{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:59:07Z","timestamp":1776931147927,"version":"3.51.2"},"reference-count":54,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,12]],"date-time":"2023-03-12T00:00:00Z","timestamp":1678579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Novartis","award":["N\u00b0 PS16060"],"award-info":[{"award-number":["N\u00b0 PS16060"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Breast cancer survivors (BCS) may face functional alterations after surgical intervention. Upper Limb Disorders (ULDs) are highly prevalent even years after a diagnosis. Clinicians may assess the upper limbs after breast cancer. The Upper Limb Functional Index (ULFI) has been validated across different populations and languages. This study aimed to assess the psychometric properties of the Upper Limb Functional Index Spanish version (ULFI-Sp) in the BCS. Methods: A psychometric validation study of the ULFI-Sp was conducted on 216 voluntary breast cancer survivors. The psychometric properties were as follows: analysis of the factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA). Results: The factor structure was one-dimensional. ULFI-Sp showed a high internal consistency for the total score (\u03b1 = 0.916) and the regression score obtained from MLE (\u03b1 = 0.996). CFA revealed a poor fit, and a new 14-item model (short version) was further tested. The developed short version of the ULFI-SP is preferable to assess upper limb function in Spanish BCS. Conclusions: Given the high prevalence of ULD in this population and the broader versions of ULFI across different languages, this study\u2019s results may be transferred to clinical practice and integrated as part of upper limb assessment after breast cancer.<\/jats:p>","DOI":"10.3390\/ijerph20064997","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T04:35:41Z","timestamp":1678682141000},"page":"4997","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Validation of the Upper Limb Functional Index on Breast Cancer Survivor"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6143-6703","authenticated-orcid":false,"given":"Jaime","family":"Mart\u00edn-Mart\u00edn","sequence":"first","affiliation":[{"name":"Legal and Forensic Medicine Area, Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Malaga, 29010 M\u00e1laga, Spain"},{"name":"Grupo Clinimetr\u00eda en Fisioterapia (F-14), Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bella","family":"Pajares-Hachero","sequence":"additional","affiliation":[{"name":"UGCI Oncolog\u00eda M\u00e9dica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 M\u00e1laga, Spain"},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Alba-Conejo","sequence":"additional","affiliation":[{"name":"UGCI Oncolog\u00eda M\u00e9dica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 M\u00e1laga, Spain"},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuria","family":"Ribelles","sequence":"additional","affiliation":[{"name":"UGCI Oncolog\u00eda M\u00e9dica, Hospitales Universitarios Regional y Virgen de la Victoria, 29010 M\u00e1laga, Spain"},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8880-4315","authenticated-orcid":false,"given":"Antonio I.","family":"Cuesta-Vargas","sequence":"additional","affiliation":[{"name":"Grupo Clinimetr\u00eda en Fisioterapia (F-14), Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"},{"name":"Department Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain"},{"name":"School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7355-9740","authenticated-orcid":false,"given":"Cristina","family":"Rold\u00e1n-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Grupo Clinimetr\u00eda en Fisioterapia (F-14), Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), 29590 M\u00e1laga, Spain"},{"name":"Department Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,12]]},"reference":[{"key":"ref_1","unstructured":"(2019, May 13). WHO | Breast Cancer: Prevention and Control. Available online: http:\/\/www.who.int\/cancer\/detection\/breastcancer\/en\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.apmr.2013.12.015","article-title":"Upper Limb Physical Function and Adverse Effects after Breast Cancer Surgery: A Prospective 2.5-Year Follow-up Study and Preoperative Measures","volume":"95","author":"Sagen","year":"2014","journal-title":"Arch. Phys. Med. Rehabil"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1002\/cncr.27474","article-title":"Prevalence of Breast Cancer Treatment Sequelae over 6 Years of Follow-up: The Pulling Through Study","volume":"118","author":"Schmitz","year":"2012","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/jso.21435","article-title":"Longitudinal Change of Treatment-Related Upper Limb Dysfunction and Its Impact on Late Dysfunction in Breast Cancer Survivors: A Prospective Cohort Study","volume":"101","author":"Yang","year":"2010","journal-title":"J. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1159\/000485023","article-title":"Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication","volume":"13","author":"Harris","year":"2018","journal-title":"Breast Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1519\/JSC.0000000000001890","article-title":"Changes in Unilateral Upper Limb Muscular Strength and Electromyographic Activity After a 16-Week Strength Training Intervention in Survivors of Breast Cancer","volume":"33","author":"Hagstrom","year":"2019","journal-title":"J. Strength Cond. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"a2597","DOI":"10.1136\/bmj.a2597","article-title":"Patient Reported Outcome Measures in Trials","volume":"338","author":"Garratt","year":"2009","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/01.mlr.0000258615.42478.55","article-title":"The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group during Its First Two Years","volume":"45","author":"Cella","year":"2007","journal-title":"Med Care"},{"key":"ref_9","unstructured":"Fayers, P.M., and Machin, D. (2013). Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes, John Wiley & Sons."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S174","DOI":"10.1002\/acr.20630","article-title":"Measures of Adult Shoulder Function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Its Short Version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society Standardized Shoulder Assessment Form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI)","volume":"63","author":"Angst","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jclinepi.2018.04.014","article-title":"Psychometric Development of the Upper Limb Lymphedema Quality of Life Questionnaire Demonstrated the Patient-Reported Outcome Measure to Be a Robust Measure for Breast Cancer-Related Lymphedema","volume":"100","author":"Williams","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00402-007-0549-7","article-title":"The Oxford Shoulder Score Revisited","volume":"129","author":"Dawson","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"Development of an Upper Extremity Outcome Measure: The DASH (Disabilities of the Arm, Shoulder and Hand) [Corrected]. The Upper Extremity Collaborative Group (UECG)","volume":"29","author":"Hudak","year":"1996","journal-title":"Am. J. Ind. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1197\/j.jht.2006.04.001","article-title":"The Upper Limb Functional Index: Development and Determination of Reliability, Validity, and Responsiveness","volume":"19","author":"Gabel","year":"2006","journal-title":"J. Hand Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jht.2009.09.007","article-title":"Modification of the Upper Limb Functional Index to a Three-Point Response Improves Clinimetric Properties","volume":"23","author":"Gabel","year":"2010","journal-title":"J. Hand Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.apmr.2013.07.022","article-title":"Patient-Reported Upper Extremity Outcome Measures Used in Breast Cancer Survivors: A Systematic Review","volume":"95","author":"Harrington","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.amjsurg.2019.04.006","article-title":"Patient Reported Outcomes Associated with Surgical Intervention for Breast Cancer","volume":"219","author":"Jay","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1023\/A:1012278023233","article-title":"The Validation of a Quality of Life Scale to Assess the Impact of Arm Morbidity in Breast Cancer Patients Post-Operatively","volume":"68","author":"Coster","year":"2001","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s10549-008-0288-7","article-title":"Kwan\u2019s Arm Problem Scale: Psychometric Examination in a Sample of Stage II Breast Cancer Survivors","volume":"117","author":"Nesvold","year":"2009","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/ptj\/65.6.896","article-title":"Efficacy of Physical Therapy for Patients Who Have Undergone Mastectomies. A Prospective Study","volume":"65","author":"Wingate","year":"1985","journal-title":"Phys. Ther."},{"key":"ref_21","unstructured":"Gabel, C.P. (2022, December 12). Development and Initial Validation of a New Regional Outcome Measure: The Upper Limb Disability Questionnaire (ULDQ), 2003. Available online: https:\/\/researchers.cdu.edu.au\/en\/studentTheses\/development-and-initial-validation-of-a-new-regional-outcome-meas."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.apmr.2013.09.016","article-title":"Validation of QuickDASH Outcome Measure in Breast Cancer Survivors for Upper Extremity Disability","volume":"95","author":"LeBlanc","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1261","DOI":"10.1016\/j.clbc.2018.02.008","article-title":"Estimating the Reliability and Validity of the Upper Extremity Functional Index in Women After Breast Cancer Surgery","volume":"18","author":"Binkley","year":"2018","journal-title":"Clin. Breast Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12955-015-0256-y","article-title":"Spanish Cultural Adaptation and Validation of the Shoulder Pain and Disability Index, and the Oxford Shoulder Score after Breast Cancer Surgery","volume":"13","year":"2015","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_25","first-page":"151","article-title":"Factors Associated with Upper Limb Function in Breast Cancer Survivors","volume":"15","author":"Pajares","year":"2021","journal-title":"PM R"},{"key":"ref_26","first-page":"1243","article-title":"Design and Implementation of a Standard Care Programme of Therapeutic Exercise and Education for Breast Cancer Survivors","volume":"30","author":"Pajares","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1093\/ptj\/pzz177","article-title":"Energy System Assessment in Survivors of Breast Cancer","volume":"100","author":"Buchan","year":"2020","journal-title":"Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8858","DOI":"10.1038\/s41598-021-88375-5","article-title":"Ultrasound Use in Metastatic Breast Cancer to Measure Body Composition Changes Following an Exercise Intervention","volume":"11","author":"Pajares","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/1477-7525-11-126","article-title":"Cross-Cultural Adaptation, Reliability and Validity of the Spanish Version of the Upper Limb Functional Index","volume":"11","author":"Gabel","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/BF02291575","article-title":"An Index of Factorial Simplicity","volume":"39","author":"Kaiser","year":"1974","journal-title":"Psychometrika"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/j.2517-6161.1954.tb00174.x","article-title":"A Note on the Multiplying Factors for Various Chi Square Approximations","volume":"16","author":"Bartlett","year":"1954","journal-title":"J. R. Stat. Soc. Ser. B Methodol."},{"key":"ref_32","first-page":"7","article-title":"Best Practices in Exploratory Factor Analysis: Four Recommendations for Getting the Most From Your Analysis","volume":"10","author":"Costello","year":"2005","journal-title":"Pract. Assess. Res. Eval."},{"key":"ref_33","unstructured":"Hair, J.F. (1999). An\u00e1lisis Multivariante, Pearson Educaci\u00f3n."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinepi.2006.03.012","article-title":"Quality Criteria Were Proposed for Measurement Properties of Health Status Questionnaires","volume":"60","author":"Terwee","year":"2007","journal-title":"J Clin. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/BF02310555","article-title":"Coefficient Alpha and the Internal Structure of Tests","volume":"16","author":"Cronbach","year":"1951","journal-title":"Psychometrika"},{"key":"ref_36","first-page":"23","article-title":"Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures","volume":"8","author":"Moosbrugger","year":"2003","journal-title":"Methods Psychol. Res. Online"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct. Equ. Model. A Multidiscip. J."},{"key":"ref_38","unstructured":"(2022, October 10). IBM SPSS Statistics. Available online: http:\/\/www-01.ibm.com\/software\/analytics\/spss\/products\/statistics\/."},{"key":"ref_39","unstructured":"J\u00f6reskog, K.G., and S\u00f6rbom, D. (2018). LISREL 10 for Windows [Computer Software], Scientific Software International, Inc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejca.2018.06.006","article-title":"Patient-Reported Symptoms after Breast Cancer Diagnosis and Treatment: A Retrospective Cohort Study","volume":"101","author":"Davis","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.apmr.2014.08.022","article-title":"Classical Test Theory and Rasch Analysis Validation of the Upper Limb Functional Index in Subjects with Upper Limb Musculoskeletal Disorders","volume":"96","author":"Bravini","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Gabel, C.P., Yelland, M., Melloh, M., and Burkett, B. (2009). A Modified QuickDASH-9 Provides a Valid Outcome Instrument for Upper Limb Function. BMC Musculoskelet. Disord., 10.","DOI":"10.1186\/1471-2474-10-161"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jht.2014.11.001","article-title":"Cross-Cultural Adaptation, Reliability and Validity of the Turkish Version of the Upper Limb Functional Index (ULFI)","volume":"28","author":"Tonga","year":"2015","journal-title":"J. Hand Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Arooj, A., Amjad, F., Tanveer, F., Arslan, A.U., Ahmad, A., and Gilani, S.A. (2022). Translation, Cross-Cultural Adaptation and Psychometric Properties of Urdu Version of Upper Limb Functional Index; a Validity and Reliability Study. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05628-8"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12955-016-0436-4","article-title":"Spanish Version of SPADI (Shoulder Pain and Disability Index) in Musculoskeletal Shoulder Pain: A New 10-Items Version after Confirmatory Factor Analysis","volume":"14","author":"Roach","year":"2016","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Hidding, J.T., Beurskens, C.H.G., van der Wees, P.J., van Laarhoven, H.W.M., and Nijhuis-van der Sanden, M.W.G.N. (2014). Treatment Related Impairments in Arm and Shoulder in Patients with Breast Cancer: A Systematic Review. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096748"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/j.1471-6712.2007.00546.x","article-title":"Women\u2019s Experience of Physical Activity Following Breast Cancer Treatment","volume":"22","author":"Larsson","year":"2008","journal-title":"Scand. J. Caring Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5606\/tftrd.2019.2585","article-title":"Is Kinesiophobia Associated with Lymphedema, Upper Extremity Function, and Psychological Morbidity in Breast Cancer Survivors?","volume":"65","author":"Can","year":"2019","journal-title":"Turk. J. Phys. Med. Rehabil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.msksp.2017.03.005","article-title":"Pain Characteristics as Important Contributing Factors to Upper Limb Dysfunctions in Breast Cancer Survivors at Long Term","volume":"29","author":"Meeus","year":"2017","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1097\/PHM.0000000000000455","article-title":"Predictors of Altered Upper Extremity Function During the First Year After Breast Cancer Treatment","volume":"95","author":"Smoot","year":"2016","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1002\/cncr.27463","article-title":"A Prospective Surveillance Model for Physical Rehabilitation of Women with Breast Cancer: Chemotherapy-Induced Peripheral Neuropathy","volume":"118","author":"Stubblefield","year":"2012","journal-title":"Cancer"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Shamley, D., and Robb, K. (2015). An Early Warning Surveillance Programme for Detecting Upper Limb Deterioration after Treatment for Breast Cancer: A Novel Technology Supported System. BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1636-8"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jht.2013.12.005","article-title":"A Cross-Cultural Adaptation of the Upper Limb Functional Index in French Canadian","volume":"27","author":"Hamasaki","year":"2014","journal-title":"J. Hand Ther."},{"key":"ref_54","first-page":"115","article-title":"Cross-cultural adaptation, and validity of the italian version of the Upper Limb Functional Index (ULFI-I)","volume":"37","author":"Sartorio","year":"2015","journal-title":"G. Ital. Med. Lav. Ergon."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4997\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:53:08Z","timestamp":1760122388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,12]]},"references-count":54,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20064997"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20064997","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,12]]}}}