{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:03:43Z","timestamp":1792008223754,"version":"4.4.0"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,20]],"date-time":"2023-05-20T00:00:00Z","timestamp":1684540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TC54 cooperation agreement signed between the National Cancer Institute (INCA) and the Pan American Health Organization (PAHO)","award":["E-26\/110.296\/2014"],"award-info":[{"award-number":["E-26\/110.296\/2014"]}]},{"name":"TC54 cooperation agreement signed between the National Cancer Institute (INCA) and the Pan American Health Organization (PAHO)","award":["000019.2013.01.004\/2"],"award-info":[{"award-number":["000019.2013.01.004\/2"]}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro\u2013FAPERJ","doi-asserted-by":"publisher","award":["E-26\/110.296\/2014"],"award-info":[{"award-number":["E-26\/110.296\/2014"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro\u2013FAPERJ","doi-asserted-by":"publisher","award":["000019.2013.01.004\/2"],"award-info":[{"award-number":["000019.2013.01.004\/2"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Public Ministry of Labor (MPT) of the Municipality of Nova Igua\u00e7\u00fa-RJ","award":["E-26\/110.296\/2014"],"award-info":[{"award-number":["E-26\/110.296\/2014"]}]},{"name":"the Public Ministry of Labor (MPT) of the Municipality of Nova Igua\u00e7\u00fa-RJ","award":["000019.2013.01.004\/2"],"award-info":[{"award-number":["000019.2013.01.004\/2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Benzene, toluene, and xylene isomers (BTX) are present in gasoline. Exposure to benzene may lead to the appearance of a series of signs, symptoms, and complications, which are characterized by benzene poisoning, which is an occupational disease. This study evaluated the presence of signs and symptoms related to occupational exposure and whether occupational exposure to BTX is associated with the development of hematological changes. (2) Material and Methods: This cross-sectional epidemiological study included 542 participants, in which 324 were gas station workers (GSWs) and 218 were office workers (OWs) with no occupational exposure to benzene. To characterize the type of exposure (exposed and not exposed), trans,trans-Muconic acid (tt-MA), Hippuric acid (HA), and Methylhippuric acid (MHA) were used as exposure biomarkers. The tt-MA analysis revealed that the GSWs had 0.29 mg\/g of urinary creatinine and the OWs had 0.13 mg\/g of urinary creatinine. For HA, the GSWs presented 0.49 g\/g of creatinine while the OWs presented 0.07. MHA analysis revealed that the GSWs had 1.57 g\/g creatinine and the OWs had 0.01 g\/g creatinine. Occupation habits and clinical symptoms were collected by questionnaire and blood samples were analyzed for hematological parameters. The persistence of hematological changes was evaluated with three serial blood collections every 15 days followed by laboratory hematological analysis. A descriptive analysis by the Chi-square test method was performed to evaluate the association between occupational exposure to fuels and the occurrence of changes in hematological parameters. (3) Results: In the GSWs, the most described signs and symptoms were somnolence (45.1%), headache (38.3%), dizziness (27.5%), tingling (25.4%), and involuntary movement (25%). Twenty GSWs that presented hematological alterations performed serial collections fifteen days apart. In addition, these workers presented total leukocyte counts above the upper limit and lymphocyte counts close to the lower limit. Leukocytosis and lymphopenia are hematological alterations present in chronic benzene poisoning. (4) Conclusions: The results found an initial change in different hematological parameters routinely used in clinics to evaluate health conditions. These findings reveal the importance of valuing clinical changes, even in the absence of disease, during the health monitoring of gas station workers and other groups that share the same space.<\/jats:p>","DOI":"10.3390\/ijerph20105896","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T02:28:42Z","timestamp":1684722522000},"page":"5896","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Hematological Changes in Gas Station Workers"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9815-1832","authenticated-orcid":false,"given":"Isabela","family":"Giardini","sequence":"first","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia Soares","family":"da Po\u00e7a","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"},{"name":"Laboratory of Environmental Mutagenesis, Department of Biochemistry, Biomedical Institute, Federal University of the State of Rio de Janeiro (UNIRIO)-Rua Frei Caneca, 94\/4\u00ba andar-Centro, Rio de Janeiro CEP 20211-010, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Vieira Baptista","family":"da Silva","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valnice Jane Caetano","family":"Andrade Silva","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4586-623X","authenticated-orcid":false,"given":"Deborah Santos","family":"Cintra","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Centro de Estudos de Sa\u00fade do Trabalhador e Ecologia Humana (CESTEH), Escola Nacional de Sa\u00fade P\u00fablica, Funda\u00e7\u00e3o Oswaldo Cruz. Rua Leopoldo Bulh\u00f5es, 1480-Manguinhos, Rio de Janeiro CEP 21041-210, RJ, Brazil"},{"name":"Department of Collective Health Biochemistry, Biomedical Institute, Federal University of the State of Rio de Janeiro (UNIRIO)-Rua Frei Caneca, 94-Centro, Rio de Janeiro CEP 20211-010, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7061-1574","authenticated-orcid":false,"given":"Barbara Rodrigues","family":"Geraldino","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"},{"name":"Laboratory of Environmental Mutagenesis, Department of Biochemistry, Biomedical Institute, Federal University of the State of Rio de Janeiro (UNIRIO)-Rua Frei Caneca, 94\/4\u00ba andar-Centro, Rio de Janeiro CEP 20211-010, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1464-2410","authenticated-orcid":false,"given":"Ubirani Barros","family":"Otero","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia","family":"Sarpa","sequence":"additional","affiliation":[{"name":"Technical Area of Environment, Work and Cancer, National Cancer Institute-INCA, Rua Marqu\u00eas do Pombal, 125\/5\u00ba andar-Centro, Rio de Janeiro CEP 20230-240, RJ, Brazil"},{"name":"Laboratory of Environmental Mutagenesis, Department of Biochemistry, Biomedical Institute, Federal University of the State of Rio de Janeiro (UNIRIO)-Rua Frei Caneca, 94\/4\u00ba andar-Centro, Rio de Janeiro CEP 20211-010, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,20]]},"reference":[{"key":"ref_1","unstructured":"Ag\u00eancia Nacional do Petr\u00f3leo, G\u00e1s Natural e Biocombust\u00edveis, Brasil (2021, February 11). Superintend\u00eancia de Desenvolvimento e Produ\u00e7\u00e3o\u2014SDP. Boletim de Produ\u00e7\u00e3o de Petr\u00f3leo e g\u00e1s Natural. 31\/1\/2020\u2014Dezembro 2019\/N\u00famero 112, Available online: http:\/\/www.anp.gov.br\/arquivos\/publicacoes\/boletins-anp\/producao\/2019-12-boletim.pdf."},{"key":"ref_2","unstructured":"IARC (2022, June 02). Monographs on the Evaluation of Carcinogenic Risks to Humans. Benzene. Available online: http:\/\/monographs.iarc.fr\/ENG\/Monographs\/vol100F\/mono100F-24.pdf."},{"key":"ref_3","first-page":"25","article-title":"Changes in the hematological profile among workers at petrol stations in Babil Province\/Iraq","volume":"3","author":"Jothery","year":"2017","journal-title":"Mesop. Environ. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/1476-069X-13-115","article-title":"Hematological and hepatic alterations in nonsmoking residents exposed to benzene following a flaring incident at the British petroleum plant in Texas City","volume":"13","author":"Reddy","year":"2014","journal-title":"Environ. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.imlet.2005.04.004","article-title":"Phenotype analysis of lymphocytes of workers with chronic benzene poisoning","volume":"101","author":"Pugliese","year":"2005","journal-title":"Immunol. Lett."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.21608\/ejom.2010.720","article-title":"Biological assessment of exposure to benzene among petrol stations\u2019 workers in Zagazig city by using trans, trans-muconic acid as urinary indicator","volume":"34","author":"Hammam","year":"2010","journal-title":"Egypt. J. Occup. Med."},{"key":"ref_7","first-page":"e5s","article-title":"Clinical-laboratory classification for clinical management of workers exposed to benzene in gas stations","volume":"42","author":"Fonseca","year":"2017","journal-title":"Rev. Bras. De Sa\u00fade Ocup."},{"key":"ref_8","unstructured":"(2023, January 29). Brasil. Minist\u00e9rio da Sa\u00fade. Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade. Departamento de A\u00e7\u00f5es Program\u00e1ticas Estrat\u00e9gicas. Risco Qu\u00edmico: Aten\u00e7\u00e3o \u00e0 Sa\u00fade dos Trabalhadores Expostos Benzeno\/Minist\u00e9rio da Sa\u00fade, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de A\u00e7\u00f5es Program\u00e1ticas Estrat\u00e9gicas.\u2014Bras\u00edlia: Editora do Minist\u00e9rio da Sa\u00fade, Available online: http:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/risco_saude_trabalhadores_expostos_benzeno.pdf."},{"key":"ref_9","unstructured":"Centers For Disease Control And Prevention (CDC) (2023, January 09). Emergency Preparedness and Response: Facts About Benzene, Available online: https:\/\/emergency.cdc.gov\/agent\/benzene\/basics\/facts.asp."},{"key":"ref_10","unstructured":"(2023, March 23). Fundacentro. Efeitos da Exposi\u00e7\u00e3o ao Benzeno Para a Sa\u00fade. Arline Sydneia Abel Arcuri et al. S\u00e3o Paulo: Fundacentro, 2012. 52p-S\u00e9rie benzeno; n. 1. Available online: https:\/\/renastonline.ensp.fiocruz.br\/sites\/default\/files\/arquivos\/recursos\/Efeitos_do_Benzeno.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/BF00381185","article-title":"Improvement in HPLC analysis of urinary trans, trans-muconic acid, a promising substitute for phenol in the assessment of benzene exposure","volume":"62","author":"Ducos","year":"1990","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1590\/S1516-93322003000100006","article-title":"Valida\u00e7\u00e3o do m\u00e9todo de Ducos Modificado para a determina\u00e7\u00e3o \u00e1cido trans,trans-muc\u00f4nico urin\u00e1rio","volume":"39","author":"Paula","year":"2003","journal-title":"Rev. Bras. Cienc. Farm"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Geraldino, B.R., Nunes, R.F.N., Gomes, J.B., Giardini, I., Silva, P.V.B., Campos, E., Po\u00e7a, K.S., Hassan, R., Otero, U.B., and Sarpa, M. (2020). Analysis of benzene exposure in gas station workers using trans,trans-muconic acid. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155295"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5553633","DOI":"10.1155\/2021\/5553633","article-title":"Evaluation of Exposure to Toluene and Xylene in Gasoline Station Workers","volume":"2021","author":"Geraldino","year":"2021","journal-title":"Adv. Prev. Med."},{"key":"ref_15","unstructured":"(2023, March 22). Brasil. Ag\u00eancia Nacional de Vigil\u00e2ncia Sanit\u00e1ria (ANVISA). RDC No 166, de 24 de Julho de 2017, Available online: http:\/\/antigo.anvisa.gov.br\/documents\/10181\/2721567\/RDC_166_2017_COMP.pdf\/d5fb92b3-6c6b-4130-8670-4e3263763401."},{"key":"ref_16","unstructured":"National Institute for Occupational Safety and Health (2023, March 22). NIOSH Pocket Guide to Chemical Hazards. United States: NIOSH; 2007. p. 26 (Benzene), Available online: https:\/\/www.cdc.gov\/niosh\/npg\/npgd0049.html."},{"key":"ref_17","unstructured":"American Conference of Governmental and Industrial Hygienists (ACGIH) (2016). Guide for Evaluation and Control of Workplace Exposures to Chemical Substances and Physical Agents (TLVs) and Biological Exposure Indices (BEIs), Signature Publications. [8th ed.]."},{"key":"ref_18","unstructured":"(2023, March 20). Brasil. Minist\u00e9rio do Trabalho e Emprego. Portaria no 14 de 20 de dezembro de 1995. Di\u00e1rio Oficial da Uni\u00e3o, 22 de Dezembro de 1995, Available online: https:\/\/www.gov.br\/trabalho-e-previdencia\/pt-br\/composicao\/orgaos-especificos\/secretaria-de-trabalho\/inspecao\/seguranca-e-saude-no-trabalho\/sst-portarias\/1995\/portaria_14_benzeno_altera_nr_15.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4236\/jep.2017.81002","article-title":"Assessment of BTEX Concentrations in Air Ambient of Gas Stations Using Passive Sampling and the Health Risks for Workers","volume":"8","author":"Cruz","year":"2017","journal-title":"J. Environ. Prot."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0378-4347(98)00065-6","article-title":"Analysis and evaluation of trans-trans-muconic acid as a biomarker for benzene exposure","volume":"717","author":"Scherer","year":"1998","journal-title":"J. Chromatogr. B"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1590\/S1516-93322004000200008","article-title":"Trans, trans-muconic acid in urine samples collected in three periods from benzene handling workers in a Brazilian refinery","volume":"40","author":"Martins","year":"2004","journal-title":"Rev. Bras. Cienc. Farm."},{"key":"ref_22","first-page":"21","article-title":"Sintomas relacionados \u00e0 exposi\u00e7\u00e3o ocupacional ao benzeno e h\u00e1bitos ocupacionais em trabalhadores de postos de revenda de combust\u00edveis a varejo na regi\u00e3o sul de Santa Catarina","volume":"12","author":"Menegali","year":"2014","journal-title":"Rev. Bras. Med. Trab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/occmed\/kqj034","article-title":"Unexpected cause of raised benzene absorption in coke oven by-product workers","volume":"56","author":"Colman","year":"2006","journal-title":"Occup. Med."},{"key":"ref_24","unstructured":"Hodgson, E., and Levi, P.E. (1987). A Textbook of Modern Toxicology, Elsevier."},{"key":"ref_25","unstructured":"(2022, November 24). Brasil. Minist\u00e9rio do Trabalho e Previd\u00eancia\/Gabinete do Ministro. Portaria MTP n\u00ba 2.776, de 5 de Setembro de 2022. Bras\u00edlia: Di\u00e1rio Oficial da Uni\u00e3o, Available online: https:\/\/www.in.gov.br\/en\/web\/dou\/-\/portaria-mtp-n-2.776-de-5-de-setembro-de-2022-427291124."},{"key":"ref_26","unstructured":"(2022, December 29). Brasil, Minist\u00e9rio do Trabalho, Gabinete do Ministro. Portaria n\u00ba 1.109, de 21 de Setembro de 2016. Bras\u00edlia: Di\u00e1rio Oficial da Uni\u00e3o. Available online: https:\/\/www.udop.com.br\/download\/legislacao\/seguranca\/institucional_site_juridico\/portaria_1109_anexo2_nr09_exposicao_ao_benzano.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"240","DOI":"10.47626\/1679-4435-2020-590","article-title":"Risks related to the domestic laundering of filling station attendant uniforms: Advances and uncertainties","volume":"19","author":"Geraldino","year":"2021","journal-title":"Rev. Bras. Med. Trab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e8s","DOI":"10.1590\/2317-6369000124515","article-title":"Avalia\u00e7\u00e3oambiental de BTEX (benzeno, tolueno, etilbenzeno, xilenos) e biomarcadores de genotoxicidadeemtrabalhadores de postos de combust\u00edveis","volume":"42","author":"Amaral","year":"2017","journal-title":"Rev. Bras. De Sa\u00fade Ocup."},{"key":"ref_29","unstructured":"(2022, July 23). Brasil. Classifica\u00e7\u00e3o Brasileira de Ocupa\u00e7\u00e3o. CBO 5211-35 Frentista. Available online: https:\/\/www.ocupacoes.com.br\/cbo-mte\/521135-frentista."},{"key":"ref_30","first-page":"20","article-title":"Preventive Aspects for Migraine and the Workplace: A European Survey","volume":"24","author":"ReinosoBarbero","year":"2021","journal-title":"Arch. Prev. Riesgos Labor"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.envres.2014.11.003","article-title":"Early hematological and immunological alterations in gasoline station attendants exposed to benzene","volume":"137","author":"Moro","year":"2015","journal-title":"Environ. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.mrgentox.2016.11.002","article-title":"Biomonitoring of gasoline station attendants exposed to benzene: Effect of gender","volume":"813","author":"Moro","year":"2017","journal-title":"Mutat. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/0748233707080907","article-title":"Occupational benzene exposure from vehicular sources in India and its effect on hematology, lymphocyte subsets and platelet P-selectin expression","volume":"23","author":"Ray","year":"2007","journal-title":"Toxicol. Ind. Health"},{"key":"ref_34","first-page":"33","article-title":"Investigation of Biochemical and Hematological Parameters of Workers Exposed to Benzene","volume":"1","author":"Ercan","year":"2015","journal-title":"Turjoem"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"20411","DOI":"10.1007\/s11356-019-05412-7","article-title":"Association of environmental exposure with hematological and oxidative stress alteration in gasoline station attendants","volume":"26","author":"Ahmadi","year":"2019","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"503322","DOI":"10.1016\/j.mrgentox.2021.503322","article-title":"Gasoline-station workers in Brazil: Benzene exposure; Genotoxic and immunotoxic effects","volume":"865","author":"Giardini","year":"2021","journal-title":"Mutat. Res.\/Genet. Toxicol. Environ. Mutagen."},{"key":"ref_37","unstructured":"(2022, November 24). Brasil. Minist\u00e9rio da Sa\u00fade. Portaria n\u00ba 776\/GM, em 24 de Abril de 2004. Disp\u00f5e Sobre a Regulamenta\u00e7\u00e3o dos Procedimentos Relativos \u00e0 Vigil\u00e2ncia da Sa\u00fade dos Trabalhadores Expostos ao Benzeno e d\u00e1 Outras Provid\u00eancias, Available online: http:\/\/www.saude.mt.gov.br\/cosat\/arquivo\/1838\/sobre-benzeno."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/10\/5896\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:39:07Z","timestamp":1760125147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/10\/5896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,20]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["ijerph20105896"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20105896","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,20]]}}}