{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:14:03Z","timestamp":1785428043440,"version":"3.56.0"},"reference-count":57,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Regional Government of Andalusia, Spain","award":["P21_00227"],"award-info":[{"award-number":["P21_00227"]}]},{"award":["P21_00227"],"award-info":[{"award-number":["P21_00227"]}],"id":[{"id":"https:\/\/ror.org\/02nkg1w23","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Spanish Ministry of Universities","award":["22\/00430"],"award-info":[{"award-number":["22\/00430"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Post-COVID-19 syndrome (PCS) is frequently accompanied by pain, which may coexist with alterations in multiple health domains. However, pain in PCS has rarely been explored from a multidimensional approach combining subjective and objective measures. Objective: To describe pain in subjects with PCS using pain intensity and the pressure pain threshold (PPT), and to examine the associations between these measures and descriptive characteristics as well as health status. Methods: A cross-sectional observational study was conducted in 45 previously hospitalised adults with PCS. Pain intensity was assessed using the visual analogue scale and PPT was assessed by algometry. Health status included fatigue, dyspnoea, anxiety, depression, quality of life, functionality, frailty, physical activity, muscle quality, muscle strength, physical performance, and functional capacity. Analyses were conducted using SPSS v30.0. Results: Participants showed moderate pain intensity and variability in PPT, with a significant inverse association between both measures. Bivariate analyses showed that higher pain intensity and lower PPT were associated with worse physical, psychological, and functional outcomes. In regression analyses, pain intensity was associated with sex, length of hospital stay, PPT, and quality of life; PPT was associated with sex, pain intensity, and grip strength. Model explanatory capacity varied, and some models were not statistically significant. Conclusions: Subjects with PCS exhibited moderate pain intensity and variability in pain sensitivity, with an association between subjective and objective pain measures. Pain measures were associated with multiple health domains at the bivariate level, while regression analyses identified a limited number of associations with variable explanatory capacity. These findings support comprehensive pain assessment in PCS.<\/jats:p>","DOI":"10.3390\/diagnostics16132023","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T08:45:20Z","timestamp":1782722720000},"page":"2023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterising Pain in Post-COVID-19 Syndrome: An Observational Study of Intensity and Sensitivity"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3391-6966","authenticated-orcid":false,"given":"Laura","family":"P\u00e9rez-Gisbert","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7674-1150","authenticated-orcid":false,"given":"Gregory","family":"Reychler","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Occupational Therapy, Saint-Luc University Clinics, 1200 Brussels, Belgium"},{"name":"Institute of Experimental and Clinical Research (IREC), Pulmonology, ENT and Dermatology Cluster (LuNS, Lung-Nose-Skin), Catholic University of Louvain (UCLouvain), 1200 Brussels, Belgium"},{"name":"Department of Pulmonology, Saint-Luc University Clinics, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Brea-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concepci\u00f3n","family":"Morales-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Virgen de las Nieves University Hospital, 18014 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-1307","authenticated-orcid":false,"given":"Marie C.","family":"Valenza","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5459-230X","authenticated-orcid":false,"given":"Irene","family":"Torres-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","unstructured":"National Institute for Health and Care Excellence (2026, March 01). COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19 (NG188). Available online: https:\/\/www.nice.org.uk\/guidance\/ng188\/resources\/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-66142028400325."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/j.pain.0000000000002711","article-title":"A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: A survey study","volume":"164","author":"Haider","year":"2023","journal-title":"Pain"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jennings, G., Monaghan, A., Xue, F., Mockler, D., and Romero-Ortu\u00f1o, R. (2021). A systematic review of persistent symptoms and residual abnormal functioning following acute COVID-19: Ongoing symptomatic phase vs. post-COVID-19 syndrome. J. Clin. Med., 10.","DOI":"10.1101\/2021.06.25.21259372"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/jmv.27309","article-title":"Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis","volume":"94","author":"Malik","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_5","unstructured":"Office for National Statistics (2026, March 17). Self-Reported Long COVID Symptoms, UK: Statistical Bulletin, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/selfreportedlongcovidsymptomsuk\/10july2023."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"436","DOI":"10.46497\/ArchRheumatol.2024.9990","article-title":"Neuropathic component of chronic musculoskeletal pain in patients with post-COVID-19: A cross-sectional study","volume":"39","author":"Atalay","year":"2024","journal-title":"Arch. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Calvache-Mateo, A., L\u00f3pez-L\u00f3pez, L., Mart\u00edn-N\u00fa\u00f1ez, J., Heredia-Ciur\u00f3, A., Granados-Santiago, M., Ortiz-Rubio, A., and Valenza, M.C. (2023). Pain and clinical presentation: A cross-sectional study of patients with new-onset chronic pain in long-COVID-19 syndrome. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054049"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e989","DOI":"10.1097\/j.pain.0000000000002564","article-title":"Prevalence and risk factors of musculoskeletal pain symptoms as long-term post-COVID sequelae in hospitalized COVID-19 survivors: A multicenter study","volume":"163","author":"Cuadrado","year":"2022","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/2348-8093.169965","article-title":"Measuring pain in clinical trials: Pain scales, endpoints, and challenges","volume":"2","author":"Bhardwaj","year":"2015","journal-title":"Int. J. Clin. Exp. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/003655099444597","article-title":"Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry","volume":"31","author":"Kosek","year":"1999","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1002\/ueg2.12668","article-title":"Impact of pain, fatigue and bowel incontinence on the quality of life of people living with inflammatory bowel disease: A UK cross-sectional survey","volume":"13","author":"Roukas","year":"2025","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"103273","DOI":"10.1016\/j.msksp.2025.103273","article-title":"Determinants of sleep quality in individuals with musculoskeletal pain and its effects on fatigue, attention, cognition, and physical performance","volume":"76","author":"Coksever","year":"2025","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103873","DOI":"10.1016\/j.ijnurstu.2021.103873","article-title":"Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study","volume":"117","author":"Liu","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Elman, I., and Borsook, D. (2018). Threat response system: Parallel brain processes in pain vis-\u00e0-vis fear and anxiety. Front. Psychiatry, 9.","DOI":"10.3389\/fpsyt.2018.00029"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Marchand, S. (2021). Mechanisms challenges of the pain phenomenon. Front. Pain Res., 1.","DOI":"10.3389\/fpain.2020.574370"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1002\/ejp.2095","article-title":"Precision management of post-COVID pain: An evidence- and clinical-based approach","volume":"27","author":"Nijs","year":"2023","journal-title":"Eur. J. Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000521288","article-title":"Charlson Comorbidity Index: A critical review of Clinimetric Properties","volume":"91","author":"Charlson","year":"2022","journal-title":"Psychother. Psychosom."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0895-4356(02)00585-1","article-title":"How to measure comorbidity. A critical review of available methods","volume":"56","author":"Beckerman","year":"2003","journal-title":"J. Clin. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S0895-4356(97)00050-4","article-title":"Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data","volume":"50","author":"Newschaffer","year":"1997","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","first-page":"394","article-title":"Validity and reliability of visual analogue scale (VAS) for pain measurement","volume":"2","author":"Begum","year":"2019","journal-title":"J. Med. Case Rep. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.rmed.2012.03.011","article-title":"Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD","volume":"106","author":"Johansson","year":"2012","journal-title":"Respir. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1519\/JSC.0b013e31818f051c","article-title":"Reliability and validity of a pressure algometer","volume":"23","author":"Kinser","year":"2009","journal-title":"J. Strength Cond. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.6018\/eglobal.16.2.255821","article-title":"Estructura factoral y consistencia interna de la Escala de severidad de fatiga en poblaci\u00f3n colombiana con enfermedades cr\u00f3nicas","volume":"16","year":"2017","journal-title":"Enferm. Glob."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1136\/thx.2009.118521","article-title":"Quantification of dyspnoea using descriptors: Development and initial testing of the Dyspnoea-12","volume":"65","author":"Yorke","year":"2010","journal-title":"Thorax"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.arbr.2017.08.015","article-title":"Translation and Validation of the Multidimensional Dyspnea-12 Questionnaire","volume":"54","year":"2018","journal-title":"Arch. Bronconeumol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_29","first-page":"494","article-title":"Hospital Anxiety and Depression Scale (HADS) review in Spanish samples","volume":"31","year":"2015","journal-title":"An. Psicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1023\/A:1008894502042","article-title":"Using the EuroQoL-5-D in the Catalan general population: Feasibility and construct validity","volume":"7","author":"Badia","year":"1998","journal-title":"Qual. Life Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2001494","DOI":"10.1183\/13993003.01494-2020","article-title":"The Post-COVID-19 Functional Status scale: A tool to measure functional status over time after COVID-19","volume":"56","author":"Klok","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_32","first-page":"1000070","article-title":"Validation of the Post-COVID-19 functional status scale into Mexican-Spanish","volume":"4","year":"2021","journal-title":"J. Rehabil. Med. Clin. Commun."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/BF02982161","article-title":"The I.A.N.A Task Force on frailty assessment of older people in clinical practice","volume":"12","author":"Rolland","year":"2008","journal-title":"J. Nutr. Health Aging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.annepidem.2016.07.006","article-title":"The muscle quality index and mortality among males and females","volume":"26","author":"Brown","year":"2016","journal-title":"Ann. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"123","DOI":"10.2114\/jpa2.28.123","article-title":"Sit-to-stand test to evaluate knee extensor muscle size and strength in the elderly: A novel approach","volume":"28","author":"Takai","year":"2009","journal-title":"J. Physiol. Anthropol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jbmt.2019.05.029","article-title":"Measurement of hand grip strength in the elderly: A scoping review with recommendations","volume":"24","author":"Mehmet","year":"2020","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mentiplay, B.F., Perraton, L.G., Bower, K.J., Adair, B., Pua, Y.H., Williams, G.P., McGaw, R., and A Clark, R. (2015). Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0140822"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1056\/NEJM199503023320902","article-title":"Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability","volume":"332","author":"Guralnik","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1016\/j.apmr.2014.03.034","article-title":"Psychometric properties of 2-minute walk test: A systematic review","volume":"95","author":"Pin","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","unstructured":"Alpar, R. (2012). Applied Statistics and Validity-Reliability with SPSS, Detay Publishing."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.2307\/2290095","article-title":"Statistical Power Analysis for the Behavioral Sciences (2nd ed.)","volume":"84","author":"Lachenbruch","year":"1989","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_44","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_45","unstructured":"Hulley, S.B., Cummings, S.R., Browner, W.S., Grady, D.G., and Newman, T.B. (2022). Designing Clinical Research, Wolters Kluwer. [5th ed.]."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"37","DOI":"10.22158\/wjssr.v3n1p37","article-title":"Sample size guideline for correlation analysis","volume":"3","author":"Bujang","year":"2016","journal-title":"World J. Soc. Sci. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3820","DOI":"10.1111\/ene.15040","article-title":"Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: A meta-analysis of the current literature","volume":"28","author":"Cuadrado","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Bileviciute-Ljungar, I., Norrefalk, J.R., and Borg, K. (2022). Pain burden in post-COVID-19 syndrome following mild COVID-19 infection. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030771"},{"key":"ref_49","first-page":"100037","article-title":"Correlations among algometry, the visual analogue scale, and the numeric rating scale to assess chronic pelvic pain in women","volume":"3","author":"Alfonsin","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol. X"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-de-las-Pe\u00f1as, C., Fuensalida-Novo, S., Ortega-Santiago, R., Valera-Calero, J.A., Cesc\u00f3n, C., Derboni, M., Giuffrida, V., and Barbero, M. (2022). Pain extent is not associated with sensory-associated symptoms, cognitive or psychological variables in post-COVID-19 survivors suffering from post-COVID pain. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154633"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Goudman, L., De Smedt, A., Roggeman, S., Fern\u00e1ndez-de-las-Pe\u00f1as, C., Hatem, S.M., Schiltz, M., Billot, M., Roulaud, M., Rigoard, P., and Moens, M. (2023). Associations between Experimental Pain Measurements and the Central Sensitization Inventory in Patients at Least 3 Months after COVID-19 Infection: A Cross-Sectional Pilot Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020661"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.bbi.2021.12.020","article-title":"Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis","volume":"101","author":"Ceban","year":"2022","journal-title":"Brain Behav. Immun."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"101019","DOI":"10.1016\/j.eclinm.2021.101019","article-title":"Characterizing long COVID in an international cohort: 7 months of symptoms and their impact","volume":"38","author":"Davis","year":"2021","journal-title":"eClinicalMedicine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2536203","DOI":"10.1080\/07853890.2025.2536203","article-title":"Exploring the interplay between pain processing mechanisms, psychosocial factors, and functional outcomes in patients with chronic low back pain: An exploratory study","volume":"57","author":"Arguisuelas","year":"2025","journal-title":"Ann. Med."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Eller-Smith, O.C., Nicol, A.L., and Christianson, J.A. (2018). Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front. Cell. Neurosci., 12.","DOI":"10.3389\/fncel.2018.00035"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.jpain.2016.10.018","article-title":"Demographic Predictors of Pain Sensitivity: Results From the OPPERA Study","volume":"18","author":"Ostrom","year":"2017","journal-title":"J. Pain"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"105530","DOI":"10.1016\/j.jpain.2025.105530","article-title":"Patterns of pain perception in individuals with anxiety or depressive disorders: A systematic review and meta-analysis of experimental pain research","volume":"35","author":"Chimenti","year":"2025","journal-title":"J. Pain"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2023\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:27:32Z","timestamp":1782725252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":57,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132023"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132023","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}