{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:36:34Z","timestamp":1792496194538,"version":"4.5.0"},"reference-count":55,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,9,22]],"date-time":"2024-09-22T00:00:00Z","timestamp":1726963200000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["Grants PI21\/01413 and RD21\/0016\/0006"],"award-info":[{"award-number":["Grants PI21\/01413 and RD21\/0016\/0006"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,8,21]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Fibromyalgia syndrome (FMS) is characterised by widespread pain and is associated with mood disorders such as depression as well as poor sleep quality. These in turn have been linked to increased risk of suicidal ideation. Clinical guidelines generally do not recommended opioids in FMS, but they are routinely prescribed to a considerable proportion of FMS patients. We assessed the association of long-term opioid prescription for FMS with risk of depression, sleep disorders and suicidal ideation, when compared with short-term opioid use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective cohort study combing several population-wide databases covering a population of five million inhabitants, including all adults who received an initial opioid prescription from 2014 to 2018 specifically prescribed for FMS. We examined the occurrence of depression, sleep disorders or suicidal ideation outcomes in patients with an initial long-term opioid prescription (&gt;90\u2009days) versus those who received a short-term treatment (&lt;29\u2009days). We employed multivariable Cox regression modelling and inverse probability of treatment weighting based on propensity scores and we performed several sensitivity analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>10\u2009334 patients initiated short-term (8309, 80.40%) or long-term (2025, 19.60%) opioids for FMS. In main adjusted analyses, long-term opioid use was associated with an increased risk for depression (HR: 1.58, 95% CI 1.29 to 1.95) and sleep disorder (HR: 1.30, 95% CI 1.09 to 1.55) but not with suicidal ideation (HR: 1.59, 95% CI 0.96 to 2.62). In models assessing outcomes since day 90, an increased risk for suicidal ideation was observed (HR: 1.76, 95% CI 1.05 to 2.98).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These findings suggest that continued opioid use for 90 days or more may aggravate depression and sleep problems in patients with FMS when compared with patterns of short-term treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-004466","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T08:55:25Z","timestamp":1727081725000},"page":"e004466","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Long versus short-term opioid therapy for fibromyalgia syndrome and risk of depression, sleep disorders and suicidal ideation: a population-based, propensity-weighted cohort study"],"prefix":"10.1136","volume":"10","author":[{"given":"Isabel","family":"Hurtado","sequence":"first","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Robles","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Peir\u00f3","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4313-3976","authenticated-orcid":false,"given":"An\u00edbal","family":"Garc\u00eda-Sempere","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Llopis","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Rodr\u00edguez-Bernal","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Sanf\u00e9lix","sequence":"additional","affiliation":[{"name":"FISABIO, Valencia, Spain"},{"name":"Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,23]]},"reference":[{"key":"2025090312034790000_10.3.e004466.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-00506-w"},{"key":"2025090312034790000_10.3.e004466.2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.040113"},{"key":"2025090312034790000_10.3.e004466.3","doi-asserted-by":"crossref","first-page":"15022","DOI":"10.1038\/nrdp.2015.22","article-title":"Fibromyalgia","volume":"1","author":"H\u00e4user","year":"2015","journal-title":"Nat Rev Dis Primers"},{"key":"2025090312034790000_10.3.e004466.4","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2020.535368","article-title":"Suicidality in fibromyalgia: a systematic review of the literature","volume":"11","author":"Levine","year":"2020","journal-title":"Front Psychiatry"},{"key":"2025090312034790000_10.3.e004466.5","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/pm\/pnad139","article-title":"Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors","volume":"25","author":"Varallo","year":"2024","journal-title":"Pain Med"},{"key":"2025090312034790000_10.3.e004466.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.02.002"},{"key":"2025090312034790000_10.3.e004466.7","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/imj.16257","article-title":"Significant use of non-evidence-based therapeutics in a cohort of Australian fibromyalgia patients","volume":"54","author":"Warren","year":"2024","journal-title":"Intern Med J"},{"key":"2025090312034790000_10.3.e004466.8","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1136\/ard-2023-224118","article-title":"High frequency of long-term opioid use among patients with rheumatic and musculoskeletal diseases initiating opioids for the first time","volume":"82","author":"Huang","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"2025090312034790000_10.3.e004466.9","first-page":"72","article-title":"Patterns of pharmacologic and non-pharmacologic treatment, treatment satisfaction and perceived tolerability in patients with fibromyalgia: a patients\u2019 survey","volume":"38 Suppl 123","author":"Rico-Villademoros","year":"2020","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312034790000_10.3.e004466.10","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/RHU.0000000000001273","article-title":"Opioid use in fibromyalgia continues despite guidelines that do not support its efficacy or risk","volume":"27","author":"Bruce","year":"2021","journal-title":"J Clin Rheumatol"},{"key":"2025090312034790000_10.3.e004466.11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/msc.1670","article-title":"Treatment patterns in fibromyalgia including the use of opioids","volume":"21","author":"Valladales-Restrepo","year":"2023","journal-title":"Musculoskeletal Care"},{"key":"2025090312034790000_10.3.e004466.12","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/1217717","article-title":"Analgesic medication in fibromyalgia patients: a cross-sectional study","volume":"2022","author":"Aster","year":"2022","journal-title":"Pain Res Manag"},{"key":"2025090312034790000_10.3.e004466.13","article-title":"Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews","volume":"10","author":"Els","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090312034790000_10.3.e004466.14","doi-asserted-by":"publisher","DOI":"10.1056\/nejmp2211040"},{"key":"2025090312034790000_10.3.e004466.15","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209724"},{"key":"2025090312034790000_10.3.e004466.16","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1002\/ejp.1736","article-title":"European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain","volume":"25","author":"H\u00e4user","year":"2021","journal-title":"Eur J Pain"},{"key":"2025090312034790000_10.3.e004466.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2008.10.008"},{"key":"2025090312034790000_10.3.e004466.18","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e3182863447"},{"key":"2025090312034790000_10.3.e004466.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.19.2388"},{"key":"2025090312034790000_10.3.e004466.20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1001\/jamapsychiatry.2020.3554","article-title":"Prescription opioid use and risk for major depressive disorder and anxiety and stress-related disorders: a multivariable mendelian randomization analysis","volume":"78","author":"Rosoff","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"2025090312034790000_10.3.e004466.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0269809","article-title":"The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data","volume":"17","author":"Luo","year":"2022","journal-title":"PLoS One"},{"key":"2025090312034790000_10.3.e004466.22","doi-asserted-by":"publisher","DOI":"10.1038\/s41386-019-0465-x"},{"key":"2025090312034790000_10.3.e004466.23","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1093\/pm\/pnac029","article-title":"Mood and anxiety symptoms in persons taking prescription opioids: a systematic review with meta-analyses of longitudinal studies","volume":"23","author":"Leung","year":"2022","journal-title":"Pain Med"},{"key":"2025090312034790000_10.3.e004466.24","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000484"},{"key":"2025090312034790000_10.3.e004466.25","doi-asserted-by":"crossref","unstructured":"Zullo AR , Danko KJ , Moyo P , et al . Prevention, diagnosis, and management of opioids, opioid misuse, and opioid use disorder in older adults. Rockville, MD: Agency for Healthcare Research and Quality (US), 2020. Available: https:\/\/effectivehealthcare.ahrq.gov\/sites\/default\/files\/pdf\/opioids-older-adults-techbrief.pdf","DOI":"10.23970\/AHRQEPCTB37"},{"key":"2025090312034790000_10.3.e004466.26","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1093\/ije\/dyz266","article-title":"Data resource profile: the valencia health system integrated database (VID)","volume":"49","author":"Garc\u00eda-Sempere","year":"2020","journal-title":"Int J Epidemiol"},{"key":"2025090312034790000_10.3.e004466.27","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2022.1025340","article-title":"Real-world patterns of opioid therapy initiation in Spain, 2012-2018: A population-based, retrospective cohort study with 957,080 patients and 1,509,488 initiations","volume":"13","author":"Hurtado","year":"2022","journal-title":"Front Pharmacol"},{"key":"2025090312034790000_10.3.e004466.28","unstructured":"Guardia Serecigni J , Henche Ruiz IA , Lligo\u00f1a Garreta A . Gu\u00eda para el buen uso de analg\u00e9sicos opioides de consenso. Madrid: Socidrogalcohol. 2017. Available: https:\/\/pnsd.sanidad.gob.es\/profesionales\/publicaciones\/catalogo\/bibliotecaDigital\/publicaciones\/pdf\/2017_GUIA_Buen_uso_opioides_Socidrigalcohol.pdf"},{"key":"2025090312034790000_10.3.e004466.29","unstructured":"Sanz Amores R . Gu\u00eda de Informaci\u00f3n Sobre Uso Seguro de Opioides En Pacientes En Situaci\u00f3n Terminal. Sevilla: Junta de Andalucia, 2012. Available: https:\/\/portal.guiasalud.es\/wp-content\/uploads\/2019\/06\/gpc_458_opioides_terminal_pacientes.pdf"},{"key":"2025090312034790000_10.3.e004466.30","unstructured":"Aliberas Moragas J , Catal\u00e0 Puigb\u00f3 E , Catal\u00e1n Ramos A , et al . Gu\u00eda de Atenci\u00f3n a Los Pacientes Con Dolor Cr\u00f3nico No Oncol\u00f3gico Utilizando Analg\u00e9sicos Opioides. Barcelona: Ag\u00e8ncia de Qualitat i Avaluaci\u00f3 Sanit\u00e0ries de Catalunya. Departament de Salut. Generalitat de Catalunya, 2018. Available: https:\/\/www.semg.es\/images\/documentos\/2018\/guia_atencion_pacientes_dolor_no.oncoloagico.pdf"},{"key":"2025090312034790000_10.3.e004466.31","unstructured":"INFAC . Dolor cr\u00f3nico no-oncol\u00f3gico: opioides. 2022. Available: https:\/\/www.euskadi.eus\/contenidos\/informacion\/cevime_infac_2022\/es_def\/adjuntos\/INFAC_Vol_30_1_OPIOIDES-DCNO.pdf"},{"key":"2025090312034790000_10.3.e004466.32","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/bmjqs-2022-015833","article-title":"Initial opioid prescription characteristics and risk of opioid misuse, poisoning and dependence: retrospective cohort study","volume":"33","author":"Garc\u00eda-Sempere","year":"2023","journal-title":"BMJ Qual Saf"},{"key":"2025090312034790000_10.3.e004466.33","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.puhe.2024.04.009","article-title":"Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study","volume":"232","author":"Hurtado","year":"2024","journal-title":"Public Health (Fairfax)"},{"key":"2025090312034790000_10.3.e004466.34","article-title":"Long-term opioid use and mortality in patients with chronic non-cancer pain: Ten-year follow-up study in South Korea from 2010 through 2019","volume":"51","author":"Song","year":"2022","journal-title":"EClinMed"},{"key":"2025090312034790000_10.3.e004466.35","unstructured":"Canadian Institute for Health Information . Opioid prescribing in Canada: how are practices changing? Ottawa, ON: Canadian Institute for Health Information, 2019. Available: https:\/\/www.cihi.ca\/sites\/default\/files\/document\/opioid-prescribing-canada-trends-en-web.pdf"},{"key":"2025090312034790000_10.3.e004466.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-030858","article-title":"Characterisation of concurrent use of prescription opioids and benzodiazepine\/Z-drugs in Alberta, Canada: a population-based study","volume":"9","author":"Sharma","year":"2019","journal-title":"BMJ Open"},{"key":"2025090312034790000_10.3.e004466.37","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2011.06.100232"},{"key":"2025090312034790000_10.3.e004466.38","doi-asserted-by":"crossref","DOI":"10.1111\/ijcp.13455","article-title":"Tramadol for management of fibromyalgia pain and symptoms: Systematic review","volume":"74","author":"da Rocha","year":"2020","journal-title":"Int J Clin Pract"},{"key":"2025090312034790000_10.3.e004466.39","unstructured":"InformedHealth . Medication for the treatment of fibromyalgia. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2018. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK492992"},{"key":"2025090312034790000_10.3.e004466.40","unstructured":"Anekar AA , Hendrix JM , Cascella M . WHO analgesic ladder. Treasure Island, FL: StatPearls Publishing, 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554435"},{"key":"2025090312034790000_10.3.e004466.41","first-page":"79","article-title":"The role of centralised pain in osteoarthritis","volume":"35","author":"Clauw","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312034790000_10.3.e004466.42","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2020.00788","article-title":"A cross-sectional study on central sensitization and autonomic changes in fibromyalgia","volume":"14","author":"Hazra","year":"2020","journal-title":"Front Neurosci"},{"key":"2025090312034790000_10.3.e004466.43","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1001\/jamainternmed.2020.5651","article-title":"Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis","volume":"181","author":"Mascarenhas","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2025090312034790000_10.3.e004466.44","article-title":"Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study","volume":"2013","author":"Fitzcharles","year":"2013","journal-title":"Pain Res Treat"},{"key":"2025090312034790000_10.3.e004466.45","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000079"},{"key":"2025090312034790000_10.3.e004466.46","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.mayocpiqo.2021.08.008","article-title":"Outcomes of a comprehensive pain rehabilitation program for patients with fibromyalgia","volume":"5","author":"Engelberg-Cook","year":"2021","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"2025090312034790000_10.3.e004466.47","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-024-07263-x","article-title":"Opioids and fibromyalgia: frequency of use and factors associated with increased consumption in patients remitted to a tertiary care center","volume":"25","author":"Rivera","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"2025090312034790000_10.3.e004466.48","doi-asserted-by":"crossref","first-page":"729","DOI":"10.5664\/jcsm.9002","article-title":"Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia","volume":"17","author":"Miller","year":"2021","journal-title":"J Clin Sleep Med"},{"key":"2025090312034790000_10.3.e004466.49","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1097\/j.pain.0000000000001600","article-title":"Opioid use, pain intensity, age, and sleep architecture in patients with fibromyalgia and insomnia","volume":"160","author":"Curtis","year":"2019","journal-title":"Pain"},{"key":"2025090312034790000_10.3.e004466.50","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003005","article-title":"Fibromyalgia and mortality: a systematic review and meta-analysis","volume":"9","author":"Treister-Goltzman","year":"2023","journal-title":"RMD Open"},{"key":"2025090312034790000_10.3.e004466.51","doi-asserted-by":"crossref","first-page":"403","DOI":"10.36076\/ppj.2023.26.403","article-title":"Green Light-Based Analgesia - Novel Nonpharmacological Approach to Fibromyalgia Pain: A Pilot Study","volume":"26","author":"Nelli","year":"2023","journal-title":"Pain Physician"},{"key":"2025090312034790000_10.3.e004466.52","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1093\/pm\/pnad043","article-title":"Suicidal thoughts and behaviors in patients with chronic pain, with and without co-occurring opioid use disorder","volume":"24","author":"Cheatle","year":"2023","journal-title":"Pain Med"},{"key":"2025090312034790000_10.3.e004466.53","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s40429-024-00585-9","article-title":"Pain, Substance Use Disorder and Suicide: on the Edge","volume":"11","author":"Cheatle","year":"2024","journal-title":"Curr Addict Rep"},{"key":"2025090312034790000_10.3.e004466.54","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.629417","article-title":"Suicidal behavior in fibromyalgia patients: rates and determinants of suicide ideation, risk, suicide, and suicidal attempts-a systematic review of the literature and meta-analysis of over 390,000 fibromyalgia patients","volume":"12","author":"Adawi","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025090312034790000_10.3.e004466.55","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1080\/03007995.2019.1601944","article-title":"Improving the accuracy of medication adherence measures using linked prescription and dispensation data: findings from the ESOSVAL cohort of patients treated with osteoporosis drugs","volume":"35","author":"Garc\u00eda-Sempere","year":"2019","journal-title":"Curr Med Res Opin"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2024-004466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:03:58Z","timestamp":1756926238000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2024-004466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9,23]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/rmdopen-2024-004466"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2024-004466","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}