{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:57:42Z","timestamp":1781636262603,"version":"3.54.5"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Health and Medical Research Council MRFF Grant","award":["2017224"],"award-info":[{"award-number":["2017224"]}]},{"name":"philanthropic donation"},{"name":"NHMRC Investigator Grant","award":["APP1197940"],"award-info":[{"award-number":["APP1197940"]}]},{"name":"Financial Markets Foundation for Children"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timely referral and diagnosis of Juvenile Idiopathic Arthritis (JIA) by a pediatric rheumatologist ensures early intervention to minimize long-term joint damage and disability. This study aimed to quantify the impact of delays in diagnosis on health service use, health-related quality of life (HRQoL) and associated costs to the health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cost-utility analysis was conducted over a lifetime horizon from a health funder perspective in 2023 Australian dollars, comparing time from actively seeking treatment to formal diagnosis (&lt;\u20096 months, 6\u2009+\u2009months). Time to diagnosis, healthcare use, including medical investigations, health professional visits, hospitalizations and medications, was determined using The IMPACT Survey. Incremental costs were estimated by applying Australian government subsidy item costs (medications), schedule fees (medical services), and National Efficient Prices (hospitalizations). HRQoL was measured using Child Health Utility Instrument (CHU9D). Incremental Quality Adjusted Life Years (QALYs) were estimated using participants\u2019 CHU9D utility values based on Australian preference weights and life expectancy. Costs and QALYs were present valued at 5% per annum. Sensitivity analyses were conducted for robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over one-third (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200961\/163) of children were diagnosed 6\u2009+\u2009months from actively seeking treatment. Compared with 6\u2009+\u2009months, diagnosis within 6 months was associated with a lower use of health services, resulting in a mean annual decrease in costs for the healthcare funder of more than $10,000 per child. The majority of the cost savings were due to reductions in hospitalizations for pain, inflammation, and investigative procedures. There were also significant increases in HRQoL; 0.14 (95%CI 0.05, 0.23) utility value. The differences in health service use and HRQoL from timely diagnosis persisted over 20 years from diagnosis. Over a lifetime, the present value of healthcare cost savings was $208,458 (95%CI $45,388, $371,528) and the increase in HRQoL resulted in an additional 2.82 (95%CI 1.03, 4.61) QALYs per child. At a willingness to pay of $50,000 per QALY, the estimated net benefit to the health funder was $349,520 (95%CI $139,630, $559,411) per child.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Interventions to improve the time to diagnosis of JIA within six months are likely cost-effective and can significantly improve HRQoL for people living with JIA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration (if any)<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12969-026-01195-7","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:16:59Z","timestamp":1771931819000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The impact of time to diagnosis on health service use, cost, and quality of life for patients with juvenile idiopathic arthritis: a cost-utility analysis"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6168-9719","authenticated-orcid":false,"given":"Amy","family":"Von Huben","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana M.","family":"Bond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Lain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davinder","family":"Singh-Grewal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Colagiuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Colagiuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Nassar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"1195_CR1","unstructured":"Arthritis Australia. Time to Move: Juvenile Idiopathic Arthritis, A national strategy to reduce a costly burden. Pdf. Accessed 14. February, 2024. https:\/\/arthritisaustralia.com.au\/wordpress\/wp-content\/uploads\/2017\/09\/Final_Time_to_Move__JIA.pdf"},{"issue":"2","key":"1195_CR2","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jbspin.2013.09.003","volume":"81","author":"S Thierry","year":"2014","unstructured":"Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: A systematic review. Joint Bone Spine. 2014;81(2):112\u20137. https:\/\/doi.org\/10.1016\/j.jbspin.2013.09.003.","journal-title":"Joint Bone Spine"},{"issue":"16","key":"1195_CR3","doi-asserted-by":"publisher","first-page":"8331","DOI":"10.3390\/ijerph18168331","volume":"18","author":"I Cardoso","year":"2021","unstructured":"Cardoso I, Frederiksen P, Specht IO, et al. Age and Sex Specific Trends in Incidence of Juvenile Idiopathic Arthritis in Danish Birth Cohorts from 1992 to 2002: A Nationwide Register Linkage Study. Int J Environ Res Public Health. 2021;18(16):8331. https:\/\/doi.org\/10.3390\/ijerph18168331.","journal-title":"Int J Environ Res Public Health"},{"issue":"9","key":"1195_CR4","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.1093\/rheumatology\/keae322","volume":"63","author":"E Uusitupa","year":"2024","unstructured":"Uusitupa E, Rahikkala H, Sard S, et al. Incidence of juvenile idiopathic arthritis in Finland, 2000\u20132020. Rheumatology (Oxford). 2024;63(9):2355\u201362. https:\/\/doi.org\/10.1093\/rheumatology\/keae322.","journal-title":"Rheumatology (Oxford)"},{"key":"1195_CR5","doi-asserted-by":"publisher","unstructured":"Haynes A, Bulsara MK, Bergman P, et al. Incidence of type 1 diabetes in 0 to 14 year olds in Australia, 2002 to 2017. Pediatr Diabetes. 2020;21(5):707\u2013712. https:\/\/doi.org\/10.1111\/pedi.13025.","DOI":"10.1111\/pedi.13025"},{"issue":"3","key":"1195_CR6","doi-asserted-by":"publisher","first-page":"101984","DOI":"10.1016\/j.berh.2024.101984","volume":"38","author":"F Oliveira Ramos","year":"2024","unstructured":"Oliveira Ramos F, Zinterl C, Fonseca JE. A lifelong journey: Long-term perspectives on Juvenile Idiopathic Arthritis. Best Pract Res Clin Rheumatol. 2024;38(3):101984. https:\/\/doi.org\/10.1016\/j.berh.2024.101984.","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"2","key":"1195_CR7","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1056\/nejmra2402073","volume":"393","author":"CI Sandborg","year":"2025","unstructured":"Sandborg CI, Schulert GS, Kimura Y. Juvenile Idiopathic Arthritis. N Engl J Med. 2025;393(2):162\u201374. https:\/\/doi.org\/10.1056\/nejmra2402073.","journal-title":"N Engl J Med"},{"issue":"9","key":"1195_CR8","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.3899\/jrheum.211316","volume":"49","author":"SJW Shoop-Worrall","year":"2022","unstructured":"Shoop-Worrall SJW, Moull L, McDonagh JE, Hyrich KL. The Role of Age in Delays to Rheumatological Care in Juvenile Idiopathic Arthritis. J Rheumatol. 2022;49(9):1037\u201341. https:\/\/doi.org\/10.3899\/jrheum.211316.","journal-title":"J Rheumatol"},{"issue":"1","key":"1195_CR9","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1546-0096-12-13","volume":"12","author":"ML Stoll","year":"2014","unstructured":"Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatr Rheumatol. 2014;12(1):13\u201313. https:\/\/doi.org\/10.1186\/1546-0096-12-13.","journal-title":"Pediatr Rheumatol"},{"issue":"1","key":"1195_CR10","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1002\/acr.23236","volume":"70","author":"K Oen","year":"2018","unstructured":"Oen K, Guzman J, Dufault B, et al. Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis. Arthritis Care Res (Hoboken). 2018;70(1):134\u201344. https:\/\/doi.org\/10.1002\/acr.23236. \/01\/01 2018.","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"10","key":"1195_CR11","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.3899\/jrheum.180948","volume":"46","author":"A Tollisen","year":"2019","unstructured":"Tollisen A, Selvaag AM, Aasland A, Lerdal A, Flat\u00f8 B. Longitudinal Health Status from Early Disease to Adulthood and Associated Prognostic Factors in Juvenile Idiopathic Arthritis. J Rheumatol. 2019;46(10):1335. https:\/\/doi.org\/10.3899\/jrheum.180948.","journal-title":"J Rheumatol"},{"issue":"11","key":"1195_CR12","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1093\/rheumatology\/kev195","volume":"54","author":"J Anink","year":"2015","unstructured":"Anink J, Prince FHM, Dijkstra M, et al. Long-term quality of life and functional outcome of patients with juvenile idiopathic arthritis in the biologic era: a longitudinal follow-up study in the Dutch Arthritis and Biologicals in Children Register. Rheumatology (Oxford). 2015;54(11):1964\u20139. https:\/\/doi.org\/10.1093\/rheumatology\/kev195.","journal-title":"Rheumatology (Oxford)"},{"issue":"7","key":"1195_CR13","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1093\/rheumatology\/kep460","volume":"49","author":"K Davies","year":"2010","unstructured":"Davies K, Cleary G, Foster H, Hutchinson E, Baildam E. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford). 2010;49(7):1406\u20138. https:\/\/doi.org\/10.1093\/rheumatology\/kep460.","journal-title":"Rheumatology (Oxford)"},{"issue":"12","key":"1195_CR14","doi-asserted-by":"publisher","first-page":"3633","DOI":"10.1093\/rheumatology\/keaa438","volume":"59","author":"A Chausset","year":"2020","unstructured":"Chausset A, Pereira B, Echaubard S, Merlin E, Freychet C. Access to paediatric rheumatology care in juvenile idiopathic arthritis: what do we know? A systematic review. Rheumatology (Oxford). 2020;59(12):3633\u201344. https:\/\/doi.org\/10.1093\/rheumatology\/keaa438.","journal-title":"Rheumatology (Oxford)"},{"issue":"2","key":"1195_CR15","doi-asserted-by":"publisher","first-page":"410","DOI":"10.3899\/jrheum.080514","volume":"36","author":"NJ Shiff","year":"2009","unstructured":"Shiff NJ, Abdwani R, Cabral DA, et al. Access to Pediatric Rheumatology Subspecialty Care in British Columbia, Canada. J Rheumatol. 2009;36(2):410\u20135. https:\/\/doi.org\/10.3899\/jrheum.080514.","journal-title":"J Rheumatol"},{"issue":"5","key":"1195_CR16","doi-asserted-by":"publisher","first-page":"600","DOI":"10.3390\/children11050600","volume":"11","author":"A Marino","year":"2024","unstructured":"Marino A, Baldassarre P, Ferrigno C, et al. Pre-Rheumatology Referral Consultation and Investigation Pattern in Children with Joint Complaints: Focus on Juvenile Idiopathic Arthritis. Child (Basel). 2024;11(5):600. https:\/\/doi.org\/10.3390\/children11050600.","journal-title":"Child (Basel)"},{"issue":"1","key":"1195_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12969-020-0413-7","volume":"18","author":"CE Barber","year":"2020","unstructured":"Barber CE, Barnabe C, Benseler S, et al. Patient factors associated with waiting time to pediatric rheumatologist consultation for patients with juvenile idiopathic arthritis. Pediatr Rheumatol. 2020;18(1):1\u20135.","journal-title":"Pediatr Rheumatol"},{"key":"1195_CR18","unstructured":"Bond D, Von Huben A, Lain S, Colagiuri R, Nassar N. The IMPACT study: Investigating the Mental, Physical, Social and Financial CosTs (IMPACT) of Juvenile Idiopathic Arthritis and Related Childhood Rheumatic Diseases. Pdf. Accessed 17 July, 2025. https:\/\/www.jafa.org.au\/impact-study-landmark-results-out-now\/."},{"issue":"8","key":"1195_CR19","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1007\/s11136-009-9524-9","volume":"18","author":"K Stevens","year":"2009","unstructured":"Stevens K. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res. 2009;18(8):1105\u201313. https:\/\/doi.org\/10.1007\/s11136-009-9524-9.","journal-title":"Qual Life Res"},{"key":"1195_CR20","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.socscimed.2016.03.042","volume":"157","author":"J Ratcliffe","year":"2016","unstructured":"Ratcliffe J, Huynh E, Chen G, et al. Valuing the Child Health Utility 9D: Using profile case best worst scaling methods to develop a new adolescent specific scoring algorithm. Soc Sci Med. 2016;157:48\u201359. https:\/\/doi.org\/10.1016\/j.socscimed.2016.03.042.","journal-title":"Soc Sci Med"},{"key":"1195_CR21","unstructured":"Australian Bureau of Statistics. Table 1.9, life tables, life expectancy. Microsoft Excel Worksheet. ABS. Accessed 27. February, 2024. https:\/\/www.abs.gov.au\/statistics\/people\/population\/life-expectancy\/2020-2022."},{"key":"1195_CR22","unstructured":"Australian Government Department of Health and Aged Care. Medicare Benefits Schedule Book, 1 November 2022. Pdf. Accessed 12. September, 2023. https:\/\/www.mbsonline.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/148049BCC6D57ED4CA25889F00110A8A\/$File\/1%20November%202022%20MBS%20Book.pdf."},{"key":"1195_CR23","unstructured":"Independent Hospital and Aged Care Pricing Authority. NWAU calculator for acute activity 2022-23. Microsoft Excel Binary Worksheet. Accessed 3. June, 2024. https:\/\/www.ihacpa.gov.au\/health-care\/pricing\/nwau-calculators."},{"key":"1195_CR24","unstructured":"NSW Treasury. NSW government guide to cost-benefit analysis, PDF. September. Accessed 9 2025. https:\/\/www.nsw.gov.au\/departments-and-agencies\/nsw-treasury\/documents-library\/tpg23-08."},{"issue":"5","key":"1195_CR25","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1177\/0272989X08315247","volume":"28","author":"AH Harris","year":"2008","unstructured":"Harris AH, Hill SR, Chin G, Li JJ, Walkom E. The Role of Value for Money in Public Insurance Coverage Decisions for Drugs in Australia: A Retrospective Analysis 1994\u20132004. Med Decis Mak. 2008;28(5):713\u201322. https:\/\/doi.org\/10.1177\/0272989X08315247. 2008\/09\/01.","journal-title":"Med Decis Mak"},{"issue":"1","key":"1195_CR26","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1017\/S0266462321001732","volume":"38","author":"D Husereau","year":"2022","unstructured":"Husereau D, Drummond M, Augustovski F, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Int J Technol Assess Health Care. 2022;38(1):e13. https:\/\/doi.org\/10.1017\/S0266462321001732.","journal-title":"Int J Technol Assess Health Care"},{"key":"1195_CR27","unstructured":"R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing. https:\/\/www.R-project.org\/."},{"key":"1195_CR28","unstructured":"Gordon M. 2023. Gmisc: descriptive statistics, transition plots, and more. R package version 3.0.3. https:\/\/CRAN.R-project.org\/package=Gmisc."},{"key":"1195_CR29","unstructured":"Gordon M. TL. 2023. forestplot: advanced forest plot using \u2018grid\u2019. R package version 3.1.3. https:\/\/gforge.se\/packages\/."},{"key":"1195_CR30","unstructured":"Xie Y. 2023. knitr: a general-purpose package for dynamic report generation in R. R package version 1.45. https:\/\/yihui.org\/knitr\/."},{"key":"1195_CR31","unstructured":"Organisation for Economic Co-operation and Development. Exchange rates (indicator). Internet. Accessed 15. September, 2025. https:\/\/www.oecd.org\/en\/data\/indicators\/exchange-rates.html."},{"key":"1195_CR32","unstructured":"Australian Bureau of Statistics. Table 7 Estimated resident population, by age and sex\u2013at 30 June 2023, National, state and territory population, Dec 2024. Miscrosoft Excel Worksheet. ABS. Accessed 7. August, 2025. https:\/\/www.abs.gov.au\/statistics\/people\/population\/national-state-and-territory-population\/dec-2024#data-downloads."},{"key":"1195_CR33","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.70098","author":"SJ Lain","year":"2025","unstructured":"Lain SJ, Ivancic L, Chaitow J, et al. Population Incidence and Burden of Juvenile Idiopathic Arthritis on Australian Health System: Data Linkage Study. J Paediatr Child Health. 2025. https:\/\/doi.org\/10.1111\/jpc.70098.","journal-title":"J Paediatr Child Health"},{"issue":"3","key":"1195_CR34","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s10826-006-9094-1","volume":"16","author":"GS Chasson","year":"2007","unstructured":"Chasson GS, Harris GE, Neely WJ. Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism. J Child Fam stud. 2007;16(3):401\u201313. https:\/\/doi.org\/10.1007\/s10826-006-9094-1.","journal-title":"J Child Fam stud"},{"issue":"6","key":"1195_CR35","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1016\/j.ridd.2012.04.006","volume":"33","author":"N Peters-Scheffer","year":"2012","unstructured":"Peters-Scheffer N, Didden R, Korzilius H, Matson J. Cost comparison of early intensive behavioral intervention and treatment as usual for children with autism spectrum disorder in the Netherlands. Res Dev Disabil. 2012;33(6):1763\u201372. https:\/\/doi.org\/10.1016\/j.ridd.2012.04.006.","journal-title":"Res Dev Disabil"},{"key":"1195_CR36","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jpeds.2019.01.027","volume":"209","author":"Y Uziel","year":"2019","unstructured":"Uziel Y. Juvenile Idiopathic Arthritis-Education, Knowledge, and Patient Outcomes. J Pediatr. 2019;209:10\u20131. https:\/\/doi.org\/10.1016\/j.jpeds.2019.01.027.","journal-title":"J Pediatr"},{"key":"1195_CR37","unstructured":"Australia JAF. 2024: Runs on the Board A report on the activities and achievements of the Juvenile Arthritis Foundation Australia in 2024. PDF. Accessed 10 September, 2025. https:\/\/www.jafa.org.au\/wp-content\/uploads\/2025\/04\/JAFA5292-Annual-Report-2024-FA_Digital.pdf."},{"issue":"5","key":"1195_CR38","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1111\/1756-185X.12802","volume":"20","author":"A Cox","year":"2017","unstructured":"Cox A, Piper S, Singh-Grewal D. Pediatric rheumatology consultant workforce in Australia and New Zealand: the current state of play and challenges for the future. Int J Rheum Dis May. 2017;20(5):647\u201353. https:\/\/doi.org\/10.1111\/1756-185X.12802.","journal-title":"Int J Rheum Dis May"},{"key":"1195_CR39","unstructured":"NSW Agency for Clinical Innovation. NSW paediatric rheumatology services advisory group findings and recommendations, PDF. October 2025 [cited 2025 Feb 7]. Available from: https:\/\/healthcarefunding.specialcommission.nsw.gov.au\/assets\/Uploads\/publications\/Exhibits-145\/Exhibit-G_TAB_G.109.002_MOH.9999.2149.0001.pdf."},{"issue":"10","key":"1195_CR40","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.3899\/jrheum.211245","volume":"49","author":"A Tollisen","year":"2022","unstructured":"Tollisen A, Selvaag AM, Aasland A, et al. Personally Generated Quality of Life Outcomes in Adults With Juvenile Idiopathic Arthritis. J Rheumatol. 2022;49(10):1138\u201345. https:\/\/doi.org\/10.3899\/jrheum.211245.","journal-title":"J Rheumatol"},{"issue":"5","key":"1195_CR41","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1002\/acr.23327","volume":"70","author":"A Tollisen","year":"2018","unstructured":"Tollisen A, Selvaag AM, Aulie HA, et al. Physical Functioning, Pain, and Health-Related QoL in Adults With JIA: A Longitudinal 30-Year Followup Study. Arth Care Res May. 2018;70(5):741\u20139. https:\/\/doi.org\/10.1002\/acr.23327.","journal-title":"Arth Care Res May"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12969-026-01195-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-026-01195-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-026-01195-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:47:04Z","timestamp":1781635624000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12969-026-01195-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1195"],"URL":"https:\/\/doi.org\/10.1186\/s12969-026-01195-7","relation":{},"ISSN":["1546-0096"],"issn-type":[{"value":"1546-0096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]},"assertion":[{"value":"21 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was obtained from The University of Sydney Human Research Ethics Committee (HREC: 2022\/902). Implied consent was obtained from each participant who completed and submitted the survey after reading the preliminary study information section.","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":"12"}}