{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:09:57Z","timestamp":1791972597979,"version":"4.3.4"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The epidemiology of pediatric respiratory tract infections (RTIs) has shifted since the COVID-19 pandemic. This study aimed to characterize the prevalence and co-infection patterns of seven key respiratory pathogens in children in Eastern China following the relaxation of pandemic-related non-pharmaceutical interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a large-scale, retrospective study involving pediatric patients aged under 18 years who presented with symptoms of acute respiratory tract infection (RTI) to a tertiary academic children's hospital between April 2,023 and March 2,024. Nasopharyngeal or oropharyngeal swab specimens were collected and tested using multiplex reverse transcription polymerase chain reaction (RT-PCR) for seven common respiratory pathogens:\n                      <jats:italic>Mycoplasma pneumoniae (M. pneumoniae)<\/jats:italic>\n                      , adenovirus (ADV), influenza A virus (IAV), influenza B virus (IBV), human rhinovirus (HRV), respiratory syncytial virus (RSV), and SARS-CoV-2. Stratified analyses were performed across four predefined age groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pathogen distribution showed distinct age-related patterns. Among high-risk pathogens, infants with RSV infection were the most common. Conversely, IAV and\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      prevalence rose with age. Infants with IAV infection increased from 1,925 (9.1%) to 18,930 (17.5%) in school-age children with IAV infection, while Infants with\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      infection surged from 2,812 (13.3%) to a peak of 48,284 (44.6%) in the oldest group with\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      infection. For lower-risk pathogens, Children with ADV infection and those with IBV infection also increased steadily with age, reaching 20,661 (19.1%) and 11,574 (10.7%) respectively in school-age children. Toddlers with HRV infection peaked at 7,501 (14.0%), while Infants with SARS-CoV-2 infection were the most common (5,244, 24.8%), followed by school-age children with SARS-CoV-2 infection (12,331, 11.4%). Co-infections were significant, with children with\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      infection being the most likely to have co-infections\u2014frequently paired with HRV infection (2,143 children), ADV infection (1,100 children), and IAV infection (1,063 children).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      The distinct epidemiological patterns and high rates of co-infection highlight the need for age-specific prevention strategies. The significant role of\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      in both single and co-infections underscores the clinical utility of multiplex diagnostics to guide appropriate antimicrobial stewardship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals significant age-dependent variations and high co-infection rates for seven respiratory pathogens in a large pediatric cohort. These findings are crucial for informing public health policies and optimizing the clinical management of pediatric RTIs in the post-pandemic era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1694989","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:58:23Z","timestamp":1773817103000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiological characteristics of single and co-infections with upper respiratory tract pathogens among children in eastern China: a retrospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"Ruizhe","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianglong","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nannan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Public Health, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e70011","DOI":"10.1111\/crj.70011","article-title":"Epidemiological characteristics of upper respiratory tract pathogens in children in Guangdong, China","volume":"18","author":"Zhao","year":"2024","journal-title":"Clin Respir J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"5026","DOI":"10.1038\/s41467-021-25120-6","article-title":"Etiological and epidemiological features of acute respiratory infections in China","volume":"12","author":"Li","year":"2021","journal-title":"Nat Commun"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11908-020-0711-8","article-title":"Respiratory virus co-infection in acute respiratory infections in children","volume":"22","author":"Meskill","year":"2020","journal-title":"Curr Infect Dis Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"30547","DOI":"10.1073\/pnas.2013182117","article-title":"The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections","volume":"117","author":"Baker","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.15585\/mmwr.mm7029a1","article-title":"Changes in influenza and other respiratory virus activity during the COVID-19 pandemic - United States, 2020\u20132021","volume":"70","author":"Olsen","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/j.idnow.2021.05.004","article-title":"Pediatric infectious disease group (gpip) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap?","volume":"51","author":"Cohen","year":"2021","journal-title":"Infect Dis Now"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0136526","DOI":"10.1371\/journal.pone.0136526","article-title":"Viral co-infections in pediatric patients hospitalized with lower tract acute respiratory infections","volume":"10","author":"Cebey-L\u00f3pez","year":"2015","journal-title":"PLoS One"},{"key":"B8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jcv.2016.04.019","article-title":"Respiratory viral coinfection and disease severity in children: a systematic review and meta-analysis","volume":"80","author":"Scotta","year":"2016","journal-title":"J Clin Virol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12866-024-03180-0","article-title":"Molecular epidemiology of Mycoplasma pneumoniae pneumoniae in children, Wuhan, 2020\u20132022","volume":"24","author":"Xu","year":"2024","journal-title":"BMC Microbiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.vhri.2017.04.004","article-title":"Burden of culture-confirmed pediatric pneumococcal pneumoniae in Latin America and the Caribbean: a systematic review and meta-analysis","volume":"14","author":"Bardach","year":"2017","journal-title":"Value Health Reg Iss"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1038\/s41598-025-85229-2","article-title":"Proteomic, metabolomic and lipidomic profiles in community acquired pneumoniae for differentiating viral and bacterial infections","volume":"15","author":"Rischke","year":"2025","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1097\/mop.0000000000001437","article-title":"The challenge of antimicrobial resistance in the Asia-Pacific: a pediatric perspective","volume":"37","author":"Huong","year":"2025","journal-title":"Curr Opin Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"vii","DOI":"10.3310\/hta18060","article-title":"Primary care streptococcal management (prism) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study","volume":"18","author":"Little","year":"2014","journal-title":"Health Technol Assess"},{"key":"B14","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1179\/2047773215y.0000000030","article-title":"Antimicrobial resistance: a global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog Glob Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/s0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3903","DOI":"10.2147\/idr.S234610","article-title":"Antimicrobial resistance: implications and costs","volume":"12","author":"Dadgostar","year":"2019","journal-title":"Infect Drug Resist"},{"key":"B17","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.eimc.2020.01.023","article-title":"Pneumoniae in children: the role of rapid diagnostic tests for virus in antimicrobial stewardship","volume":"38","author":"Prieto","year":"2020","journal-title":"Enferm Infecc Microbiol Clin (Engl Ed)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3390\/bioengineering9040153","article-title":"COVID-19 diagnosis: a review of rapid antigen, rt-pcr and artificial intelligence methods","volume":"9","author":"Aruleba","year":"2022","journal-title":"Bioengineering (Basel)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1111\/cbdd.13761","article-title":"The recent challenges of highly contagious COVID-19, causing respiratory infections: symptoms, diagnosis, transmission, possible vaccines, animal models, and immunotherapy","volume":"96","author":"Mohapatra","year":"2020","journal-title":"Chem Biol Drug Des"},{"key":"B20","doi-asserted-by":"publisher","first-page":"317","DOI":"10.5588\/ijtld.10.0295","article-title":"Accuracy of symptoms and signs in predicting hypoxaemia among young children with acute respiratory infection: a meta-analysis","volume":"15","author":"Zhang","year":"2011","journal-title":"Int J Tuberc Lung Dis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"4337","DOI":"10.1128\/jcm.40.11.4337-4339.2002","article-title":"Nasal swab versus nasopharyngeal aspirate for isolation of respiratory viruses","volume":"40","author":"Heikkinen","year":"2002","journal-title":"J Clin Microbiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3439","DOI":"10.1128\/jcm.00886-09","article-title":"Identification of respiratory viruses in adults: nasopharyngeal versus oropharyngeal sampling","volume":"47","author":"Lieberman","year":"2009","journal-title":"J Clin Microbiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1016\/s0140-6736(10)61459-6","article-title":"Viral pneumoniae","volume":"377","author":"Ruuskanen","year":"2011","journal-title":"Lancet"},{"key":"B24","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12879-016-2118-6","article-title":"Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen","volume":"17","author":"Wishaupt","year":"2017","journal-title":"BMC Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1086\/431588","article-title":"Improved diagnosis of the etiology of community-acquired pneumoniae with real-time polymerase chain reaction","volume":"41","author":"Templeton","year":"2005","journal-title":"Clin Infect Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2812","DOI":"10.1128\/jcm.00556-09","article-title":"Cost analysis of Multiplex pcr testing for diagnosing respiratory virus infections","volume":"47","author":"Mahony","year":"2009","journal-title":"J Clin Microbiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2000045","DOI":"10.2807\/1560-7917.Es.2020.25.3.2000045","article-title":"Detection of 2019 novel coronavirus (2019-ncov) by real-time rt-pcr","volume":"25","author":"Corman","year":"2020","journal-title":"Euro Surveill"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2213","DOI":"10.1128\/jcm.02446-09","article-title":"Comparison of the luminex respiratory virus panel fast assay with in-house real-time pcr for respiratory viral infection diagnosis","volume":"48","author":"Gadsby","year":"2010","journal-title":"J Clin Microbiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e44568","DOI":"10.1371\/journal.pone.0044568","article-title":"High incidence of multiple viral infections identified in upper respiratory tract infected children under three years of age in Shanghai, China","volume":"7","author":"Zhang","year":"2012","journal-title":"PLoS One"},{"key":"B30","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1093\/fampra\/cmi035","article-title":"The prevalence of symptoms and consultations in pre-school children in the avon longitudinal study of parents and children (alspac): a prospective cohort study","volume":"22","author":"Hay","year":"2005","journal-title":"Fam Pract"},{"key":"B31","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1093\/cid\/civ1214","article-title":"Comprehensive molecular testing for respiratory pathogens in community-acquired pneumoniae","volume":"62","author":"Gadsby","year":"2016","journal-title":"Clin Infect Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"309","DOI":"10.3947\/ic.2016.48.4.309","article-title":"Clinical impact of mixed respiratory viral infection in children with adenoviral infection","volume":"48","author":"Lee","year":"2016","journal-title":"Infect Chemother"},{"key":"B33","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1186\/s12879-020-05356-1","article-title":"Impact of viral coinfection and macrolide-resistant Mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumoniae","volume":"20","author":"Zhou","year":"2020","journal-title":"BMC Infect Dis"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e13212","DOI":"10.1111\/irv.13212","article-title":"Interactions among acute respiratory viruses in Beijing, Chongqing, Guangzhou, and Shanghai, China, 2009\u20132019","volume":"17","author":"Madewell","year":"2023","journal-title":"Influenza Respir Viruses"},{"key":"B35","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1093\/infdis\/jiae423","article-title":"Respiratory viral infections from 2015 to 2022 in the hive cohort of American households: incidence, illness characteristics, and seasonality","volume":"231","author":"Monto","year":"2025","journal-title":"J Infect Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3947\/ic.2024.0122","article-title":"Rsv prevention strategies in Korean children: a review of current approaches and emerging options","volume":"57","author":"Kim","year":"2025","journal-title":"Infect Chemother"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2201569","DOI":"10.1183\/13993003.01569-2022","article-title":"New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic","volume":"61","author":"Teirlinck","year":"2023","journal-title":"Eur Respir J"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/s0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","year":"2024","journal-title":"Lancet"},{"key":"B39","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.cmi.2017.08.026","article-title":"What is antimicrobial stewardship?","volume":"23","author":"Dyar","year":"2017","journal-title":"Clin Microbiol Infect"},{"key":"B40","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/s1473-3099(16)00065-7","article-title":"Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis","volume":"16","author":"Schuts","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the society for healthcare epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e1003139","DOI":"10.1371\/journal.pmed.1003139","article-title":"Antibiotic prescription practices in primary care in low- and middle-income countries: a systematic review and meta-analysis","volume":"17","author":"Sulis","year":"2020","journal-title":"PLoS Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/j.cmi.2017.07.010","article-title":"Antibiotic stewardship in low- and middle-income countries: the same but different?","volume":"23","author":"Cox","year":"2017","journal-title":"Clin Microbiol Infect"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e633","DOI":"10.1016\/s2214-109x(16)30142-5","article-title":"Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial","volume":"4","author":"Do","year":"2016","journal-title":"Lancet Glob Health"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e001239","DOI":"10.1136\/bmjgh-2018-001239","article-title":"How to improve antibiotic awareness campaigns: findings of a who global survey","volume":"4","author":"Huttner","year":"2019","journal-title":"BMJ Glob Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"010401","DOI":"10.7189\/jogh.03.010401","article-title":"Epidemiology and etiology of childhood pneumoniae in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries","volume":"3","author":"Rudan","year":"2013","journal-title":"J Glob Health"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1016\/s0140-6736(10)60206-1","article-title":"Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis","volume":"375","author":"Nair","year":"2010","journal-title":"Lancet"},{"key":"B48","doi-asserted-by":"publisher","first-page":"106302","DOI":"10.1016\/j.ijantimicag.2021.106302","article-title":"Large-scale survey of parental antibiotic use for paediatric upper respiratory tract infections in China: implications for stewardship programmes and national policy","volume":"57","author":"Lin","year":"2021","journal-title":"Int J Antimicrob Agents"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e1004211","DOI":"10.1371\/journal.pmed.1004211","article-title":"Inappropriate antibiotic prescribing and its determinants among outpatient children in 3 low- and middle-income countries: a multicentric community-based cohort study","volume":"20","author":"Ardillon","year":"2023","journal-title":"PLoS Med"},{"key":"B50","doi-asserted-by":"publisher","first-page":"ofae445","DOI":"10.1093\/ofid\/ofae445","article-title":"Understanding acceptability and willingness-to-pay for a C-reactive protein point-of-care testing service to improve antibiotic dispensing for respiratory infections in Vietnamese pharmacies: a mixed-methods study","volume":"11","author":"Vinh Nguyen","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1016\/s0140-6736(18)30308-8","article-title":"Laboratory medicine in low-income and middle-income countries: progress and challenges","volume":"391","author":"Nkengasong","year":"2018","journal-title":"Lancet"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e1001552","DOI":"10.1371\/journal.pmed.1001552","article-title":"Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: spatio-temporal modeling of surveillance data","volume":"10","author":"Yu","year":"2013","journal-title":"PLoS Med"},{"key":"B53","doi-asserted-by":"publisher","first-page":"S153","DOI":"10.1093\/infdis\/jis575","article-title":"Twenty-five years of outpatient influenza surveillance in South Africa, 1984\u20132008","volume":"206","author":"McAnerney","year":"2012","journal-title":"J Infect Dis"},{"key":"B54","doi-asserted-by":"publisher","first-page":"e0124122","DOI":"10.1371\/journal.pone.0124122","article-title":"Dynamics of influenza seasonality at sub-regional levels in India and implications for vaccination timing","volume":"10","author":"Chadha","year":"2015","journal-title":"PLoS One"},{"key":"B55","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/14787210.2021.1951705","article-title":"Antimicrobial resistance in low- and middle-income countries: current Status and future directions","volume":"20","author":"Sulis","year":"2022","journal-title":"Expert Rev Anti Infect Ther"},{"key":"B56","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/s1473-3099(18)30547-4","article-title":"Consumption of oral antibiotic formulations for young children according to the who access, watch, reserve (aware) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries","volume":"19","author":"Hsia","year":"2019","journal-title":"Lancet Infect Dis"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1694989\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:58:26Z","timestamp":1773817106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1694989\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":56,"alternative-id":["10.3389\/fped.2026.1694989"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1694989","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"article-number":"1694989"}}