{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:14:16Z","timestamp":1778523256195,"version":"3.51.4"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","award":["E-26\/211.078\/2021"],"award-info":[{"award-number":["E-26\/211.078\/2021"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>The COVID-19 pandemic had a significant impact on Brazil, although its effects were not homogeneous across the country. Socioeconomic disparities may influence epidemiological patterns during health emergencies, which impact population mental health. This study aimed to analyze the consumption of psychoactive medicines during the COVID-19 pandemic in Brazil and to characterize its spatiotemporal dynamics, identifying associated social, economic, and demographic factors. We used publicly available retail pharmacies dispensing data from January 2018 to September 2021 across Brazil\u2019s municipalities. A statistical model was developed based on indicators of infrastructure, human capital, and labor and income. Generalized additive models were used to characterize the spatiotemporal distribution of drug consumption. In September 2021, average consumption in municipalities reporting COVID-19\u2013related deaths was 22% higher than in municipalities with no reported deaths. Among the most frequently consumed medicines during the study period, second-generation antidepressants were predominant. Life expectancy, employment and education showed positive linear associations with consumption, whereas inadequate water supply and sanitation were inversely associated. Municipality income was positively associated with average consumption of psychoactive medicines, but those with a very high-income development index showed more complex dynamics. Our results suggest that COVID-19 mortality was associated with psychotropic medicines consumption and indicate the need to address socioeconomic vulnerability as a key component of public health emergency response. The COVID-19 pandemic had a significant impact on Brazil, although its effects were not homogeneous across the country. Socioeconomic disparities may influence epidemiological patterns during health emergencies, impacting population mental health. This study aimed to analyze the consumption of psychoactive medicines during the COVID-19 pandemic in Brazil and to characterize its spatiotemporal dynamics, identifying associated social, economic, and demographic factors. We used publicly available data from retail pharmacy dispensing from January 2018 to September 2021 across Brazilian municipalities. A statistical model was developed based on indicators of infrastructure, human capital, labor, and income. Generalized additive models were used to characterize the spatiotemporal distribution of drug consumption. In September 2021, average consumption in municipalities reporting COVID-19\u2013related deaths was 22% higher than in municipalities with no reported deaths. Among the most frequently consumed medicines during the study period, second-generation antidepressants were predominant. Life expectancy, employment, and education showed positive linear associations with consumption, whereas inadequate water supply and sanitation were inversely associated. Municipality income was positively associated with the average consumption of psychoactive medicines, but those with a very high human development index for income showed more complex dynamics. Our results suggest that COVID-19 mortality was associated with psychotropic medicine consumption and indicate the need to address socioeconomic vulnerability as a key component of public health emergency responses.<\/jats:p>","DOI":"10.1371\/journal.pone.0343552","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:50:51Z","timestamp":1778521851000},"page":"e0343552","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatiotemporal analysis of psychoactive drug consumption in Brazil during the COVID-19 pandemic"],"prefix":"10.1371","volume":"21","author":[{"given":"Evani Leite de","family":"Freitas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6869-8391","authenticated-orcid":true,"given":"Rafael Santos","family":"Erbisti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Branca","family":"Grinberg-Weller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Claudiano Cabral","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6204-5023","authenticated-orcid":true,"given":"Elaine Silva","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"1","key":"pone.0343552.ref001","article-title":"Excesso de mortes durante a pandemia de COVID-19: subnotifica\u00e7\u00e3o e desigualdades regionais no Brasil","volume":"37","author":"JDY Orellana","year":"2021","journal-title":"Cad Saude Publica"},{"key":"pone.0343552.ref002","unstructured":"Health Ministry. Painel Coronav\u00edrus. https:\/\/covid.saude.gov.br\/. 2024. Accessed 2024 July 22."},{"key":"pone.0343552.ref003","first-page":"100222","article-title":"Brazil\u2019s health system functionality amidst of the COVID-19 pandemic: An analysis of resilience","volume":"10","author":"A Bigoni","year":"2022","journal-title":"Lancet Reg Health Am"},{"issue":"10072","key":"pone.0343552.ref004","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/S0140-6736(17)30599-8","article-title":"Syndemics: committing to a healthier future","volume":"389","author":"L Hart","year":"2017","journal-title":"Lancet"},{"issue":"9","key":"pone.0343552.ref005","article-title":"Social vulnerability and health crisis in Brazil","volume":"37","author":"AR Carvalho","year":"2021","journal-title":"Cad Saude Publica"},{"issue":"11","key":"pone.0343552.ref006","article-title":"Synergistic epidemic or syndemic: an emerging pattern of human diseases","volume":"15","author":"A Shelke","year":"2023","journal-title":"Cureus"},{"issue":"1","key":"pone.0343552.ref007","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4161\/dish.24705","article-title":"Long-term mental health outcomes following the 2004 Asian tsunami disaster: A comparative study on direct and indirect exposure","volume":"2","author":"N Kar","year":"2013","journal-title":"Disaster Health"},{"issue":"1","key":"pone.0343552.ref008","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/jts.20607","article-title":"A quantitative analysis of antidepressant and antipsychotic prescriptions following an earthquake in Italy","volume":"24","author":"A Rossi","year":"2011","journal-title":"J Trauma Stress"},{"issue":"8","key":"pone.0343552.ref009","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1080\/14737167.2022.2117691","article-title":"Consumption of antidepressants and economic austerity in Brazil","volume":"22","author":"LT de Mattos","year":"2022","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"pone.0343552.ref010","doi-asserted-by":"crossref","first-page":"886652","DOI":"10.3389\/fphar.2022.886652","article-title":"Psychotropic medication use before and during COVID-19: A population-wide study","volume":"13","author":"C Leong","year":"2022","journal-title":"Frontiers in Pharmacology"},{"issue":"1","key":"pone.0343552.ref011","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1186\/s12889-023-15360-0","article-title":"Psychotropic consumption before and during COVID-19 in Asturias, Spain","volume":"23","author":"MLN Garc\u00eda","year":"2023","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0343552.ref012","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s40199-021-00390-z","article-title":"Surging trends in prescriptions and costs of antidepressants in England amid COVID-19","volume":"29","author":"SA Rabeea","year":"2021","journal-title":"Daru"},{"key":"pone.0343552.ref013","doi-asserted-by":"crossref","first-page":"1020023","DOI":"10.3389\/fpsyt.2022.1020023","article-title":"Effect of the COVID-19 pandemic on the psychotropic drug consumption","volume":"13","author":"P Benistand","year":"2022","journal-title":"Front Psychiatry"},{"key":"pone.0343552.ref014","doi-asserted-by":"crossref","first-page":"1131357","DOI":"10.3389\/fphar.2023.1131357","article-title":"Sales trends of psychotropic drugs in the COVID-19 pandemic: A national database study in Brazil","volume":"14","author":"S Del Fiol F de","year":"2023","journal-title":"Front Pharmacol"},{"issue":"12","key":"pone.0343552.ref015","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S2215-0366(21)00292-3","article-title":"Psychotropic medicine consumption in 65 countries and regions, 2008-19: a longitudinal study","volume":"8","author":"R Brauer","year":"2021","journal-title":"The Lancet Psychiatry"},{"key":"pone.0343552.ref016","unstructured":"Portaria No. 344, de 12 de Maio de 1998, Di\u00e1rio Oficial da Uni\u00e3o [D.O.U.] de 15.05. 1998."},{"key":"pone.0343552.ref017","unstructured":"National System for the Management of Controlled Products. https:\/\/www.gov.br\/anvisa\/pt-br\/assuntos\/fiscalizacao-e-monitoramento\/sngpc. 2024. Accessed 2024 July 22."},{"key":"pone.0343552.ref018","unstructured":"Lei No. 12.527, de 18 de Novembro de 2011, Col. Leis Rep. Fed. Brasil, Di\u00e1rio Oficial da Uni\u00e3o [D.O.U.] de 18.11.2011 (Braz.). 2011."},{"key":"pone.0343552.ref019","author":"Brazilian Institute of Geography and Statistics","year":"2024"},{"key":"pone.0343552.ref020","unstructured":"Institute for Applied Economic Research. Atlas of Social Vulnerability. 2024. https:\/\/ivs.ipea.gov.br\/#\/"},{"key":"pone.0343552.ref021","unstructured":"Norwegian Institute of Public Health. ATC\/DDD Index 2024. https:\/\/atcddd.fhi.no\/atc_ddd_index\/. 2024. Accessed 2022 October 24."},{"issue":"8","key":"pone.0343552.ref022","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1590\/1413-81232018248.23232017","article-title":"Consumption of the benzodiazepine clonazepam (Rivotril\u00ae) in Rio de Janeiro State, Brazil, 2009-2013: an ecological study","volume":"24","author":"RT Zorzanelli","year":"2019","journal-title":"Cien Saude Colet"},{"key":"pone.0343552.ref023","doi-asserted-by":"crossref","DOI":"10.7476\/9788575412657","volume-title":"Estudos de utiliza\u00e7\u00e3o de medicamentos: no\u00e7\u00f5es b\u00e1sicas","author":"CGSO Castro","year":"2000","edition":"1"},{"issue":"1","key":"pone.0343552.ref024","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection Via the Lasso","volume":"58","author":"R Tibshirani","year":"1996","journal-title":"Journal of the Royal Statistical Society Series B: Statistical Methodology"},{"issue":"2","key":"pone.0343552.ref025","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.1467-9868.2005.00503.x","article-title":"Regularization and Variable Selection Via the Elastic Net","volume":"67","author":"H Zou","year":"2005","journal-title":"Journal of the Royal Statistical Society Series B: Statistical Methodology"},{"key":"pone.0343552.ref026","volume-title":"Generalized additive models","author":"TJ Hastie","year":"1990","edition":"1"},{"issue":"2","key":"pone.0343552.ref027","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/1467-9876.00229","article-title":"Bayesian inference for generalized additive mixed models based on markov random field priors","volume":"50","author":"L Fahrmeir","year":"2001","journal-title":"Journal of the Royal Statistical Society Series C: Applied Statistics"},{"issue":"4","key":"pone.0343552.ref028","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1038\/s41409-019-0679-x","article-title":"Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians","volume":"55","author":"J Gauthier","year":"2020","journal-title":"Bone Marrow Transplant"},{"issue":"4","key":"pone.0343552.ref029","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.pld.2024.06.002","article-title":"Evaluating the relative importance of predictors in Generalized Additive Models using the gam.hp R package","volume":"46","author":"J Lai","year":"2024","journal-title":"Plant Divers"},{"key":"pone.0343552.ref030","unstructured":"R Core Team. R: A language and environment for statistical computing. https:\/\/www.R-project.org\/. 2013. Accessed 2024 July 10."},{"issue":"4","key":"pone.0343552.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012984","article-title":"ARBOALVO: A Bayesian spatiotemporal learning and predictive model for dengue cases in the endemic Northeast city of Natal, Rio Grande do Norte, Brazil","volume":"19","author":"MB Alves","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0343552.ref032","unstructured":"American Psychological Association. Clinical practice guideline for the treatment of depression across three age cohorts. https:\/\/www.apa.org\/depression-guideline\/guideline.pdf. 2019. Accessed 2024 October 24."},{"issue":"2","key":"pone.0343552.ref033","doi-asserted-by":"crossref","first-page":"239","DOI":"10.7326\/M22-2056","article-title":"Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: A Living Clinical Guideline From the American College of Physicians","volume":"176","author":"A Qaseem","year":"2023","journal-title":"Ann Intern Med"},{"issue":"10","key":"pone.0343552.ref034","article-title":"Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008 to 2018: a sales data analysis","volume":"46","author":"TT Ma","year":"2023","journal-title":"Sleep"},{"key":"pone.0343552.ref035","unstructured":"Brazil. National Health Surveillance Agency. Collegiate Board Resolution No. 357, of March 24, 2020. Provides for measures to address the public health emergency of international concern arising from the coronavirus (COVID-19). 2020. https:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/anvisa\/2020\/RDC_357_2020_.pdf"},{"issue":"2","key":"pone.0343552.ref036","article-title":"\u201cKit-covid\u201d and the Popular Pharmacy Program in Brazil","volume":"37","author":"CDB Santos-Pinto","year":"2021","journal-title":"Cad Saude Publica"},{"key":"pone.0343552.ref037","unstructured":"Brazil NHSA. Collegiate Board Resolution No. 586, of December 17, 2021. Provides for technical requirements for the manufacture, import, commercialization and use of medical devices. Di\u00e1rio Oficial da Uni\u00e3o. 2021. https:\/\/www.cff.org.br\/userfiles\/RESOLU%C3%87%C3%83O%20RDC%20N%C2%BA%20586,%20DE%2017%20DE%20DEZEMBRO%20DE%202021.pdf"},{"issue":"5","key":"pone.0343552.ref038","article-title":"Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials","volume":"39","author":"TJN Ferreira","year":"2023","journal-title":"Cad Saude Publica"},{"key":"pone.0343552.ref039","unstructured":"United Nations. WHO chief declares end to COVID-19 as a global health emergency. https:\/\/news.un.org\/en\/story\/2023\/05\/1136367. 2023. Accessed 2024 August 14."},{"key":"pone.0343552.ref040","article-title":"Factors associated with poor access to health services in Brazil","volume":"24","author":"MNP Dantas","year":"2020","journal-title":"Rev Bras Epidemiol"},{"key":"pone.0343552.ref041","year":"2023"},{"issue":"1","key":"pone.0343552.ref042","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4269\/ajtmh.21-0744","article-title":"Spatiotemporal Pattern of COVID-19-Related Mortality during the First Year of the Pandemic in Brazil: A Population-based Study in a Region of High Social Vulnerability","volume":"106","author":"L Almeida Andrade","year":"2021","journal-title":"Am J Trop Med Hyg"},{"issue":"6544","key":"pone.0343552.ref043","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1126\/science.abh1558","article-title":"Spatiotemporal pattern of COVID-19 spread in Brazil","volume":"372","author":"MC Castro","year":"2021","journal-title":"Science"},{"key":"pone.0343552.ref044","doi-asserted-by":"crossref","first-page":"101945","DOI":"10.1016\/j.tmaid.2020.101945","article-title":"Spatiotemporal ecological study of COVID-19 mortality in the city of S\u00e3o Paulo, Brazil: Shifting of the high mortality risk from areas with the best to those with the worst socio-economic conditions","volume":"39","author":"PMM Bermudi","year":"2021","journal-title":"Travel Med Infect Dis"},{"key":"pone.0343552.ref045","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1590\/0103-11042020e205","article-title":"Proposta de an\u00e1lise integrada de emerg\u00eancias em sa\u00fade p\u00fablica por arboviroses: o caso do Zika v\u00edrus no Brasil","volume":"44","author":"VLE Pepe","year":"2020","journal-title":"Sa\u00fade debate"},{"issue":"1","key":"pone.0343552.ref046","article-title":"Time trend, social vulnerability, and identification of risk areas for tuberculosis in Brazil: An ecological study","volume":"17","author":"JPS de Paiva","year":"2022","journal-title":"PLoS One"},{"issue":"2","key":"pone.0343552.ref047","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10754-022-09338-5","article-title":"Determinants of life expectancy at birth: A longitudinal study on OECD countries","volume":"23","author":"P Roffia","year":"2023","journal-title":"Int J Health Econ Manag"},{"key":"pone.0343552.ref048","doi-asserted-by":"crossref","unstructured":"Organisation for Economic Co-operation and Development. Life Expectancy at Birth. Organisation for Economic Co-operation and Development. https:\/\/doi.org\/10.1787\/27e0fc9d-en. 2024. Accessed 2024 August 2.","DOI":"10.1787\/27e0fc9d-en"},{"key":"pone.0343552.ref049","author":"MAP Lameiras","year":"2018"},{"issue":"6","key":"pone.0343552.ref050","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311xpt114721","article-title":"Preval\u00eancias e desigualdades no acesso aos medicamentos por usu\u00e1rios do Sistema \u00danico de Sa\u00fade no Brasil em 2013 e 2019","volume":"38","author":"AC Boing","year":"2022","journal-title":"Cad Saude Publica"},{"key":"pone.0343552.ref051","unstructured":"Instituto Trata Brasil. Saneamento e doen\u00e7as de veicula\u00e7\u00e3o h\u00eddrica DATASUS e SNIS 2019. Instituto Trata Brasil. https:\/\/tratabrasil.org.br\/wp-content\/uploads\/2022\/09\/Sumario_Executivo_-_Saneamento_e_Saude_2021__2.pdf. 2021. Accessed 2024 August 2."},{"key":"pone.0343552.ref052","year":"2020"},{"issue":"9","key":"pone.0343552.ref053","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1017\/S0033291717003336","article-title":"Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys","volume":"48","author":"S Evans-Lacko","year":"2018","journal-title":"Psychol Med"},{"issue":"4","key":"pone.0343552.ref054","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1590\/S0034-89102008005000034","article-title":"Transtornos mentais comuns e uso de psicof\u00e1rmacos: Impacto das condi\u00e7\u00f5es socioecon\u00f4micas","volume":"42","author":"MC Lima","year":"2008","journal-title":"Rev Saude Publica"},{"issue":"6","key":"pone.0343552.ref055","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1590\/S0034-8910.2014048005406","article-title":"Trends in the use of antidepressants among older adults: Bambu\u00ed Project","volume":"48","author":"AI Loyola Filho","year":"2014","journal-title":"Rev Saude Publica"},{"key":"pone.0343552.ref056","year":"2023"},{"issue":"3","key":"pone.0343552.ref057","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/wps.20911","article-title":"Socioeconomic and sociocultural factors affecting access to psychotherapies: The way forward","volume":"20","author":"P Fonagy","year":"2021","journal-title":"World Psychiatry"},{"issue":"1","key":"pone.0343552.ref058","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1186\/s12889-020-08820-4","article-title":"Do people living in disadvantaged circumstances receive different mental health treatments than those from less disadvantaged backgrounds?","volume":"20","author":"C Giebel","year":"2020","journal-title":"BMC Public Health"},{"key":"pone.0343552.ref059","year":"2021"},{"key":"pone.0343552.ref060","doi-asserted-by":"crossref","DOI":"10.1017\/S1754470X20000215","article-title":"Death anxiety in the time of COVID-19: Theoretical explanations and clinical implications","volume":"13","author":"RE Menzies","year":"2020","journal-title":"Cogn Behav Therap"},{"key":"pone.0343552.ref061","author":"M Mrejen","year":"2021"},{"issue":"7","key":"pone.0343552.ref062","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0269855","article-title":"Covid and mental health in America","volume":"17","author":"DG Blanchflower","year":"2022","journal-title":"PLoS One"},{"key":"pone.0343552.ref063","doi-asserted-by":"crossref","first-page":"1428674","DOI":"10.3389\/fpubh.2024.1428674","article-title":"The rise in mortality due to intentional self-poisoning by medicines in Brazil between 2003 and 2022: Relationship with regional and global crises","volume":"12","author":"MLP Souza","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0343552.ref064","unstructured":"Brazil. Law No. 8.080, 19 September 1990. Provides for the conditions for the promotion, protection and recovery of health, the organization and functioning of the corresponding services, and other provisions. Di\u00e1rio Oficial da Uni\u00e3o. 1990. https:\/\/www.planalto.gov.br\/ccivil_03\/leis\/l8080.htm"},{"key":"pone.0343552.ref065","first-page":"22","article-title":"The resilience of the Brazilian Unified Health System is not (only) in responding to disasters","volume":"58","author":"A Jatob\u00e1","year":"2024","journal-title":"Rev Saude Publica"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:51:03Z","timestamp":1778521863000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343552"}},"subtitle":[],"editor":[{"given":"Giuliana","family":"Pardelli","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":65,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343552","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}