{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T03:53:06Z","timestamp":1776916386181,"version":"3.51.2"},"reference-count":55,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T00:00:00Z","timestamp":1573084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71774178"],"award-info":[{"award-number":["71774178"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012245","name":"Science and Technology Planning Project of Guangdong Province","doi-asserted-by":"publisher","award":["2017A020212006"],"award-info":[{"award-number":["2017A020212006"]}],"id":[{"id":"10.13039\/501100012245","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010256","name":"Guangzhou Municipal Science and Technology Project","doi-asserted-by":"publisher","award":["201607010368"],"award-info":[{"award-number":["201607010368"]}],"id":[{"id":"10.13039\/501100010256","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Community-based integrated interventions for the prevention and control of AIDS, hepatitis B and tuberculosis in Guangdong, China","award":["2018ZX10715004"],"award-info":[{"award-number":["2018ZX10715004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Methadone maintenance treatment (MMT) is an important approach to address opioid dependence. However, MMT clinics usually report high attrition rates. Our previous randomized controlled trial demonstrated additional psycho-social services delivered by social workers could reduce attrition rates compared to MMT alone. This study aimed to evaluate the effectiveness of psycho-social service in a real-world context. A quasi-experimental design and propensity score matching was adopted. 359 clients were recruited from five MMT clinics in Guangzhou from July 2013 to April 2015. One 20-minute counseling session was offered to the control group after enrolment. The intervention group received six sessions of psycho-social services. The baseline characteristics were unbalanced between two arms in the original sample. After propensity score matching, 248 participants remained in the analysis. At month six, the intervention group had a lower attrition rate [intervention (39.5%) versus control (52.4%), P = 0.041], higher monthly income [monthly income of 1000 CNY or higher: intervention (55.9%) versus control (39.0%), P = 0.028)], higher detoxification intention score [full intention score: intervention (51.6%) versus control (32.5%), P = 0.012)], higher family support in MMT participation [intervention (77.9%) versus control (61.4%), P = 0.049)]. This study demonstrated that psycho-social services delivered by social workers can reduce MMT clients\u2019 attrition and improve their well-being in real-world settings.<\/jats:p>","DOI":"10.3390\/ijerph16224337","type":"journal-article","created":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T11:17:25Z","timestamp":1573125445000},"page":"4337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3946-3892","authenticated-orcid":false,"given":"Xiaoyan","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huifang","family":"Xu","sequence":"additional","affiliation":[{"name":"Guangzhou Centre for Disease Prevention and Control, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2853-7769","authenticated-orcid":false,"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Project-China, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph T.F.","family":"Lau","sequence":"additional","affiliation":[{"name":"Centre for Medical Anthropology and Behavioural Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9571-7359","authenticated-orcid":false,"given":"Jinghua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuteng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Guangzhou Centre for Disease Prevention and Control, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8024-5312","authenticated-orcid":false,"given":"Yuantao","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-2339","authenticated-orcid":false,"given":"Jing","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"},{"name":"Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,7]]},"reference":[{"key":"ref_1","unstructured":"Ritchie, H., and Roser, M. (2019, October 29). Drug Use. Available online: https:\/\/ourworldindata.org\/drug-use."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/2046-4053-3-105","article-title":"The effectiveness of opioid substitution treatments for patients with opioid dependence: A systematic review and multiple treatment comparison protocol","volume":"3","author":"Dennis","year":"2014","journal-title":"Syst. Rev."},{"key":"ref_3","first-page":"347","article-title":"Methadone maintenance treatment (MMT): A review of historical and clinical issues","volume":"67","author":"Joseph","year":"2000","journal-title":"Mt. Sinai J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mattick, R.P., Breen, C., Kimber, J., and Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD002209.pub2"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0140-6736(98)05356-2","article-title":"Role of maintenance treatment in opioid dependence","volume":"353","author":"Ward","year":"1999","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e445","DOI":"10.1016\/S2352-3018(15)00129-0","article-title":"Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: An observational cohort study","volume":"2","author":"Ahamad","year":"2015","journal-title":"Lancet HIV"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e005997","DOI":"10.1136\/bmjopen-2014-005997","article-title":"Methadone maintenance treatment programme reduces criminal activity and improves social well-being of drug users in China: A systematic review and meta-analysis","volume":"5","author":"Sun","year":"2015","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.drugalcdep.2008.01.015","article-title":"Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in 2694 patients","volume":"95","author":"Wittchen","year":"2008","journal-title":"Drug Alcohol Depend."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"551","DOI":"10.3109\/00952990.2012.694516","article-title":"A national study of the retention of Irish opiate users in methadone substitution treatment","volume":"38","author":"Mullen","year":"2012","journal-title":"Am. J. Drug Alcohol Abus."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.drugalcdep.2009.09.013","article-title":"15-Year survival and retention of patients in a general hospital-affiliated methadone maintenance treatment (MMT) center in Israel","volume":"107","author":"Peles","year":"2010","journal-title":"Drug Alcohol Depend."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1080\/08897077.2014.899944","article-title":"Trends in substance abuse and infectious disease over 20 years in a large methadone maintenance treatment (MMT) clinic in Israel","volume":"35","author":"Peles","year":"2014","journal-title":"Subst. Abus."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1093\/cid\/ciu382","article-title":"Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: A retrospective cohort study","volume":"59","author":"Lambdin","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","first-page":"e29121","article-title":"Predictors of One-Year Retention in Methadone Maintenance Treatment (MMT) in Iran, Rafsanjan","volume":"5","author":"Torkashvand","year":"2016","journal-title":"Int. J. High Risk Behav. Addict."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.drugalcdep.2014.09.776","article-title":"Retention and its predictors among methadone maintenance treatment clients in China: A six-year cohort study","volume":"145","author":"Cao","year":"2014","journal-title":"Drug Alcohol Depend."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, L., Chow, E.P., Zhuang, X., Liang, Y., Wang, Y., Tang, C., Ling, L., Tucker, J.D., and Wilson, D.P. (2013). Methadone maintenance treatment participant retention and behavioural effectiveness in China: A systematic review and meta-analysis. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0068906"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.addbeh.2013.09.001","article-title":"Retention in methadone maintenance treatment in mainland China, 2004\u20132012: A literature review","volume":"39","author":"Zhou","year":"2014","journal-title":"Addict. Behav."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Effective Medical Treatment of Opiate Addiction (1998). National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. JAMA, 280, 1936\u20131943.","DOI":"10.1001\/jama.280.22.1936"},{"key":"ref_18","unstructured":"World Health Organization (2009). Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence, World Health Organization."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/10550490290088063","article-title":"Need for medical and psychosocial services among injection drug users: A comparative study of needle exchange and methadone maintenance","volume":"11","author":"Stein","year":"2002","journal-title":"Am. J. Addict."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1001\/jama.1993.03500150065028","article-title":"The effects of psychosocial services in substance abuse treatment","volume":"269","author":"McLellan","year":"1993","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Amato, L., Minozzi, S., Davoli, M., and Vecchi, S. (2011). Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD004147.pub4"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, L., Wei, X., Wang, X., Li, J., Li, H., and Jia, W. (2014). Long-term effects of methadone maintenance treatment with different psychosocial intervention models. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087931"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3389\/fpsyt.2018.00113","article-title":"Educational and Behavioral Counseling in a Methadone Maintenance Treatment Program in China: A Randomized Controlled Trial","volume":"9","author":"Liu","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.drugalcdep.2007.11.021","article-title":"A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification","volume":"94","author":"Gruber","year":"2008","journal-title":"Drug Alcohol Depend."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/00981389.2015.1058311","article-title":"Prolonged Exposure for Treating PTSD Among Female Methadone Patients Who Were Survivors of Sexual Abuse in Israel","volume":"54","author":"Schiff","year":"2015","journal-title":"Soc. Work Health Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1111\/j.1360-0443.2011.03490.x","article-title":"Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China","volume":"106","author":"Hser","year":"2011","journal-title":"Addiction"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/j.1360-0443.2012.04020.x","article-title":"An intervention targeting service providers and clients for methadone maintenance treatment in China: A cluster-randomized trial","volume":"108","author":"Li","year":"2013","journal-title":"Addiction"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.drugpo.2009.09.002","article-title":"Challenges in providing services in methadone maintenance therapy clinics in China: Service providers\u2019 perceptions","volume":"21","author":"Lin","year":"2010","journal-title":"Int. J. Drug Policy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.puhe.2007.02.017","article-title":"A humble service that has delivered public health good","volume":"121","author":"Lee","year":"2007","journal-title":"Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e015524","DOI":"10.1136\/bmjopen-2016-015524","article-title":"Trends and factors in human immunodeficiency virus and\/or hepatitis C virus testing and infection among injection drug users newly entering methadone maintenance treatment in Guangdong Province, China 2006\u20132013: A consecutive cross sectional study","volume":"7","author":"Liu","year":"2017","journal-title":"BMJ Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1007\/s10461-012-0393-9","article-title":"A randomized controlled trial to evaluate the relative efficacy of the addition of a psycho-social intervention to standard-of-care services in reducing attrition and improving attendance among first-time users of methadone maintenance treatment in China","volume":"17","author":"Gu","year":"2013","journal-title":"AIDS Behav."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1111\/j.1360-0443.2012.03859.x","article-title":"Misconceptions predict dropout and poor adherence prospectively among newly admitted first-time methadone maintenance treatment clients in Guangzhou, China","volume":"107","author":"Gu","year":"2012","journal-title":"Addiction"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1080\/03630241003601137","article-title":"Mental health and interpersonal factors associated with HIV-related risk behaviors among non-institutionalized female injection drug users who are also sex workers in China","volume":"50","author":"Gu","year":"2010","journal-title":"Women Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1080\/03630242.2017.1353571","article-title":"Anticipated suicidal ideation among female injecting drug users who are sex workers of negative or unknown HIV status in China","volume":"58","author":"Lau","year":"2018","journal-title":"Women Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s40520-015-0401-9","article-title":"Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai","volume":"28","author":"Shou","year":"2016","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s11136-004-0704-3","article-title":"Is the standard SF-12 health survey valid and equivalent for a Chinese population?","volume":"14","author":"Lam","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/j.1465-3362.2009.00157.x","article-title":"Predictors of early dropout in methadone maintenance treatment program in Yunnan province, China","volume":"29","author":"Che","year":"2010","journal-title":"Drug Alcohol Rev."},{"key":"ref_38","first-page":"1230","article-title":"Predictors of retention related factors at the initial methadone maintenance treatment clinics in Guangdong province","volume":"30","author":"Chen","year":"2009","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref_39","first-page":"672","article-title":"Study on the time of retention and related influencing factors of patients receiving methadone maintenance treatment in Hunan province","volume":"30","author":"Li","year":"2009","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/sim.5984","article-title":"The use of propensity score methods with survival or time-to-event outcomes: Reporting measures of effect similar to those used in randomized experiments","volume":"33","author":"Austin","year":"2014","journal-title":"Stat. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1161\/CIRCOUTCOMES.108.790634","article-title":"Primer on statistical interpretation or methods report card on propensity-score matching in the cardiology literature from 2004 to 2006: A systematic review","volume":"1","author":"Austin","year":"2008","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jclinepi.2014.08.011","article-title":"Reporting of covariate selection and balance assessment in propensity score analysis is suboptimal: A systematic review","volume":"68","author":"Ali","year":"2015","journal-title":"J. Clin. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1214\/09-STS313","article-title":"Matching methods for causal inference: A review and a look forward","volume":"25","author":"Stuart","year":"2010","journal-title":"Stat. Sci."},{"key":"ref_44","unstructured":"IBM Corp (2011). IBM SPSS Statistics for Windows, Version 20.0., IBM Corp."},{"key":"ref_45","unstructured":"R Core Team (2019). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_46","unstructured":"StataCorp (2011). Stata Statistical Software: Release 12, StataCorp LP."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.drugalcdep.2018.07.019","article-title":"Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island: Safety, dose, retention, and relapse at 6 months","volume":"192","author":"Stone","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s11845-015-1314-5","article-title":"Demographic and clinical factors predicting retention in methadone maintenance: Results from an Irish cohort","volume":"185","author":"Darker","year":"2016","journal-title":"Ir J. Med. Sci."},{"key":"ref_49","first-page":"896","article-title":"Effectiveness of Relapse Prevention Cognitive-Behavioral Model in Opioid-Dependent Patients Participating in the Methadone Maintenance Treatment in Iran","volume":"42","author":"Pashaei","year":"2013","journal-title":"Iran. J. Public Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.1097\/01.aids.0000304704.71917.64","article-title":"Effectiveness of first eight methadone maintenance treatment clinics in China","volume":"21","author":"Pang","year":"2007","journal-title":"AIDS"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2018.04.029","article-title":"Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies","volume":"191","author":"Gauthier","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1080\/10826084.2017.1298619","article-title":"Characteristics and Outcome of Male and Female Methadone Maintenance Patients: MMT in Tel Aviv and Las Vegas","volume":"53","author":"Adelson","year":"2018","journal-title":"Subst. Use Misuse"},{"key":"ref_53","first-page":"e19601","article-title":"Risk Factors of Hepatitis C Virus Infection in Drug Users from Eleven Methadone Maintenance Treatment Clinics in Xi\u2019an, China","volume":"14","author":"Xiaoli","year":"2014","journal-title":"Hepat. Mon."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.4088\/JCP.17f11446","article-title":"Propensity Score Matching in Nonrandomized Studies: A Concept Simply Explained Using Antidepressant Treatment During Pregnancy as an Example","volume":"78","author":"Andrade","year":"2017","journal-title":"J. Clin. Psychiatry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1053\/j.jfas.2017.01.013","article-title":"Propensity Score Matching: Retrospective Randomization?","volume":"56","author":"Jupiter","year":"2017","journal-title":"J. Foot Ankle Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/22\/4337\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:32:32Z","timestamp":1760189552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/22\/4337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,7]]},"references-count":55,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["ijerph16224337"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16224337","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,7]]}}}