{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:41:20Z","timestamp":1792662080434,"version":"4.5.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the association between cognitive social capital and patient-reported saliva-related quality of life among head and neck cancer survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross-sectional study included adults treated with curative intent for squamous cell carcinoma of the lip\/oral cavity, oropharynx, hypopharynx, or larynx at a referral hospital in southern Brazil. The outcome was patient-reported saliva-related quality of life, assessed using the saliva domain of the University of Washington Quality of Life questionnaire (UW-QOL); higher scores indicate better outcomes. Cognitive social capital was assessed using a brief three-item proxy index; participants were classified as scoring 3 (the maximum) or below 3. Hierarchical multiple linear regression estimated unstandardised coefficients (\n                      <jats:italic>B<\/jats:italic>\n                      ) and 95% confidence intervals (95% CI), adjusting for education, tumour location, radiotherapy (yes vs. no), and time since treatment completion. Sensitivity analyses tested alternative operationalisations and adjustments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 105 adults participated (response rate 84.7%). The mean UW-QOL saliva-domain score was 61.85\u2009\u00b1\u200933.90, and 18 participants (17.1%) scored below 3. In the fully adjusted model, a score below 3 was associated with poorer saliva-related quality of life (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009= \u221218.53; 95% CI\u2009\u221233.85 to\u2009\u22123.21;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018); sensitivity analyses were consistent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this exploratory study, lower scores on a three-item cognitive social capital proxy index were associated with poorer saliva-related quality of life among head and neck cancer survivors. Perceived social resources may be relevant to this burden, but these preliminary findings require confirmation in larger longitudinal studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-11361-y","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:07:40Z","timestamp":1792660060000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between cognitive social capital and saliva-related quality of life among head and neck cancer survivors: a cross-sectional study"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2374-5657","authenticated-orcid":false,"given":"Alan Carvalho","family":"Dar\u00f3s","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7792-8032","authenticated-orcid":false,"given":"Jessica Kl\u00f6ckner","family":"Knorst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9226-0832","authenticated-orcid":false,"given":"Bruno","family":"Emmanuelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9941-0748","authenticated-orcid":false,"given":"Jo\u00e3o Alberto","family":"de Almeida Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0282-6896","authenticated-orcid":false,"given":"Raquel Pippi","family":"Antoniazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6651-5651","authenticated-orcid":false,"given":"K\u00edvia Linhares","family":"Ferrazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"3","key":"11361_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA Cancer J Clin"},{"issue":"3","key":"11361_CR2","doi-asserted-by":"publisher","first-page":"224","DOI":"10.6004\/jnccn.2022.0016","volume":"20","author":"JJ Caudell","year":"2022","unstructured":"Caudell JJ, Gillison ML, Maghami E et al (2022) NCCN Guidelines\u00ae insights: head and neck cancers, version 1.2022. J Natl Compr Canc Netw 20(3):224\u2013234. https:\/\/doi.org\/10.6004\/jnccn.2022.0016","journal-title":"J Natl Compr Canc Netw"},{"key":"11361_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2021.103335","volume":"162","author":"GB Ortigara","year":"2021","unstructured":"Ortigara GB, Bonzanini LIL, Schulz RE, Ferrazzo KL (2021) Late radiation effects in survivors of head and neck cancer: state of the science. Crit Rev Oncol Hematol 162:103335. https:\/\/doi.org\/10.1016\/j.critrevonc.2021.103335","journal-title":"Crit Rev Oncol Hematol"},{"issue":"8","key":"11361_CR4","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1007\/s00520-010-0827-8","volume":"18","author":"SB Jensen","year":"2010","unstructured":"Jensen SB, Pedersen AM, Vissink A et al (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18(8):1039\u20131060. https:\/\/doi.org\/10.1007\/s00520-010-0827-8","journal-title":"Support Care Cancer"},{"key":"11361_CR5","doi-asserted-by":"publisher","DOI":"10.1590\/1678-7757-2020-0854","volume":"29","author":"RE Schulz","year":"2021","unstructured":"Schulz RE, Bonzanini LIL, Ortigara GB et al (2021) Prevalence of hyposalivation and associated factors in survivors of head and neck cancer treated with radiotherapy. J Appl Oral Sci 29:e20200854. https:\/\/doi.org\/10.1590\/1678-7757-2020-0854","journal-title":"J Appl Oral Sci"},{"issue":"1","key":"11361_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-025-02737-1","volume":"20","author":"A Abou-Bakr","year":"2025","unstructured":"Abou-Bakr A, Hassanein FEA, William H, Ibrahim SS (2025) Prevalence of late xerostomia and hyposalivation with associated risk factors in survivors of head and neck cancer after radiotherapy: a multi-centric cross-sectional study. Radiat Oncol 20(1):162. https:\/\/doi.org\/10.1186\/s13014-025-02737-1","journal-title":"Radiat Oncol"},{"issue":"4","key":"11361_CR7","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1007\/s00520-019-05008-4","volume":"28","author":"LIL Bonzanini","year":"2020","unstructured":"Bonzanini LIL, Soldera EB, Ortigara GB et al (2020) Clinical and sociodemographic factors that affect the quality of life of survivors of head and neck cancer. Support Care Cancer 28(4):1941\u20131950. https:\/\/doi.org\/10.1007\/s00520-019-05008-4","journal-title":"Support Care Cancer"},{"issue":"5","key":"11361_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-023-07750-2","volume":"31","author":"LL Patton","year":"2023","unstructured":"Patton LL, Helgeson ES, Brennan MT et al (2023) Oral health-related quality of life after radiation therapy for head and neck cancer: the OraRad study. Support Care Cancer 31(5):286. https:\/\/doi.org\/10.1007\/s00520-023-07750-2","journal-title":"Support Care Cancer"},{"issue":"6","key":"11361_CR9","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1002\/ohn.70219","volume":"174","author":"D Zarrella","year":"2026","unstructured":"Zarrella D, Chitnis O, Kim HE et al (2026) Long-term health-related quality of life in oropharyngeal squamous cell carcinoma: a systematic review. Otolaryngol Head Neck Surg 174(6):1421\u20131433. https:\/\/doi.org\/10.1002\/ohn.70219","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"2","key":"11361_CR10","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.bjoms.2010.12.005","volume":"50","author":"DC Laraway","year":"2012","unstructured":"Laraway DC, Rogers SN (2012) A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale. Br J Oral Maxillofac Surg 50(2):122\u2013131. https:\/\/doi.org\/10.1016\/j.bjoms.2010.12.005","journal-title":"Br J Oral Maxillofac Surg"},{"issue":"1","key":"11361_CR11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ijrobp.2009.04.021","volume":"77","author":"SN Rogers","year":"2010","unstructured":"Rogers SN, Johnson IA, Lowe D (2010) Xerostomia after treatment for oral and oropharyngeal cancer using the University of Washington saliva domain and a xerostomia-related quality-of-life scale. Int J Radiat Oncol Biol Phys 77(1):16\u201323. https:\/\/doi.org\/10.1016\/j.ijrobp.2009.04.021","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"5","key":"11361_CR12","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1136\/jech-2016-208313","volume":"71","author":"S Moore","year":"2017","unstructured":"Moore S, Kawachi I (2017) Twenty years of social capital and health research: a glossary. J Epidemiol Community Health 71(5):513\u2013517. https:\/\/doi.org\/10.1136\/jech-2016-208313","journal-title":"J Epidemiol Community Health"},{"issue":"7","key":"11361_CR13","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1177\/1359105308095060","volume":"13","author":"S Abbott","year":"2008","unstructured":"Abbott S, Freeth D (2008) Social capital and health: starting to make sense of the role of generalized trust and reciprocity. J Health Psychol 13(7):874\u2013883. https:\/\/doi.org\/10.1177\/1359105308095060","journal-title":"J Health Psychol"},{"issue":"8","key":"11361_CR14","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1097\/PSY.0000000000000197","volume":"77","author":"P Rouxel","year":"2015","unstructured":"Rouxel P, Tsakos G, Demakakos P, Zaninotto P, Watt RG (2015) Social capital and oral health among adults 50 years and older: results from the English Longitudinal Study of Ageing. Psychosom Med 77(8):927\u2013937. https:\/\/doi.org\/10.1097\/PSY.0000000000000197","journal-title":"Psychosom Med"},{"key":"11361_CR15","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2022.1075576","volume":"3","author":"JK Knorst","year":"2022","unstructured":"Knorst JK, Vettore MV, Ardenghi TM (2022) Social capital and oral health promotion: past, present, and future challenges. Front Oral Health 3:1075576. https:\/\/doi.org\/10.3389\/froh.2022.1075576","journal-title":"Front Oral Health"},{"key":"11361_CR16","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1602804","volume":"13","author":"A Pitis","year":"2025","unstructured":"Pitis A, Diamantopoulou M, Panagiotou A, Papageorgiou D, Tzavella F (2025) Social capital as a determinant of quality of life in Greek cancer patients: a cross-sectional study. Front Public Health 13:1602804. https:\/\/doi.org\/10.3389\/fpubh.2025.1602804","journal-title":"Front Public Health"},{"issue":"2","key":"11361_CR17","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/hed.20501","volume":"29","author":"LH Karnell","year":"2007","unstructured":"Karnell LH, Christensen AJ, Rosenthal EL, Magnuson JS, Funk GF (2007) Influence of social support on health-related quality of life outcomes in head and neck cancer. Head Neck 29(2):143\u2013146. https:\/\/doi.org\/10.1002\/hed.20501","journal-title":"Head Neck"},{"issue":"6","key":"11361_CR18","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1002\/hed.23029","volume":"35","author":"MB Howren","year":"2013","unstructured":"Howren MB, Christensen AJ, Hynds Karnell L, Van Liew JR, Funk GF (2013) Influence of pretreatment social support on health-related quality of life in head and neck cancer survivors: results from a prospective study. Head Neck 35(6):779\u2013787. https:\/\/doi.org\/10.1002\/hed.23029","journal-title":"Head Neck"},{"issue":"9596","key":"11361_CR19","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E Von Elm","year":"2007","unstructured":"Von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453\u20131457. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X","journal-title":"Lancet"},{"key":"11361_CR20","unstructured":"World Health Organization (2010) International statistical classification of diseases and related health problems. 10th revision, vol 2. https:\/\/icd.who.int\/browse10\/Content\/statichtml\/ICD10Volume2_en_2010.pdf. Accessed 10 February 2026"},{"key":"11361_CR21","unstructured":"Rio Grande do Sul, Secretaria da Sa\u00fade (2024) Plano de a\u00e7\u00e3o estadual de oncologia: tri\u00eanio 2024\u20132026, 5\u00aa ed. https:\/\/saude.rs.gov.br\/upload\/arquivos\/202407\/17150639-plano-estadual-de-oncologia-2024-2026.pdf. Accessed 19 July 2026"},{"issue":"3","key":"11361_CR22","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.otohns.2006.10.018","volume":"136","author":"KT Vakharia","year":"2007","unstructured":"Vakharia KT, Ali MJ, Wang SJ (2007) Quality-of-life impact of participation in a head and neck cancer support group. Otolaryngol Head Neck Surg 136(3):405\u2013410. https:\/\/doi.org\/10.1016\/j.otohns.2006.10.018","journal-title":"Otolaryngol Head Neck Surg"},{"key":"11361_CR23","volume-title":"AJCC cancer staging manual","year":"2010","unstructured":"Edge SB, Byrd DR, Compton CC (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York","edition":"7th edn"},{"issue":"12","key":"11361_CR24","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1002\/hed.20464","volume":"28","author":"JG Vartanian","year":"2006","unstructured":"Vartanian JG, Carvalho AL, Yueh B et al (2006) Brazilian-Portuguese validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Head Neck 28(12):1115\u20131121. https:\/\/doi.org\/10.1002\/hed.20464","journal-title":"Head Neck"},{"issue":"7","key":"11361_CR25","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1007\/s11136-019-02138-4","volume":"28","author":"JK Knorst","year":"2019","unstructured":"Knorst JK, Menegazzo GR, Emmanuelli B, Mendes FM, Ardenghi TM (2019) Effect of neighborhood and individual social capital in early childhood on oral health-related quality of life: a 7-year cohort study. Qual Life Res 28(7):1773\u20131782. https:\/\/doi.org\/10.1007\/s11136-019-02138-4","journal-title":"Qual Life Res"},{"issue":"8","key":"11361_CR26","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20085603","volume":"20","author":"JK Knorst","year":"2023","unstructured":"Knorst JK, Vettore MV, Brondani B, Emmanuelli B, Ardenghi TM (2023) The different roles of structural and cognitive social capital on oral health-related quality of life among adolescents. Int J Environ Res Public Health 20(8):5603. https:\/\/doi.org\/10.3390\/ijerph20085603","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"11361_CR27","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/j.socscimed.2005.06.050","volume":"62","author":"MJ De Silva","year":"2006","unstructured":"De Silva MJ, Harpham T, Tuan T, Bartolini R, Penny ME, Huttly SR (2006) Psychometric and cognitive validation of a social capital measurement tool in Peru and Vietnam. Soc Sci Med 62(4):941\u2013953. https:\/\/doi.org\/10.1016\/j.socscimed.2005.06.050","journal-title":"Soc Sci Med"},{"key":"11361_CR28","doi-asserted-by":"publisher","unstructured":"Grootaert C, Narayan D, Nyhan Jones V, Woolcock M (2004) Measuring social capital: an integrated questionnaire. World Bank Working Paper No. 18. World Bank, Washington, DC. https:\/\/doi.org\/10.1596\/0-8213-5661-5","DOI":"10.1596\/0-8213-5661-5"},{"key":"11361_CR29","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.jclinepi.2017.12.006","volume":"98","author":"AF Schmidt","year":"2018","unstructured":"Schmidt AF, Finan C (2018) Linear regression and the normality assumption. J Clin Epidemiol 98:146\u2013151. https:\/\/doi.org\/10.1016\/j.jclinepi.2017.12.006","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"11361_CR30","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1097\/01.MLR.0000062554.74615.4C","volume":"41","author":"GR Norman","year":"2003","unstructured":"Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582\u2013592. https:\/\/doi.org\/10.1097\/01.MLR.0000062554.74615.4C","journal-title":"Med Care"},{"issue":"8","key":"11361_CR31","doi-asserted-by":"publisher","first-page":"2773","DOI":"10.1245\/s10434-014-3656-z","volume":"21","author":"Y Binenbaum","year":"2014","unstructured":"Binenbaum Y, Amit M, Billan S, Cohen JT, Gil Z (2014) Minimal clinically important differences in quality of life scores of oral cavity and oropharynx cancer patients. Ann Surg Oncol 21(8):2773\u20132781. https:\/\/doi.org\/10.1245\/s10434-014-3656-z","journal-title":"Ann Surg Oncol"},{"issue":"10","key":"11361_CR32","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1007\/s00520-025-09930-8","volume":"33","author":"KL Westgaard","year":"2025","unstructured":"Westgaard KL, Amdal CD, Taylor KJ et al (2025) Oral health-related quality of life among long-term head and neck cancer survivors: a multinational study. Support Care Cancer 33(10):868. https:\/\/doi.org\/10.1007\/s00520-025-09930-8","journal-title":"Support Care Cancer"},{"issue":"3","key":"11361_CR33","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.ijrobp.2006.09.021","volume":"67","author":"Y Li","year":"2007","unstructured":"Li Y, Taylor JMG, Ten Haken RK, Eisbruch A (2007) The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 67(3):660\u2013669. https:\/\/doi.org\/10.1016\/j.ijrobp.2006.09.021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"11361_CR34","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.105783","volume":"127","author":"A Lin","year":"2022","unstructured":"Lin A, Helgeson ES, Treister NS et al (2022) The impact of head and neck radiotherapy on salivary flow and quality of life: results of the ORARAD study. Oral Oncol 127:105783. https:\/\/doi.org\/10.1016\/j.oraloncology.2022.105783","journal-title":"Oral Oncol"},{"key":"11361_CR35","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1668696","volume":"13","author":"A Buja","year":"2025","unstructured":"Buja A, Akhtar S (2025) The association between social capital and quality of life in old adults: a systematic review and meta-analysis. Front Public Health 13:1668696. https:\/\/doi.org\/10.3389\/fpubh.2025.1668696","journal-title":"Front Public Health"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11361-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-11361-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11361-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:07:42Z","timestamp":1792660062000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-11361-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["11361"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-11361-y","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"assertion":[{"value":"21 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was obtained from the Research Ethics Committee of the Federal University of Santa Maria (CAAE 64691522.0.000.5346). The study was conducted in accordance with the 1964 Helsinki Declaration and Brazilian regulations governing research involving human participants.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to study participation. Participant confidentiality and data privacy were maintained throughout the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation and revision of this manuscript, the authors used generative artificial intelligence tools (Claude, Anthropic; and ChatGPT, OpenAI) to assist with language editing, organisation, clarity, and refinement of academic writing. All AI-assisted content was critically reviewed and verified by the authors, who take full responsibility for the accuracy, integrity, interpretation, and final content of the manuscript.","order":3,"name":"Ethics","label":"Use of AI-assisted technologies","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Clinical trial number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1141"}}