{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:45:51Z","timestamp":1785735951114,"version":"3.56.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute bronchiolitis, mainly attributed to respiratory syncytial virus (RSV), is the leading cause of infant hospitalization for lower respiratory tract disease worldwide. Nirsevimab and maternal RSVpreF (Abrysvo) confer about 6 months of protection, so timing relative to the season affects their impact. Ecuador spans the equator from sea level to valleys above 4,000 m and is considering introducing these products, yet lacks subnational evidence on the seasonality of bronchiolitis, altitudinal patterning, or post-pandemic stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a national ecological time-series analysis of hospital discharges from the Ecuadorian Statistics Institute, 2007\u20132024 (19,788,097 discharges; 204 of 224 cantons had complete data and formed the analytic panel). The primary outcome was acute bronchiolitis (ICD-10 code J21) in children younger than 12 months (\n                      <jats:italic>n<\/jats:italic>\n                      = 23,190 nationally; 22,724 in the panel), with secondary outcomes across three RSV-relevant age bands, ICD-10 code J21 under 5 years, and two RSV-specific ICD-10 codes (J12.1 and J20.5; 2018\u20132024). K35 (appendicitis) was a negative control. Analyses combined circular seasonality metrics with block-bootstrap confidence intervals (CIs), year-by-year disaggregation, and complementary sensitivity analyses [Moving Epidemics Method (MEM), Bai\u2013Perron breaks, and lagged climate correlations].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The weighted circular peak month of infant bronchiolitis hospitalizations shifted after the pandemic in Costa (+2.16 months), Sierra (+1.22), and Amazon\u00eda (+1.91), attenuating with altitude from +2.19 months below 500 m to +0.88 at 1,500\u20133,000 m. Costa was stable across 2022\u20132024; Sierra and, more so, Amazon\u00eda varied widely year to year (Amazon\u00eda peak ranged March\u2013July,\n                      <jats:italic>n<\/jats:italic>\n                      = 37\u201342\/year), so the pooled estimate should be read with caution. The composite RSV-coded outcome tracked ICD-10 code J21's timing closely in Costa (0.15-month difference) and Sierra (0.40), supporting ICD-10 code J21 as a reasonable RSV proxy in both, and the three regional peaks now span 2 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bronchiolitis seasonality in Ecuador changed after the pandemic, most clearly and stably in Costa; Sierra showed a transient 2022 perturbation with partial reversion by 2023\u20132024, and Amazon\u00eda's estimates remained unstable and underpowered. As region-tailored estimates are less stable in Sierra and Amazon\u00eda than in Costa, a single national window (nirsevimab February\u2013April; maternal RSVpreF for pregnancies expected to deliver January\u2013May) is a more defensible starting point, pending confirmation from further seasons and, ideally, laboratory-confirmed surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1892098","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:29:51Z","timestamp":1785734991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional, altitudinal, and age-specific heterogeneity of bronchiolitis hospitalization seasonality in Ecuador, 2007\u20132024, and implications for RSV immunoprophylaxis timing"],"prefix":"10.3389","volume":"14","author":[{"given":"Jaime","family":"Angamarca-Iguago","sequence":"first","affiliation":[{"name":"Center for Evidence Ecosystems, Implementation Science and Decision-Making (CIDES), Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica","place":["Ambato, Ecuador"]},{"name":"TEPHINET","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaen","family":"Cagua-Ord\u00f3\u00f1ez","sequence":"additional","affiliation":[{"name":"Center for Evidence Ecosystems, Implementation Science and Decision-Making (CIDES), Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica","place":["Ambato, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Marcos","family":"Parise-Vasco","sequence":"additional","affiliation":[{"name":"Center for Evidence Ecosystems, Implementation Science and Decision-Making (CIDES), Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica","place":["Ambato, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dom\u00e9nica","family":"de Mora","sequence":"additional","affiliation":[{"name":"National Reference Laboratory for Influenza and Other Respiratory Viruses, INSPI","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Escobar-Naranjo","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n Nacional de Vigilancia Epidemiol\u00f3gica, Ministerio de Salud P\u00fablica del Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Bruno","sequence":"additional","affiliation":[{"name":"National Reference Laboratory for Influenza and Other Respiratory Viruses, INSPI","place":["Guayaquil, Ecuador"]},{"name":"Universidad Agraria del Ecuador","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Simancas-Racines","sequence":"additional","affiliation":[{"name":"Center for Evidence Ecosystems, Implementation Science and Decision-Making (CIDES), Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica","place":["Ambato, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2174\/1573396318666220810161945","article-title":"Respiratory syncytial virus is the most common causative agent of viral bronchiolitis in young children: an updated review","volume":"19","author":"Hon","year":"2023","journal-title":"Curr Pediatr Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/S1473-3099(25)00689-9","article-title":"Global burden of lower respiratory infections and aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023","volume":"26","author":"GBD","year":"2026","journal-title":"Lancet Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/S0140-6736(22)00478-0","article-title":"Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis","volume":"399","author":"Li","year":"2022","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/S0140-6736(17)30938-8","article-title":"Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study","volume":"390","author":"Shi","year":"2017","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1080\/20477724.2022.2038053","article-title":"Global distribution of respiratory syncytial virus A and B infections: a systematic review","volume":"116","author":"Cant\u00fa-Flores","year":"2022","journal-title":"Pathog Glob Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.arbr.2016.03.010","article-title":"Pediatric asthma and viral infection","volume":"52","author":"Garc\u00eda-Garc\u00eda","year":"2016","journal-title":"Arch Bronconeumol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"553","DOI":"10.23736\/S0026-4946.18.05312-4","article-title":"Respiratory syncytial virus","volume":"70","author":"Esposito","year":"2018","journal-title":"Minerva Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13052-022-01392-6","article-title":"UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants","volume":"49","author":"Manti","year":"2023","journal-title":"Ital J Pediatr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1056\/NEJMoa2314885","article-title":"Nirsevimab and Hospitalization for RSV Bronchiolitis","volume":"391","author":"Assad","year":"2024","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1056\/NEJMoa2110275","article-title":"Nirsevimab for prevention of RSV in healthy late-preterm and term infants","volume":"386","author":"Hammitt","year":"2022","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/S2352-4642(22)00321-2","article-title":"Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials","volume":"7","author":"Sim\u00f5es","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1136\/archdischild-2024-327153","article-title":"Effectiveness of nirsevimab immunoprophylaxis against respiratory syncytial virus-related outcomes in hospital and primary care settings: a retrospective cohort study in infants in Catalonia (Spain)","volume":"109","author":"Coma","year":"2024","journal-title":"Arch Dis Childhood"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2634505","DOI":"10.1080\/21645515.2026.2634505","article-title":"Strategies used to improve immunization coverage of nirsevimab in an autonomous community in Spain","volume":"22","author":"Zornoza","year":"2026","journal-title":"Hum Vaccines Immunother"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2658377","DOI":"10.1080\/21645515.2026.2658377","article-title":"Post-licensure safety of nirsevimab from the Canadian National Vaccine Safety (CANVAS) network","volume":"22","author":"Vi\u00f1eta Paramo","year":"2026","journal-title":"Hum Vaccin Immunother"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1056\/NEJMoa2216480","article-title":"Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants","volume":"388","author":"Kampmann","year":"2023","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/S2352-4642(26)00075-1","article-title":"Effectiveness of nirsevimab immunisation after birth versus RSVpreF maternal vaccination in preventing RSV-related hospitalisations in infants: a population-based retrospective cohort study","volume":"10","author":"Valtuille","year":"2026","journal-title":"Lancet Child Adolesc Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"101166","DOI":"10.1016\/j.lana.2025.101166","article-title":"Characterisation of the respiratory syncytial virus seasonality and its environmental factors in the Americas\u2013a multi-country observational study using routine surveillance networks","volume":"48","author":"Couto","year":"2025","journal-title":"Lancet Reg Health Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1753511","DOI":"10.3389\/fpubh.2026.1753511","article-title":"Parra-Rodr\u00edguez E. Zero-inflated and distributed lag nonlinear models with random effects for assessing environmental impacts on respiratory health in peripheral regions of Costa Rica","volume":"14","author":"Chou-Chen","year":"2026","journal-title":"Front Public Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e1005","DOI":"10.1016\/S2214-109X(24)00090-1","article-title":"Respiratory syncytial virus seasonality, transmission zones, and implications for seasonal prevention strategy in China: a systematic analysis","volume":"12","author":"Guo","year":"2024","journal-title":"Lancet Glob Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s41182-026-00972-0","article-title":"Epidemiological trends and seasonality of respiratory syncytial virus infection in children based on sentinel hospital surveillance data","volume":"54","author":"Hu","year":"2026","journal-title":"Tropic Med Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"52362","DOI":"10.1038\/s41598-026-52362-5","article-title":"Clinical and epidemiological changes in severe viral respiratory infections in pediatric patients after the COVID-19 pandemic in Spain","volume":"16","author":"Garc\u00eda-Garc\u00eda","year":"2026","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"eadq3003","DOI":"10.1126\/science.adq3003","article-title":"COVID-19 pandemic interventions reshaped the global dispersal of seasonal influenza viruses","volume":"386","author":"Chen","year":"2024","journal-title":"Science"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1111\/all.70314","article-title":"Risk and protective factors for infection, severe disease, and mortality in epidemic respiratory viruses","volume":"81","author":"Zheng","year":"2026","journal-title":"Allergy"},{"key":"B24","doi-asserted-by":"publisher","first-page":"117445","DOI":"10.1016\/j.diagmicrobio.2026.117445","article-title":"The resurgent threat: human metapneumovirus in a post-pandemic landscape","volume":"116","author":"Ching","year":"2026","journal-title":"Diagn Microbiol Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"114835","DOI":"10.1016\/j.jpeds.2025.114835","article-title":"Sustained increase in pediatric mastoiditis in the post-COVID-19 era: a 9-year interrupted Time-Series Analysis Based on National Data","volume":"289","author":"Furgier","year":"2025","journal-title":"J Pediatr"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e64","DOI":"10.3346\/jkms.2026.41.e64","article-title":"Delayed at the door: impact of pandemic response policies on emergency and critical care in Korea: an interrupted time-series analysis","volume":"41","author":"Sung","year":"2026","journal-title":"J Korean Med Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3390\/epidemiologia7020057","article-title":"Post-pandemic resurgence and seasonal patterns of influenza viruses and respiratory syncytial virus in Arequipa, Peru (2021-2023)","volume":"7","author":"Chipana-Ramos","year":"2026","journal-title":"Epidemiologia"},{"key":"B28","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1111\/irv.12833","article-title":"Transmission of respiratory syncytial virus genotypes in Cali, Colombia","volume":"15","author":"Londo\u00f1o Avenda\u00f1o","year":"2021","journal-title":"Influenza Other Respir Viruses"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e13056","DOI":"10.1111\/irv.13056","article-title":"Etiologies of outpatient medically attended acute respiratory infections among young Ecuadorian children prior to the start of the 2020 SARS-CoV-2 pandemic","volume":"17","author":"Suryadevara","year":"2022","journal-title":"Influenza Other Respi Viruses"},{"key":"B30","doi-asserted-by":"publisher","first-page":"101475","DOI":"10.1016\/j.lana.2026.101475","article-title":"Health care utilization and cost implications of Chile's 2024 nirsevimab strategy for RSV prevention: a counterfactual analysis","volume":"59","author":"Saur\u00e9","year":"2026","journal-title":"Lancet Reg Health Am"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e0010430","DOI":"10.1371\/journal.pntd.0010430","article-title":"Leptospirosis: morbidity, mortality, and spatial distribution of hospitalized cases in Ecuador. A nationwide study 2000-2020","volume":"16","author":"Calvopi\u00f1a","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e0011408","DOI":"10.1371\/journal.pntd.0011408","article-title":"Increasing transmission of dengue virus across ecologically diverse regions of Ecuador and associated risk factors","volume":"18","author":"Katzelnick","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"B33","unstructured":"Quito\n          Instituto Nacional de Estad\u00edstica y Censos\n          Camas y Egresos Hospitalarios\n          \n          2022"},{"key":"B34","unstructured":"Quito\n          Instituto Nacional de Estad\u00edstica y Censos\n          Clasificador geogr\u00e1fico estad\u00edstico\u2013esquema de codificaci\u00f3n de la divisi\u00f3n pol\u00edtico administrativa del pa\u00eds\n          \n          2022"},{"key":"B35","unstructured":"Quito\n          Instituto Nacional de Estad\u00edstica y Censos\n          Proyecciones poblacionales Ecuador 2010-2050\n          \n          2020"},{"key":"B36","author":"Lalangui","year":"2025","journal-title":"Time Series Dataset of Precipitation, Temperature, and Vegetation Index for Ecuador's Parishes, 2005-2024"},{"key":"B37","unstructured":"NOAA\n              Climate Prediction Center\n            \n          \n          Monthly SST indices: Ni\u00f1o 1+2, 3, 3\n          \n          2026"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.1007\/s10096-011-1529-y","article-title":"Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis","volume":"31","author":"Herv\u00e1s","year":"2012","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2719","DOI":"10.1007\/s40121-025-01241-z","article-title":"Estimation of the respiratory syncytial virus hospitalization burden in older adults in the Veneto Region, Italy: a modeling study","volume":"14","author":"Cozzolino","year":"2025","journal-title":"Infect Dis Ther"},{"key":"B42","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1111\/j.1750-2659.2012.00422.x","article-title":"Influenza surveillance in Europe: establishing epidemic thresholds by the moving epidemic method","volume":"7","author":"Vega","year":"2013","journal-title":"Influenza Other Respir Viruses"},{"key":"B43","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1136\/jech.53.4.235","article-title":"Studying seasonality by using sine and cosine functions in regression analysis","volume":"53","author":"Stolwijk","year":"1999","journal-title":"J Epidemiol Community Health"},{"key":"B44","doi-asserted-by":"publisher","first-page":"108741","DOI":"10.1016\/j.ijid.2026.108741","article-title":"Respiratory syncytial virus as an independent driver of a subsequent influenza epidemic in Berlin before and after the COVID-19 pandemic","volume":"168","author":"Terliesner","year":"2026","journal-title":"Int J Infect Dis"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jae.659","article-title":"Computation and analysis of multiple structural change models","volume":"18","author":"Bai","year":"2003","journal-title":"J Appl Econom"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1002\/sim.3940","article-title":"Distributed lag non-linear models","volume":"29","author":"Gasparrini","year":"2010","journal-title":"Stat Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1175\/1520-0442(","article-title":"Blad\u00e9 I. The effective number of spatial degrees of freedom of a time-varying field","volume":"12","author":"Bretherton","year":"1999","journal-title":"J Clim"},{"key":"B48","doi-asserted-by":"publisher","first-page":"100860","DOI":"10.1016\/j.epidem.2025.100860","article-title":"Investigating the impact of non-pharmaceutical interventions (NPIs) on post-pandemic Respiratory Syncytial Virus (RSV) hospitalisations and seasonality in Wales, UK","volume":"53","author":"Santiago","year":"2025","journal-title":"Epidemics"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e70658","DOI":"10.1002\/jmv.70658","article-title":"Rebound of respiratory virus activity and seasonality to pre-pandemic patterns","volume":"97","author":"Gosert","year":"2025","journal-title":"J Med Virol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"4600","DOI":"10.57187\/s.4600","article-title":"Molecular epidemiology of respiratory syncytial virus in Switzerland 2019-2024 from nucleic acid testing and whole-genome sequencing","volume":"155","author":"Kuznetsov","year":"2025","journal-title":"Swiss Med Wkly"},{"key":"B51","doi-asserted-by":"publisher","first-page":"120065","DOI":"10.1016\/j.envres.2024.120065","article-title":"Characterizing the seasonal influenza disease burden attributable to climate variability: a nationwide time-series modelling study in Japan, 2000-2019","volume":"263","author":"Wagatsuma","year":"2024","journal-title":"Environ Res"},{"key":"B52","doi-asserted-by":"publisher","first-page":"114453","DOI":"10.1016\/j.envres.2022.114453","article-title":"The influence of air quality and meteorological variations on influenza A and B virus infections in a paediatric population in Singapore","volume":"216","author":"Seah","year":"2022","journal-title":"Environ Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1892098\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:29:53Z","timestamp":1785734993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1892098\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":52,"alternative-id":["10.3389\/fpubh.2026.1892098"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1892098","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1892098"}}