{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T21:05:41Z","timestamp":1775595941642,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005888","name":"Medical University of Lodz","doi-asserted-by":"publisher","award":["503\/5-108-03\/503-51-001-19-00"],"award-info":[{"award-number":["503\/5-108-03\/503-51-001-19-00"]}],"id":[{"id":"10.13039\/501100005888","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Probiotic therapies and fermented food diets hold promise for improving mental health. Although in this regard psychiatric patients appear to benefit more than healthy individuals, no research has been performed to directly evaluate this hypothesis. The present study examined a cohort of medical students facing a stressful event, and some of the students reported suffering from chronic psychiatric diseases. The amount of fermented food consumption was calculated with the use of seven-day dietary records, while depressive and anxiety symptoms were assessed with the use of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. In psychiatrically healthy medical students under psychological stress (n = 372), higher fermented food consumption was associated with more depressive and anxiety symptoms. In contrast, psychiatrically ill medical students (n = 25, 6.3% of all the participants) were found to present a negative association between the amount of fermented food consumed and the severity of depressive symptoms (adjusted \u03b2 \u22120.52, 95% CI \u22120.85 to \u22120.19, p = 0.0042); however, this relationship was insignificant for anxiety symptoms (adjusted \u03b2 \u22120.22, 95% CI \u22120.59 to 0.15, p = 0.22). A significant interaction was found between the consumption of fermented food and psychiatric diagnosis in predicting depressive symptoms (p = 0.0001), and a borderline significant interaction for anxiety symptoms (p = 0.053). In conclusion, psychiatrically ill people, but not healthy ones, may benefit from fermented food consumption in terms of alleviation of depressive symptoms. Our findings require cautious interpretation and further investigation.<\/jats:p>","DOI":"10.3390\/ijerph19073861","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:05:18Z","timestamp":1648166718000},"page":"3861","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Who Benefits from Fermented Food Consumption? A Comparative Analysis between Psychiatrically Ill and Psychiatrically Healthy Medical Students"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-2736","authenticated-orcid":false,"given":"Micha\u0142 Seweryn","family":"Karbownik","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Toxicology, Medical University of Lodz, \u017beligowskiego 7\/9, 90-752 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1331-8408","authenticated-orcid":false,"given":"\u0141ukasz","family":"Mokros","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Lodz, Kopci\u0144skiego 22, 90-153 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Kowalczyk","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, Medical University of Lodz, \u017beligowskiego 7\/9, 90-752 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1042\/BCJ20160510","article-title":"Introduction to the Human Gut Microbiota","volume":"474","author":"Thursby","year":"2017","journal-title":"Biochem. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1093\/nutrit\/nuy009","article-title":"Relationship between the Gut Microbiome and Brain Function","volume":"76","author":"Mohajeri","year":"2018","journal-title":"Nutr. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1111\/brv.12603","article-title":"The Role of the Microbiome in the Neurobiology of Social Behaviour","volume":"95","author":"Sarkar","year":"2020","journal-title":"Biol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fendo.2020.00025","article-title":"The Role of Short-Chain Fatty Acids from Gut Microbiota in Gut-Brain Communication","volume":"11","author":"Silva","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1093\/advances\/nmz127","article-title":"Tryptophan Metabolism: A Link Between the Gut Microbiota and Brain","volume":"11","author":"Gao","year":"2020","journal-title":"Adv. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"862","DOI":"10.4172\/Neuropsychiatry.1000291","article-title":"Efficacy of Probiotics on Anxiety: A Meta-Analysis of Randomized Controlled Trials","volume":"7","author":"Huang","year":"2017","journal-title":"Neuropsychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Reis, D.J., Ilardi, S.S., and Punt, S.E.W. (2018). The Anxiolytic Effect of Probiotics: A Systematic Review and Meta-Analysis of the Clinical and Preclinical Literature. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0199041"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jad.2017.11.063","article-title":"A Meta-Analysis of the Use of Probiotics to Alleviate Depressive Symptoms","volume":"228","author":"Ng","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.neubiorev.2019.03.023","article-title":"Prebiotics and Probiotics for Depression and Anxiety: A Systematic Review and Meta-Analysis of Controlled Clinical Trials","volume":"102","author":"Liu","year":"2019","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"112568","DOI":"10.1016\/j.psychres.2019.112568","article-title":"Effect of Probiotics on Depressive Symptoms: A Meta-Analysis of Human Studies","volume":"282","author":"Goh","year":"2019","journal-title":"Psychiatry Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3389\/fneur.2020.00421","article-title":"Effects of Probiotics on Depressive or Anxiety Variables in Healthy Participants Under Stress Conditions or With a Depressive or Anxiety Diagnosis: A Meta-Analysis of Randomized Controlled Trials","volume":"11","author":"Chao","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1038\/s41398-021-01422-7","article-title":"Psychobiotic Interventions for Anxiety in Young People: A Systematic Review and Meta-Analysis, with Youth Consultation","volume":"11","author":"Basso","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.clnesp.2021.07.027","article-title":"Probiotics for the Treatment of Depression and Anxiety: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"45","author":"Periyasamy","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.psychres.2015.04.023","article-title":"Fermented Foods, Neuroticism, and Social Anxiety: An Interaction Model","volume":"228","author":"Hilimire","year":"2015","journal-title":"Psychiatry Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.nut.2019.02.007","article-title":"Probiotic Food Consumption Is Associated with Lower Severity and Prevalence of Depression: A Nationwide Cross-Sectional Study","volume":"63","author":"Kim","year":"2019","journal-title":"Nutrition"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3653","DOI":"10.1080\/10408398.2019.1703641","article-title":"Is Dairy Consumption Associated with Depressive Symptoms or Disorders in Adults? A Systematic Review of Observational Studies","volume":"60","author":"Hockey","year":"2020","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"850249","DOI":"10.3389\/fnut.2022.850249","article-title":"Association between Consumption of Fermented Food and Food-Derived Prebiotics with Cognitive Performance, Depressive and Anxiety Symptoms in Psychiatrically Healthy Medical Students under Psychological Stress: A Prospective Cohort Study","volume":"9","author":"Karbownik","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_18","unstructured":"Karbownik, M.S. (2022, February 01). Study Protocol. Association between Consumption of Fermented and Prebiotic-Containing Food and Cognitive Performance under Stress in Healthy Volunteers. Available online: https:\/\/osf.io\/ny2vf\/."},{"key":"ref_19","unstructured":"Gerlitz, J.-Y., and Schupp, J. (2005). Zur Erhebung Der Big-Five-Basierten Pers\u00f6nlichkeitsmerkmale Im SOEP. Dokumentation der Instrumententwicklung BFI-S Auf Basis Des SOEP-Pretests 2005, Deutsches Institut f\u00fcr Wirtschaftsforschung. Research Notes."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"110544","DOI":"10.1016\/j.paid.2020.110544","article-title":"Higher-Order Factors of the Big Six\u2014Similarities between Big Twos Identified above the Big Five and the Big Six","volume":"171","author":"Strus","year":"2021","journal-title":"Personal. Individ. Differ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.amepre.2010.10.009","article-title":"Starting the Conversation Performance of a Brief Dietary Assessment and Intervention Tool for Health Professionals","volume":"40","author":"Paxton","year":"2011","journal-title":"Am. J. Prev. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e25228","DOI":"10.2196\/25228","article-title":"Determinants of Knowledge About Dietary Supplements Among Polish Internet Users: Nationwide Cross-Sectional Study","volume":"23","author":"Karbownik","year":"2021","journal-title":"J. Med. Internet. Res."},{"key":"ref_23","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_24","first-page":"47","article-title":"International Physical Activity Questionnaire (IPAQ)\u2014Polish version","volume":"51","author":"Biernat","year":"2007","journal-title":"Phys. Educ. Sport"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a Brief Depression Severity Measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"420","DOI":"10.26444\/aaem\/99246","article-title":"Validation of the Polish Language Version of the Patient Health Questionnaire-9 in a Population of Adults Aged 35\u201364","volume":"26","author":"Nowicki","year":"2019","journal-title":"Ann. Agric. Environ. Med. AAEM"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"497","DOI":"10.12740\/PP\/OnlineFirst\/126230","article-title":"The Occurrence of Anxiety Disorders among Poles during the COVID-19 Pandemic","volume":"55","author":"Babicki","year":"2021","journal-title":"Psychiatr. Pol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.psychres.2016.06.021","article-title":"The Psychometric Properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and the Patient Health Questionnaire-9 (PHQ-9) in Depressed Inpatients in China","volume":"243","author":"Feng","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_30","unstructured":"Nowlin, R.B., and Brown, S.K. (2022, March 14). Monitoring Patient Treatment Outcomes in Inpatient Psychiatric Care with the PHQ-9. Available online: https:\/\/www.psychiatrictimes.com\/view\/monitoring-patient-treatment-outcomes-in-inpatient-psychiatric-care-with-the-phq-9."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Surono, I.S., and Hosono, A. (2011). Fermented Milks. Types and Standards of Identity. Encyclopedia of Dairy Sciences, Academic Press.","DOI":"10.1016\/B978-0-12-374407-4.00180-1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.3389\/fmicb.2018.01785","article-title":"Fermented Foods as a Dietary Source of Live Organisms","volume":"9","author":"Rezac","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Liu, T., Zhong, S., Liao, X., Chen, J., He, T., Lai, S., and Jia, Y. (2015). A Meta-Analysis of Oxidative Stress Markers in Depression. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138904"},{"key":"ref_34","first-page":"122","article-title":"Increased Oxidative Stress in the Prefrontal Cortex as a Shared Feature of Depressive- and PTSD-Like Syndromes: Effects of a Standardized Herbal Antioxidant","volume":"8","author":"Pavlov","year":"2021","journal-title":"Front. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.3389\/fimmu.2019.01696","article-title":"The Role of Inflammation in Depression and Fatigue","volume":"10","author":"Lee","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/nri.2015.5","article-title":"The Role of Inflammation in Depression: From Evolutionary Imperative to Modern Treatment Target","volume":"16","author":"Miller","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/wps.20229","article-title":"What Has Serotonin to Do with Depression?","volume":"14","author":"Cowen","year":"2015","journal-title":"World Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.tins.2008.06.006","article-title":"The HPA Axis in Major Depression: Classical Theories and New Developments","volume":"31","author":"Pariante","year":"2008","journal-title":"Trends Neurosci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3389\/fpsyt.2019.00101","article-title":"Is the HPA Axis as Target for Depression Outdated, or Is There a New Hope?","volume":"10","author":"Menke","year":"2019","journal-title":"Front. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.coph.2006.11.006","article-title":"Neurodevelopmental Origins of Depressive Disorders","volume":"7","author":"Ansorge","year":"2007","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_41","first-page":"e11396","article-title":"Neuroplasticity and the Biological Role of Brain Derived Neurotrophic Factor in the Pathophysiology and Management of Depression","volume":"12","author":"Chakrapani","year":"2020","journal-title":"Cureus"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Dimidi, E., Cox, S.R., Rossi, M., and Whelan, K. (2019). Fermented Foods: Definitions and Characteristics, Impact on the Gut Microbiota and Effects on Gastrointestinal Health and Disease. Nutrients, 11.","DOI":"10.3390\/nu11081806"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Shandilya, S., Kumar, S., Kumar Jha, N., Kumar Kesari, K., and Ruokolainen, J. (J. Adv. Res., 2021). Interplay of Gut Microbiota and Oxidative Stress: Perspective on Neurodegeneration and Neuroprotection, J. Adv. Res., in press.","DOI":"10.1016\/j.jare.2021.09.005"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.bbi.2018.07.006","article-title":"Probiotics for the Treatment of Depressive Symptoms: An Anti-Inflammatory Mechanism?","volume":"73","author":"Park","year":"2018","journal-title":"Brain Behav. Immun."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12991-017-0138-2","article-title":"The Effects of Probiotics on Depressive Symptoms in Humans: A Systematic Review","volume":"16","author":"Wallace","year":"2017","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_46","first-page":"145","article-title":"Effect of the Probiotic Lactobacillus Plantarum IS-10506 on BDNF and 5HT Stimulation: Role of Intestinal Microbiota on the Gut-Brain Axis","volume":"11","author":"Ranuh","year":"2019","journal-title":"Iran. J. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.3389\/fnins.2019.01361","article-title":"Antidepressive Mechanisms of Probiotics and Their Therapeutic Potential","volume":"13","author":"Yong","year":"2020","journal-title":"Front. Neurosci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ejphar.2018.06.026","article-title":"Let Thy Food Be Thy Medicine\u2026.When Possible","volume":"836","author":"Witkamp","year":"2018","journal-title":"Eur. J. Pharmacol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1136\/neurintsurg-2014-011612","article-title":"Ignoring Floor and Ceiling Effects May Underestimate the Effect of Carotid Artery Stenting on Cognitive Performance","volume":"8","author":"Scherr","year":"2016","journal-title":"J. Neurointerventional Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"100391","DOI":"10.1016\/j.bbih.2021.100391","article-title":"A Physiometric Investigation of Inflammatory Composites: Comparison of \u201ca Priori\u201d Aggregates, Empirically-Identified Factors, and Individual Proteins","volume":"18","author":"Moriarity","year":"2021","journal-title":"Brain Behav. Immun. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1192\/bjp.163.3.322","article-title":"Seasonal Variations of Current Symptoms in a Healthy Population","volume":"163","author":"Schlager","year":"1993","journal-title":"Br. J. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/0004867419899165","article-title":"Mental Health during and after Protests, Riots and Revolutions: A Systematic Review","volume":"54","author":"Ni","year":"2020","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"69","DOI":"10.11604\/pamj.2019.33.69.17516","article-title":"Predictors and Correlates of Examination Anxiety and Depression among High School Students Taking the Sudanese National Board Examination in Khartoum State, Sudan: A Cross-Sectional Study","volume":"33","author":"Bashir","year":"2019","journal-title":"Pan Afr. Med. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"102491","DOI":"10.1016\/j.janxdis.2021.102491","article-title":"Comparison of Symptom-Based versus Self-Reported Diagnostic Measures of Anxiety and Depression Disorders in the GLAD and COPING Cohorts","volume":"85","author":"Davies","year":"2022","journal-title":"J. Anxiety Disord."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Leung, K., Xu, E., Rosic, T., Worster, A., Thabane, L., and Samaan, Z. (2021). Sensitivity and Specificity of Self-Reported Psychiatric Diagnoses amongst Patients Treated for Opioid Use Disorder. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03489-4"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"10084","DOI":"10.1038\/s41598-018-28478-8","article-title":"Discordance between Self-Report and Clinical Diagnosis of Internet Gaming Disorder in Adolescents","volume":"8","author":"Jeong","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"503","DOI":"10.12740\/PP\/OnlineFirst\/67373","article-title":"Medical Students and Stigma of Depression. Part 2. Self-Stigma","volume":"51","author":"Suwalska","year":"2017","journal-title":"Psychiatr. Pol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"15","DOI":"10.12740\/PP\/30811","article-title":"[The prevalence of common mental disorders in the population of adult Poles by sex and age structure\u2014an EZOP Poland study]","volume":"49","author":"Kiejna","year":"2015","journal-title":"Psychiatr. Pol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Forycka, J., Paw\u0142owicz-Szlarska, E., Burczy\u0144ska, A., Cegielska, N., Harendarz, K., and Nowicki, M. (2022). Polish Medical Students Facing the Pandemic\u2014Assessment of Resilience, Well-Being and Burnout in the COVID-19 Era. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0261652"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3861\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:42:19Z","timestamp":1760136139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3861"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":59,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19073861"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19073861","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]}}}