{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T04:19:07Z","timestamp":1751429947273,"version":"3.41.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"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":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>This study aimed to identify the biopsychosocial stressors influencing child and adolescent mental health during periods when facetoface education was suspended and to evaluate the psychological sequelae of school closures and related restrictions. We conducted a retrospective observational study at Kartal Dr. L\u00fctfi K\u0131rdar City Hospital, a tertiary care center in \u0130stanbul, reviewing all patients referred to the child and adolescent consultation-liaison psychiatry (CLP) unit between March 2020 and March 2022. We assessed associations between psychiatric diagnoses and health-related stressors, school closure status, age, and sex using both frequentist and Bayesian methods. During the study period, 264,013 pediatric admissions were recorded, of whom 270 (0.10%) required psychiatric consultation. The proportions of suicide attempts and anxiety diagnoses did not differ between periods of open and closed schools (BF10\u2009=\u20090.21 and 0.138, respectively; moderate evidence for the null). Multivariate analysis showed that the odds of suicide attempts were higher in patients exposed to family or schoolrelated stressors (OR\u2009=\u20096.63, 95% CI 2.72\u201316.19), in females (OR\u2009=\u20098.10, 95% CI 4.16\u201315.77), and with increasing age (OR\u2009=\u20091.32 per year, 95% CI 1.16\u20131.50). Female sex (OR\u2009=\u20094.17, 95% CI 2.03\u20138.55) and older age (OR\u2009=\u20091.30 per year, 95% CI 1.12\u20131.50) were also associated with depression. Anxiety was more likely in those facing isolation or healthrelated stressors (OR\u2009=\u20093.91, 95% CI 1.66\u20139.22). These findings highlight the differential impact of stressor type on internalizing symptoms and may inform resource allocation and crisisresponse planning in child mental health services.<\/jats:p>","DOI":"10.1038\/s41598-025-08566-2","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T18:00:25Z","timestamp":1751392825000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Child and adolescent psychiatry consultations during the COVID-19 pandemic"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3834-9262","authenticated-orcid":false,"given":"Zeynep","family":"Vatansever P\u0131nar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-6681","authenticated-orcid":false,"given":"\u0130rem Damla","family":"\u00c7imen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-5323","authenticated-orcid":false,"given":"Elif","family":"K\u00fc\u00e7\u00fck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6055-7746","authenticated-orcid":false,"given":"Mehmet Tolga","family":"K\u00f6le","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1720-9711","authenticated-orcid":false,"given":"\u0130brahim","family":"Kandemir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"8566_CR1","doi-asserted-by":"publisher","first-page":"110526","DOI":"10.1016\/j.jpsychores.2021.110526","volume":"147","author":"A Vincent","year":"2021","unstructured":"Vincent, A. et al. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: a prospective observational cohort study. J. Psychosom. Res. 147, 110526 (2021).","journal-title":"J. Psychosom. Res."},{"key":"8566_CR2","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jaclp.2021.05.001","volume":"62","author":"PA Shapiro","year":"2021","unstructured":"Shapiro, P. A. et al. Report of the academy of consultation-liaison psychiatry task force on lessons learned from the COVID-19 pandemic: executive summary. J. Acad. Consult Liaison Psychiatry. 62, 377\u2013386 (2021).","journal-title":"J. Acad. Consult Liaison Psychiatry"},{"key":"8566_CR3","doi-asserted-by":"publisher","first-page":"110214","DOI":"10.1016\/j.jpsychores.2020.110214","volume":"137","author":"M Horn","year":"2020","unstructured":"Horn, M., Granon, B., Vaiva, G., Fovet, T. & Amad, A. Role and importance of consultation-liaison psychiatry during the Covid-19 epidemic. J. Psychosom. Res. 137, 110214 (2020).","journal-title":"J. Psychosom. Res."},{"key":"8566_CR4","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/S2215-0366(20)30073-0","volume":"7","author":"L Duan","year":"2020","unstructured":"Duan, L. & Zhu, G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 7, 300\u2013302 (2020).","journal-title":"Lancet Psychiatry"},{"key":"8566_CR5","unstructured":"World Health Organization. WHO Director-General\u2019s opening remarks at the media briefing on COVID-19\u201311 March 2020. Accessed 25. January (2025). https:\/\/www.who.int\/director-general\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020"},{"key":"8566_CR6","doi-asserted-by":"publisher","first-page":"100185","DOI":"10.1016\/j.lanepe.2021.100185","volume":"8","author":"EN Iftekhar","year":"2021","unstructured":"Iftekhar, E. N. et al. A look into the future of the COVID-19 pandemic in europe: an expert consultation. Lancet Reg. Health Eur. 8, 100185 (2021).","journal-title":"Lancet Reg. Health Eur."},{"key":"8566_CR7","unstructured":"Johns Hopkins University & Medicine. Johns Hopkins Coronavirus Resource Center. https:\/\/coronavirus.jhu.edu (2022)."},{"key":"8566_CR8","doi-asserted-by":"publisher","first-page":"2000188","DOI":"10.2807\/1560-7917.ES.2020.25.13.2000188","volume":"25","author":"SK Brooks","year":"2020","unstructured":"Brooks, S. K. et al. The impact of unplanned school closure on children\u2019s social contact: rapid evidence review. Euro. Surveill. 25, 2000188 (2020).","journal-title":"Euro. Surveill"},{"key":"8566_CR9","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s00787-020-01570-z","volume":"29","author":"PJ Hoekstra","year":"2020","unstructured":"Hoekstra, P. J. Suicidality in children and adolescents: lessons to be learned from the COVID-19 crisis. Eur. Child. Adolesc. Psychiatry. 29, 737\u2013738 (2020).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR10","doi-asserted-by":"publisher","first-page":"104680","DOI":"10.1016\/j.chiabu.2020.104680","volume":"110","author":"A Isumi","year":"2020","unstructured":"Isumi, A., Doi, S., Yamaoka, Y., Takahashi, K. & Fujiwara, T. Do suicide rates in children and adolescents change during school closure in japan?? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health. Child. Abuse Negl. 110, 104680 (2020).","journal-title":"Child. Abuse Negl."},{"key":"8566_CR11","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.jaclp.2021.05.003","volume":"62","author":"K Brahmbhatt","year":"2021","unstructured":"Brahmbhatt, K. et al. Adaptations made to pediatric consultation-liaison psychiatry service delivery during the early months of the COVID-19 pandemic: a North American multisite survey. J. Acad. Consult Liaison Psychiatry. 62, 511\u2013521 (2021).","journal-title":"J. Acad. Consult Liaison Psychiatry"},{"key":"8566_CR12","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1017\/S003329170700027X","volume":"37","author":"EE Lloyd-Richardson","year":"2007","unstructured":"Lloyd-Richardson, E. E., Perrine, N., Dierker, L. & Kelley, M. L. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol. Med. 37, 1183\u20131192 (2007).","journal-title":"Psychol. Med."},{"key":"8566_CR13","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.15585\/mmwr.mm6945a3","volume":"69","author":"RT Leeb","year":"2020","unstructured":"Leeb, R. T. et al. Mental health-related emergency department visits among children aged\u2009<\u200918 years during the COVID-19 pandemic\u2014United states, January 1\u2013October 17, 2020. MMWR Morb Mortal. Wkly. Rep. 69, 1675\u20131680 (2020).","journal-title":"MMWR Morb Mortal. Wkly. Rep."},{"key":"8566_CR14","doi-asserted-by":"publisher","first-page":"204","DOI":"10.4274\/tjcamh.galenos.2021.36450","volume":"29","author":"H \u00d6zek Erkuran","year":"2022","unstructured":"\u00d6zek Erkuran, H. & \u00d6nen, \u00d6. Evaluation of psychiatric consultations requested for \u0131npatient children and adolescents in a training and research hospital. Turk. J. Child. Adolesc. Ment Health. 29, 204\u2013209 (2022).","journal-title":"Turk. J. Child. Adolesc. Ment Health"},{"key":"8566_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21926\/obm.neurobiol.2301159","volume":"7","author":"E Kuo","year":"2023","unstructured":"Kuo, E. et al. Coronavirus disease 2019 (COVID-19) pandemic\u2019s effect on child and adolescent mental health: analysis of pediatric intensive care unit and consultation-liaison psychiatry service. OBM Neurobiol. 7, 1\u201312 (2023).","journal-title":"OBM Neurobiol."},{"key":"8566_CR16","doi-asserted-by":"publisher","first-page":"102678","DOI":"10.1016\/j.ajp.2021.102678","volume":"61","author":"S Kose","year":"2021","unstructured":"Kose, S. et al. Effects of a pandemic on child and adolescent psychiatry emergency admissions: early experiences during the COVID-19 outbreak. Asian J. Psychiatry. 61, 102678 (2021).","journal-title":"Asian J. Psychiatry"},{"key":"8566_CR17","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s00787-021-01889-1","volume":"32","author":"U Ravens-Sieberer","year":"2021","unstructured":"Ravens-Sieberer, U. et al. Quality of life and mental health in children and adolescents during the first year of the COVID-19 pandemic: results of a two-wave nationwide population-based study. Eur. Child. Adolesc. Psychiatry. 32, 575\u2013588 (2021).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR18","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/jamapediatrics.2021.2482","volume":"175","author":"N Racine","year":"2021","unstructured":"Racine, N. et al. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr. 175, 1142\u20131150. https:\/\/doi.org\/10.1001\/jamapediatrics.2021.2482 (2021).","journal-title":"JAMA Pediatr."},{"key":"8566_CR19","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jad.2021.06.021","volume":"293","author":"L Ma","year":"2021","unstructured":"Ma, L. et al. Prevalence of mental health problems among children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis. J. Affect. Disord. 293, 78\u201389 (2021).","journal-title":"J. Affect. Disord"},{"key":"8566_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00787-021-01741-6","volume":"31","author":"D Ougrin","year":"2022","unstructured":"Ougrin, D. et al. Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study. Eur. Child. Adolesc. Psychiatry. 31, 1\u201313 (2022).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR21","first-page":"217","volume":"10","author":"N Emiroglu","year":"2009","unstructured":"Emiroglu, N., Aras, S., Yalin, S., Dogan, O. & Akay, A. Evaluation of the child and adolescent psychiatric inpatient consultations. Anatol. J. Psychiatry. 10, 217 (2009).","journal-title":"Anatol. J. Psychiatry"},{"key":"8566_CR22","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1007\/s00787-020-01541-4","volume":"29","author":"SJ Zhou","year":"2020","unstructured":"Zhou, S. J. et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur. Child. Adolesc. Psychiatry. 29, 749\u2013758 (2020).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR23","doi-asserted-by":"publisher","first-page":"2740","DOI":"10.1002\/jcop.22453","volume":"48","author":"C Branquinho","year":"2020","unstructured":"Branquinho, C., Kelly, C., Arevalo, L. C., Santos, A. & de Gaspar, M. Hey, we also have something to say: A qualitative study of Portuguese adolescents\u2019 and young people\u2019s experiences under COVID-19. J. Community Psychol. 48, 2740\u20132752 (2020).","journal-title":"J. Community Psychol."},{"key":"8566_CR24","doi-asserted-by":"publisher","first-page":"16","DOI":"10.15585\/mmwr.su7103a3","volume":"71","author":"SE Jones","year":"2022","unstructured":"Jones, S. E. et al. Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic \u2014 Adolescent behaviors and experiences survey, united states, January\u2013June 2021. MMWR Suppl. 71, 16\u201321. https:\/\/doi.org\/10.15585\/mmwr.su7103a3 (2022).","journal-title":"MMWR Suppl."},{"key":"8566_CR25","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1177\/00048674211029648","volume":"56","author":"MG Sawyer","year":"2022","unstructured":"Sawyer, M. G. et al. Mental health trajectories from childhood to adolescence: findings from the longitudinal study of Australian children. Aust N Z. J. Psychiatry. 56, 190\u2013200. https:\/\/doi.org\/10.1177\/00048674211029648 (2022).","journal-title":"Aust N Z. J. Psychiatry"},{"key":"8566_CR26","doi-asserted-by":"publisher","first-page":"e1631","DOI":"10.1097\/PEC.0000000000002141","volume":"37","author":"P Gonzalez-Urdiales","year":"2021","unstructured":"Gonzalez-Urdiales, P. et al. Pediatric \u0131ntentional self-poisoning evaluated in the emergency department: an international study. Pediatr. Emerg. Care. 37, e1631\u2013e1636. https:\/\/doi.org\/10.1097\/PEC.0000000000002141 (2021).","journal-title":"Pediatr. Emerg. Care"},{"key":"8566_CR27","doi-asserted-by":"publisher","first-page":"72","DOI":"10.59213\/TP.2024.143","volume":"5","author":"S Y\u0131ld\u0131r\u0131m","year":"2024","unstructured":"Y\u0131ld\u0131r\u0131m, S., A\u015f\u0131k, A. & Duyu, M. Evaluation of attempted suicide events through oral intake among children in a metropolitan city: a single-center study. Trends Pediatr. 5, 72\u201378. https:\/\/doi.org\/10.59213\/TP.2024.143 (2024).","journal-title":"Trends Pediatr."},{"key":"8566_CR28","first-page":"123","volume":"43","author":"J Neehall","year":"1994","unstructured":"Neehall, J. & Beharry, N. Demographic and clinical features of adolescent parasuicides. West. Indian Med. J. 43, 123\u2013126 (1994).","journal-title":"West. Indian Med. J."},{"key":"8566_CR29","doi-asserted-by":"crossref","unstructured":"Gizli \u00c7oban, \u00d6., G\u00fcl, M. & \u00d6nder, A. Evaluation of children and adolescents admitted to emergency service with suicide attempt. J Pediatr. Emerg. Intensive Care Med. 9, 153\u2013157 (2022).","DOI":"10.4274\/cayd.galenos.2021.69875"},{"key":"8566_CR30","doi-asserted-by":"publisher","first-page":"e2021482","DOI":"10.1001\/jamanetworkopen.2020.21482","volume":"3","author":"L Zhang","year":"2020","unstructured":"Zhang, L. et al. Assessment of mental health of Chinese primary school students before and after school closing and opening during the COVID-19 pandemic. JAMA Netw. Open. 3, e2021482 (2020).","journal-title":"JAMA Netw. Open."},{"key":"8566_CR31","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.bbi.2020.05.061","volume":"88","author":"F Chen","year":"2020","unstructured":"Chen, F. et al. Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav. Immun. 88, 36\u201338 (2020).","journal-title":"Brain Behav. Immun."},{"key":"8566_CR32","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1007\/s10964-020-01332-9","volume":"50","author":"NR Magson","year":"2021","unstructured":"Magson, N. R. et al. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J. Youth Adolesc. 50, 44\u201357 (2021).","journal-title":"J. Youth Adolesc."},{"key":"8566_CR33","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00787-018-01270-9","volume":"29","author":"JJ Carballo","year":"2020","unstructured":"Carballo, J. J. et al. Psychosocial risk factors for suicidality in children and adolescents. Eur. Child. Adolesc. Psychiatry. 29, 759\u2013776 (2020).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR34","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1007\/s00787-021-01924-1","volume":"32","author":"K Kostev","year":"2023","unstructured":"Kostev, K., Weber, K., Riedel-Heller, S., von Vult\u00e9e, C. & Bohlken, J. Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany. Eur. Child. Adolesc. Psychiatry. 32, 873\u2013879. https:\/\/doi.org\/10.1007\/s00787-021-01924-1 (2023).","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"8566_CR35","doi-asserted-by":"publisher","first-page":"1374327","DOI":"10.3389\/fpubh.2024.1374327","volume":"12","author":"AL Pinkse-Schepers","year":"2024","unstructured":"Pinkse-Schepers, A. L. et al. The development of depression and social anxiety symptoms in adolescents and the negative impact of the COVID-19 pandemic and desire for peer contact. Front. Public. Health. 12, 1374327 (2024).","journal-title":"Front. Public. Health"},{"key":"8566_CR36","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.chc.2023.02.002","volume":"32","author":"LR Fortuna","year":"2023","unstructured":"Fortuna, L. R., Brown, I. C., Woods, L., Porche, M. V. & G. G., & The impact of COVID-19 on anxiety disorders in youth: coping with stress, worry, and recovering from a pandemic. Child. Adolesc. Psychiatr Clin. N Am. 32, 531\u2013542 (2023).","journal-title":"Child. Adolesc. Psychiatr Clin. N Am."},{"key":"8566_CR37","doi-asserted-by":"publisher","first-page":"104699","DOI":"10.1016\/j.chiabu.2020.104699","volume":"110","author":"SM Brown","year":"2020","unstructured":"Brown, S. M., Doom, J. R., Lechuga-Pe\u00f1a, S., Watamura, S. E. & Koppels, T. Stress and parenting during the global COVID-19 pandemic. Child. Abuse Negl. 110, 104699 (2020).","journal-title":"Child. Abuse Negl."},{"key":"8566_CR38","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s13034-020-00329-3","volume":"14","author":"JM Fegert","year":"2020","unstructured":"Fegert, J. M., Vitiello, B., Plener, P. L. & Clemens, V. Challenges and burden of the coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child. Adolesc. Psychiatry Ment Health. 14, 20 (2020).","journal-title":"Child. Adolesc. Psychiatry Ment Health"},{"key":"8566_CR39","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1007\/s10896-020-00200-1","volume":"37","author":"G Chung","year":"2022","unstructured":"Chung, G., Lanier, P. & Wong, P. Y. J. Mediating effects of parental stress on harsh parenting and parent-child relationship during coronavirus (COVID-19) pandemic in Singapore. J. Fam Violence. 37, 801\u2013812 (2022).","journal-title":"J. Fam Violence"},{"key":"8566_CR40","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.jad.2020.10.016","volume":"279","author":"S Tang","year":"2021","unstructured":"Tang, S., Xiang, M., Cheung, T. & Xiang, Y. T. Mental health and its correlates among children and adolescents during COVID-19 school closure: the importance of parent-child discussion. J. Affect. Disord. 279, 353\u2013360 (2021).","journal-title":"J. Affect. Disord"},{"key":"8566_CR41","doi-asserted-by":"crossref","first-page":"30","DOI":"10.18663\/tjcl.1219858","volume":"1","author":"\u00d6 Sandal Sara\u00e7","year":"2023","unstructured":"Sandal Sara\u00e7, \u00d6. et al. Evaluation of child and adolescent psychiatry consultations requested for patients in the pediatric intensive care unit. Turk. J. Clin. Lab. 1, 30\u201336 (2023).","journal-title":"Turk. J. Clin. Lab."},{"key":"8566_CR42","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.jaac.2020.08.417","volume":"59","author":"A Sheen","year":"2020","unstructured":"Sheen, A. et al. 51.7 Impact of Covid-19-related school closures on children and adolescents worldwide: a literature review. J. Am. Acad. Child. Adolesc. Psychiatry. 59, 253 (2020).","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08566-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08566-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08566-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T18:00:27Z","timestamp":1751392827000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-08566-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["8566"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-08566-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"25 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was approved by the Ethics Committee of the Ministry of Health on 23.02.2022 and by the Medical Research Ethics Committee of our hospital on 09.03.2022 (decision number: 2022\/514\/221\/8).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Due to the retrospective nature of the study, Kartal Dr. L\u00fctfi K\u0131rdar Hospital Ethics Committee waived the need of obtaining informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"21510"}}