{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:38:44Z","timestamp":1789493924962,"version":"build-2803163510"},"reference-count":65,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The relative age effect (RAE) is where an individual\u2019s age relative to their age-banded cohort influences various outcomes and has a globally observed pattern impacting health, academic performance and psychosocial development. Scotland\u2019s unique school commencement laws have resulted in extended schooling cohorts spanning up to 19 months, thus exacerbating RAE and subsequently widening health inequities. This research synthesises evidence to delineate the public health problem posed by RAE in the Scottish educational context and proposes evidence-based policy interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A comprehensive policy brief methodology was employed, integrating a systematic literature review with extensive stakeholder engagement and detailed analysis of local data, including Scottish Government statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Web of Science and EBSCOhost databases were searched, along with Scottish Government statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Population, Intervention, Comparator, Outcome, Study Design frameworks and targeted search terms were used for study selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Ethical approval was obtained, and Sex and Gender Equity in Research and patient and public involvement considerations were integrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis of Scottish data reveals increasing school entry deferral rates, particularly among children born in January and February. Furthermore, the trend appears to be influenced by government funding for additional childcare. This deferral appears to disproportionately favour white ethnic backgrounds, boys and higher socioeconomic strata, widening inequities. More so, RAE is associated with increased physical injury rates, adverse mental health outcomes (anxiety, depression, suicide), higher incidence of learning disabilities, diminished academic attainment and reduced psychosocial development (lower self-esteem and fewer leadership opportunities). Extended 19-month cohorts, such as the one offered in the Scottish education system, are predicted to amplify these disadvantages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The existence of extended 19-month schooling cohorts in Scotland represents a significant, yet under-recognised, public health issue. This structural anomaly perpetuates and exacerbates existing inequities in child development and well-being. A strategic realignment of default school entry with the legally stipulated age, complemented by multi-faceted RAE-mitigation strategies, offers a pragmatic, evidence-based and equitable pathway to improve holistic child health and developmental outcomes across the Scottish population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003676","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:35:45Z","timestamp":1775842545000},"page":"e003676","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Systemic review of the relative age effect in Scottish schooling: a public health imperative for policy reform and equity"],"prefix":"10.1136","volume":"4","author":[{"given":"Andrew","family":"Stuart","sequence":"first","affiliation":[{"name":"Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK"},{"name":"Medical Training and Support Service, British Royal Army Medical Service, Camberley, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7096-541X","authenticated-orcid":false,"given":"Timothy","family":"Lynch","sequence":"additional","affiliation":[{"name":"Education, Yew Chung College of Early Childhood Education, Hong Kong, People's Republic of China"},{"name":"ECE and Primary, Yew Chung International School of Chongqing, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofen","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Education, The University of Texas at Austin, Austin, Texas, USA"},{"name":"Education, China\u2019s Minzhu University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0665-2793","authenticated-orcid":false,"given":"Wendy","family":"Goff","sequence":"additional","affiliation":[{"name":"School of Education, Australian Catholic University, Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4187-2342","authenticated-orcid":false,"given":"Qing","family":"Liu","sequence":"additional","affiliation":[{"name":"Education, Yew Chung College of Early Childhood Education, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"2026070901201765000_4.2.e003676.1","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1080\/17461391.2013.775352","article-title":"A proposed theoretical model to explain relative age effects in sport","volume":"13","author":"Hancock","year":"2013","journal-title":"Eur J Sport Sci"},{"key":"2026070901201765000_4.2.e003676.2","article-title":"Relative Age Effect in Attention Deficit\/Hyperactivity Disorder at Various Stages of the Medicalization Process","volume":"9","author":"Brault","year":"2022","journal-title":"Children (Basel)"},{"key":"2026070901201765000_4.2.e003676.3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/jcpp.13684","article-title":"Relative age in the school year and risk of mental health problems in childhood, adolescence and young adulthood","volume":"64","author":"Broughton","year":"2023","journal-title":"Child Psychology Psychiatry"},{"key":"2026070901201765000_4.2.e003676.4","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1249\/MSS.0000000000000868","article-title":"The Relative Age Effect on Youth Sports Injuries","volume":"48","author":"Stracciolini","year":"2016","journal-title":"Med Sci Sports Exerc"},{"key":"2026070901201765000_4.2.e003676.5","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.econlet.2012.08.017","article-title":"The relative-age effect and career success: Evidence from corporate CEOs","volume":"117","author":"Du","year":"2012","journal-title":"Econ Lett"},{"key":"2026070901201765000_4.2.e003676.6","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/09645292.2017.1287881","article-title":"Left behind by birth month","volume":"25","author":"Solli","year":"2017","journal-title":"Educ Econ"},{"key":"2026070901201765000_4.2.e003676.7","doi-asserted-by":"crossref","unstructured":"Lynch T . Physical Education and Wellbeing: Global and Holistic Approaches to Child Health. London, UK: Palgrave Macmillan, 2019.","DOI":"10.1007\/978-3-030-22266-6"},{"key":"2026070901201765000_4.2.e003676.8","doi-asserted-by":"crossref","DOI":"10.3390\/sports7050127","article-title":"Physical Activity and Sports-Real Health Benefits: A Review with Insight into the Public Health of Sweden","volume":"7","author":"Malm","year":"2019","journal-title":"Sports (Basel)"},{"key":"2026070901201765000_4.2.e003676.9","doi-asserted-by":"crossref","unstructured":"Lynch T . Physical Education and Wellbeing: Global and Holistic Approaches to Child Health and Academic Learning. 2nd edn. London, UK: Palgrave Macmillan, 2024.","DOI":"10.1007\/978-3-031-72874-7"},{"key":"2026070901201765000_4.2.e003676.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0176206","article-title":"Tails of the Travelling Gaussian model and the relative age effect: Tales of age discrimination and wasted talent","volume":"12","author":"Doyle","year":"2017","journal-title":"PLoS ONE"},{"key":"2026070901201765000_4.2.e003676.11","first-page":"447","article-title":"Forced to Redshirt: Quasi-Experimental Impacts of Delayed Kindergarten Entry","volume":"18","author":"Jenkins","year":"2025","journal-title":"J Res Educ Eff"},{"key":"2026070901201765000_4.2.e003676.12","unstructured":"Sharp C , George N , Sargent C , et al . International Thematic Probe: The Influence of Relative Age on Learner Attainment and Development. National Foundation for Educational Research, 2009."},{"key":"2026070901201765000_4.2.e003676.13","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2022.1066264","article-title":"The relative age effect shifts students\u2019 choice of educational track even within a school system promoting equal opportunities","volume":"13","author":"Oterhals","year":"2022","journal-title":"Front Psychol"},{"key":"2026070901201765000_4.2.e003676.14","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/sjoe.12046","article-title":"Early Tracking and the Misfortune of Being Young","volume":"116","author":"Schneeweis","year":"2014","journal-title":"Scandinavian J Economics"},{"key":"2026070901201765000_4.2.e003676.15","unstructured":"World Bank . Primary education, pupils. 2019. Available: https:\/\/data.worldbank.org\/indicator\/SE.PRM.ENRL?end=2019&start=2000"},{"key":"2026070901201765000_4.2.e003676.16","unstructured":"World Bank . Secondary education, pupils. 2019. Available: https:\/\/data.worldbank.org\/indicator\/SE.SEC.ENRL?end=2019&start=2000"},{"key":"2026070901201765000_4.2.e003676.17","unstructured":"Scottish Government Statistics . Summary statistics for schools in Scotland 2023. 2023. Available: https:\/\/www.gov.scot\/publications\/summary-statistics-for-schools-in-scotland-2023\/pages\/early-learning-and-childcare-elc\/"},{"key":"2026070901201765000_4.2.e003676.18","unstructured":"Bronfenbrenner U . Ecological Systems Theory. Jessica Kingsley Publishers, 1992:187\u2013249."},{"key":"2026070901201765000_4.2.e003676.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0135349","article-title":"Relative Age in School and Suicide among Young Individuals in Japan: A Regression Discontinuity Approach","volume":"10","author":"Matsubayashi","year":"2015","journal-title":"PLoS ONE"},{"key":"2026070901201765000_4.2.e003676.20","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1001\/jamapediatrics.2019.3194","article-title":"Association of Relative Age in the School Year With Diagnosis of Intellectual Disability, Attention-Deficit\/Hyperactivity Disorder, and Depression","volume":"173","author":"Root","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2026070901201765000_4.2.e003676.21","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1002\/berj.3127","article-title":"Stratified at seven: in\u2010class ability grouping and the relative age effect","volume":"40","author":"Campbell","year":"2014","journal-title":"British Educational Res J"},{"key":"2026070901201765000_4.2.e003676.22","unstructured":"Education (Scotland) Act . Section 32\u201d. UK Public General Acts 1980 c. 44, Part II, 1980. Available: https:\/\/www.legislation.gov.uk\/ukpga\/1980\/44\/section\/32"},{"key":"2026070901201765000_4.2.e003676.23","unstructured":"Scottish Government . Early learning and childcare statistics, 2025. Available: https:\/\/www.gov.scot\/collections\/early-learning-and-childcare-statistics\/"},{"key":"2026070901201765000_4.2.e003676.24","unstructured":"Davidson E . Letter from directorate for learning (Scotland). 2024."},{"key":"2026070901201765000_4.2.e003676.25","unstructured":"Covidence systematic review software . Covidence (version 2.0). n.d. Available: https:\/\/www.covidence.org"},{"key":"2026070901201765000_4.2.e003676.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"2026070901201765000_4.2.e003676.27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res Synth Methods"},{"key":"2026070901201765000_4.2.e003676.28","unstructured":"Give them time . Research on the potential benefit of deferral. 2021. Available: https:\/\/drive.google.com\/file\/d\/1Mb4NdqclaLoki6uOI0WHIBjx4g6IkEit\/view?pli=1"},{"key":"2026070901201765000_4.2.e003676.29","unstructured":"Spencer T . Email from national records of Scotland. 2024."},{"key":"2026070901201765000_4.2.e003676.30","unstructured":"Scottish Government . Growing up in Scotland: early experiences of primary school. 2012. Available: https:\/\/www.gov.scot\/publications\/growing-up-scotland-early-experiences-primary-school\/"},{"key":"2026070901201765000_4.2.e003676.31","doi-asserted-by":"crossref","unstructured":"Fleming M , Bandyopadhyay A , McLay JS , et al . Age within schoolyear and attention-deficit hyperactivity disorder in Scotland and Wales. BMC Public Health 2022;22. doi:10.1186\/s12889-022-13453-w","DOI":"10.1186\/s12889-022-13453-w"},{"key":"2026070901201765000_4.2.e003676.32","doi-asserted-by":"publisher","DOI":"10.1177\/07419325050260060401"},{"key":"2026070901201765000_4.2.e003676.33","doi-asserted-by":"crossref","unstructured":"Huang FL . Investigating the Prevalence of Academic Redshirting Using Population-Level Data. AERA Open 2015;1. doi:10.1177\/2332858415590800","DOI":"10.1177\/2332858415590800"},{"key":"2026070901201765000_4.2.e003676.34","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/09645292.2018.1468873","article-title":"Maturity and minorities: the impact of redshirting on achievement gaps","volume":"26","author":"Lenard","year":"2018","journal-title":"Educ Econ"},{"key":"2026070901201765000_4.2.e003676.35","unstructured":"Scottish Government Statistics . Deferred entry to primary school: statistics. 2020. Available: https:\/\/www.gov.scot\/publications\/deferred-entry-primary-school-statistics\/pages\/2\/"},{"key":"2026070901201765000_4.2.e003676.36","unstructured":"Scottish Government Statistics . Summary statistics of schools in Scotland. 2020. Available: https:\/\/www.gov.scot\/publications\/summary-statistics-schools-scotland\/pages\/5\/"},{"key":"2026070901201765000_4.2.e003676.37","unstructured":"Scottish Government Statistics . Early learning and childcare funding: primary 1 deferral pilot evaluation. 2023. Available: https:\/\/www.gov.scot\/publications\/pilot-evaluation-report-access-funded-early-learning-childcare-eligible-children-defer-entry-primary-1\/"},{"key":"2026070901201765000_4.2.e003676.38","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1002\/1520-6807(199007)27:3<260::AID-PITS2310270313>3.0.CO;2-V","article-title":"The effects of chronological age, gender, and delay of entry on academic achievement and retention: Implications for academic redshirting","volume":"27","author":"Cameron","year":"1990","journal-title":"Psychol Schs"},{"key":"2026070901201765000_4.2.e003676.39","doi-asserted-by":"publisher","DOI":"10.1002\/pam.22135"},{"key":"2026070901201765000_4.2.e003676.40","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1080\/09540253.2017.1309009","article-title":"Tilting the playing field: \u2018Redshirting\u2019 kindergarten boys in the US and the competition for hegemonic masculinity","volume":"31","author":"Albanesi","year":"2019","journal-title":"Gend Educ"},{"key":"2026070901201765000_4.2.e003676.41","doi-asserted-by":"crossref","first-page":"283","DOI":"10.3102\/0162373713482764","article-title":"Academic Redshirting\" in Kindergarten: Prevalence, Patterns, and Implications","volume":"35","author":"Bassok","year":"2013","journal-title":"Educ Eval Policy Anal"},{"key":"2026070901201765000_4.2.e003676.42","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ecresq.2016.09.002","article-title":"Kindergarten redshirting: Motivations and spillovers using census-level data","volume":"38","author":"Fortner","year":"2017","journal-title":"Early Child Res Q"},{"key":"2026070901201765000_4.2.e003676.43","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1017\/dem.2020.16","article-title":"Age culture, school-entry cutoff, and the choices of birth month and school-entry timing in South Korea","volume":"87","author":"Kim","year":"2021","journal-title":"J Dem Econ"},{"key":"2026070901201765000_4.2.e003676.44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.ecresq.2019.01.008","article-title":"School starting age and child development in a state-wide, population-level cohort of children in their first year of school in New South Wales, Australia","volume":"48","author":"Hanly","year":"2019","journal-title":"Early Child Res Q"},{"key":"2026070901201765000_4.2.e003676.45","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/(SICI)1520-6807(199704)34:2<85::AID-PITS2>3.0.CO;2-R","article-title":"Children not ready to learn? The invalidity of school readiness testing","volume":"34","author":"Shepard","year":"1997","journal-title":"Psychol Schs"},{"key":"2026070901201765000_4.2.e003676.46","doi-asserted-by":"publisher","DOI":"10.1177\/0038040714524258"},{"key":"2026070901201765000_4.2.e003676.47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7413.472"},{"key":"2026070901201765000_4.2.e003676.48","doi-asserted-by":"publisher","DOI":"10.1177\/070674379904400111"},{"key":"2026070901201765000_4.2.e003676.49","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1007\/s00787-018-1229-6","article-title":"Relative age and ADHD symptoms, diagnosis and medication: a systematic review","volume":"28","author":"Holland","year":"2019","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2026070901201765000_4.2.e003676.50","doi-asserted-by":"crossref","DOI":"10.1186\/s40798-021-00300-2","article-title":"Darwinian Selection Discriminates Young Athletes: the Relative Age Effect in Relation to Sporting Performance","volume":"7","author":"Jakobsson","year":"2021","journal-title":"Sports Med Open"},{"key":"2026070901201765000_4.2.e003676.51","doi-asserted-by":"publisher","DOI":"10.1093\/qje\/121.4.1437"},{"key":"2026070901201765000_4.2.e003676.52","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jpolmod.2016.01.004","article-title":"Early effects of an early start: Evidence from lowering the school starting age in Poland","volume":"38","author":"Herbst","year":"2016","journal-title":"Journal of Policy Modeling"},{"key":"2026070901201765000_4.2.e003676.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.econedurev.2016.12.001"},{"key":"2026070901201765000_4.2.e003676.54","doi-asserted-by":"publisher","DOI":"10.1111\/bjep.12630"},{"key":"2026070901201765000_4.2.e003676.55","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0117860","article-title":"Human height is positively related to interpersonal dominance in dyadic interactions","volume":"10","author":"Stulp","year":"2015","journal-title":"PLoS One"},{"key":"2026070901201765000_4.2.e003676.56","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16162837","article-title":"Relative Age Effect in the Sport Environment. Role of Physical Fitness and Cognitive Function in Youth Soccer Players","volume":"16","author":"Huertas","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026070901201765000_4.2.e003676.57","unstructured":"GL Assessments . All assessments, 2025. Available: https:\/\/www.gl-assessment.co.uk\/assessments\/"},{"key":"2026070901201765000_4.2.e003676.58","unstructured":"Hachette Learning . Standardised assessments, 2025. Available: https:\/\/www.hachettelearning.com\/assessment\/standardised-assessments"},{"key":"2026070901201765000_4.2.e003676.59","doi-asserted-by":"crossref","unstructured":"Lynch T . Physically educated: developing children\u2019s health and well-being through movement and motor skills. In: Garvis S , Pendergast D , eds. Health & wellbeing in childhood. Melbourne, Australia: Cambridge, 2017: 77\u201394.","DOI":"10.1017\/9781316780107.007"},{"key":"2026070901201765000_4.2.e003676.60","unstructured":"Department for Children, Schools and Families . Statutory Framework for the Early Years Foundation Stage \u2013 Setting the Standards for Learning, Development and Care for Children from Birth to Five. Nottingham, UK: Department for Children, Schools and Families, 2008."},{"key":"2026070901201765000_4.2.e003676.61","unstructured":"Kohn A . No Contest: The Case against Competition. Houghton Mifflin Company, 1992."},{"key":"2026070901201765000_4.2.e003676.62","doi-asserted-by":"crossref","first-page":"1217820","DOI":"10.1080\/2331186X.2016.1217820","article-title":"\u201cPhysical education\u201d, \u201chealth and physical education\u201d, \u201cphysical literacy\u201d and \u201chealth literacy\u201d: Global nomenclature confusion","volume":"3","author":"Lynch","year":"2016","journal-title":"Cogent Education"},{"key":"2026070901201765000_4.2.e003676.63","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/S2215-0366(23)00272-9","article-title":"Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis","volume":"10","author":"Gosling","year":"2023","journal-title":"Lancet Psychiatry"},{"key":"2026070901201765000_4.2.e003676.64","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-6-145","article-title":"Continuous admission to primary school and mental health problems","volume":"6","author":"Reijneveld","year":"2006","journal-title":"BMC Public Health"},{"key":"2026070901201765000_4.2.e003676.65","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6947-7-16","article-title":"Utilization of the PICO framework to improve searching PubMed for clinical questions","volume":"7","author":"Schardt","year":"2007","journal-title":"BMC Med Inform Decis Mak"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003676","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T08:20:29Z","timestamp":1783585229000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":65,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,10]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjph-2025-003676"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003676","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}