{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:28:33Z","timestamp":1773797313136,"version":"3.50.1"},"reference-count":61,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"unspecified","delay-in-days":28,"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":[[2025,10,3]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the geospatial distribution of gestational diabetes mellitus (GDM) over time in Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An ecological study was conducted using data from the National Diabetes Services Scheme (GDM cases). Data at Statistical Area Level 2 (SA2) level, a medium-sized spatial unit, on population denominators (women who gave birth) were obtained from the Australian Bureau of Statistics. The spatiotemporal distribution of GDM was explored at the SA2 level over three periods: 20162017, 20182019 and 20202021. Hotspot and cluster analyses were undertaken using Getis-Ord Gi* and local Morans I statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A nationwide study in Australia was conducted between 2016 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women diagnosed with GDM and those who gave birth were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Age-standardised and crude incidence of GDM per SA2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 20162021, 1 718 963 eligible women who gave birth in Australia were included. Hotspot areas of GDM were consistently observed in Victoria (Southwest and North Melbourne); Western Australia (South and Southwest Perth); Australian Capital Territory (ACT) (East and North Canberra); Queensland (North Brisbane) and New South Wales (West and Southwest Sydney and Southeast New South Wales). ACT (South Canberra), North Tasmania, Northern Territory (North Darwin) and Victoria (South East Melbourne) had new hotspot regions recorded in the last two consecutive study periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GDM incidence varies by geographical area over time, with hotspots in specific regions suggesting the need for geographically targeted policy interventions to curb the growing burden of GDM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101272","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:05:22Z","timestamp":1761807922000},"page":"e101272","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Mapping fine-scale spatial risk patterns of gestational diabetes over time in Australia: a nationwide geospatial study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-5808","authenticated-orcid":false,"given":"Wubet Worku","family":"Takele","sequence":"first","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-6451","authenticated-orcid":false,"given":"Siew","family":"Lim","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiki","family":"Adhinugraha","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Information Technology, La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Taniar","sequence":"additional","affiliation":[{"name":"Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lachlan L","family":"Dalli","sequence":"additional","affiliation":[{"name":"Stroke and Ageing Research, Department of Medicine, Monash University, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline A","family":"Boyle","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2025110323184626000_15.10.e101272.1","doi-asserted-by":"crossref","first-page":"831297","DOI":"10.3389\/fcvm.2022.831297","article-title":"Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors","volume":"9","author":"Yang","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2025110323184626000_15.10.e101272.2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-S002"},{"key":"2025110323184626000_15.10.e101272.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph191710846","article-title":"A Systematic Review to Compare Adverse Pregnancy Outcomes in Women with Pregestational Diabetes and Gestational Diabetes","volume":"19","author":"Malaza","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025110323184626000_15.10.e101272.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109050"},{"key":"2025110323184626000_15.10.e101272.5","unstructured":"Australian Institute of Health and Welfare . Diabetes: Australian facts, 2023. Available: https:\/\/www.aihw.gov.au\/reports\/diabetes\/diabetes\/contents\/how-common-is-diabetes\/gestational-diabetes"},{"key":"2025110323184626000_15.10.e101272.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108072"},{"key":"2025110323184626000_15.10.e101272.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.orcp.2013.12.609","article-title":"Healthcare costs associated with gestational diabetes mellitus during pregnancy and potential cost-effectiveness of prevention in high-risk women","volume":"7","author":"Keating","year":"2013","journal-title":"Obes Res Clin Pract"},{"key":"2025110323184626000_15.10.e101272.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m1361","article-title":"Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis","volume":"369","author":"Vounzoulaki","year":"2020","journal-title":"BMJ"},{"key":"2025110323184626000_15.10.e101272.9","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02492-1"},{"key":"2025110323184626000_15.10.e101272.10","doi-asserted-by":"crossref","first-page":"109283","DOI":"10.1007\/s11356-023-29953-0","article-title":"Bayesian spatiotemporal modelling for disease mapping: an application to preeclampsia and gestational diabetes in Florida, United States","volume":"30","author":"Sun","year":"2023","journal-title":"Environ Sci Pollut Res Int"},{"key":"2025110323184626000_15.10.e101272.11","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/ppe.12952","article-title":"Neighbourhood walkability is associated with risk of gestational diabetes: A cross-sectional study in New York City","volume":"37","author":"Rundle","year":"2023","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2025110323184626000_15.10.e101272.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-13340-4","article-title":"Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity","volume":"22","author":"Lobczowska","year":"2022","journal-title":"BMC Public Health"},{"key":"2025110323184626000_15.10.e101272.13","doi-asserted-by":"crossref","DOI":"10.5888\/pcd16.190237","article-title":"Population Health, Place, and Space: Spatial Perspectives in Chronic Disease Research and Practice","volume":"16","author":"Casper","year":"2019","journal-title":"Prev Chronic Dis"},{"key":"2025110323184626000_15.10.e101272.14","doi-asserted-by":"crossref","DOI":"10.5888\/pcd16.180493","article-title":"Using Geographic Information Systems to Highlight Diabetes Prevention Program Expansion Areas in Pennsylvania","volume":"16","author":"Zepka","year":"2019","journal-title":"Prev Chronic Dis"},{"key":"2025110323184626000_15.10.e101272.15","unstructured":"World Health Organisation . Seventy-fifth world health assembly: resolutions and decisions, 2022. Available: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA75-REC1\/A75_REC1_Interactive_en.pdf#page=105"},{"key":"2025110323184626000_15.10.e101272.16","unstructured":"Australian Statistical Geography Standard (ASGS) Edition 3 . Australian Bureau of Statistics, 2021. Available: https:\/\/www.abs.gov.au\/statistics\/standards\/australian-statistical-geography-standard-asgs-edition-3\/jul2021-jun2026"},{"key":"2025110323184626000_15.10.e101272.17","unstructured":"Nankervis A , McIntyre H , Moses R , et al . ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. 2014;18."},{"key":"2025110323184626000_15.10.e101272.18","unstructured":"Australian Institute of Health and Welfare . Incidence of gestational diabetes in Australia, 2019. Available: https:\/\/www.aihw.gov.au\/reports\/diabetes\/incidence-of-gestational-diabetes-in-australia\/contents\/gestational-diabetes-incidence"},{"key":"2025110323184626000_15.10.e101272.19","unstructured":"Australasian Diabetes in Pregnancy Society . Diagnostic testing for gestational diabetes mellitus (GDM) during the COVID-19 pandemic: Antenatal and postnatal testing advice, 2020. Available: https:\/\/www.adips.org\/documents\/RevisedGDMCOVID-19GuidelineFINAL30April2020pdf_000.pdf"},{"key":"2025110323184626000_15.10.e101272.20","unstructured":"Australian Institute of Health and Welfare . Diabetes Prevalence in Australia: An assessment of national data sources, 2009. Available: https:\/\/www.aihw.gov.au\/reports\/diabetes\/diabetes-prevalence-australia-assessment\/summary"},{"key":"2025110323184626000_15.10.e101272.21","unstructured":"Australian Bureau of Statistics . Correspondences, 2021. Available: https:\/\/www.abs.gov.au\/statistics\/standards\/australian-statistical-geography-standard-asgs-edition-3\/jul2021-jun2026\/access-and-downloads\/correspondences"},{"key":"2025110323184626000_15.10.e101272.22","unstructured":"Australian Bureau of Statistics . Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2016, 2018. Available: https:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/mf\/1270.0.55.005"},{"key":"2025110323184626000_15.10.e101272.23","unstructured":"Australian Bureau of Statistics . Births, Australia, 2021. Available: https:\/\/www.abs.gov.au\/statistics\/people\/population\/births-australia"},{"key":"2025110323184626000_15.10.e101272.24","unstructured":"Australian Bureau of Statistics . Births, Australia methodology, 2023. Available: https:\/\/www.abs.gov.au\/methodologies\/births-australia-methodology\/2023"},{"key":"2025110323184626000_15.10.e101272.25","unstructured":"Australian Bureau of Statistics . Australian Statistical Geography Standard (ASGS): Volume 1 - Main Structure and Greater Capital City Statistical Areas, 2016. Available: https:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/mf\/1270.0.55.001"},{"key":"2025110323184626000_15.10.e101272.26","unstructured":"Australian Bureau of Statistics . Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. Available: https:\/\/www.abs.gov.au\/statistics\/people\/people-and-communities\/socio-economic-indexes-areas-seifa-australia\/latest-release"},{"key":"2025110323184626000_15.10.e101272.27","unstructured":"Australian Institute of Health and Welfare . The National (insulin-treated) Diabetes Register 2021; Quality Statement, 2022. Available: https:\/\/meteor.aihw.gov.au\/content\/768933"},{"key":"2025110323184626000_15.10.e101272.28","unstructured":"Australian Bureau of Statistics . Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG), 2019. Available: https:\/\/www.abs.gov.au\/statistics\/classifications\/australian-standard-classification-cultural-and-ethnic-groups-ascceg\/latest-release"},{"key":"2025110323184626000_15.10.e101272.29","doi-asserted-by":"crossref","DOI":"10.1016\/j.anzjph.2024.100202","article-title":"National, state and territory trends in gestational diabetes mellitus in Australia, 2016-2021: Differences by state\/territory and country of birth","volume":"49","author":"Takele","year":"2025","journal-title":"Aust N Z J Public Health"},{"key":"2025110323184626000_15.10.e101272.30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5194\/isprsarchives-XL-4-W3-47-2013","article-title":"Research on Geographical Environment Unit Division Based on the Method of Natural Breaks (Jenks)","volume":"XL-4\/W3","author":"Chen","year":"2013","journal-title":"Int Arch Photogramm Remote Sens Spatial Inf Sci"},{"key":"2025110323184626000_15.10.e101272.31","unstructured":"Jenks GF . The data model concept in statistical mapping. Int Yearbook Cartograp 1967;18690."},{"key":"2025110323184626000_15.10.e101272.32","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19960415)15:7\/9<887::AID-SIM257>3.0.CO;2-E"},{"key":"2025110323184626000_15.10.e101272.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-4632.1992.tb00261.x"},{"key":"2025110323184626000_15.10.e101272.34","unstructured":"Environmental Systems Research Institute (ESRI) . Modeling spatial relationships, 2021. Available: https:\/\/desktop.arcgis.com\/en\/arcmap\/latest\/tools\/spatial-statistics-toolbox\/modeling-spatial-relationships.htm#GUID-F6CB66DC-6B46-42BE-96C2-EEFF4BFC13D9"},{"key":"2025110323184626000_15.10.e101272.35","unstructured":"Environmental Systems Research Institute (ESRI) . Hot Spot Analysis (Getis-Ord Gi) [Spatial Statistics], Available: https:\/\/pro.arcgis.com\/en\/pro-app\/latest\/tool-reference\/spatial-statistics\/hot-spot-analysis.htm"},{"key":"2025110323184626000_15.10.e101272.36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-4632.1995.tb00338.x"},{"key":"2025110323184626000_15.10.e101272.37","doi-asserted-by":"crossref","first-page":"101249","DOI":"10.1016\/j.ajogmf.2023.101249","article-title":"Community-level social determinants of health and pregestational and gestational diabetes","volume":"6","author":"Field","year":"2024","journal-title":"Am J Obstet Gynecol MFM"},{"key":"2025110323184626000_15.10.e101272.38","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.diabres.2018.08.023","article-title":"Indicators of socio-economic status and risk of gestational diabetes mellitus in pregnant women in urban Tianjin, China","volume":"144","author":"Liu","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"2025110323184626000_15.10.e101272.39","unstructured":"Australian Health Policy Collaboration . Australias health tracker by area, 2020. Available: https:\/\/atlasesaustralia.au\/ahpc\/atlas_single\/atlas.html?indicator=i10"},{"key":"2025110323184626000_15.10.e101272.40","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0233793","article-title":"Associations between area socioeconomic status, individual mental health, physical activity, diet and change in cardiometabolic risk amongst a cohort of Australian adults: A longitudinal path analysis","volume":"15","author":"Carroll","year":"2020","journal-title":"PLoS One"},{"key":"2025110323184626000_15.10.e101272.41","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30058-X"},{"key":"2025110323184626000_15.10.e101272.42","doi-asserted-by":"publisher","DOI":"10.1177\/0017896906069378"},{"key":"2025110323184626000_15.10.e101272.43","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0145074","article-title":"Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review","volume":"11","author":"Kelly","year":"2016","journal-title":"PLoS ONE"},{"key":"2025110323184626000_15.10.e101272.44","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232250","article-title":"Barriers and facilitating factors in the prevention of diabetes type 2 and gestational diabetes in vulnerable groups: A scoping review","volume":"15","author":"Breuing","year":"2020","journal-title":"PLoS One"},{"key":"2025110323184626000_15.10.e101272.45","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s00592-014-0668-x","article-title":"Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study","volume":"52","author":"Bouthoorn","year":"2015","journal-title":"Acta Diabetol"},{"key":"2025110323184626000_15.10.e101272.46","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-022-01247-7","article-title":"A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study","volume":"19","author":"Lang","year":"2022","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2025110323184626000_15.10.e101272.47","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-18-0032"},{"key":"2025110323184626000_15.10.e101272.48","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1017\/S136898001900418X","article-title":"Eating and physical activity behaviours among ethnic groups in Queensland, Australia","volume":"23","author":"Gallegos","year":"2020","journal-title":"Public Health Nutr"},{"key":"2025110323184626000_15.10.e101272.49","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0153044","article-title":"Transcription Factor 7-Like 2 (TCF7L2) rs7903146 Polymorphism as a Risk Factor for Gestational Diabetes Mellitus: A Meta-Analysis","volume":"11","author":"Lin","year":"2016","journal-title":"PLoS One"},{"key":"2025110323184626000_15.10.e101272.50","doi-asserted-by":"crossref","first-page":"100222","DOI":"10.1016\/j.ajogmf.2020.100222","article-title":"Maternal perceived discrimination and association with gestational diabetes","volume":"2","author":"MacGregor","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"key":"2025110323184626000_15.10.e101272.51","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/AOG.0000000000005324","article-title":"Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus","volume":"142","author":"Janevic","year":"2023","journal-title":"Obstet Gynecol"},{"key":"2025110323184626000_15.10.e101272.52","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2010.01140.x"},{"key":"2025110323184626000_15.10.e101272.53","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-12828-3","article-title":"The design and impact of culturally-safe community-based physical activity promotion for immigrant women: descriptive review","volume":"22","author":"Gagliardi","year":"2022","journal-title":"BMC Public Health"},{"key":"2025110323184626000_15.10.e101272.54","unstructured":"Australian Institute of Health and Welfare . Profile of First Nations people, 2024. Available: https:\/\/www.aihw.gov.au\/reports\/australias-welfare\/profile-of-indigenous-australians#:~:text=2018).-,Population%20size%20and%20location,3.8%25"},{"key":"2025110323184626000_15.10.e101272.55","unstructured":"Australian Institute of Health and Welfare . Stillbirths and neonatal deaths in Australia, 2021, 2025. Available: https:\/\/www.aihw.gov.au\/reports\/mothers-babies\/australias-mothers-babies\/contents\/stillbirths-neonatal-deaths\/stillbirths-and-neonatal-deaths-in-australia"},{"key":"2025110323184626000_15.10.e101272.56","unstructured":"Australian Institute of Health and Welfare . Rural and remote health, 2024. Available: https:\/\/www.aihw.gov.au\/reports\/rural-remote-australians\/rural-and-remote-health"},{"key":"2025110323184626000_15.10.e101272.57","doi-asserted-by":"crossref","first-page":"445","DOI":"10.31128\/AJGP-01-18-4479","article-title":"Gestational diabetes mellitus: A pragmatic approach to diagnosis and management","volume":"47","author":"Nankervis","year":"2018","journal-title":"Aust J Gen Pract"},{"key":"2025110323184626000_15.10.e101272.58","doi-asserted-by":"crossref","first-page":"462","DOI":"10.5694\/mja2.52143","article-title":"Diagnosing gestational diabetes during the COVID-19 pandemic: a glimpse into the future?","volume":"219","author":"Kevat","year":"2023","journal-title":"Med J Aust"},{"key":"2025110323184626000_15.10.e101272.59","doi-asserted-by":"crossref","first-page":"467","DOI":"10.5694\/mja2.52129","article-title":"Gestational diabetes mellitus screening and diagnosis criteria before and during the COVID-19 pandemic: a retrospective pre-post study","volume":"219","author":"Meloncelli","year":"2023","journal-title":"Med J Aust"},{"key":"2025110323184626000_15.10.e101272.60","doi-asserted-by":"crossref","first-page":"108353","DOI":"10.1016\/j.diabres.2020.108353","article-title":"Testing for gestational diabetes during the COVID-19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia","volume":"167","author":"McIntyre","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"2025110323184626000_15.10.e101272.61","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1177\/1753495X221094899","article-title":"Impact of new diagnostic pathway for gestational diabetes in time of COVID-19","volume":"16","author":"Walker","year":"2023","journal-title":"Obstet Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-101272","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T18:31:57Z","timestamp":1762281117000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-101272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":61,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,29]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/bmjopen-2025-101272"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-101272","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}