{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:04:20Z","timestamp":1794330260155,"version":"4.9.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100024743","name":"Suez Canal University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100024743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Anesthesiologists are vulnerable to work-related musculoskeletal disorders (WMSDs) due to sustained repetitive movements and awkward postures. This study aimed to assess the prevalence of WMSDs among anesthesiologists and to evaluate its association with ergonomic risk factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A convenience sample of 380 Egyptian anesthesiologists were invited to participate in this cross-sectional study through an electronic questionnaire. Data were collected from May to August 2022 and involved questions about participants\u2019 demographic, health, and work-related characteristics; the ergonomic risks and perceived hazards; and the musculoskeletal complaints during the past 12 months and 7 days - using Nordic Musculoskeletal Questionnaire (NMQ). Descriptive, bivariate, and multivariate statistical analyses were used to estimate the prevalence of MSD and identify its determinants in the studied sample.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 215 anesthesiologists were included in this study, with a 56.8% response rate, 66% males with an average age of 38 (\u00b1\u20090.7) years. 21% were resident physicians, 47% were specialists, and 32% were consultants. The 12-month prevalence of MSD among anesthesiologists was 71.6% (95% CI: 65.6\u2013 77.7%). Multivariate analysis showed that the main determinants of MSD among the studied sample were age of 45-years and older (OR: 3.22, 95% CI: 1.21\u20138.52, <jats:italic>p<\/jats:italic>\u2009=\u20090.018), regular physical exercise (OR: 0.25, 95% CI: 0.10\u20130.65, <jats:italic>p<\/jats:italic>\u2009=\u20090.005), insufficient rest time between procedures (OR: 2.25, 95% CI: 1.15\u20134.41, <jats:italic>p<\/jats:italic>\u2009=\u20090.018), and three or more awkward postures of the trunk (OR: 3.55, 95% CI: 1.43\u20138.82, <jats:italic>p<\/jats:italic>\u2009=\u20090.006).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The study highlights a high prevalence of WMSDs among Egyptian anesthesiologists, linked to advancing age, lack of regular exercise, insufficient rest between procedures, and frequent awkward postures. Addressing these ergonomic risk factors through targeted workplace interventions is crucial for promoting the overall well-being of anesthesiologists and ensuring the provision of safe anesthesia services.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-024-17757-x","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T15:02:51Z","timestamp":1706022171000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Work-related musculoskeletal complaints and ergonomic risk factors among Egyptian anesthesiologists: a cross-sectional study"],"prefix":"10.1186","volume":"24","author":[{"given":"Ahmed Mahmoud","family":"Fouad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman Ekram","family":"Fahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Abdelmohsen","family":"Bedewy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman","family":"Al-Touny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimaa A.","family":"Al-Touny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,23]]},"reference":[{"key":"17757_CR1","unstructured":"Centers for Disease Control and Prevention. Work-Related Musculoskeletal Disorders & Ergonomics. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion 2023; https:\/\/www.cdc.gov\/workplacehealthpromotion\/health-strategies\/musculoskeletal-disorders. Accessed 25August, 2023."},{"issue":"5","key":"17757_CR2","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.5455\/2320-6012.ijrms20150523","volume":"3","author":"SK Sulaiman","year":"2015","unstructured":"Sulaiman SK, Kamalanathan P, Ibrahim AA, et al. Musculoskeletal disorders and associated disabilities among bank workers. Int J Res Med Sci. 2015;3(5):1153\u20138. https:\/\/doi.org\/10.5455\/2320-6012.ijrms20150523.","journal-title":"Int J Res Med Sci"},{"issue":"5","key":"17757_CR3","doi-asserted-by":"publisher","first-page":"777","DOI":"10.3390\/healthcare11050777","volume":"11","author":"L Muthelo","year":"2023","unstructured":"Muthelo L, Sinyegwe NF, Phukubye TA, et al. Prevalence of work-related Musculoskeletal disorders and its effects amongst nurses in the selected intellectual disability unit of the Limpopo Province. Healthcare. 2023;11(5):777. https:\/\/doi.org\/10.3390\/healthcare11050777.","journal-title":"Healthcare"},{"issue":"1","key":"17757_CR4","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/PXH.0000000000000003","volume":"1","author":"R Bonfiglioli","year":"2022","unstructured":"Bonfiglioli R, Caraballo-Arias Y, Salmen-Navarro A. Epidemiology of work-related musculoskeletal disorders. Curr Opin Epidemiol Public Health. 2022;1(1):18\u201324. https:\/\/doi.org\/10.1097\/PXH.0000000000000003.","journal-title":"Curr Opin Epidemiol Public Health"},{"key":"17757_CR5","doi-asserted-by":"publisher","unstructured":"Mengistu DA, Gutema GD, Demmu YM, et al. Occupational-related Upper and Lower Extremity Musculoskeletal Pain among Working Population of Ethiopia: systematic review and Meta-analysis. INQUIRY: The Journal of Health Care Organization Provision and Financing. 2022;59. https:\/\/doi.org\/10.1177\/00469580221088620.","DOI":"10.1177\/00469580221088620"},{"issue":"5","key":"17757_CR6","doi-asserted-by":"publisher","first-page":"366","DOI":"10.2471\/BLT.17.204891","volume":"96","author":"AM Briggs","year":"2018","unstructured":"Briggs AM, Woolf AD, Dreinh\u00f6fer K, et al. Reducing the global burden of musculoskeletal conditions. Bull World Health Organ. 2018;96(5):366\u20138. https:\/\/doi.org\/10.2471\/BLT.17.204891.","journal-title":"Bull World Health Organ"},{"issue":"6","key":"17757_CR7","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2665-9913(23)00098-X","volume":"5","author":"ML Ferreira","year":"2023","unstructured":"Ferreira ML, de Luca K, Haile LM, et al. Global, regional, and national burden of low back pain, 1990\u20132020, its attributable risk factors, and projections to 2050: a systematic analysis of the global burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316\u201329. https:\/\/doi.org\/10.1016\/S2665-9913(23)00098-X.","journal-title":"Lancet Rheumatol"},{"issue":"3","key":"17757_CR8","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/j.berh.2015.08.002","volume":"29","author":"S Bevan","year":"2015","unstructured":"Bevan S. Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best Pract Res Clin Rheumatol. 2015;29(3):356\u201373. https:\/\/doi.org\/10.1016\/j.berh.2015.08.002.","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"17757_CR9","doi-asserted-by":"publisher","unstructured":"Shaikh S, Siddiqui AA, Alshammary F et al. Musculoskeletal disorders among healthcare workers: prevalence and risk factors in the Arab World. Handbook of Healthcare in the Arab World. 2021:2899\u20132937. https:\/\/doi.org\/10.1007\/978-3-030-36811-1_129.","DOI":"10.1007\/978-3-030-36811-1_129"},{"key":"17757_CR10","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1111\/nhs.12767","volume":"22","author":"\u0141 Rypicz","year":"2020","unstructured":"Rypicz \u0141, Karniej P, Witczak I, et al. Evaluation of the occurrence of work-related musculoskeletal pain among anesthesiology, intensive care, and surgical nurses: an observational and descriptive study. Nurs Health Sci. 2020;22:1056\u201364. https:\/\/doi.org\/10.1111\/nhs.12767.","journal-title":"Nurs Health Sci"},{"issue":"12","key":"17757_CR11","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1111\/anae.15530","volume":"76","author":"CR Bailey","year":"2021","unstructured":"Bailey CR, Radhakrishna S, Asanati K, et al. Ergonomics in the anaesthetic workplace. Anaesthesia. 2021;76(12):1635\u201347. https:\/\/doi.org\/10.1111\/anae.15530.","journal-title":"Anaesthesia"},{"issue":"1","key":"17757_CR12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jpsychores.2005.10.002","volume":"61","author":"T Honkonen","year":"2006","unstructured":"Honkonen T, Ahola K, Pertovaara M, et al. The association between burnout and physical illness in the general population\u2014results from the Finnish Health 2000 study. J Psychosom Res. 2006;61(1):59\u201366. https:\/\/doi.org\/10.1016\/j.jpsychores.2005.10.002.","journal-title":"J Psychosom Res"},{"issue":"3","key":"17757_CR13","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1111\/anae.14537","volume":"74","author":"S Vargas-Prada","year":"2019","unstructured":"Vargas-Prada S, Macdonald EB. Increased reporting of musculoskeletal pain in anaesthetists: is it an occupational issue? Anaesthesia. 2019;74(3):274\u20136. https:\/\/doi.org\/10.1111\/anae.14537.","journal-title":"Anaesthesia"},{"key":"17757_CR14","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1002\/9781119636113.ch53","volume-title":"Handbook of human factors and Ergonomics","author":"P Carayon","year":"2021","unstructured":"Carayon P, Wust K, Hose B-Z, et al. Human factors and ergonomics in health care. In: Salvendy G, Karwowski W, editors. Handbook of human factors and Ergonomics. Hoboken, NJ: John Wiley & Sons, Inc; 2021. pp. 1417\u201337. https:\/\/doi.org\/10.1002\/9781119636113.ch53."},{"issue":"3","key":"17757_CR15","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/anae.14446","volume":"74","author":"S Leifer","year":"2019","unstructured":"Leifer S, Choi SW, Asanati K, et al. Upper limb disorders in anaesthetists\u2013 a survey of Association of Anaesthetists members. Anaesthesia. 2019;74(3):285\u201391. https:\/\/doi.org\/10.1111\/anae.14446.","journal-title":"Anaesthesia"},{"issue":"7","key":"17757_CR16","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.5455\/annalsmedres.2019.04.211","volume":"26","author":"S Tolu","year":"2021","unstructured":"Tolu S, Basaran B. Work-related musculoskeletal disorders in anesthesiologists: a cross-sectional study on prevalence and risk factors. Ann Med Res. 2021;26(7):1406\u201314. https:\/\/doi.org\/10.5455\/annalsmedres.2019.04.211.","journal-title":"Ann Med Res"},{"key":"17757_CR17","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.jclinane.2016.06.009","volume":"34","author":"JA Anson","year":"2016","unstructured":"Anson JA, Mets EJ, Vaida SJ, et al. Are we hurting ourselves? What is the prevalence of back pain in anesthesia providers? J Clin Anesth. 2016;34:502\u20136. https:\/\/doi.org\/10.1016\/j.jclinane.2016.06.009.","journal-title":"J Clin Anesth"},{"issue":"1","key":"17757_CR18","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1080\/11101849.2023.2193016","volume":"39","author":"E Albayadi","year":"2023","unstructured":"Albayadi E, Soliman A, Alyeddin WF. Prevalence of musculoskeletal disorders in anesthesiologists in Ismailia Governorate. Egypt J Anaesth. 2023;39(1):289\u201395. https:\/\/doi.org\/10.1080\/11101849.2023.2193016.","journal-title":"Egypt J Anaesth"},{"issue":"1","key":"17757_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40557-016-0089-0","volume":"28","author":"M Bin Homaid","year":"2016","unstructured":"Bin Homaid M, Abdelmoety D, Alshareef W, et al. Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study. Ann Occup Environ Med. 2016;28(1):1. https:\/\/doi.org\/10.1186\/s40557-016-0089-0.","journal-title":"Ann Occup Environ Med"},{"issue":"5","key":"17757_CR20","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1136\/jech-2018-211309","volume":"73","author":"G Weston","year":"2019","unstructured":"Weston G, Zilanawala A, Webb E, et al. Long work hours, weekend working and depressive symptoms in men and women: findings from a UK population-based study. J Epidemiol Community Health. 2019;73(5):465\u201374. https:\/\/doi.org\/10.1136\/jech-2018-211309.","journal-title":"J Epidemiol Community Health"},{"issue":"3","key":"17757_CR21","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/0003-6870(87)90010-x","volume":"18","author":"I Kuorinka","year":"1987","unstructured":"Kuorinka I, Jonsson B, Kilbom A, et al. Standardised nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233\u20137. https:\/\/doi.org\/10.1016\/0003-6870(87)90010-x.","journal-title":"Appl Ergon"},{"issue":"2","key":"17757_CR22","doi-asserted-by":"publisher","first-page":"e174947","DOI":"10.1001\/jamasurg.2017.4947","volume":"153","author":"S Epstein","year":"2018","unstructured":"Epstein S, Sparer EH, Tran BN, et al. Prevalence of work-related Musculoskeletal disorders among surgeons and interventionalists: a systematic review and Meta-analysis. JAMA Surg. 2018;153(2):e174947\u20137. https:\/\/doi.org\/10.1001\/jamasurg.2017.4947.","journal-title":"JAMA Surg"},{"issue":"3","key":"17757_CR23","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1080\/00140139.2017.1361552","volume":"61","author":"NO Oranye","year":"2018","unstructured":"Oranye NO, Bennett JJE. Prevalence of work-related musculoskeletal and non-musculoskeletal injuries in health care workers: the implications for work disability management. Ergonomics. 2018;61(3):355\u201366. https:\/\/doi.org\/10.1080\/00140139.2017.1361552.","journal-title":"Ergonomics"},{"issue":"12","key":"17757_CR24","doi-asserted-by":"publisher","first-page":"487","DOI":"10.3928\/08910162-20081201-06","volume":"56","author":"NN Menzel","year":"2008","unstructured":"Menzel NN. Underreporting of musculoskeletal disorders among health care workers: research needs. AAOHN J. 2008;56(12):487\u201394. https:\/\/doi.org\/10.3928\/08910162-20081201-06.","journal-title":"AAOHN J"},{"issue":"4","key":"17757_CR25","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1016\/j.cegh.2020.03.019","volume":"8","author":"R Tavakkol","year":"2020","unstructured":"Tavakkol R, Kavi E, Hassanipour S, et al. The global prevalence of musculoskeletal disorders among operating room personnel: a systematic review and meta-analysis. Clin Epidemiol Glob Health. 2020;8(4):1053\u201361. https:\/\/doi.org\/10.1016\/j.cegh.2020.03.019.","journal-title":"Clin Epidemiol Glob Health"},{"key":"17757_CR26","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/978-1-4471-5451-8_61","volume-title":"Classic papers in Orthopaedics","author":"ADL Baker","year":"2014","unstructured":"Baker ADL. Volvo Award in Clinical sciences: a New Clinical Model for the treatment of Low-Back Pain. In: Banaszkiewicz PA, Kader DF, editors. Classic papers in Orthopaedics. London: Springer London; 2014. pp. 249\u201351. https:\/\/doi.org\/10.1007\/978-1-4471-5451-8_61."},{"issue":"1","key":"17757_CR27","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/14639220512331335160","volume":"7","author":"BT Karsh","year":"2006","unstructured":"Karsh BT. Theories of work-related musculoskeletal disorders: implications for ergonomic interventions. Theor Issues Ergon Sci. 2006;7(1):71\u201388. https:\/\/doi.org\/10.1080\/14639220512331335160.","journal-title":"Theor Issues Ergon Sci"},{"issue":"6","key":"17757_CR28","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1539\/joh.17-0057-OA","volume":"59","author":"D Zhang","year":"2017","unstructured":"Zhang D, Huang H. Prevalence of work-related musculoskeletal disorders among sonographers in China: results from a national web-based survey. J Occup Health. 2017;59(6):529\u201341. https:\/\/doi.org\/10.1539\/joh.17-0057-OA.","journal-title":"J Occup Health"},{"key":"17757_CR29","doi-asserted-by":"publisher","unstructured":"Punnett L, Herbert RJW, health. Work-related musculoskeletal disorders: is there a gender differential, and if so, what does it mean? Women Health. 2000;474\u201392. https:\/\/doi.org\/10.1016\/B978-012288145-9\/50044-9.","DOI":"10.1016\/B978-012288145-9\/50044-9"},{"issue":"1","key":"17757_CR30","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s00405-017-4787-1","volume":"275","author":"J Bolduc-B\u00e9gin","year":"2018","unstructured":"Bolduc-B\u00e9gin J, Prince F, Christopoulos A, et al. Work-related musculoskeletal symptoms amongst otolaryngologists and Head and Neck surgeons in Canada. Eur Arch Otorhinolaryngol. 2018;275(1):261\u20137. https:\/\/doi.org\/10.1007\/s00405-017-4787-1.","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"1","key":"17757_CR31","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/01.aoa.0000393152.23005.96","volume":"31","author":"M Ajmal","year":"2011","unstructured":"Ajmal M, Power S, Smith T, et al. An Ergonomic Task Analysis of spinal anesthesia. Obstetric Anesth Digest. 2011;31(1):24\u20135. https:\/\/doi.org\/10.1097\/01.aoa.0000393152.23005.96.","journal-title":"Obstetric Anesth Digest"},{"issue":"2","key":"17757_CR32","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/s10926-009-9176-1","volume":"19","author":"GPY Szeto","year":"2009","unstructured":"Szeto GPY, Ho P, Ting ACW, et al. Work-related Musculoskeletal symptoms in surgeons. J Occup Rehabil. 2009;19(2):175\u201384. https:\/\/doi.org\/10.1007\/s10926-009-9176-1.","journal-title":"J Occup Rehabil"},{"key":"17757_CR33","unstructured":"National Research Council (US) and Institute of Medicine (US) Panel on Musculoskeletal Disorders and the Workplace. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington (DC): National Academies Press (US).; 2001. 6, Biomechanics. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK222434\/. Accessed 10 August 2023, 2023."},{"key":"17757_CR34","unstructured":"The Association of Anaesthetists of Great Britain & Ireland. Fatigue and Anaesthetists 2014. Available from https:\/\/rcoa.ac.uk\/sites\/default\/files\/documents\/2019-11\/Guideline_fatigue_anaesthetists_2014_final.pdf. Accessed 16 July 2023."}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-17757-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-024-17757-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-17757-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T15:05:24Z","timestamp":1706022324000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-024-17757-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,23]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["17757"],"URL":"https:\/\/doi.org\/10.1186\/s12889-024-17757-x","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,23]]},"assertion":[{"value":"22 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The proposal of this study was approved by the research ethics committee of the Faculty of Medicine at Suez Canal University, Ismailia, Egypt (Approval No. 4903\/2022). All participants gave their informed consent before proceeding with the survey questions.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"279"}}