstructured":"ACOG (2020) Gynecologic considerations for adolescents and young women with cardiac conditions: ACOG Committee Opinion Summary, Number 813. Obstet Gynecol 136(5):1072\u20133","DOI":"10.1097\/AOG.0000000000004134"},{"issue":"2","key":"6357_CR30","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3899\/jrheum.220217","volume":"50","author":"D Mitchell","year":"2023","unstructured":"Mitchell D, Lesoon L, Edens C, Kazmerski TM, Stransky OM, Cameron FA et al (2023) How to provide sexual and reproductive health care to patients: focus groups with rheumatologists and rheumatology advanced practice providers. J Rheumatol 50(2):240\u2013245","journal-title":"J Rheumatol"},{"issue":"1","key":"6357_CR31","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1097\/01.NAJ.0000511566.12446.45","volume":"117","author":"D Santa Maria","year":"2017","unstructured":"Santa Maria D, Guilamo-Ramos V, Jemmott LS, Derouin A, Villarruel A (2017) Nurses on the front lines: improving adolescent sexual and reproductive health across health care settings. Am J Nurs 117(1):42\u201351","journal-title":"Am J Nurs"},{"issue":"4","key":"6357_CR32","first-page":"e1257","volume":"134","author":"MA Ott","year":"2014","unstructured":"Ott MA, Sucato GS (2014) Committee on A. Contraception for adolescents Pediatrics 134(4):e1257\u2013e1281","journal-title":"Contraception for adolescents Pediatrics"},{"key":"6357_CR33","unstructured":"Goldenring J, Rosen D (2004) Getting into adolescent heads: an essential update. Contemp Pediatr 21(64)"},{"issue":"9","key":"6357_CR34","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1016\/S2352-4642(20)30098-5","volume":"4","author":"RC Roden","year":"2020","unstructured":"Roden RC, Schmidt EK, Holland-Hall C (2020) Sexual health education for adolescents and young adults with intellectual and developmental disabilities: recommendations for accessible sexual and reproductive health information. Lancet Child Adolesc Health 4(9):699\u2013708","journal-title":"Lancet Child Adolesc Health"},{"issue":"2","key":"6357_CR35","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1111\/cch.12529","volume":"44","author":"EL Bratt","year":"2018","unstructured":"Bratt EL, Burstrom A, Hanseus K, Rydberg A, Berghammer M, On behalf on the S-CHDc (2018) Do not forget the parents-parents\u2019 concerns during transition to adult care for adolescents with congenital heart disease. Child Care Health Dev 44(2):278\u201384","journal-title":"Child Care Health Dev"},{"issue":"8","key":"6357_CR36","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1017\/S1047951121000019","volume":"31","author":"SM Lyon","year":"2021","unstructured":"Lyon SM, Katz AJ, Farrell AG, Shew ML (2021) Reproductive health conversations in adolescents with CHD. Cardiol Young 31(8):1263\u20131268","journal-title":"Cardiol Young"},{"issue":"7","key":"6357_CR37","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1007\/s00431-017-2917-9","volume":"176","author":"A Burstr\u00f6m","year":"2017","unstructured":"Burstr\u00f6m A, Bratt EL, Frenckner B, Nisell M, Hanseus K, Rydberg A et al (2017) Adolescents with congenital heart disease: their opinions about the preparation for transfer to adult care. Eur J Pediatr 176(7):881\u2013889","journal-title":"Eur J Pediatr"},{"issue":"2","key":"6357_CR38","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.nedt.2003.10.001","volume":"24","author":"UH Graneheim","year":"2004","unstructured":"Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24(2):105\u2013112","journal-title":"Nurse Educ Today"},{"issue":"6","key":"6357_CR39","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1080\/13625187.2016.1237629","volume":"21","author":"J Bitzer","year":"2016","unstructured":"Bitzer J, Abalos V, Apter D, Martin R, Black A, Global CARE (Contraception: Access R, E.ucation) Group (2016) Targeting factors for change: contraceptive counselling and care of female adolescents. Eur J Contracept Reprod Health Care 21(6):417\u201330","journal-title":"Eur J Contracept Reprod Health Care"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06357-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-025-06357-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06357-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T07:43:35Z","timestamp":1758008615000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-025-06357-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["6357"],"URL":"https:\/\/doi.org\/10.1007\/s00431-025-06357-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-6679589\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]},"assertion":[{"value":"16 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Swedish Ethical Review Authority (ref. 2022\u201305042-1, 2024\u201300947-02).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from the participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"520"}}