{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:47:02Z","timestamp":1788562022845,"version":"build-2803163510"},"reference-count":65,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001590","name":"Health Research Board","doi-asserted-by":"publisher","award":["Employees personal development"],"award-info":[{"award-number":["Employees personal development"]}],"id":[{"id":"10.13039\/501100001590","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,16]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Repeated cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Drug poisoning deaths in Ireland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>National Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) \u22652\u2009CNS depressants and (3) specific drugs\/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004\u20132017), change points over time and average annual percentage changes (AAPCs) with 95% CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Increased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100\u2009000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100\u2009000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving \u22652\u2009CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95%\u2009CI 2.2 to 13.6), benzodiazepines (7.2%, 95%\u2009CI 2.9 to 11.6), antidepressants (6.1%, 95%\u2009CI 2.4 to 10.0) and prescription opioids (3.5%, 95%\u2009CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95%\u2009CI 0.2 to 8.3), benzodiazepines (3.3%, 95%\u2009CI 0.1 to 6.5) and prescription opioids (3.0%, 95%\u2009CI 0.7 to 5.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Drugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048000","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T12:24:44Z","timestamp":1630671884000},"page":"e048000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Trends in drug poisoning deaths, by sex, in Ireland: a repeated cross-sectional study from 2004 to 2017"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5360-6650","authenticated-orcid":false,"given":"Ena","family":"Lynn","sequence":"first","affiliation":[{"name":"National Health Information Systems, Health Research Board, Dublin 2, Ireland"},{"name":"Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2985-7668","authenticated-orcid":false,"given":"Gr\u00e1inne","family":"Cousins","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzi","family":"Lyons","sequence":"additional","affiliation":[{"name":"National Health Information Systems, Health Research Board, Dublin 2, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2861-7665","authenticated-orcid":false,"given":"Kathleen E","family":"Bennett","sequence":"additional","affiliation":[{"name":"Data Science Centre, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"2025121515252380000_11.9.e048000.1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.16217"},{"key":"2025121515252380000_11.9.e048000.2","first-page":"1419","article-title":"Drug and Opioid-Involved Overdose Deaths - United States, 2013-2017","volume":"67","author":"Scholl","year":"2019","journal-title":"MMWR: Morb Mortal Wkly Rep"},{"key":"2025121515252380000_11.9.e048000.3","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6712a1"},{"key":"2025121515252380000_11.9.e048000.4","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303627"},{"key":"2025121515252380000_11.9.e048000.5","doi-asserted-by":"crossref","first-page":"e374","DOI":"10.1016\/S2468-2667(18)30114-2","article-title":"Premature mortality projections in the USA through 2030: a modelling study","volume":"3","author":"Best","year":"2018","journal-title":"Lancet Public Health"},{"key":"2025121515252380000_11.9.e048000.6","unstructured":"Man N , Chrzanowska A , Dobbins T . Trends in drug-induced deaths in Australia, 1997-2018. drug trends Bulletin series. Sydney National Drug and Alcohol Research Centre; 2019. https:\/\/ndarc.med.unsw.edu.au\/resource\/trends-drug-induced-deaths-australia-1997-2018 [Accessed Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.7","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S2215-0366(19)30209-3","article-title":"Rising opioid-related deaths in England and Scotland must be recognised as a public health crisis","volume":"6","author":"Kimber","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2025121515252380000_11.9.e048000.8","unstructured":"EMCDDA . European drug report 2014: trends and developments, 2014. Available: https:\/\/www.emcdda.europa.eu\/publications\/edr\/trends-developments\/2014_en [Accessed Oct 2020]."},{"key":"2025121515252380000_11.9.e048000.9","unstructured":"EMCDDA . European drug report 2020: trends and developments, 2020. Available: https:\/\/www.emcdda.europa.eu\/publications\/edr\/trends-developments\/2020_en [Accessed 25 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.10","doi-asserted-by":"publisher","DOI":"10.1126\/science.aat5236"},{"key":"2025121515252380000_11.9.e048000.11","doi-asserted-by":"crossref","first-page":"543","DOI":"10.15288\/jsad.2020.81.543","article-title":"Drug poisoning deaths among women: a scoping review","volume":"81","author":"Lynn","year":"2020","journal-title":"J Stud Alcohol Drugs"},{"key":"2025121515252380000_11.9.e048000.12","unstructured":"Tweed E , Miller R , Mathesone C . Why are drug-related deaths among women increasing in Scotland? A scoping of possible explanations. Edinburgh Scottish government; 2018. http:\/\/www.gov.scot\/publications\/drug-related-deaths-women-increasing-scotland-9781787810129\/ [Accessed Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.13","unstructured":"Centers for Disease Control and Prevention . Prescription painkiller overdoses: a growing epidemic, especially among women, 2013. Available: https:\/\/www.cdc.gov\/vitalsigns\/prescriptionpainkilleroverdoses\/index.html [Accessed 7 Mar 2020]."},{"key":"2025121515252380000_11.9.e048000.14","doi-asserted-by":"publisher","DOI":"10.1002\/hup.630"},{"key":"2025121515252380000_11.9.e048000.15","unstructured":"Health Research Board . National drug-related deaths index 2008 to 2017 data, 2019. Available: https:\/\/www.drugsandalcohol.ie\/31275 [Accessed Oct 2020]."},{"key":"2025121515252380000_11.9.e048000.16","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s13181-012-0285-4","article-title":"Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006)","volume":"9","author":"Algren","year":"2013","journal-title":"J Med Toxicol"},{"key":"2025121515252380000_11.9.e048000.17","first-page":"1254","article-title":"Sex-based differences in drug activity","volume":"80","author":"Whitley","year":"2009","journal-title":"Am Fam Physician"},{"key":"2025121515252380000_11.9.e048000.18","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6801a1"},{"key":"2025121515252380000_11.9.e048000.19","unstructured":"Osborn E . Deaths related to drug poisoning in England and Wales: 2017 registrations. Statistical Bulletin Office for National Statistics; 2018. https:\/\/www.ons.gov.uk\/releases\/deathsrelatedtodrugpoisoninginenglandandwales2017registrations [Accessed Oct 2020]."},{"key":"2025121515252380000_11.9.e048000.20","first-page":"e1","article-title":"Differing patterns in intentional and unintentional poisonings among young people in England, 1998-2014: a population-based cohort study","volume":"39","author":"Tyrrell","year":"2017","journal-title":"J Public Health"},{"key":"2025121515252380000_11.9.e048000.21","unstructured":"STROBE Statement . STROBE Statement\u2014checklist of items that should be included in reports of observational studies. Available: https:\/\/www.strobe-statement.org\/fileadmin\/Strobe\/uploads\/checklists\/STROBE_checklist_v4_combined.pdf [Accessed 30 May 2019]."},{"key":"2025121515252380000_11.9.e048000.22","unstructured":"Lynn E , Lyons S , Walsh S . Trends in deaths among drug users in Ireland from traumatic and medical causes, 1998 to 2005. Dublin Health Research Board; 2019. https:\/\/www.drugsandalcohol.ie\/12775\/ [Accessed Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.23","unstructured":"EMCDDA . Drug-Related deaths (DRD) standard protocol, version 3.2, 2010. Available: https:\/\/www.emcdda.europa.eu\/html.cfm\/index107404EN.html_en [Accessed Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2018.03.032"},{"key":"2025121515252380000_11.9.e048000.25","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-017-2310-7"},{"key":"2025121515252380000_11.9.e048000.26","unstructured":"Central Statistics Office . StatBank annual population estimates, 2020. Available: https:\/\/statbank.cso.ie\/px\/pxeirestat\/Statire\/SelectVarVal\/Define.asp?maintable=PEA01&PLanguage=0 [Accessed 15 Feb 2020]."},{"key":"2025121515252380000_11.9.e048000.27","unstructured":"Health Service Executive . Primary care reimbursement service: statistical analysis of claims and payments 2008 to 2017, 2017. Available: https:\/\/www.sspcrs.ie\/portal\/annual-reporting\/report\/annual [Accessed 12 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.28","unstructured":"Eurostat . Revision of the European Standard Population \u2013 Report of Eurostat\u2019s Task Force. Luxembourg European Commission; 2013.doi:10.2785\/11470"},{"key":"2025121515252380000_11.9.e048000.29","unstructured":"National Cancer Institute . Joinpoint trend analysis softward, 2020. Available: https:\/\/surveillance.cancer.gov\/joinpoint\/ [Accessed 4 Aug 2020]."},{"key":"2025121515252380000_11.9.e048000.30","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2019.107741","article-title":"A repeated cross-sectional study of factors associated with pregabalin-positive poisoning deaths in Ireland","volume":"206","author":"Lynn","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"2025121515252380000_11.9.e048000.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.12.009"},{"key":"2025121515252380000_11.9.e048000.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1550"},{"key":"2025121515252380000_11.9.e048000.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2011.05.001"},{"key":"2025121515252380000_11.9.e048000.34","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1111\/add.15004","article-title":"Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug-related poisoning deaths? A retrospective cohort study","volume":"115","author":"Durand","year":"2020","journal-title":"Addiction"},{"key":"2025121515252380000_11.9.e048000.35","doi-asserted-by":"publisher","DOI":"10.1111\/add.12863"},{"key":"2025121515252380000_11.9.e048000.36","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S2215-0366(15)00366-1","article-title":"Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study","volume":"2","author":"Kimber","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"2025121515252380000_11.9.e048000.37","doi-asserted-by":"crossref","DOI":"10.1001\/jamapsychiatry.2021.0976","article-title":"Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and meta-analysis","author":"Santo","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"2025121515252380000_11.9.e048000.38","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.2105\/AJPH.2017.303825","article-title":"Polysubstance use among US women of reproductive age who use opioids for nonmedical reasons","volume":"107","author":"Jarlenski","year":"2017","journal-title":"Am J Public Health"},{"key":"2025121515252380000_11.9.e048000.39","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.drugalcdep.2019.01.031","article-title":"Polydrug use disorders in individuals with opioid use disorder","volume":"198","author":"Hassan","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"2025121515252380000_11.9.e048000.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.11.018"},{"key":"2025121515252380000_11.9.e048000.41","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/0706743718762388","article-title":"Men's mental health: social determinants and implications for services","volume":"63","author":"Affleck","year":"2018","journal-title":"Can J Psychiatry"},{"key":"2025121515252380000_11.9.e048000.42","unstructured":"National Advisory Committee on Drugs and Alcohol, Northern Ireland, Department of Health . Prevalence of drug use and gambling in Ireland & drug use in Northern Ireland. Bulletin 1, 2016. Available: https:\/\/www.drugsandalcohol.ie\/26364\/ [Accessed Oct 2020]."},{"key":"2025121515252380000_11.9.e048000.43","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/dar.12983","article-title":"The connection between per capita alcohol consumption and alcohol-specific mortality accounting for unrecorded alcohol consumption: the case of Finland 1975-2015","volume":"38","author":"Norstr\u00f6m","year":"2019","journal-title":"Drug Alcohol Rev"},{"key":"2025121515252380000_11.9.e048000.44","unstructured":"Office of Revenue Commissioners . Excise Receipts by commodity, 2020. Available: https:\/\/www.revenue.ie\/en\/corporate\/information-about-revenue\/statistics\/excise\/receipts-volume-and-price\/excise-receipts-commodity.aspx [Accessed 4 Jul 2020]."},{"key":"2025121515252380000_11.9.e048000.45","unstructured":"Government of Ireland . Public health (alcohol) act 2018, 2018. Available: http:\/\/www.irishstatutebook.ie\/eli\/2018\/act\/24\/enacted\/en\/html [Accessed 14 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.46","unstructured":"Eurostat . General government deficit\/surplus: % of GDP and million Eur, 2020. Available: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/tec00127\/default\/table?lang=en [Accessed 23 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.47","unstructured":"Hedegaard H , Spencer MR , Garnett MF . Increase in drug overdose deaths involving cocaine: United States, 2009\u20132018. NCHS data brief No.384 Centre for Disease Control and Prevention; 2020. https:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db384-H.pdf"},{"key":"2025121515252380000_11.9.e048000.48","unstructured":"O\u2019Neill D , Carew A , Lyons S . Drug treatment in Ireland 2013 to 2019. Dublin Health Research Board; 2020. https:\/\/www.drugsandalcohol.ie\/32094 [Accessed 19 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.49","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-016-0909-3","article-title":"Nonmedical use of prescription drugs in the European Union","volume":"16","author":"Novak","year":"2016","journal-title":"BMC Psychiatry"},{"key":"2025121515252380000_11.9.e048000.50","unstructured":"Benzodiazepine Committee . Benzodiazepines: good practice guidelines for clinicians. Dublin Department of health and children; 2002. https:\/\/www.drugsandalcohol.ie\/5349\/ [Accessed 27 Sep 2020]."},{"key":"2025121515252380000_11.9.e048000.51","unstructured":"Duffin T , Keane M , Millar SR . Street tablet use in Ireland. A Trendspotter study on use, markets, and harms. Dublin ANA Liffey drug project; 2020. https:\/\/www.drugsandalcohol.ie\/31872\/"},{"key":"2025121515252380000_11.9.e048000.52","unstructured":"Ryan V . \u2018Fake\u2019 benzos potency fears rise. Irish Medical Times. Available: https:\/\/www.imt.ie\/news\/fake-benzos-potency-fears-rise-31-08-2020\/ [Accessed 31 Aug 2020]."},{"key":"2025121515252380000_11.9.e048000.53","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugpo.2020.102966","article-title":"Harm reduction in the time of COVID-19: case study of homelessness and drug use in Dublin, Ireland","volume":"87","author":"O'Carroll","year":"2021","journal-title":"Int J Drug Policy"},{"key":"2025121515252380000_11.9.e048000.54","unstructured":"UNODC . Global smart update volume 18: non-medical use of benzodiazepines: a growing threat to public health? 2017. Available: https:\/\/www.unodc.org\/documents\/scientific\/Global_SMART_Update_2017_Vol_18.pdf [Accessed 13 Jun 2021]."},{"key":"2025121515252380000_11.9.e048000.55","doi-asserted-by":"publisher","DOI":"10.1111\/add.14981"},{"key":"2025121515252380000_11.9.e048000.56","unstructured":"EMCDDA . Trendspotter summary report recent shocks in the European heroin market: explanations and ramifications. Lisbon EMCDDA; 2011. https:\/\/www.emcdda.europa.eu\/scientific-studies\/2011\/trendspotters-report_en"},{"key":"2025121515252380000_11.9.e048000.57","doi-asserted-by":"publisher","DOI":"10.1080\/09595230412331289446"},{"key":"2025121515252380000_11.9.e048000.58","doi-asserted-by":"publisher","DOI":"10.1093\/bjc\/azh096"},{"key":"2025121515252380000_11.9.e048000.59","unstructured":"Australian Institute of Health and Welfare . Alcohol, tobacco & other drugs in Australia, 2020. Available: https:\/\/www.aihw.gov.au\/reports\/phe\/221\/alcohol-tobacco-other-drugs-australia\/contents\/drug-types\/illicit-opioids-heroin [Accessed 3 Sept 2020]."},{"key":"2025121515252380000_11.9.e048000.60","unstructured":"The Pharmaceutical Society of Ireland . Non-Prescription medicinal products containing codeine: guidance for pharmacists on safe supply to patients. Dublin The Pharmaceutical Society of Ireland; 2010. www.drugsandalcohol.ie\/13191 [Accessed 6 Oct 2020]."},{"key":"2025121515252380000_11.9.e048000.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.06.005"},{"key":"2025121515252380000_11.9.e048000.62","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1016\/S0140-6736(19)32229-9","article-title":"Global patterns of opioid use and dependence: harms to populations, interventions, and future action","volume":"394","author":"Degenhardt","year":"2019","journal-title":"Lancet"},{"key":"2025121515252380000_11.9.e048000.63","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-020-00394-z","article-title":"A national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report","volume":"17","author":"Crowley","year":"2020","journal-title":"Harm Reduct J"},{"key":"2025121515252380000_11.9.e048000.64","unstructured":"EMCDDA . Health and social responses to drug problems: a European guide, 2017. Available: https:\/\/www.emcdda.europa.eu\/publications\/manuals\/health-and-social-responses-to-drug-problems-a-european-guide_en [Accessed assessed 20 Sept 2020]."},{"key":"2025121515252380000_11.9.e048000.65","unstructured":"UNODC . Treatment and care of people with drug use disorders in contact with the criminal justice system: alternatives to Conviction or punishment, 2016. Available: https:\/\/www.unodc.org\/unodc\/en\/drug-prevention-and-treatment\/treatment-and-care-of-people-with-drug-use-disorders-in-contact-with-the-criminal-justice-system_-alternatives-to-conviction-or-punishment.html [Accessed assessed Oct 2020]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-048000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T23:25:32Z","timestamp":1765841132000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-048000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":65,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,3]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bmjopen-2020-048000"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-048000","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}