{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T05:57:44Z","timestamp":1762063064644,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T00:00:00Z","timestamp":1661126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Study of Obesity and Metabolic Syndrome","award":["SOMS 2021-001"],"award-info":[{"award-number":["SOMS 2021-001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In response to the COVID-19 pandemic, the Korean government implemented policies including the systematic social distancing (SSD) system which started on 28 June 2020. The present study investigated the development and aggravation of fatty liver measured using ultrasonography during the transition period (from pre-SSD to SSD) compared to the fatty liver changes during the pre-SSD period. Changes in fatty liver and liver enzymes were assessed in different groups stratified by alcohol consumption. Our retrospective cohort analysis included 5668 participants who underwent health checkups at 13 university hospitals during the SSD period and two or more checkups before the SSD period. Fatty liver developed and aggravated more in the transition period (13.6% development and 12.0% aggravation) than in the pre-SSD period (10.8% development and 10.1% aggravation) in the alcohol consumption group. This finding was more prominent in women than in men. Abnormal alanine transaminase levels were more often developed in the transition period than in the pre-SSD period, especially in men (11.1% vs. 8.6% in each period). In conclusion, the SSD system may contribute to fatty liver changes in individuals who regularly consume alcohol. Further research of the post-pandemic period is needed to assess long-term changes in fatty liver disease.<\/jats:p>","DOI":"10.3390\/ijerph191610444","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T21:30:34Z","timestamp":1661203834000},"page":"10444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fatty Liver Change in Korean Adults in a Systematic Social Distancing System Amid the COVID-19 Pandemic: A Multicenter Analysis"],"prefix":"10.3390","volume":"19","author":[{"given":"Ji-Hee","family":"Haam","sequence":"first","affiliation":[{"name":"Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea"},{"name":"Chaum Life Center, CHA University, Seoul 06062, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2633-9980","authenticated-orcid":false,"given":"Yang-Im","family":"Hur","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7397-5410","authenticated-orcid":false,"given":"Young-Sang","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoung-Kon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jee-Hyun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Konyang University College of Medicine, Daejeon 35365, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-1476","authenticated-orcid":false,"given":"Hae-Jin","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kyungpook National University Hospital, Daegu 41944, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0960-5976","authenticated-orcid":false,"given":"Yoon Jeong","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Daegu Catholic University, Daegu 42472, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9438-8680","authenticated-orcid":false,"given":"Hye-In","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kyungpook National University Hospital, Daegu 41944, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyu Rae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung Ha","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Jeju National University Hospital, Jeju 63241, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0054-2366","authenticated-orcid":false,"given":"Soo Hyun","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, College of Medicine, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2880-277X","authenticated-orcid":false,"given":"Jong-Koo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0706-167X","authenticated-orcid":false,"given":"Taesic","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5852-4323","authenticated-orcid":false,"given":"Myung-Jae","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeong Sook","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoobin","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Sanbon Medical Center, Wonkwang University, Gunpo 15865, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ga Eun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3221-3460","authenticated-orcid":false,"given":"Sun Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, International St. Mary\u2019s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.spc.2020.10.016","article-title":"Impact of COVID-19 on the social, economic, environmental and energy domains: Lessons learnt from a global pandemic","volume":"26","author":"Mofijur","year":"2021","journal-title":"Sustain. Prod. Consum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"27277","DOI":"10.1073\/pnas.2009609117","article-title":"Economic hardship and mental health complaints during COVID-19","volume":"117","author":"Witteveen","year":"2020","journal-title":"Proc. Natl. Acad Sci. USA"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Algahtani, F.D., Hassan, S.U., Alsaif, B., and Zrieq, R. (2021). Assessment of the Quality of Life during COVID-19 Pandemic: A Cross-Sectional Survey from the Kingdom of Saudi Arabia. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18030847"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Karakose, T., Ozdemir, T.Y., Papadakis, S., Yirci, R., Ozkayran, S.E., and Polat, H. (2022). Investigating the Relationships between COVID-19 Quality of Life, Loneliness, Happiness, and Internet Addiction among K-12 Teachers and School Administrators\u2014A Structural Equation Modeling Approach. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031052"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ammar, A., Brach, M., Trabelsi, K., Chtourou, H., Boukhris, O., Masmoudi, L., Bouaziz, B., Bentlage, E., How, D., and Ahmed, M. (2020). Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients, 12.","DOI":"10.3390\/nu12061583"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/hep4.1873","article-title":"Fatty Liver and the Coronavirus Disease 2019 Pandemic: Health Behaviors, Social Factors, and Telemedicine Satisfaction in Vulnerable Populations","volume":"6","author":"Kim","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/s41574-020-0387-z","article-title":"Will the COVID-19 pandemic worsen the obesity epidemic?","volume":"16","author":"Clemmensen","year":"2020","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14284","DOI":"10.1038\/s41598-021-93375-6","article-title":"Author Correction: COVID-19-related school closing aggravate obesity and glucose intolerance in pediatric patients with obesity","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1001\/jama.2021.15036","article-title":"Changes in Body Mass Index Among Children and Adolescents During the COVID-19 Pandemic","volume":"326","author":"Woolford","year":"2021","journal-title":"JAMA"},{"key":"ref_10","first-page":"167","article-title":"Pathogenesis and Prevention of Hepatic Steatosis","volume":"11","author":"Nassir","year":"2015","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5009\/gnl16477","article-title":"Pathophysiology and Management of Alcoholic Liver Disease: Update 2016","volume":"11","author":"Stickel","year":"2017","journal-title":"Gut Liver"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jhep.2004.03.002","article-title":"Alcohol and cirrhosis: Dose-response or threshold effect?","volume":"41","author":"Gronbaek","year":"2004","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mazzolini, G., Sowa, J.P., Atorrasagasti, C., Kucukoglu, O., Syn, W.K., and Canbay, A. (2020). Significance of Simple Steatosis: An Update on the Clinical and Molecular Evidence. Cells, 9.","DOI":"10.3390\/cells9112458"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1152\/japplphysiol.00384.2011","article-title":"Does physical inactivity cause nonalcoholic fatty liver disease?","volume":"111","author":"Rector","year":"2011","journal-title":"J. Appl. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3350\/cmh.2021.0178","article-title":"KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease","volume":"27","author":"Kang","year":"2021","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.shaw.2020.07.006","article-title":"Social Distancing and Public Health Guidelines at Workplaces in Korea: Responses to Coronavirus Disease-19","volume":"11","author":"Kim","year":"2020","journal-title":"Saf. Health Work"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e264","DOI":"10.3346\/jkms.2020.35.e264","article-title":"Stepwise Strategy of Social Distancing in Korea","volume":"35","author":"Park","year":"2020","journal-title":"J. Korean Med. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Meyer, J., McDowell, C., Lansing, J., Brower, C., Smith, L., Tully, M., and Herring, M. (2020). Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186469"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000960","DOI":"10.1136\/bmjsem-2020-000960","article-title":"Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: A systematic review","volume":"7","author":"Stockwell","year":"2021","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Skotnicka, M., Karwowska, K., Klobukowski, F., Wasilewska, E., and Malgorzewicz, S. (2021). Dietary Habits before and during the COVID-19 Epidemic in Selected European Countries. Nutrients, 13.","DOI":"10.3390\/nu13051690"},{"key":"ref_22","first-page":"353","article-title":"Did social isolation during the SARS-CoV-2 epidemic have an impact on the lifestyles of citizens?","volume":"44","author":"Ferrante","year":"2020","journal-title":"Epidemiol. Prev."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Grossman, E.R., Benjamin-Neelon, S.E., and Sonnenschein, S. (2020). Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17249189"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2022942","DOI":"10.1001\/jamanetworkopen.2020.22942","article-title":"Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US","volume":"3","author":"Pollard","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jurecka, A., Skucinska, P., and Gadek, A. (2021). Impact of the SARS-CoV-2 Coronavirus Pandemic on Physical Activity, Mental Health and Quality of Life in Professional Athletes-A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18179423"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.pcd.2021.01.003","article-title":"Impact of lockdown COVID-19 on metabolic control in type 2 diabetes mellitus and healthy people","volume":"15","author":"Karatas","year":"2021","journal-title":"Prim. Care Diabetes"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s13098-021-00705-9","article-title":"Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: A systematic review","volume":"13","author":"Eberle","year":"2021","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1038\/s41392-021-00822-x","article-title":"COVID-19 induces new-onset insulin resistance and lipid metabolic dysregulation via regulation of secreted metabolic factors","volume":"6","author":"He","year":"2021","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"789","DOI":"10.5604\/16652681.1171749","article-title":"Drug-induced fatty liver disease: An overview of pathogenesis and management","volume":"14","author":"Satapathy","year":"2015","journal-title":"Ann. Hepatol."},{"key":"ref_30","first-page":"731","article-title":"Drug-induced Fatty Liver Disease: Pathogenesis and Treatment","volume":"9","author":"Kolaric","year":"2021","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/bmj.292.6512.13","article-title":"Ultrasound scanning in the detection of hepatic fibrosis and steatosis","volume":"292","author":"Saverymuttu","year":"1986","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1053\/gast.2002.35354","article-title":"The utility of radiological imaging in nonalcoholic fatty liver disease","volume":"123","author":"Saadeh","year":"2002","journal-title":"Gastroenterology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1056\/NEJM200004273421707","article-title":"Evaluation of abnormal liver-enzyme results in asymptomatic patients","volume":"342","author":"Pratt","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/000456327000700601","article-title":"Determination of serum \u03b3-glutamyl transpeptidase activity and its clinical applications","volume":"7","author":"Rosalki","year":"1970","journal-title":"Ann. Clin. Biochem."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1007\/s10620-016-4079-4","article-title":"Fibrosis Assessment in Nonalcoholic Fatty Liver Disease (NAFLD) in 2016","volume":"61","author":"Kaswala","year":"2016","journal-title":"Dig. Dis. Sci."},{"key":"ref_37","unstructured":"(2021, October 01). COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Available online: https:\/\/github.com\/CSSEGISandData\/COVID-19."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1002\/hep.32272","article-title":"Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study","volume":"75","author":"Julien","year":"2022","journal-title":"Hepatology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s12944-020-01385-6","article-title":"Association between sitting time and non-alcoholic fatty live disease in South Korean population: A cross-sectional study","volume":"19","author":"Joo","year":"2020","journal-title":"Lipids Health Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.cld.2013.09.006","article-title":"The impact of obesity and metabolic syndrome on alcoholic liver disease","volume":"18","author":"Chiang","year":"2014","journal-title":"Clin. Liver Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.3748\/wjg.14.2418","article-title":"Alcohol consumption and metabolic syndrome among Shanghai adults: A randomized multistage stratified cluster sampling investigation","volume":"14","author":"Fan","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E23","DOI":"10.1017\/dmp.2020.237","article-title":"Changes in Body Weight, Physical Activity, and Lifestyle During the Semi-lockdown Period After the Outbreak of COVID-19 in China: An Online Survey","volume":"15","author":"He","year":"2021","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"304","DOI":"10.21215\/kjfp.2021.11.4.304","article-title":"Changes in Body Mass Index and Prevalence of Metabolic Syndrome during COVID-19 Lockdown Period","volume":"11","author":"Kwon","year":"2021","journal-title":"Korean J. Fam. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"254","DOI":"10.24095\/hpcdp.41.9.02","article-title":"Changes in alcohol consumption during the COVID-19 pandemic: Exploring gender differences and the role of emotional distress","volume":"41","author":"Thompson","year":"2021","journal-title":"Health Promot. Chronic Dis. Prev. Can."},{"key":"ref_45","first-page":"633","article-title":"Liver disease in women: The influence of gender on epidemiology, natural history, and patient outcomes","volume":"9","author":"Guy","year":"2013","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1002\/hep.510230513","article-title":"Prediction of risk of liver disease by alcohol intake, sex, and age: A prospective population study","volume":"23","author":"Becker","year":"1996","journal-title":"Hepatology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"G652","DOI":"10.1152\/ajpgi.2000.278.4.G652","article-title":"Gender differences in early alcohol-induced liver injury: Role of CD14, NF-kappaB, and TNF-alpha","volume":"278","author":"Kono","year":"2000","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jhep.2009.05.023","article-title":"Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance","volume":"51","author":"Schwenzer","year":"2009","journal-title":"J. Hepatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10444\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:13:28Z","timestamp":1760141608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,22]]},"references-count":48,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph191610444"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191610444","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,8,22]]}}}