{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:43:35Z","timestamp":1791549815104,"version":"4.3.4"},"reference-count":58,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T00:00:00Z","timestamp":1720137600000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,6,10]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess healthcare workers\u2019 (HCWs) confidence level in diagnosing and managing mpox disease and its associated factors in hospitals in the Amhara Region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Institution-based cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospitals in the Amhara Region, Northwest Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 640 HCWs, with a response rate of 96.9%, participated from 1 October to 30 December 2022. A multistage stratified random sampling technique with proportional allocation was used to recruit study participants. Data were collected using the KoboCollect toolbox and exported to STATA V.17 for analysis. Descriptive statistics were used to describe data. Ordinal logistic regression analysis was used to identify predictors of confidence level to diagnose and manage mpox at p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome<\/jats:title>\n                    <jats:p>HCWs\u2019 confidence level in diagnosing and managing mpox disease and its associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall proportion of HCWs who had high confidence level in diagnosing and managing mpox disease was found to be 31.5% (95% CI: 27.9%, 35.2%). Similarly, 26.8% (95% CI: 23.2%, 30.3%) and 41.8% (95% CI: 38.1%, 45.4%) of HCWs expressed medium and low confidence level to diagnose and manage the disease, respectively. The odds of higher confidence versus lower or medium confidence level in diagnosing and managing mpox were greater for HCWs who regularly visit amenable websites (adjusted OR (AOR)=1.59, 95% CI: 1.16, 2.2), were physicians (AOR=1.9, 95% CI: 1.32, 2.73), were aged 30\u201335 years old (AOR=1.64, 95% CI: 1.12, 2.39), had got public health emergency epidemic disease management training (AOR=2.8, 95% CI: 1.94, 4.04) and had positive attitudes (AOR=1.72, 95% CI: 1.26, 2.36) compared with their counterparts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The overall confidence level of HCWs in diagnosing and managing mpox disease in the study area was low. Therefore, the HCWs should be regularly updated about mpox disease through morning sessions and training in the diagnosis and clinical management of mpox disease including infection prevention and control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080791","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T10:50:44Z","timestamp":1720176644000},"page":"e080791","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Assessing healthcare workers\u2019 confidence level in diagnosing and managing emerging infectious virus of human mpox in hospitals in Amhara Region, Northwest Ethiopia: multicentre institution-based cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1803-5450","authenticated-orcid":false,"given":"Almaw Genet","family":"Yeshiwas","sequence":"first","affiliation":[{"name":"Department of Environmental Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abathun","family":"Temesegen","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gashaw","family":"Melkie","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2388-3171","authenticated-orcid":false,"given":"Tilahun Degu","family":"Tsega","sequence":"additional","affiliation":[{"name":"Department of Public Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebaw","family":"Mola","sequence":"additional","affiliation":[{"name":"Department of Public Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2533-339X","authenticated-orcid":false,"given":"Hiwot","family":"Tesfa","sequence":"additional","affiliation":[{"name":"Department of Public Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aschale","family":"Shimels","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengist","family":"Asmamaw","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Injibara University, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anley","family":"Shiferaw","sequence":"additional","affiliation":[{"name":"Department of Epidemology, Bichena Hospital, Injibara, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejen","family":"Tsegaye","sequence":"additional","affiliation":[{"name":"Department of Public Health, West Gojjam Zone, Finoteselam, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esubalew","family":"Muchie","sequence":"additional","affiliation":[{"name":"Department of Public Health, Dangila Primary Hospital, Dangila, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derseh","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"Department of Public Health, Dejen Primary Hospital, Dejen, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chalachew","family":"Yenew","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Public Health, Debre Tabor University, Debre Tabor, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,5]]},"reference":[{"key":"2025121410391287000_14.7.e080791.1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jiph.2023.02.003","article-title":"Monkeypox (Mpox) virus: classification, origin, transmission, genome organization, antiviral drugs, and molecular diagnosis","volume":"16","author":"Karagoz","year":"2023","journal-title":"J Infect Public Health"},{"key":"2025121410391287000_14.7.e080791.2","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms11112713","article-title":"A review of the past, present, and future of the Monkeypox virus: challenges, opportunities, and lessons from COVID-19 for global health security","volume":"11","author":"Hirani","year":"2023","journal-title":"Microorganisms"},{"key":"2025121410391287000_14.7.e080791.3","unstructured":"Perramon A . Analysis of the Epidemiological dynamic of Monkeypox from 15th may to 31st August 2022. 2022;160. Available: www.enfermedadesemergentes.com"},{"key":"2025121410391287000_14.7.e080791.4","doi-asserted-by":"crossref","DOI":"10.3390\/tropicalmed7100264","article-title":"Global outbreak of human Monkeypox in 2022: update of epidemiology","volume":"7","author":"Ilic","year":"2022","journal-title":"Trop Med Infect Dis"},{"key":"2025121410391287000_14.7.e080791.5","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.clindermatol.2023.04.001","article-title":"Monkeypox between Dermatology and anthropology: A model for evolutionary medicine","volume":"41","author":"Galassi","year":"2023","journal-title":"Clin Dermatol"},{"key":"2025121410391287000_14.7.e080791.6","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1080\/22221751.2022.2095309","article-title":"Monkeypox virus emerges from the shadow of its more infamous cousin: family biology matters","volume":"11","author":"Xiang","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"2025121410391287000_14.7.e080791.7","article-title":"Monkeypox: A review of clinical features, diagnosis, and treatment","volume":"14","author":"Cheema","year":"2022","journal-title":"Cureus"},{"key":"2025121410391287000_14.7.e080791.8","first-page":"593","article-title":"A human infection caused by Monkeypox virus in Basankusu territory, democratic Republic of the Congo","volume":"46","author":"Ladnyj","year":"1972","journal-title":"Bull World Health Organ"},{"key":"2025121410391287000_14.7.e080791.9","doi-asserted-by":"publisher","DOI":"10.3390\/idr14050079"},{"key":"2025121410391287000_14.7.e080791.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2022.06.060"},{"key":"2025121410391287000_14.7.e080791.11","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S1473-3099(22)00359-0","article-title":"Tracking the 2022 Monkeypox outbreak with Epidemiological data in real-time","volume":"22","author":"Kraemer","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2025121410391287000_14.7.e080791.12","unstructured":"Update E . Monkeypox multi-country outbreak. European Centre for Disease Prevention and Control 2022."},{"key":"2025121410391287000_14.7.e080791.13","unstructured":"WHO . 2022-23 Mpox (Monkeypox) Outbreak: Global Trends, 2023. Available: https:\/\/worldhealthorg.shinyapps.io\/mpx_global"},{"key":"2025121410391287000_14.7.e080791.14","unstructured":"CDC . 2022-2023 Mpox Outbreak Global Map, 2023. Available: https:\/\/www.cdc.gov\/poxvirus\/mpox\/response\/2022\/world-map.html"},{"key":"2025121410391287000_14.7.e080791.15","doi-asserted-by":"crossref","DOI":"10.1016\/j.tmaid.2022.102327","article-title":"Historical review: towards the 50th anniversary of the last major smallpox outbreak (Yugoslavia, 1972)","volume":"48","author":"Ilic","year":"2022","journal-title":"Travel Med Infect Dis"},{"key":"2025121410391287000_14.7.e080791.16","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.1035924","article-title":"Immuno-Informatics profiling of Monkeypox virus cell surface binding protein for designing a next generation multi-Valent peptide-based vaccine","volume":"13","author":"Yousaf","year":"2022","journal-title":"Front Immunol"},{"key":"2025121410391287000_14.7.e080791.17","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac310","article-title":"Monkeypox: a contemporary review for healthcare professionals","volume":"9","author":"Titanji","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2025121410391287000_14.7.e080791.18","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.3390\/healthcare10091722","article-title":"Assessing Healthcare workers\u2019 knowledge and their confidence in the diagnosis and management of human Monkeypox: A cross-sectional study in a middle Eastern country","volume":"10","author":"Sallam","year":"2022","journal-title":"Healthcare"},{"key":"2025121410391287000_14.7.e080791.19","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical presentation and virological assessment of confirmed human Monkeypox virus cases in Spain: a prospective observational cohort study","volume":"400","author":"Tar\u00edn-Vicente","year":"2022","journal-title":"The Lancet"},{"key":"2025121410391287000_14.7.e080791.20","doi-asserted-by":"publisher","DOI":"10.3201\/eid2810.221047"},{"key":"2025121410391287000_14.7.e080791.21","article-title":"Frequent detection of Monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients","volume":"27","author":"Peir\u00f3-Mestres","year":"2022","journal-title":"Euro Surveill"},{"key":"2025121410391287000_14.7.e080791.22","doi-asserted-by":"publisher","DOI":"10.3201\/eid2604.191164"},{"key":"2025121410391287000_14.7.e080791.23","doi-asserted-by":"crossref","DOI":"10.3389\/fitd.2022.951380","article-title":"The outbreak of human Monkeypox in 2022: A changing epidemiology or an impending Aftereffect of smallpox eradication","volume":"3","author":"Al-Tammemi","year":"2022","journal-title":"Front Trop Dis"},{"key":"2025121410391287000_14.7.e080791.24","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix260"},{"key":"2025121410391287000_14.7.e080791.25","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens11070713","article-title":"Monkeypox: another sexually transmitted infection","volume":"11","author":"Rodriguez-Morales","year":"2022","journal-title":"Pathogens"},{"key":"2025121410391287000_14.7.e080791.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010141","article-title":"The changing epidemiology of human Monkeypox\u2014A potential threat? A systematic Review| PLOS neglected tropical diseases","volume":"16","author":"Bunge","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121410391287000_14.7.e080791.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.04.062"},{"key":"2025121410391287000_14.7.e080791.28","doi-asserted-by":"publisher","DOI":"10.1086\/498155"},{"key":"2025121410391287000_14.7.e080791.29","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007791","article-title":"A systematic review of the epidemiology of human Monkeypox outbreaks and implications for outbreak strategy","volume":"13","author":"Beer","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121410391287000_14.7.e080791.30","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1005769107"},{"key":"2025121410391287000_14.7.e080791.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2018.11.004"},{"key":"2025121410391287000_14.7.e080791.32","first-page":"56","article-title":"Monkeypox virus in relation to the ecological features surrounding human settlements in Bumba zone, Zaire","volume":"39","author":"Khodakevich","year":"1987","journal-title":"Trop Geogr Med"},{"key":"2025121410391287000_14.7.e080791.33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijid.2022.05.058","article-title":"Increased outbreaks of Monkeypox highlight gaps in actual disease burden in sub-Saharan Africa and in animal reservoirs","volume":"122","author":"Haider","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2025121410391287000_14.7.e080791.34","doi-asserted-by":"crossref","unstructured":"Ortiz-Mart\u00ednez Y , Galvis-Cata\u00f1o LM , Arias-Rodr\u00edguez D , et al . Youtube and 2022 Monkeypox outbreak: opportunities for awareness and infection control. J Hosp Infect 2022.:S0195-6701(22)00226-2. doi:10.1016\/j.jhin.2022.07.007","DOI":"10.1016\/j.jhin.2022.07.007"},{"key":"2025121410391287000_14.7.e080791.35","unstructured":"Assessment RR . Monkeypox multi-country outbreak. 2022."},{"key":"2025121410391287000_14.7.e080791.36","article-title":"The emergence of Monkeypox: A global health threat","volume":"14","author":"Sah","year":"2022","journal-title":"Cureus"},{"key":"2025121410391287000_14.7.e080791.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.clim.2022.109108","article-title":"The resurgence of a neglected Orthopoxvirus: immunologic and clinical aspects of Monkeypox virus infections over the past six decades","volume":"243","author":"Al-Musa","year":"2022","journal-title":"Clin Immunol"},{"key":"2025121410391287000_14.7.e080791.38","first-page":"29","article-title":"Epidemiology of human Monkeypox (Mpox)\u2013Worldwide, 2018\u20132021\u2013\u00c9pid\u00e9miologie de la Variole Simienne Chez L\u2019Humain\u2013Dans le Monde, 2018-2021","volume":"98","year":"2023","journal-title":"Weekly Epidemiological Record= Relev\u00e9 \u00c9pid\u00e9miologique Hebdomadaire"},{"key":"2025121410391287000_14.7.e080791.39","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph192214881","article-title":"Monkeypox mysteries of the new outbreak in non-Endemic areas","volume":"19","author":"Antunes","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025121410391287000_14.7.e080791.40","first-page":"1","article-title":"Human Monkeypox: an update on knowledge and future implications","volume":"16","author":"Shariq","year":"2022","journal-title":"Int J Health Sci (Qassim)"},{"key":"2025121410391287000_14.7.e080791.41","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/S1049023X22001121","article-title":"Monkeypox 2022: a primer and identify-isolate-inform (3I) tool for emergency medical services professionals","volume":"37","author":"Koenig","year":"2022","journal-title":"Prehosp Disaster Med"},{"key":"2025121410391287000_14.7.e080791.42","unstructured":"Taherdoost H . Determining sample size; how to calculate survey sample size. Int J Econom Manag Syst 2017."},{"key":"2025121410391287000_14.7.e080791.43","doi-asserted-by":"crossref","first-page":"924","DOI":"10.3390\/medicina58070924","article-title":"Knowledge of human Monkeypox and its relation to conspiracy beliefs among students in Jordanian health schools: filling the knowledge gap on emerging Zoonotic viruses","volume":"58","author":"Sallam","year":"2022","journal-title":"Medicina"},{"key":"2025121410391287000_14.7.e080791.44","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5152\/etd.2018.18103","article-title":"Knowledge, attitude, and practice regarding osteoporosis among Allied health sciences students in a public University in Malaysia","volume":"40","author":"Ramli","year":"2018","journal-title":"Erciyes Med J"},{"key":"2025121410391287000_14.7.e080791.45","doi-asserted-by":"crossref","DOI":"10.1177\/23779608231216619","article-title":"Knowledge and attitude regarding human Monkeypox virus infection among nurses: A cross-sectional study","volume":"9","author":"Rony","year":"2023","journal-title":"SAGE Open Nursing"},{"key":"2025121410391287000_14.7.e080791.46","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens11090994","article-title":"Monkeypox knowledge and confidence in diagnosis and management with evaluation of emerging virus infection conspiracies among health professionals in Kuwait","volume":"11","author":"Alsanafi","year":"2022","journal-title":"Pathogens"},{"key":"2025121410391287000_14.7.e080791.47","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens11080904","article-title":"Assessment of knowledge of Monkeypox viral infection among the general population in Saudi Arabia","volume":"11","author":"Alshahrani","year":"2022","journal-title":"Pathogens"},{"key":"2025121410391287000_14.7.e080791.48","doi-asserted-by":"crossref","DOI":"10.3390\/tropicalmed7100283","article-title":"Monkeypox disease: an emerging public health concern in the shadow of COVID-19 pandemic: an update","volume":"7","author":"Hasan","year":"2022","journal-title":"Trop Med Infect Dis"},{"key":"2025121410391287000_14.7.e080791.49","doi-asserted-by":"crossref","DOI":"10.1002\/jmv.28294","article-title":"The willingness of Chinese Healthcare workers to receive Monkeypox vaccine and its independent predictors: A Cross\u2010Sectional survey","volume":"95","author":"Hong","year":"2023","journal-title":"J Med Virol"},{"key":"2025121410391287000_14.7.e080791.50","doi-asserted-by":"crossref","DOI":"10.1038\/s41392-022-01215-4","article-title":"Monkeypox: epidemiology, pathogenesis, treatment and prevention","volume":"7","author":"Huang","year":"2022","journal-title":"Signal Transduct Target Ther"},{"key":"2025121410391287000_14.7.e080791.51","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1016\/S0140-6736(22)01437-4","article-title":"Monkeypox as a PHEIC: implications for global health governance","volume":"400","author":"Wenham","year":"2022","journal-title":"The Lancet"},{"key":"2025121410391287000_14.7.e080791.52","doi-asserted-by":"crossref","DOI":"10.1016\/j.actatropica.2020.105450","article-title":"Confidence in managing human Monkeypox cases in Asia: A cross-sectional survey among general practitioners in Indonesia","volume":"206","author":"Harapan","year":"2020","journal-title":"Acta Tropica"},{"key":"2025121410391287000_14.7.e080791.53","unstructured":"World Health Organization . Obesity: preventing and managing the global epidemic. 2000."},{"key":"2025121410391287000_14.7.e080791.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.08.034"},{"key":"2025121410391287000_14.7.e080791.55","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-016-0689-y","article-title":"Medical students developing confidence and patient Centredness in diverse clinical settings: a longitudinal survey study","volume":"16","author":"McNair","year":"2016","journal-title":"BMC Med Educ"},{"key":"2025121410391287000_14.7.e080791.56","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens11111285","article-title":"Monkeypox: what do you know about that?\u201d Italian adults\u2019 awareness of a new epidemic","volume":"11","author":"Gall\u00e8","year":"2022","journal-title":"Pathogens"},{"key":"2025121410391287000_14.7.e080791.57","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-142-4-200502150-00008"},{"key":"2025121410391287000_14.7.e080791.58","unstructured":"WHO . Clinical management and infection prevention and control guideline, 2022. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/355798\/WHO-MPX-Clinical_and_IPC-2022.1-eng.pdf?sequence=1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-080791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T18:39:26Z","timestamp":1765737566000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-080791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":58,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,5]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bmjopen-2023-080791"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-080791","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}