{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:36:06Z","timestamp":1790786166274,"version":"4.1.0"},"reference-count":65,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010001","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["UA3MC25735"],"award-info":[{"award-number":["UA3MC25735"]}],"id":[{"id":"10.13039\/100010001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Joseph P. Healey Research Fund UMASS Boston","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Adolescent girls with intellectual disabilities (ID) are at risk for low physical activity (PA) participation due to their limited opportunities. Purpose: To evaluate the feasibility and preliminary efficacy of a 12-week dance intervention to promote engagement in moderate-to-vigorous PA (MVPA) and increase cardiorespiratory fitness. Methods: The 12-week intervention included two 75-min weekly dance sessions. Continuous heart-rate (HR) monitoring assessed time spent below\/at\/above each girl\u2019s target HR zone. Cardiorespiratory fitness was measured by the 6-min walk test (6MWT). Survey items assessed participant enjoyment and participant and parent satisfaction. Results: The mean (SD) age of 18 adolescent girls was 17.3 (2.7) years. Overall, girls attended 88% of sessions and spent 52.3% of each session in MVPA. Mean MVPA was unchanged across the 12 weeks, but the pattern differed across the three sites. We observed a non-significant pre-post increase of 74.6 feet on the 6MWT. Post-intervention surveys indicated that most girls liked the program, perceived improved fitness, and wished to continue dancing. The majority also reported a preference for a girls-only dance program exclusively for those with ID. Conclusion: Our findings suggest that dance is viable for promoting PA for girls with ID. More frequent exercise training is likely needed to improve cardiorespiratory fitness.<\/jats:p>","DOI":"10.3390\/ijerph19084661","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:15:35Z","timestamp":1649798135000},"page":"4661","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Pilot Dance Intervention to Encourage Physical Activity Engagement for Adolescent Girls with Intellectual Disabilities"],"prefix":"10.3390","volume":"19","author":[{"given":"Aviva","family":"Must","sequence":"first","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda G.","family":"Bandini","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Curtin","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine M.","family":"Ranca\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha","family":"Eliasziw","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DJ","family":"Tybor","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Stanish","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1352\/1944-7558-126.6.439","article-title":"An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports","volume":"126","author":"Schalock","year":"2021","journal-title":"Am. J. Intellect. Dev. Disabil."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Olusanya, B.O., Wright, S.M., Nair, M., Boo, N.-Y., Halpern, R., Kuper, H., Abubakar, A.A., Almasri, N.A., Arabloo, J., and Arora, N.K. (2020). Global burden of childhood epilepsy, intellectual disability, and sensory impairments. Pediatrics, 146.","DOI":"10.1542\/peds.2019-2623"},{"key":"ref_3","first-page":"1","article-title":"Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014\u20132016","volume":"291","author":"Zablotsky","year":"2017","journal-title":"NCHS Data Brief"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Patrick, M.E., Shaw, K.A., Dietz, P.M., Baio, J., Yeargin-Allsopp, M., Bilder, D.A., Kirby, R.S., Hall-Lande, J.A., Harrington, R.A., and Lee, L.-C. (2021). Prevalence of intellectual disability among eight-year-old children from selected communities in the United States, 2014. Disabil. Health J., 14.","DOI":"10.1016\/j.dhjo.2020.101023"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kumar, B., Robinson, R., and Till, S. (2015). Physical activity and health in adolescence. Clin. Med., 15.","DOI":"10.7861\/clinmedicine.15-3-267"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S422","DOI":"10.1123\/jpah.2018-0476","article-title":"Results from the United States 2018 report card on physical activity for children and youth","volume":"15","author":"Katzmarzyk","year":"2018","journal-title":"J. Phys. Act. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ridd.2016.05.016","article-title":"Physical activity during school and after school among youth with and without intellectual disability","volume":"56","author":"Einarsson","year":"2016","journal-title":"Res. Dev. Disabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ridd.2012.07.022","article-title":"Measuring physical activity in children and youth living with intellectual disabilities: A systematic review","volume":"34","author":"Hinckson","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_9","first-page":"95","article-title":"Physical activity of youth with intellectual disability: Review and research agenda","volume":"25","author":"Frey","year":"2008","journal-title":"Adapt. Phys. Act. Q."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dhjo.2019.02.006","article-title":"Does physical activity differ between youth with and without intellectual disabilities?","volume":"12","author":"Stanish","year":"2019","journal-title":"Disabil. Health J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/jar.12515","article-title":"Physical activity levels of children and adolescents with moderate-to-severe intellectual disability","volume":"32","author":"Wouters","year":"2019","journal-title":"J. Appl. Res. Intellect. Disabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1249\/MSS.0000000000000412","article-title":"Differences in physical activity among youth with and without intellectual disability","volume":"47","author":"Einarsson","year":"2015","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Phillips, A.C., and Holland, A.J. (2011). Assessment of objectively measured physical activity levels in individuals with intellectual disabilities with and without Down\u2019s syndrome. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0028618"},{"key":"ref_14","first-page":"374","article-title":"Physical activity patterns in youth with intellectual disabilities","volume":"33","author":"Downs","year":"2016","journal-title":"Adapt. Phys. Act. Q."},{"key":"ref_15","first-page":"277","article-title":"Fitness of black African early adolescents with and without mild mental retardation","volume":"23","author":"Onyewadume","year":"2006","journal-title":"Adapt. Phys. Act. Q."},{"key":"ref_16","first-page":"54","article-title":"Eurofit special: European fitness battery score variation among individuals with intellectual disabilities","volume":"26","author":"Horvat","year":"2009","journal-title":"Adapt. Phys. Act. Q."},{"key":"ref_17","first-page":"296","article-title":"Cardiovascular fitness of young Canadian children with and without mental retardation","volume":"38","author":"Gillespie","year":"2003","journal-title":"Educ. Train. Dev. Disabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3301","DOI":"10.1016\/j.ridd.2013.07.005","article-title":"Cardiorespiratory fitness in individuals with intellectual disabilities\u2014A review","volume":"34","author":"Oppewal","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/j.1600-0838.2010.01120.x","article-title":"Health-related physical fitness in children and adolescents with Down syndrome and response to training","volume":"20","author":"Moreno","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/j.1651-2227.2008.01197.x","article-title":"High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability","volume":"98","author":"Wallen","year":"2009","journal-title":"Acta Paediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/j.1365-2788.2010.01305.x","article-title":"Obesity and obesity-related secondary conditions in adolescents with intellectual\/developmental disabilities","volume":"54","author":"Rimmer","year":"2010","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1467-789X.2010.00744.x","article-title":"Prevalence and risk factors of overweight and obesity among children and adolescents with intellectual disabilities","volume":"12","author":"Maiano","year":"2010","journal-title":"Obes. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/1744629511430772","article-title":"Health inequalities experienced by children and young people with intellectual disabilities: A review of literature from the United Kingdom","volume":"15","author":"Allerton","year":"2011","journal-title":"J. Intellect. Disabil."},{"key":"ref_24","unstructured":"World Health Organization (2019). Global Action Plan on Physical Activity 2018\u20132030: More Active People for a Healthier World, World Health Organization."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1123\/jpah.2020-0629","article-title":"The First Global Physical Activity and Sedentary Behavior Guidelines for People Living With Disability","volume":"18","author":"Carty","year":"2021","journal-title":"J. Phys. Act. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/j.1365-2788.2011.01425.x","article-title":"Identifying the barriers and facilitators to participation in physical activity for children with Down syndrome","volume":"55","author":"Barr","year":"2011","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ridd.2017.12.007","article-title":"Parental perceptions of facilitators and barriers to physical activity for children with intellectual disabilities: A mixed methods systematic review","volume":"73","author":"McGarty","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.ridd.2013.11.026","article-title":"Objective assessment of sedentary time and physical activity throughout the week in adolescents with Down syndrome. The UP&DOWN study","volume":"35","author":"Acha","year":"2014","journal-title":"Res. Dev. Disabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S2352-4642(19)30323-2","article-title":"Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1\u00b7 6 million participants","volume":"4","author":"Guthold","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1093\/her\/cyr040","article-title":"Interventions to promote physical activity among young and adolescent girls: A systematic review","volume":"26","author":"LaVoi","year":"2011","journal-title":"Health Educ. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1352\/1934-9556-50.2.109","article-title":"Physical activity patterns of youth with Down syndrome","volume":"50","author":"Esposito","year":"2012","journal-title":"Intellect. Dev. Disabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jadohealth.2007.11.143","article-title":"Patterns and determinants of physical activity in US adolescents","volume":"42","author":"Kahn","year":"2008","journal-title":"J. Adolesc. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/1090198105282416","article-title":"Physical activity attitudes, preferences, and practices in African American, Hispanic, and Caucasian girls","volume":"33","author":"Grieser","year":"2006","journal-title":"Health Educ. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Jago, R., Davis, L., McNeill, J., Sebire, S.J., Haase, A., Powell, J., and Cooper, A.R. (2011). Adolescent girls\u2019 and parents\u2019 views on recruiting and retaining girls into an after-school dance intervention: Implications for extra-curricular physical activity provision. Int. J. Behav. Nutr. Phys. Act., 8.","DOI":"10.1186\/1479-5868-8-91"},{"key":"ref_36","first-page":"1","article-title":"Interest and participation in selected sports among New Zealand adolescents","volume":"117","author":"Richards","year":"2004","journal-title":"J. N. Z. Med. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1123\/jpah.9.3.382","article-title":"Physical activity levels of adolescent girls during dance classes","volume":"9","author":"Pate","year":"2012","journal-title":"J. Phys. Act. Health"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"O\u2019Neill, J.R., Pate, R.R., and Hooker, S.P. (2011). The contribution of dance to daily physical activity among adolescent girls. Int. J. Behav. Nutr. Phys. Act., 8.","DOI":"10.1186\/1479-5868-8-87"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/17533015.2012.665810","article-title":"The effects of recreational dance interventions on the health and well-being of children and young people: A systematic review","volume":"4","author":"Burkhardt","year":"2012","journal-title":"Arts Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/09638288.2019.1615139","article-title":"Physical, cognitive, psychological and social effects of dance in children with disabilities: Systematic review and meta-analysis","volume":"43","author":"May","year":"2021","journal-title":"Disabil. Rehabil."},{"key":"ref_41","first-page":"189","article-title":"Dance for health: Improving fitness in African American and Hispanic adolescents","volume":"110","author":"Flores","year":"1995","journal-title":"Public Health Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4278\/ajhp.090123-ARB-24","article-title":"A pilot test of the Latin Active Hip Hop Intervention to increase physical activity among low-income Mexican-American adolescents","volume":"26","author":"Romero","year":"2012","journal-title":"Am. J. Health Promot."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/19325037.2008.10599062","article-title":"Cultural dance and health: A review of the literature","volume":"39","author":"Olvera","year":"2008","journal-title":"Am. J. Health Educ."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.ridd.2015.12.004","article-title":"Comparing participation in physical recreation activities between children with disability and children with typical development: A secondary analysis of matched data","volume":"49","author":"Woodmansee","year":"2016","journal-title":"Res. Dev. Disabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1080\/14647893.2016.1223028","article-title":"\u2018Dance Makes Me Happy\u2019: Experiences of children with disabilities in elementary school dance education","volume":"17","author":"Zitomer","year":"2016","journal-title":"Res. Danc. Educ."},{"key":"ref_46","first-page":"349","article-title":"Dance programs for school-age individuals with disabilities: A systematic review","volume":"37","author":"Prieto","year":"2020","journal-title":"Adapt. Phys. Act. Q."},{"key":"ref_47","first-page":"S1","article-title":"Dance and reducing television viewing to prevent weight gain in African-American girls: The Stanford GEMS pilot study","volume":"13","author":"Robinson","year":"2003","journal-title":"Ethn. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1080\/13676261.2011.616488","article-title":"\u2018Bigger than hip-hop?\u2019Impact of a community-based physical activity program on youth living in a disadvantaged neighborhood in Canada","volume":"14","author":"Beaulac","year":"2011","journal-title":"J. Youth Stud."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1001\/jama.2018.14854","article-title":"The physical activity guidelines for Americans","volume":"320","author":"Piercy","year":"2018","journal-title":"JAMA"},{"key":"ref_50","unstructured":"Turnbull, H., and Turnbull, A. (1998). Re Appropriate Public Education: The Law and Children with Disabilities, Love Publishing Company. [5th ed.]."},{"key":"ref_51","unstructured":"American College of Sports Medicine (2009). ACSM\u2019s Exercise Management for Persons with Chronic Diseases and Disabilities, Human Kinetics. [3rd ed.]."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3109\/13668250.2012.748885","article-title":"The Six-Minute Walk Test in adults with intellectual disability: A study of validity and reliability","volume":"38","author":"Nasuti","year":"2010","journal-title":"J. Intellect. Dev. Disabil."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"846","DOI":"10.3109\/09638288.2011.623757","article-title":"Reproducibility, validity and predictors of six-minute walk test in overweight and obese adolescents with intellectual disability","volume":"34","author":"Elmahgoub","year":"2012","journal-title":"Disabil. Rehabil."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1080\/00222895.2021.1941736","article-title":"Effects of traditional Indian dance on motor skills and balance in children with Down syndrome","volume":"54","author":"Raghupathy","year":"2021","journal-title":"J. Mot. Behav."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"283","DOI":"10.14486\/IJSCS200","article-title":"The effect of 12 weeks dance education on physical fitness values at mentally retarded children","volume":"2","author":"Dorsan","year":"2014","journal-title":"Int. J. Sport Cult. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/PEP.0000000000000559","article-title":"Adapted dance improves motor abilities and participation in children with Down syndrome: A pilot study","volume":"31","author":"McGuire","year":"2019","journal-title":"Pediatric Phys. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/ped.13338","article-title":"Factors affecting dance exercise performance in students at a special needs school","volume":"59","author":"Ito","year":"2017","journal-title":"Pediatrics Int."},{"key":"ref_58","unstructured":"Arzoglou, D., Tsimaras, V., Kotsikas, G., Fotiadou, E., Sidiropoulou, M., Proios, M., and Bassa, E. (2013). The effect of [alpha] tradinional dance training program on neuromuscular coordination of individuals with autism. J. Phys. Educ. Sport, 13."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1089\/chi.2011.0300.pers","article-title":"Promoting inclusive community-based obesity prevention programs for children and adolescents with disabilities: The why and how","volume":"7","author":"Rimmer","year":"2011","journal-title":"Child. Obes."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Rimmer, J.H. (2015). Physical activity for people with disabilities: How do we reach those with the greatest need?. NAM Perspect.","DOI":"10.31478\/201504d"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1177\/1559827608317397","article-title":"Health promotion for people with disabilities: Implications for empowering the person and promoting disability-friendly environments","volume":"2","author":"Rimmer","year":"2008","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.1468-3156.2010.00665.x","article-title":"Participation or exclusion? Perspectives of pupils with autistic spectrum disorders on their participation in leisure activities","volume":"39","author":"Brewster","year":"2010","journal-title":"Br. J. Learn. Disabil."},{"key":"ref_63","first-page":"61","article-title":"Parent perspectives of barriers to child participation in recreational activities","volume":"48","author":"Schleien","year":"2014","journal-title":"Ther. Recreat. J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/09687599.2011.529667","article-title":"\u2018They say every child matters, but they don\u2019t\u2019: An investigation into parental and carer perceptions of access to leisure facilities and respite care for children and young people with Autistic Spectrum Disorder (ASD) or Attention Deficit, Hyperactivity Disorder (ADHD)","volume":"26","author":"Thompson","year":"2011","journal-title":"Disabil. Soc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/jar.12205","article-title":"Including youth with intellectual disabilities in health promotion research: Development and reliability of a structured interview to assess the correlates of physical activity among youth","volume":"29","author":"Curtin","year":"2016","journal-title":"J. Appl. Res. Intellect. Disabil. JARID"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4661\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:52Z","timestamp":1760136772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":65,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084661"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084661","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]}}}