{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:31:18Z","timestamp":1793734278430,"version":"4.6.1"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003669","name":"Korea Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["Not available"],"award-info":[{"award-number":["Not available"]}],"id":[{"id":"10.13039\/501100003669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Dengue fever is hyperendemic in the Lao People\u2019s Democratic Republic (PDR), where transmission is driven by\n                      <jats:italic>Aedes<\/jats:italic>\n                      mosquitoes and influenced by large-scale climatic phenomena, including the El Ni\u00f1o-Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD). As a landlocked nation, the Lao PDR experiences sharper winter temperature declines than coastal regions, which may impose a seasonal \u201cbottleneck\u201d on vector survival and dengue transmission. This study examined whether winter minimum temperatures act as a seasonal transmission bottleneck, alongside the Oceanic Ni\u00f1o Index (ONI) and the Dipole Mode Index (DMI), during 2014\u20132023.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Monthly dengue case counts reported to the National Center for Laboratory and Epidemiology, Ministry of Health, Lao PDR, from January 2014 to December 2023 were analyzed using region-specific quasi-Poisson distributed lag nonlinear models. Models incorporated 3-month-lagged ONI\/DMI cross-basis functions, winter minimum temperature hinges, long-term trends, and seasonality, with population as an offset. Region-specific estimates were pooled using multivariate meta-analysis to generate best linear unbiased predictions (BLUPs). Optimal lag structures and temperature thresholds were selected by minimizing the quasi-Akaike information criterion and residual sum of squares.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 134,093 dengue cases were reported, with substantial regional heterogeneity. The Capital Region had the highest burden (40,672 cases; annual incidence 35.4 per 100,000), followed by the Southern Mountains and Tropical Rainforests region (20,176 cases; 23.3 per 100,000). Annual incidence in each region appeared constrained by region-specific winter minimum temperature thresholds. Pooled BLUPs analyses adjusted for covariates revealed monotonic cumulative relative risk increases with ONI [RR\u2009=\u20092.83 at ONI\u2009=\u20092.0; 95% confidence interval (\n                      <jats:italic>CI<\/jats:italic>\n                      ): 1.46\u20135.49) and decreases with DMI (RR\u2009=\u20090.37 at DMI\u2009=\u20091.5; 95%\n                      <jats:italic>CI:<\/jats:italic>\n                      0.24\u20130.59).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Winter cold functions as a primary bottleneck for dengue transmission in the Lao PDR, with ENSO amplifying and IOD suppressing outbreak risk. These findings support the development of climate-integrated, region-specific early warning systems. Incorporating 3-month-lagged climate indices may enhance public health preparedness for future dengue outbreaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-026-01438-5","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:04:21Z","timestamp":1777590261000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Climate drivers and winter constraints of dengue epidemics: a 10-year epidemiological perspective study in the Lao People\u2019s Democratic Republic"],"prefix":"10.1186","volume":"15","author":[{"given":"Souphatsone","family":"Houatthongkham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bouaphanh","family":"Khamphaphongphane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phonepadith","family":"Xangsayarath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Hun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-894X","authenticated-orcid":false,"given":"Sung Hye","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"1438_CR1","unstructured":"WHO. Global dengue surveillance https:\/\/worldhealthorg.shinyapps.io\/dengue_global\/ Accessed Feb 19 2026"},{"key":"1438_CR2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.08347","volume":"4","author":"MUG Kraemer","year":"2015","unstructured":"Kraemer MUG, Sinka ME, Duda KA, Mylne AQN, Shearer FM, Barker CM, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. eLife. 2015;4:e08347. https:\/\/doi.org\/10.7554\/eLife.08347.","journal-title":"eLife"},{"key":"1438_CR3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009631","volume":"15","author":"A Kolimenakis","year":"2021","unstructured":"Kolimenakis A, Heinz S, Wilson ML, Winkler V, Yakob L, Michaelakis A, et al. The role of urbanisation in the spread of Aedes mosquitoes and the diseases they transmit-A systematic review. PLOS Negl Trop Dis. 2021;15:e0009631. https:\/\/doi.org\/10.1371\/journal.pntd.0009631.","journal-title":"PLOS Negl Trop Dis"},{"key":"1438_CR4","doi-asserted-by":"publisher","first-page":"2348","DOI":"10.1186\/s12889-023-17277-0","volume":"23","author":"M Sugeno","year":"2023","unstructured":"Sugeno M, Kawazu EC, Kim H, Banouvong V, Pehlivan N, Gilfillan D, et al. Association between environmental factors and dengue incidence in Lao People\u2019s Democratic Republic: A nationwide time-series study. BMC Public Health. 2023;23:2348. https:\/\/doi.org\/10.1186\/s12889-023-17277-0.","journal-title":"BMC Public Health"},{"key":"1438_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5365\/wpsar.2022.13.4.932","volume":"13","author":"S Zafar","year":"2022","unstructured":"Zafar S, Overgaard HJ, Pongvongsa T, Vannavong N, Phommachanh S, Shipin O, et al. Epidemiological profile of dengue in Champasak and Savannakhet provinces, Lao People\u2019s Democratic Republic, 2003\u20132020. Western Pac Surveill Response J. 2022;13:1\u201313. https:\/\/doi.org\/10.5365\/wpsar.2022.13.4.932.","journal-title":"Western Pac Surveill Response J"},{"key":"1438_CR6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007213","volume":"13","author":"SJ Ryan","year":"2019","unstructured":"Ryan SJ, Carlson CJ, Mordecai EA, Johnson LR. Global expansion and redistribution of Aedes-borne virus transmission risk with climate change. PLOS Negl Trop Dis. 2019;13:e0007213. https:\/\/doi.org\/10.1371\/journal.pntd.0007213.","journal-title":"PLOS Negl Trop Dis"},{"key":"1438_CR7","doi-asserted-by":"publisher","first-page":"1074028","DOI":"10.3389\/fpubh.2022.1074028","volume":"10","author":"NMH Nik Abdull Halim","year":"2022","unstructured":"Nik Abdull Halim NMH, Che Dom N, Dapari R, Salim H, Precha NA. Systematic review and meta-analysis of the effects of temperature on the development and survival of the Aedes mosquito. Front Public Health. 2022;10:1074028. https:\/\/doi.org\/10.3389\/fpubh.2022.1074028.","journal-title":"Front Public Health"},{"key":"1438_CR8","doi-asserted-by":"publisher","first-page":"1242173","DOI":"10.3389\/fcimb.2023.1242173","volume":"13","author":"Z Liu","year":"2023","unstructured":"Liu Z, Zhang Q, Li L, He J, Guo J, Wang Z, et al. The effect of temperature on dengue virus transmission by Aedes mosquitoes. Front Cell Infect Microbiol. 2023;13:1242173. https:\/\/doi.org\/10.3389\/fcimb.2023.1242173.","journal-title":"Front Cell Infect Microbiol"},{"key":"1438_CR9","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1289\/ehp.1306556","volume":"121","author":"CW Morin","year":"2013","unstructured":"Morin CW, Comrie AC, Ernst K. Climate and dengue transmission: Evidence and implications. Environ Health Perspect. 2013;121:1264\u201372. https:\/\/doi.org\/10.1289\/ehp.1306556.","journal-title":"Environ Health Perspect"},{"key":"1438_CR10","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/1471-2334-14-167","volume":"14","author":"S Naish","year":"2014","unstructured":"Naish S, Dale P, Mackenzie JS, McBride J, Mengersen K, Tong S. Climate change and dengue: A critical and systematic review of quantitative modelling approaches. BMC Infect Dis. 2014;14:167. https:\/\/doi.org\/10.1186\/1471-2334-14-167.","journal-title":"BMC Infect Dis"},{"key":"1438_CR11","doi-asserted-by":"publisher","first-page":"4024","DOI":"10.1186\/s12889-025-25420-2","volume":"25","author":"W Polrob","year":"2025","unstructured":"Polrob W, La-Up A. Nonlinear and lagged effects of climate variability on dengue incidence in an urban megacity: A distributed lag non-linear model (DLNM) based study in Bangkok. Thailand BMC Public Health. 2025;25:4024. https:\/\/doi.org\/10.1186\/s12889-025-25420-2.","journal-title":"Thailand BMC Public Health"},{"key":"1438_CR12","doi-asserted-by":"publisher","first-page":"7460","DOI":"10.1073\/pnas.1101377108","volume":"108","author":"L Lambrechts","year":"2011","unstructured":"Lambrechts L, Paaijmans KP, Fansiri T, Carrington LB, Kramer LD, Thomas MB, et al. Impact of daily temperature fluctuations on dengue virus transmission by Aedes aegypti. Proc Natl Acad Sci U S A. 2011;108:7460\u20135. https:\/\/doi.org\/10.1073\/pnas.1101377108.","journal-title":"Proc Natl Acad Sci U S A"},{"key":"1438_CR13","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3390\/ijerph13111087","volume":"13","author":"P Liyanage","year":"2016","unstructured":"Liyanage P, Tissera H, Sewe M, Quam M, Amarasinghe A, Palihawadana P, et al. A spatial hierarchical analysis of the temporal influences of the El Ni\u00f1o-southern oscillation and weather on dengue in Kalutara District, Sri Lanka. Int J Environ Res Public Health. 2016;13:1087. https:\/\/doi.org\/10.3390\/ijerph13111087.","journal-title":"Int J Environ Res Public Health"},{"key":"1438_CR14","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms15531","volume":"8","author":"K Thirumalai","year":"2017","unstructured":"Thirumalai K, DiNezio PN, Okumura Y, Deser C. Extreme temperatures in Southeast Asia caused by el Ni\u00f1o and worsened by global warming. Nat Commun. 2017;8:15531. https:\/\/doi.org\/10.1038\/ncomms15531.","journal-title":"Nat Commun"},{"key":"1438_CR15","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-58288-0","volume":"14","author":"J Eggeling","year":"2024","unstructured":"Eggeling J, Gao C, An D, Cruz-Cano R, He H, Zhang L, et al. Spatiotemporal link between el Ni\u00f1o Southern Oscillation (ENSO), extreme heat, and thermal stress in the Asia-Pacific region. Sci Rep. 2024;14:7448. https:\/\/doi.org\/10.1038\/s41598-024-58288-0.","journal-title":"Sci Rep"},{"key":"1438_CR16","doi-asserted-by":"publisher","DOI":"10.1029\/2023GL106437","author":"S Lin","year":"2024","unstructured":"Lin S, Dong B, Yang S. Enhanced impacts of ENSO on the Southeast Asian summer monsoon under global warming and associated mechanisms. Geophys Res Lett. 2024. https:\/\/doi.org\/10.1029\/2023GL106437.","journal-title":"Geophys Res Lett"},{"key":"1438_CR17","unstructured":"National Weather Service. Climate prediction Center\u2014ONI https:\/\/www.cpc.ncep.noaa.gov\/products\/analysis_monitoring\/ensostuff\/ONI_v5.php Accessed 21 Feb 2026"},{"key":"1438_CR18","unstructured":"NOAA. DMI: Physical sciences laboratory https:\/\/psl.noaa.gov\/data\/timeseries\/month\/DMI\/ Accessed 21 Feb 2026"},{"key":"1438_CR19","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1126\/science.adj4427","volume":"384","author":"Y Chen","year":"2024","unstructured":"Chen Y, Xu Y, Wang L, Liang Y, Li N, Louren\u00e7o J, et al. Indian Ocean temperature anomalies predict long-term global dengue trends. Science. 2024;384:639\u201346. https:\/\/doi.org\/10.1126\/science.adj4427.","journal-title":"Science"},{"key":"1438_CR20","doi-asserted-by":"publisher","DOI":"10.1029\/2024GH001059","author":"F Feng","year":"2024","unstructured":"Feng F, Ma Y, Qin P, Zhao Y, Liu Z, Wang W, et al. Temperature-driven dengue transmission in a changing climate: Patterns, trends, and future projections. GeoHealth. 2024. https:\/\/doi.org\/10.1029\/2024GH001059.","journal-title":"GeoHealth"},{"key":"1438_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-017-2606-6","volume":"11","author":"P-J Tsai","year":"2018","unstructured":"Tsai P-J, Lin T-H, Teng H-J, Yeh H-C. Critical low temperature for the survival of Aedes aegypti in Taiwan. Parasit Vectors. 2018;11:22. https:\/\/doi.org\/10.1186\/s13071-017-2606-6.","journal-title":"Parasit Vectors"},{"key":"1438_CR22","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.bj.2018.06.002","volume":"41","author":"W-J Chen","year":"2018","unstructured":"Chen W-J. Dengue outbreaks and the geographic distribution of dengue vectors in Taiwan: a 20-year epidemiological analysis. Biomed J. 2018;41:283\u20139. https:\/\/doi.org\/10.1016\/j.bj.2018.06.002.","journal-title":"Biomed J"},{"key":"1438_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/1756-3305-5-100","volume":"5","author":"SM Thomas","year":"2012","unstructured":"Thomas SM, Obermayr U, Fischer D, Kreyling J, Beierkuhnlein C. Low-temperature threshold for egg survival of a post-diapause and non-diapause European aedine strain, Aedes albopictus (Diptera: Culicidae). Parasit Vectors. 2012;5:100. https:\/\/doi.org\/10.1186\/1756-3305-5-100.","journal-title":"Parasit Vectors"},{"key":"1438_CR24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0095606","volume":"9","author":"T Tsunoda","year":"2014","unstructured":"Tsunoda T, Cuong TC, Dong TD, Yen NT, Le NH, Phong TV, et al. Winter refuge for Aedes aegypti and Ae. albopictus mosquitoes in Hanoi during Winter. PLOS One. 2014;9:e95606. https:\/\/doi.org\/10.1371\/journal.pone.0095606.","journal-title":"PLOS One"},{"key":"1438_CR25","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-71807-3","volume":"14","author":"M Soukavong","year":"2024","unstructured":"Soukavong M, Thinkhamrop K, Pratumchart K, Soulaphy C, Xangsayarath P, Mayxay M, et al. Bayesian spatio-temporal analysis of dengue transmission in Lao PDR. Sci Rep. 2024;14:21327. https:\/\/doi.org\/10.1038\/s41598-024-71807-3.","journal-title":"Sci Rep"},{"key":"1438_CR26","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1007\/s10980-025-02102-3","volume":"40","author":"S Zafar","year":"2025","unstructured":"Zafar S, Rockl\u00f6v J, Paul RE, Shipin O, Rahman MdS, Pientong C, et al. Landscape and climatic drivers of dengue fever in Lao People\u2019s Democratic Republic and Thailand: A retrospective analysis during 2002\u20132019. Landsc Ecol. 2025;40:102. https:\/\/doi.org\/10.1007\/s10980-025-02102-3.","journal-title":"Landsc Ecol"},{"key":"1438_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens9090728","volume":"9","author":"E Calvez","year":"2020","unstructured":"Calvez E, Pommelet V, Somlor S, Pompon J, Viengphouthong S, Bounmany P, et al. Trends of the dengue Serotype-4 circulation with epidemiological, phylogenetic, and entomological insights in Lao PDR between 2015 and 2019. Pathogens. 2020;9:728. https:\/\/doi.org\/10.3390\/pathogens9090728.","journal-title":"Pathogens"},{"key":"1438_CR28","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms13020318","volume":"13","author":"C Troupin","year":"2025","unstructured":"Troupin C, Intavong K, Somlor S, Viengphouthong S, Keosenhom S, Chindavong TA, et al. Molecular epidemiology of dengue viruses in Lao People\u2019s Democratic Republic, 2020\u20132023. Microorganisms. 2025;13:318. https:\/\/doi.org\/10.3390\/microorganisms13020318.","journal-title":"Microorganisms"},{"key":"1438_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2024.107229","volume":"256","author":"S Phanhkongsy","year":"2024","unstructured":"Phanhkongsy S, Suwannatrai A, Thinkhamrop K, Somlor S, Sorsavanh T, Tavinyan V, et al. Spatial analysis of dengue fever incidence and serotype distribution in Vientiane Capital, Laos: a multi-year study. Acta Trop. 2024;256:107229. https:\/\/doi.org\/10.1016\/j.actatropica.2024.107229.","journal-title":"Acta Trop"},{"key":"1438_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5365\/wpsar.2023.14.1.973","volume":"14","author":"E Togami","year":"2023","unstructured":"Togami E, Chiew M, Lowbridge C, Biaukula V, Bell L, Yajima A, et al. Epidemiology of dengue reported in the World Health Organization\u2019s western Pacific Region, 2013\u20132019. Western Pac Surveill Response J. 2023;14:1\u201316. https:\/\/doi.org\/10.5365\/wpsar.2023.14.1.973.","journal-title":"Western Pac Surveill Response J"},{"key":"1438_CR31","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1002\/sim.3940","volume":"29","author":"A Gasparrini","year":"2010","unstructured":"Gasparrini A, Armstrong B, Kenward MG. Distributed lag non-linear models. Stat Med. 2010;29:2224\u201334. https:\/\/doi.org\/10.1002\/sim.3940.","journal-title":"Stat Med"},{"key":"1438_CR32","first-page":"1","volume":"43","author":"A Gasparrini","year":"2021","unstructured":"Gasparrini A. Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw. 2021;43:1\u201320.","journal-title":"J Stat Softw"},{"key":"1438_CR33","doi-asserted-by":"publisher","unstructured":"Yang X, Bao Y, Song Z, Shu Q, Song Y, Wang X, et al 2023 Key to ENSO phase-locking simulation: Effects of sea surface temperature diurnal amplitude. npj Clim Atmos Sci 6 159 https:\/\/doi.org\/10.1038\/s41612-023-00483-3","DOI":"10.1038\/s41612-023-00483-3"},{"key":"1438_CR34","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1002\/2013GL059137","volume":"41","author":"S-K Lee","year":"2014","unstructured":"Lee S-K, Mapes BE, Wang C, Enfield DB, Weaver SJ. Springtime ENSO phase evolution and its relation to rainfall in the continental U.S. Geophys Res Lett. 2014;41:1673\u201380. https:\/\/doi.org\/10.1002\/2013GL059137.","journal-title":"Geophys Res Lett"},{"key":"1438_CR35","doi-asserted-by":"publisher","first-page":"2872","DOI":"10.1175\/JCLI4152.1","volume":"20","author":"G Meyers","year":"2007","unstructured":"Meyers G, McIntosh P, Pigot L, Pook M. The years of El Ni\u00f1o, La Ni\u00f1a, and interactions with the tropical Indian Ocean. J Clim. 2007;20:2872\u201380. https:\/\/doi.org\/10.1175\/JCLI4152.1.","journal-title":"J Clim"},{"key":"1438_CR36","doi-asserted-by":"publisher","DOI":"10.3390\/cli13090193","volume":"13","author":"AB Almahri","year":"2025","unstructured":"Almahri AB, Hasanean HM, Labban AH. Teleconnections between the Pacific and Indian Ocean SSTs and the tropical cyclone activity over the Arabian Sea. Climate. 2025;13:193. https:\/\/doi.org\/10.3390\/cli13090193.","journal-title":"Climate"}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-026-01438-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40249-026-01438-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-026-01438-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:04:22Z","timestamp":1777590262000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40249-026-01438-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1438"],"URL":"https:\/\/doi.org\/10.1186\/s40249-026-01438-5","relation":{},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]},"assertion":[{"value":"29 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 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":"Ethical approval for secondary data analysis was obtained from the Institutional Review Board (IRB) of Sungkyunkwan University (IRB file no. 2025-02-010). Consent to participate was not applicable.","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 that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"46"}}