{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:34:53Z","timestamp":1785807293085,"version":"3.56.0"},"reference-count":59,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Children\u2019s Hospital of the University of Erlangen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Diagnosing a child by newborn screening with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) causes multiple challenges for the affected parents and the whole family. We aimed to examine the health-related Quality of Life (HrQoL), coping, and needs of parents caring for a child with CAH to develop demand-responsive interventions for improving the psychosocial situation of affected families. In a retrospective cross-sectional design, we assessed HrQoL, coping patterns, and the needs of parents caring for a CAH-diagnosed child using specific questionnaires. Data of 59 families with at least one child diagnosed with CAH were analyzed. The results show that mothers and fathers in this study reached significantly higher HrQoL scores compared to reference cohorts. Decisive for the above-average parental HrQoL were effective coping behaviors and the parental needs being met. These findings verify the importance of helpful coping patterns and rapid fulfillment of parental needs for maintaining a good and stable HrQoL of parents with a child diagnosed with CAH. It is crucial to strengthen the parental HrQoL to build a reasonable basis for a healthy upbringing and improve the medical care of CAH-diagnosed children.<\/jats:p>","DOI":"10.3390\/ijerph20054493","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T02:03:08Z","timestamp":1677808988000},"page":"4493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Caring for a Child with Congenital Adrenal Hyperplasia Diagnosed by Newborn Screening: Parental Health-Related Quality of Life, Coping Patterns, and Needs"],"prefix":"10.3390","volume":"20","author":[{"given":"Laura","family":"Rautmann","sequence":"first","affiliation":[{"name":"Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistra\u00dfe 52, W26, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-7594","authenticated-orcid":false,"given":"Stefanie","family":"Witt","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistra\u00dfe 52, W26, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7011-9459","authenticated-orcid":false,"given":"Christoph","family":"Theiding","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistra\u00dfe 52, W26, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0137-4819","authenticated-orcid":false,"given":"Birgit","family":"Odenwald","sequence":"additional","affiliation":[{"name":"Bavarian Screening Center, Bavarian State Office for Health and Food Safety, Veterin\u00e4rstra\u00dfe 2, 85764 Oberschlei\u00dfheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5659-9820","authenticated-orcid":false,"given":"Uta","family":"Nennstiel-Ratzel","sequence":"additional","affiliation":[{"name":"Bavarian Screening Center, Bavarian State Office for Health and Food Safety, Veterin\u00e4rstra\u00dfe 2, 85764 Oberschlei\u00dfheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4838-6737","authenticated-orcid":false,"given":"Helmuth-G\u00fcnther","family":"D\u00f6rr","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, University Children\u2019s Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-2339","authenticated-orcid":false,"given":"Julia Hannah","family":"Quitmann","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistra\u00dfe 52, W26, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00112-016-0233-5","article-title":"Neugeborenenscreening 2020","volume":"165","author":"Gramer","year":"2017","journal-title":"Mon. Kinderheilkd."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00112-017-0355-4","article-title":"50 Jahre Neugeborenenscreening in Deutschland","volume":"166","author":"Gramer","year":"2018","journal-title":"Mon. Kinderheilkd."},{"key":"ref_3","first-page":"11","article-title":"Neonatal screening for metabolic and endocrine disor-ders","volume":"108","author":"Harms","year":"2011","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jpag.2017.04.001","article-title":"Congenital Adrenal Hyperplasia","volume":"30","author":"Witchel","year":"2017","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1210\/jc.2018-01865","article-title":"Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline","volume":"103","author":"Speiser","year":"2018","journal-title":"J. Clin. Endocrinol. Metab"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.ccell.2009.01.008","article-title":"Congenital adrenal hyperplasia: An endocrine disorder with neonatal onset","volume":"21","author":"Stokowski","year":"2009","journal-title":"Crit. Care Nurs Clin. N. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1055\/s-0032-1324724","article-title":"Congenital adrenal hyperplasia due to 21 hydroxylase deficiency: From birth to adulthood","volume":"30","author":"White","year":"2012","journal-title":"Semin. Reprod Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1016\/S0140-6736(17)31431-9","article-title":"Congenital adrenal hyperplasia","volume":"390","author":"Arlt","year":"2017","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s41969-022-00159-y","article-title":"Neue Behandlungsstrategien bei adrenogenitalem Syndrom\/21-Hydroxylase-Mangel [Novel treatment strategies in congenital adrenal hyperplasia\/21-hydroxylase deficiency]","volume":"15","author":"Riedl","year":"2022","journal-title":"J. F\u00fcr Klin. Endokrinol. Stoffwechs."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1159\/000494903","article-title":"Androgens in Congenital Adrenal Hyperplasia","volume":"53","author":"Pignatelli","year":"2019","journal-title":"Front. Horm. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/00004356-197801000-00002","article-title":"Impact of chronic illness on child and family: An overview based on five surveys with implications for management","volume":"1","author":"Satterwhite","year":"1978","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1111\/j.1651-2227.2009.01321.x","article-title":"Paediatric illness! Family matters","volume":"98","author":"Grootenhuis","year":"2009","journal-title":"Acta Paediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/jpepsy\/jst049","article-title":"Parenting stress among caregivers of children with chronic illness: A systematic review","volume":"38","author":"Cousino","year":"2013","journal-title":"J. Pediatr. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2190\/PM.46.4.c","article-title":"The role of children with congenital anomalies in generating parental depressive symptoms","volume":"46","author":"Sundus","year":"2013","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_15","first-page":"238","article-title":"The analysis of psychological and social problems, the physical development in young people with congenital adrenal hyperplasia\u2014owner experience","volume":"16","author":"Barg","year":"2010","journal-title":"Pediatr. Endocrinol. Diabetes Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.pedn.2014.01.007","article-title":"\u201cIt was an overwhelming thing\u201c: Parents\u2018 needs after infant diagnosis with congenital adrenal hyperplasia","volume":"29","author":"Boyse","year":"2014","journal-title":"J. Pediatr. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jspn.12190","article-title":"Parental management of adrenal crisis in children with congenital adrenal hyperplasia","volume":"22","author":"Fleming","year":"2017","journal-title":"J. Spec. Pediatr. Nurs."},{"key":"ref_18","first-page":"29","article-title":"Adrenogenitales Syndrom (AGS) mit 21-Hydroxylase-Defekt bei Kleinkindern. Erste Ergebnisse einer Pilotstudie zur psychosozialen Situation der Eltern [Psychosocial situation of parents with children with diagnosed 21-hydroxylase adrenogenital syndrome (AGS)\u2014preliminary results of a pilot study]","volume":"90","author":"Witt","year":"2018","journal-title":"P\u00e4diatr. Prax."},{"key":"ref_19","unstructured":"Waldthausen, U.M. (2007). Die Psychosoziale Situation von Familien mit Einem an Adrenogenitalem Syndrom Erkrankten Kind, Ludwig-Maximilians-Universit\u00e4t zu M\u00fcnchen."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1542\/peds.2010-3413","article-title":"Parents\u2019 experiences of expanded newborn screening evaluations","volume":"128","author":"DeLuca","year":"2011","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Moody, L., Atkinson, L., Kehal, I., and Bonham, J.R. (2017). Healthcare professionals\u2019 and parents\u2019 experiences of the confirmatory testing period: A qualitative study of the UK expanded newborn screening pilot. BMC Pediatr., 17.","DOI":"10.1186\/s12887-017-0873-1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1038\/gim.2011.5","article-title":"The impact of false-positive newborn screening results on families: A qualitative study","volume":"14","author":"Schmidt","year":"2012","journal-title":"Genet. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/j.1365-2214.2006.00666.x","article-title":"Why do we need a diagnosis? A qualitative study of parents\u2019 experiences, coping and needs, when the newborn child is severely disabled","volume":"33","author":"Graungaard","year":"2007","journal-title":"Child Care Health Dev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1207\/s15374424jccp2504_8","article-title":"Mothers\u2018 reactions to their child\u2018s diagnosis: Relations with security of attachment","volume":"25","author":"Marvin","year":"1996","journal-title":"J. Clin. Child Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s10897-016-9959-4","article-title":"Parents\u2019 Experiences of Receiving the Initial Positive Newborn Screening (NBS) Result for Cystic Fibrosis and Sickle Cell Disease","volume":"25","author":"Chudleigh","year":"2016","journal-title":"J. Genet. Couns"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/1367493512443906","article-title":"Informing parents about positive newborn screen results: Parents\u2019 recommendations","volume":"16","author":"Salm","year":"2012","journal-title":"J. Child Health Care"},{"key":"ref_27","first-page":"102","article-title":"Psychosocial Situation of Families with Chronically Ill Children: A Survey of Parent Initiatives [Psychosoziale Lage von Familien mit chronisch kranken Kindern: Eine Befragung betroffener Eltern in Selbsthilfegruppen]","volume":"77","author":"Nehring","year":"2015","journal-title":"Gesundheitswesen"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1007\/s00103-007-0382-8","article-title":"Patientenzentrierte Versorgung bei seltenen Erkrankungen","volume":"50","author":"Reimann","year":"2007","journal-title":"Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s40273-016-0389-9","article-title":"Health, Health-Related Quality of Life, and Quality of Life: What is the Difference?","volume":"34","author":"Karimi","year":"2016","journal-title":"Pharmacoeconomics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3109\/09638288.2015.1060267","article-title":"The impact of care on family and health-related quality of life of parents with chronically ill and disabled children","volume":"38","author":"Vonneilich","year":"2016","journal-title":"Disabil. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1352\/0047-6765(2004)42<413:EIOCAM>2.0.CO;2","article-title":"Economic implications of caregiving at midlife: Comparing parents with and without children who have developmental disabilities","volume":"42","author":"Parish","year":"2004","journal-title":"Ment. Retard."},{"key":"ref_32","first-page":"520","article-title":"From Knowing Nothing to Knowing What, How and Now: Parents\u2019 Experiences of Caring for their Children With Congenital Adrenal Hyperplasia","volume":"42","author":"Lundberg","year":"2017","journal-title":"J. Pediatr. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1007\/s00431-015-2530-8","article-title":"Subjective need for psychological support (PsySupp) in parents of children and adolescents with disorders of sex development (dsd)","volume":"174","author":"Bennecke","year":"2015","journal-title":"Eur. J. Pediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1687-9856-2012-2","article-title":"Physical, social and societal functioning of children with congenital adrenal hyperplasia (CAH) and their parents, in a Dutch population","volume":"2012","author":"Sanches","year":"2012","journal-title":"Int. J. Pediatr. Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1055\/s-0035-1554639","article-title":"Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase-Deficiency: 13 Years of Neonatal Screening and Follow-up in Bavaria","volume":"227","author":"Odenwald","year":"2015","journal-title":"Klin. Padiatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1530\/EJE-15-0775","article-title":"Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: Evaluation of adrenal crises during the first 6 years of life","volume":"174","author":"Odenwald","year":"2016","journal-title":"Eur. J. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1026\/0084-5345.31.1.31","article-title":"ULQIE: A quality-of-life inventory for parents of chronically ill children","volume":"31","author":"Goldbeck","year":"2002","journal-title":"Zeitschrift f\u00fcr Klinische Psychologie und Psychotherapie"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2307\/351514","article-title":"CHIP\u2014Coping Health Inventory for Parents: An assessment of parental coping patterns in the care of the chronically ill child","volume":"45","author":"McCubbin","year":"1983","journal-title":"J. Marriage Fam."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1026\/\/0942-5403.10.1.28","article-title":"Fragebogen zur elterlichen Krankheitsbew\u00e4ltigung: Coping Health Inventory for Parents (CHIP)\u2014Deutsche Version","volume":"10","author":"McCubbin","year":"2001","journal-title":"Kindh. Entw."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wiedebusch-Quante, S. (2009). Eltern Chronisch Kranker Kinder-Lebensqualit\u00e4t, Psychosoziale Krankheitsbelastungen, Coping, Ressourcen und Bed\u00fcrfnisse, Westf\u00e4lische Wilhelms-Universit\u00e4t M\u00fcnster.","DOI":"10.1007\/s00112-009-1996-8"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/j.1440-1614.2005.01630.x","article-title":"Imputing cross-sectional missing data: Comparison of common techniques","volume":"39","author":"Hawthorne","year":"2005","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The age of adolescence","volume":"2","author":"Sawyer","year":"2018","journal-title":"Lancet Child. Adolesc. Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1055\/s-0029-1216364","article-title":"Effectiveness of a family-oriented rehabilitation program on the quality of life of parents of chronically ill children","volume":"221","author":"West","year":"2009","journal-title":"Klin. Padiatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1111\/famp.12480","article-title":"Individual and Dyadic Coping and Fear of Progression in Mothers and Fathers of Children with Hematologic Cancer","volume":"59","author":"Clever","year":"2019","journal-title":"Fam. Process"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1177\/1074840717735499","article-title":"How the Child\u2019s Gender Matters for Families Having a Child With Congenital Adrenal Hyperplasia","volume":"23","author":"Fleming","year":"2017","journal-title":"J. Fam. Nurs."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/pon.530","article-title":"Parental coping with the diagnosis of childhood cancer: Gender effects, dissimilarity within couples, and quality of life","volume":"10","author":"Goldbeck","year":"2001","journal-title":"Psychooncology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1055\/s-2001-10753","article-title":"Adaptation of parents to the diagnosis of a chronic disease in their child","volume":"51","author":"Goldbeck","year":"2001","journal-title":"Psychother Psychosom Med. Psychol."},{"key":"ref_48","first-page":"1","article-title":"Family Members Dealing With Childhood Cancer: A Study on the Role of Family Functioning and Cancer Appraisal","volume":"10","author":"Norga","year":"2019","journal-title":"Front. Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.apnr.2015.03.010","article-title":"Stress and coping of parents caring for a child with mitochondrial disease","volume":"29","author":"Senger","year":"2016","journal-title":"Appl. Nurs. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s10897-016-0043-x","article-title":"Communication about Congenital Adrenal Hyperplasia: Perspective of Filipino Families","volume":"26","author":"Abad","year":"2017","journal-title":"J. Genet. Couns"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.pedhc.2017.02.004","article-title":"Management of Childhood Congenital Adrenal Hyperplasia-An Integrative Review of the Literature","volume":"31","author":"Fleming","year":"2017","journal-title":"J. Pediatr. Health Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/j.1365-2516.2012.02853.x","article-title":"Effect of a self-help progrAm. for mothers of hemophilic children in Korea","volume":"18","author":"Kang","year":"2012","journal-title":"Haemophilia"},{"key":"ref_53","first-page":"169","article-title":"A randomized controlled trial to improve the quality of life of type 2 diabetic patients using a self-help group program","volume":"40","author":"Chaveepojnkamjorn","year":"2009","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"602","DOI":"10.4040\/jkan.2005.35.3.602","article-title":"Effects of a self-help group program for young adults with hemophilia","volume":"35","author":"Kang","year":"2005","journal-title":"J. Korean Acad. Nurs."},{"key":"ref_55","unstructured":"New, M.I., Lekarev, O., Parsa, A., Yuen, T.T., O\u2019Malley, B.W., and Hammer, G.D. (2014). Genetic Steroid Disorders, Academic Press."},{"key":"ref_56","first-page":"475","article-title":"Psychological impact on parents of children with congenital adrenal hyperplasia: A study from Sri Lanka","volume":"27","author":"Dilanka","year":"2014","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1365-2648.2006.03736.x","article-title":"Stress and well-being among parents of children with rare diseases: A prospective intervention study","volume":"53","author":"Dellve","year":"2006","journal-title":"J. Adv. Nurs."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1440-1754.2009.01608.x","article-title":"Call for a national plan for rare diseases","volume":"46","author":"Jaffe","year":"2010","journal-title":"J. Paediatr. Child Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4081\/pr.2015.5872","article-title":"Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Parenting Stress","volume":"7","author":"Epifanio","year":"2015","journal-title":"Pediatr. Rep."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:46:41Z","timestamp":1760122001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,3]]},"references-count":59,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054493"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054493","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,3]]}}}