{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:23:50Z","timestamp":1780536230674,"version":"3.54.1"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Genetic disposition is a major etiologic factor in childhood cancer. More than 100 cancer predisposing syndromes (CPS) are known. Surveillance protocols seek to mitigate morbidity and mortality. To implement recommendations in patient care and to ascertain that the constant gain of knowledge forces its way into practice specific pediatric CPS programs were established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>We retrospectively analyzed data on children, adolescents, and young adults referred to our pediatric CPS program between October 1, 2021, and March 31, 2023. Follow-up ended on December 31, 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 67 patients (30 male, 36 female, 1 non-binary, median age 9.5 years). Thirty-five patients were referred for CPS surveillance, 32 for features suspicious of a CPS including caf\u00e9-au-lait macules (<jats:italic>n<\/jats:italic>\u2009=\u200910), overgrowth (<jats:italic>n<\/jats:italic>\u2009=\u20099), other specific symptoms (<jats:italic>n<\/jats:italic>\u2009=\u20094), cancer suspicious of a CPS (<jats:italic>n<\/jats:italic>\u2009=\u20096), and rare neoplasms (<jats:italic>n<\/jats:italic>\u2009=\u20093). CPS was confirmed by clinical criteria in 6 patients and genetic testing in 7 (of 13). In addition, 6 clinically unaffected at-risk relatives were identified carrying a cancer predisposing pathogenic variant. A total of 48 patients were eventually diagnosed with CPS, surveillance recommendations were on record for 45. Of those, 8 patients did not keep their appointments for various reasons. Surveillance revealed neoplasms (<jats:italic>n<\/jats:italic>\u2009=\u20092) and metachronous tumors (<jats:italic>n<\/jats:italic>\u2009=\u20094) by clinical (<jats:italic>n<\/jats:italic>\u2009=\u20092), radiological examination (<jats:italic>n<\/jats:italic>\u2009=\u20092), and endoscopy (<jats:italic>n<\/jats:italic>\u2009=\u20092). Psychosocial counselling was utilized by 16 (of 45; 35.6%) families.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The diverse pediatric CPSs pose several challenges necessitating interdisciplinary care in specified CPS programs. To ultimately improve outcome including psychosocial well-being joint clinical and research efforts are necessary.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2024.1410061","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T04:39:03Z","timestamp":1717389543000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Cancer predisposing syndromes in childhood and adolescence pose several challenges necessitating interdisciplinary care in dedicated programs"],"prefix":"10.3389","volume":"12","author":[{"given":"Stefanie","family":"Kaffai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Angelova-Toshkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas B.","family":"Weins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Ickinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Steinke-Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Vollert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Fr\u00fchwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Kuhlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.1056\/NEJMoa1508054","article-title":"Germline mutations in predisposition genes in pediatric cancer","volume":"373","author":"Zhang","year":"2015","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1038\/s41431-021-00878-x","article-title":"Comprehensive germline-genomic and clinical profiling in 160 unselected children and adolescents with cancer","volume":"29","author":"Wagener","year":"2021","journal-title":"Eur J Hum Genet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1038\/nature25480","article-title":"The landscape of genomic alterations across childhood cancers","volume":"555","author":"Grobner","year":"2018","journal-title":"Nature"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1158\/1078-0432.CCR-17-1725","article-title":"High yield of pathogenic germline mutations causative or likely causative of the cancer phenotype in selected children with cancer","volume":"24","author":"Diets","year":"2018","journal-title":"Clin Cancer Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2206","DOI":"10.1038\/s41467-020-16067-1","article-title":"Comprehensive germline genomic profiles of children, adolescents and young adults with solid tumors","volume":"11","author":"Akhavanfard","year":"2020","journal-title":"Nat Commun"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e1009231","DOI":"10.1371\/journal.pgen.1009231","article-title":"Nationwide germline whole genome sequencing of 198 consecutive pediatric cancer patients reveals a high incidence of cancer prone syndromes","volume":"16","author":"Byrjalsen","year":"2020","journal-title":"PLoS Genet"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1158\/1078-0432.CCR-22-2482","article-title":"Pathogenic variants in adult-onset cancer predisposition genes in pediatric cancer: prevalence and impact on tumor molecular features and clinical management","volume":"29","author":"McGee","year":"2023","journal-title":"Clin Cancer Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.ejmg.2016.01.008","article-title":"Recognition of genetic predisposition in pediatric cancer patients: an easy-to-use selection tool","volume":"59","author":"Jongmans","year":"2016","journal-title":"Eur J Med Genet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e27916","DOI":"10.1002\/pbc.27916","article-title":"How I approach hereditary cancer predisposition in a child with cancer","volume":"66","author":"Kuhlen","year":"2019","journal-title":"Pediatr Blood Cancer"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1002\/ajmg.a.38142","article-title":"Childhood cancer predisposition syndromes-a concise review and recommendations by the cancer predisposition working group of the society for pediatric oncology and hematology","volume":"173","author":"Ripperger","year":"2017","journal-title":"Am J Med Genet A"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e26441","DOI":"10.1002\/pbc.26441","article-title":"The McGill interactive pediatric OncoGenetic guidelines: an approach to identifying pediatric oncology patients most likely to benefit from a genetic evaluation","volume":"64","author":"Goudie","year":"2017","journal-title":"Pediatr Blood Cancer"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1158\/1078-0432.CCR-17-0702","article-title":"Pediatric cancer predisposition and surveillance: an overview, and a tribute to Alfred G. Knudson Jr","volume":"23","author":"Brodeur","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s10689-021-00229-1","article-title":"Current recommendations for clinical surveillance and genetic testing in rhabdoid tumor predisposition: a report from the SIOPE host genome working group","volume":"20","author":"Fruhwald","year":"2021","journal-title":"Fam Cancer"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1158\/1078-0432.CCR-17-0408","article-title":"Cancer screening recommendations for individuals with Li-Fraumeni syndrome","volume":"23","author":"Kratz","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1158\/1078-0432.CCR-17-0515","article-title":"Pediatric cancer predisposition imaging: focus on whole-body MRI","volume":"23","author":"Greer","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e8641","DOI":"10.15252\/emmm.201708641","article-title":"Trio sequencing in pediatric cancer and clinical implications","volume":"10","author":"Kuhlen","year":"2018","journal-title":"EMBO Mol Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e91","DOI":"10.1158\/1078-0432.CCR-17-0834","article-title":"Genetic counselor recommendations for cancer predisposition evaluation and surveillance in the pediatric oncology patient","volume":"23","author":"Druker","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.3390\/cancers15051381","article-title":"Scanxiety among adults with cancer: a scoping review to guide research and interventions","volume":"15","author":"Derry-Vick","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"E685","DOI":"10.1001\/amajethics.2022.685","article-title":"Imprints of \u201cscanxiety\u201d","volume":"24","author":"Mindrup","year":"2022","journal-title":"AMA J Ethics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1158\/1078-0432.CCR-17-2026","article-title":"The future of surveillance in the context of cancer predisposition: through the murky looking glass","volume":"23","author":"Malkin","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1007\/s00431-021-04347-x","article-title":"The need for tumor surveillance of children and adolescents with cancer predisposition syndromes: a retrospective cohort study in a tertiary-care children\u2019s hospital","volume":"181","author":"Huber","year":"2022","journal-title":"Eur J Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/S1470-2045(23)00403-5","article-title":"Cancer germline predisposing variants and late mortality from subsequent malignant neoplasms among long-term childhood cancer survivors: a report from the St Jude lifetime cohort and the childhood cancer survivor study","volume":"24","author":"Chen","year":"2023","journal-title":"Lancet Oncol"},{"key":"B23","doi-asserted-by":"crossref","DOI":"10.1016\/B978-0-12-374984-0.00146-7","article-title":"Beckwith-Wiedemann syndrome","volume-title":"GeneReviews\u00ae","author":"Shuman","year":""},{"key":"B24","doi-asserted-by":"publisher","first-page":"17","DOI":"10.25646\/11828","article-title":"Research on rare diseases in Germany\u2014the cancer predisposition syndrome registry","volume":"8","author":"Dutzmann","year":"2023","journal-title":"J Health Monit"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1038\/s41436-021-01170-5","article-title":"Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation","volume":"23","author":"Legius","year":"2021","journal-title":"Genet Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s11060-010-0159-z","article-title":"Natural history and management of low-grade glioma in NF-1 children","volume":"100","author":"Hernaiz Driever","year":"2010","journal-title":"J Neurooncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1016\/j.gim.2022.05.013","article-title":"Neurofibromatosis type 1: a comparison of the 1997 NIH and the 2021 revised diagnostic criteria in 75 children and adolescents","volume":"24","author":"Angelova-Toshkina","year":"2022","journal-title":"Genet Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1136\/jmedgenet-2018-105664","article-title":"Constitutional mismatch repair deficiency as a differential diagnosis of neurofibromatosis type 1: consensus guidelines for testing a child without malignancy","volume":"56","author":"Suerink","year":"2019","journal-title":"J Med Genet"},{"key":"B29","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1002\/cncr.35041","article-title":"Pediatric cancer incidence among individuals with overgrowth syndromes and overgrowth features: a population-based assessment in seven million children","volume":"130","author":"Connolly","year":"2024","journal-title":"Cancer"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1200\/JCO.21.02510","article-title":"Prevalence of (epi)genetic predisposing factors in a 5-year unselected national Wilms tumor cohort: a comprehensive clinical and genomic characterization","volume":"40","author":"Hol","year":"2022","journal-title":"J Clin Oncol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.3390\/genes12111839","article-title":"Characteristics associated with tumor development in individuals diagnosed with beckwith-wiedemann spectrum: novel tumor-(epi)genotype-phenotype associations in the BWSp population","volume":"12","author":"Duffy","year":"2021","journal-title":"Genes (Basel)"},{"key":"B32","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1038\/s41416-020-0911-x","article-title":"Cancer incidence and spectrum among children with genetically confirmed Beckwith-Wiedemann spectrum in Germany: a retrospective cohort study","volume":"123","author":"Coktu","year":"2020","journal-title":"Br J Cancer"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e115","DOI":"10.1158\/1078-0432.CCR-17-0710","article-title":"Surveillance recommendations for children with overgrowth syndromes and predisposition to Wilms tumors and hepatoblastoma","volume":"23","author":"Kalish","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B34","article-title":"Simpson-Golabi-Behmel syndrome type 1","volume-title":"GeneReviews\u00ae","author":"Klein","year":""},{"key":"B35","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1038\/s41574-019-0180-z","article-title":"Overgrowth syndromes\u2014clinical and molecular aspects and tumour risk","volume":"15","author":"Brioude","year":"2019","journal-title":"Nat Rev Endocrinol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e28056","DOI":"10.1002\/pbc.28056","article-title":"Multiple endocrine neoplasia type 2B: frequency of physical stigmata-results of the GPOH-MET registry","volume":"67","author":"Redlich","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"B37","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s40348-022-00135-1","article-title":"PTEN Hamartoma tumor syndrome in childhood and adolescence-a comprehensive review and presentation of the German pediatric guideline","volume":"9","author":"Plamper","year":"2022","journal-title":"Mol Cell Pediatr"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1542\/peds.91.6.1116","article-title":"The need for more accurate and timely diagnosis in Fanconi anemia: a report from the international Fanconi Anemia registry","volume":"91","author":"Giampietro","year":"1993","journal-title":"Pediatrics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e62","DOI":"10.1158\/1078-0432.CCR-17-0595","article-title":"Cancer surveillance in Gorlin syndrome and rhabdoid tumor predisposition syndrome","volume":"23","author":"Foulkes","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/S1470-2045(18)30242-0","article-title":"Spectrum and prevalence of genetic predisposition in medulloblastoma: a retrospective genetic study and prospective validation in a clinical trial cohort","volume":"19","author":"Waszak","year":"2018","journal-title":"Lancet Oncol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e68","DOI":"10.1158\/1078-0432.CCR-17-0547","article-title":"Von Hippel-Lindau and hereditary pheochromocytoma\/paraganglioma syndromes: clinical features, genetics, and surveillance recommendations in childhood","volume":"23","author":"Rednam","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B42","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1515\/cclm-2020-0904","article-title":"Plasma metanephrines and prospective prediction of tumor location, size and mutation type in patients with pheochromocytoma and paraganglioma","volume":"59","author":"Eisenhofer","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"E214","DOI":"10.1210\/jc.2014-2138","article-title":"Genotype-specific differences in the tumor metabolite profile of pheochromocytoma and paraganglioma using untargeted and targeted metabolomics","volume":"100","author":"Rao","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"B44","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s00431-017-2997-6","article-title":"Genetic predisposition in children with cancer\u2014affected families\u2019 acceptance of trio-WES","volume":"177","author":"Brozou","year":"2018","journal-title":"Eur J Pediatr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e107","DOI":"10.1158\/1078-0432.CCR-17-0790","article-title":"Cancer screening recommendations and clinical management of inherited gastrointestinal cancer syndromes in childhood","volume":"23","author":"Achatz","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B46","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1158\/1078-0432.CCR-17-0652","article-title":"Retinoblastoma and neuroblastoma predisposition and surveillance","volume":"23","author":"Kamihara","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B47","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.1158\/1078-0432.CCR-17-0428","article-title":"Recommendations for surveillance for children with leukemia-predisposing conditions","volume":"23","author":"Porter","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B48","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1158\/1078-0432.CCR-17-0574","article-title":"Clinical management and tumor surveillance recommendations of inherited mismatch repair deficiency in childhood","volume":"23","author":"Tabori","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1158\/1078-0432.CCR-17-0631","article-title":"Recommendations for cancer surveillance in individuals with RASopathies and other rare genetic conditions with increased cancer risk","volume":"23","author":"Villani","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1158\/1078-0432.CCR-17-0548","article-title":"Multiple endocrine neoplasia and hyperparathyroid-jaw tumor syndromes: clinical features, genetics, and surveillance recommendations in childhood","volume":"23","author":"Wasserman","year":"2017","journal-title":"Clin Cancer Res"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1038\/s41431-020-00709-5","article-title":"Cancer surveillance for individuals with Li-Fraumeni syndrome","volume":"28","author":"Kratz","year":"2020","journal-title":"Eur J Hum Genet"},{"key":"B52","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1136\/jmg-2022-108829","article-title":"High yield of surveillance in patients diagnosed with constitutional mismatch repair deficiency","volume":"60","author":"Ghorbanoghli","year":"2023","journal-title":"J Med Genet"},{"key":"B53","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00520-024-08370-0","article-title":"Facing life-threat during youth: a qualitative study on challenges, coping, and needs among adolescents and young adults with cancer","volume":"32","author":"Wilharm","year":"2024","journal-title":"Support Care Cancer"},{"key":"B54","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1016\/j.ijnurstu.2012.09.002","article-title":"Communicating inherited genetic risk between parent and child: a meta-thematic synthesis","volume":"50","author":"Rowland","year":"2013","journal-title":"Int J Nurs Stud"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1859","article-title":"Health-related quality of life and fear of progression in individuals with Li-Fraumeni syndrome","author":"Kiermeier","year":"2024","journal-title":"J Genet Couns"},{"key":"B56","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1007\/s10689-010-9368-z","article-title":"Regular surveillance for Li-Fraumeni syndrome: advice, adherence and perceived benefits","volume":"9","author":"Lammens","year":"2010","journal-title":"Fam Cancer"},{"key":"B57","doi-asserted-by":"publisher","first-page":"e29021","DOI":"10.1002\/pbc.29021","article-title":"Tumor surveillance for children and adolescents with cancer predisposition syndromes: the psychosocial impact reported by adolescents and caregivers","volume":"68","author":"van Engelen","year":"2021","journal-title":"Pediatr Blood Cancer"},{"key":"B58","doi-asserted-by":"publisher","first-page":"e27445","DOI":"10.1002\/pbc.27445","article-title":"A change in perspective\": exploring the experiences of adolescents with hereditary tumor predisposition","volume":"66","author":"Weber","year":"2019","journal-title":"Pediatr Blood Cancer"},{"key":"B59","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s10689-009-9294-0","article-title":"The challenge of developmentally appropriate care: predictive genetic testing in young people for familial adenomatous polyposis","volume":"9","author":"Duncan","year":"2010","journal-title":"Fam Cancer"},{"key":"B60","doi-asserted-by":"publisher","first-page":"3008","DOI":"10.1200\/JCO.2009.27.2112","article-title":"Genetic testing in Li-Fraumeni syndrome: uptake and psychosocial consequences","volume":"28","author":"Lammens","year":"2010","journal-title":"J Clin Oncol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/j.1399-0004.2010.01333.x","article-title":"Psychosocial impact of Von Hippel-Lindau disease: levels and sources of distress","volume":"77","author":"Lammens","year":"2010","journal-title":"Clin Genet"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1410061\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T10:16:39Z","timestamp":1721384199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1410061\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,3]]},"references-count":61,"alternative-id":["10.3389\/fped.2024.1410061"],"URL":"https:\/\/doi.org\/10.3389\/fped.2024.1410061","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,3]]},"article-number":"1410061"}}