{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:33:28Z","timestamp":1763012008450,"version":"3.45.0"},"reference-count":45,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"crossref","award":["402281\/2024-1"],"award-info":[{"award-number":["402281\/2024-1"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Hospital readmission among stroke survivors is frequent, especially in contexts of social vulnerability, compromising recovery and overburdening health services. This study aimed to develop a predictive model of hospital readmission among socially vulnerable stroke survivors, based on the Chronic Conditions Care Model (CCCM). Machine learning algorithms were applied, specifically decision tree and logistic regression, with data split into training (70% and 80%) and testing (30% and 20%) sets. Analyses were conducted using Python, with accuracy evaluated through ROC curves, AUC, and the confusion matrix in Analyse-it\u00ae, adopting a 5% significance level. The decision tree with an 80\/20 partition achieved an accuracy of 92.45%. The variables most associated with readmission were falls, time since the first stroke, presence of a caregiver, and difficulty sleeping. In logistic regression, falls increased the risk by 235%, ischemic stroke by 155%, complications by 153.53%, COVID-19 by 132%, and time since stroke by 11.5% per year. The model proved to be feasible and robust, with the decision tree standing out, highlighting its potential to support preventive strategies and enhance care management.<\/jats:p>","DOI":"10.3390\/ijerph22111705","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T14:28:59Z","timestamp":1762871339000},"page":"1705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Readmission in Stroke Survivors in Social Vulnerability: Predictive Modeling with Machine Learning from the Perspective of the Chronic Conditions Care Model"],"prefix":"10.3390","volume":"22","author":[{"given":"Erisonval Saraiva","family":"da Silva","sequence":"first","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1424-0649","authenticated-orcid":false,"given":"Thereza Maria Magalh\u00e3es","family":"Moreira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Clinical Care in Nursing, State University of Cear\u00e1 (UECE), Fortaleza 60.714-903, CE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana C\u00e9lia Caetano","family":"de Souza","sequence":"additional","affiliation":[{"name":"Walter Cant\u00eddio University Hospital, Federal University of Cear\u00e1 (UFC), Fortaleza 60.020-181, CE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5825-5335","authenticated-orcid":false,"given":"Ana Maria Ribeiro dos","family":"Santos","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5087-4310","authenticated-orcid":false,"given":"Ana Roberta Vilarouca","family":"da Silva","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lariza Martins","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Nursing Department, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2324-107X","authenticated-orcid":false,"given":"Livia Carvalho","family":"Pereira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5956-9072","authenticated-orcid":false,"given":"Jardeliny Corr\u00eaa","family":"da Penha","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health and Community, Federal University of Piau\u00ed (UFPI), Teresina 64.000-020, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoel Borges","family":"da Silva Junior","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health and Community, Federal University of Piau\u00ed (UFPI), Teresina 64.000-020, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-9329","authenticated-orcid":false,"given":"Francisco Lucas","family":"de Lima Fontes","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8729-2098","authenticated-orcid":false,"given":"Isaias Wilmer Due\u00f1as","family":"Sayaverde","sequence":"additional","affiliation":[{"name":"School of Nursing, National Autonomous University of Chota (UNACH), Chota-Cajamarca 06421, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5163-6821","authenticated-orcid":false,"given":"Maria del Pilar Serrano","family":"Gallardo","sequence":"additional","affiliation":[{"name":"Nursing Department, Faculty of Medicine, Universidad Aut\u00f3noma de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3292-1942","authenticated-orcid":false,"given":"Jos\u00e9 Wicto Pereira","family":"Borges","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nursing, Federal University of Piau\u00ed (UFPI), Teresina 64.049-550, PI, Brazil"},{"name":"Postgraduate Program in Health and Community, Federal University of Piau\u00ed (UFPI), Teresina 64.000-020, PI, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/S0716-8640(12)70365-6","article-title":"Estratificaci\u00f3n de riesgo cardiovascular en la poblaci\u00f3n chilena","volume":"23","author":"Kunstmann","year":"2012","journal-title":"Rev. M\u00e9dica Cl\u00ednica Las Condes"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Monroy, B., Sanchez, K., Arguello, P., Estupi\u00f1\u00e1n, J., Bacca, J., Correa, C.V., Valencia, L., Castillo, J.C., Mieles, O., and Arguello, H. (2023). Automated Chronic Wounds Medical Assessment and Tracking Framework Based on Deep Learning. Comput. Biol. Med., 165.","DOI":"10.1016\/j.compbiomed.2023.107335"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Prieto, K. (2022). Current Forecast of COVID-19 in Mexico: A Bayesian and Machine Learning Approaches. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0259958"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e00050818","DOI":"10.1590\/0102-311x00050818","article-title":"Machine Learning Para An\u00e1lises Preditivas Em Sa\u00fade: Exemplo de Aplica\u00e7\u00e3o Para Predizer \u00d3bito Em Idosos de S\u00e3o Paulo, Brasil","volume":"35","author":"Santos","year":"2019","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_5","unstructured":"Global Burden of Disease Collaborative Network (2020). Global Burden of Disease Study 2019 (GBD 2019) Results, Institute for Health Metrics and Evaluation (IHME). Available online: https:\/\/vizhub.healthdata.org\/gbd-compare."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.11606\/issn.2317-0190.v27i1a169615","article-title":"Independ\u00eancia Funcional e Comprometimento Motor Em Indiv\u00edduos P\u00f3s-AVE Da Comunidade","volume":"27","author":"Rissetti","year":"2020","journal-title":"Acta Fisi\u00e1tr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107917","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107917","article-title":"Availability and Barriers to Access Post-Stroke Rehabilitation in Latin America","volume":"33","author":"Rosales","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ang, S.H., Hwong, W.Y., Bots, M.L., Sivasampu, S., Abdul Aziz, A.F., Hoo, F.K., and Vaartjes, I. (2021). Risk of 28-Day Readmissions among Stroke Patients in Malaysia (2008\u20132015): Trends, Causes and Its Associated Factors. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245448"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11083","DOI":"10.21037\/apm-21-2884","article-title":"Risk Factors for 30-Day Readmission in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis","volume":"10","author":"Deng","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1161\/STROKEAHA.119.026133","article-title":"Factors Associated With 90-Day Readmission After Stroke or Transient Ischemic Attack: Linked Data From the Australian Stroke Clinical Registry","volume":"51","author":"Kilkenny","year":"2020","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"144","DOI":"10.11606\/issn.2317-0190.v26i3a168160","article-title":"Perfil de Pacientes Com Sequelas de Acidente Vascular Cerebral Internados Em Um Centro de Reabilita\u00e7\u00e3o","volume":"26","author":"Marques","year":"2019","journal-title":"Acta Fisi\u00e1tr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/01616412.2020.1815954","article-title":"Predictors, Causes and Outcome of 30-Day Readmission among Acute Ischemic Stroke","volume":"43","author":"Qiu","year":"2021","journal-title":"Neurol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"jrm00208","DOI":"10.2340\/16501977-2849","article-title":"Hospital Readmission in Stroke Survivors One Year versus Three Years after Discharge from Inpatient Rehabilitation: Prevalence and Associations in an Asian Cohort","volume":"53","author":"Tay","year":"2021","journal-title":"J. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wen, T., Liu, B., Wan, X., Zhang, X., Zhang, J., Zhou, X., Lau, A.Y.L., and Zhang, Y. (2018). Risk Factors Associated with 31-Day Unplanned Readmission in 50,912 Discharged Patients after Stroke in China. BMC Neurol., 18.","DOI":"10.1186\/s12883-018-1209-y"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e073933","DOI":"10.1136\/bmjopen-2023-073933","article-title":"Social and Clinical Vulnerability in Stroke and STEMI Management during the COVID-19 Pandemic: A Registry-Based Study","volume":"14","author":"Lesaine","year":"2024","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101258","DOI":"10.1016\/j.jacadv.2024.101258","article-title":"Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020\u20132023","volume":"3","author":"Tong","year":"2024","journal-title":"JACC Adv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e00101417","DOI":"10.1590\/0102-311x00101417","article-title":"O Conceito de Vulnerabilidade e Seus Sentidos Para as Pol\u00edticas P\u00fablicas de Sa\u00fade e Assist\u00eancia Social","volume":"34","author":"Carmo","year":"2018","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_18","first-page":"1","article-title":"Abordagens conceituais da vulnerabilidade no \u00e2mbito da sa\u00fade e assist\u00eancia social","volume":"15","author":"Dimenstein","year":"2020","journal-title":"Rev. Pesqui. Pr\u00e1ticas Psicossociais"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1590\/1413-81232021262.29922020","article-title":"Viol\u00eancia e Vulnerabilidade No Territ\u00f3rio Do Agente Comunit\u00e1rio de Sa\u00fade: Implica\u00e7\u00f5es No Enfrentamento Da COVID-19","volume":"26","author":"Morais","year":"2021","journal-title":"Ci\u00eanc. Sa\u00fade Coletiva"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"89","DOI":"10.36660\/abc.20190532","article-title":"Tend\u00eancia Da Mortalidade Por Doen\u00e7as Cerebrovasculares No Brasil (1996\u20132015) e Associa\u00e7\u00e3o Com Desenvolvimento Humano e Vulnerabilidade Social","volume":"116","author":"Souza","year":"2021","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_21","unstructured":"Mendes, E.V. (2012). O Cuidado das Condi\u00e7\u00f5es Cr\u00f4nicas na Aten\u00e7\u00e3o Prim\u00e1ria \u00e0 Sa\u00fade: O Imperativo da Consolida\u00e7\u00e3o da Estrat\u00e9gia da Sa\u00fade da Fam\u00edlia, Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade. [1st ed.]."},{"key":"ref_22","unstructured":"Polit, D., and Beck, C. (2021). Fundamentos de Pesquisa em Enfermagem: Avalia\u00e7\u00e3o de Evid\u00eancias Para a Pr\u00e1tica da Enfermagem, Artmed."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1590\/S0034-89102010000300021","article-title":"Iniciativa STROBE: Subs\u00eddios Para a Comunica\u00e7\u00e3o de Estudos Observacionais","volume":"44","author":"Malta","year":"2010","journal-title":"Rev. Sa\u00fade P\u00fablica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e5155","DOI":"10.25248\/reas.e5155.2021","article-title":"Perfil Epidemiol\u00f3gico Dos Pacientes Internados Por Acidente Vascular Cerebral No Nordeste Do Brasil","volume":"13","author":"Barbosa","year":"2021","journal-title":"Acervo Sa\u00fade"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1590\/S0004-282X2006000400034","article-title":"Confiabilidade de Escalas de Comprometimento Neurol\u00f3gico Em Pacientes Com Acidente Vascular Cerebral","volume":"64","author":"Caneda","year":"2006","journal-title":"Arq. Neuro-Psiquiatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1590\/S1413-81232013000600027","article-title":"Ades\u00e3o Ao Tratamento Farmacol\u00f3gico e N\u00e3o Farmacol\u00f3gico e Fatores Associados Na Aten\u00e7\u00e3o Prim\u00e1ria Da Hipertens\u00e3o Arterial","volume":"18","author":"Girotto","year":"2013","journal-title":"Ci\u00eanc. Sa\u00fade Coletiva"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20180015","DOI":"10.1590\/2317-1782\/20182018015","article-title":"Reabilita\u00e7\u00e3o P\u00f3s-AVC: Identifica\u00e7\u00e3o de Sinais e Sintomas Fonoaudiol\u00f3gicos Por Enfermeiros e M\u00e9dicos Da Aten\u00e7\u00e3o Prim\u00e1ria \u00e0 Sa\u00fade","volume":"31","author":"Anderle","year":"2019","journal-title":"CoDAS"},{"key":"ref_29","unstructured":"Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade (OPAS) (2015). Cuidados Inovadores Para Condi\u00e7\u00f5es Cr\u00f4nicas: Organiza\u00e7\u00e3o e Presta\u00e7\u00e3o de Aten\u00e7\u00e3o de Alta Qualidade \u00c0s Doen\u00e7as Cr\u00f4nicas N\u00e3o Transmiss\u00edveis Nas Am\u00e9ricas, OPAS."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fabrizzio, G.C., Erdmann, A.L., Oliveira, L.M.D., Lorenzini, E., Jensen, R., and Santos, J.L.G.D. (2024). Prediction of COVID-19 Patients\u2019 Admission to the Intensive Care Unit Based on the Precision Nursing Framework. J. Health Inform., 16.","DOI":"10.59681\/2175-4411.v16.i1.2024.1027"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-Performance Medicine: The Convergence of Human and Artificial Intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4023","DOI":"10.53555\/AJBR.v27i4S.4345","article-title":"Confusion Matrix-Based Performance Evaluation Metrics","volume":"27","author":"Sathyanarayanan","year":"2024","journal-title":"Afr. J. Biomed. Res."},{"key":"ref_33","unstructured":"Lundberg, S.M., Erion, G.G., and Lee, S.-I. (2018). Consistent Individualized Feature Attribution for Tree Ensembles. arXiv."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chicco, D., and Jurman, G. (2020). Machine Learning Can Predict Survival of Patients with Heart Failure from Serum Creatinine and Ejection Fraction Alone. BMC Med. Inform. Decis. Mak., 20.","DOI":"10.1186\/s12911-020-1023-5"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1001\/jama.2017.18391","article-title":"Big Data and Machine Learning in Health Care","volume":"319","author":"Beam","year":"2018","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s42256-019-0138-9","article-title":"From Local Explanations to Global Understanding with Explainable AI for Trees","volume":"2","author":"Lundberg","year":"2020","journal-title":"Nat. Mach. Intell."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"106146","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106146","article-title":"The Association of Socioeconomic Status and Discharge Destination with 30-Day Readmission after Ischemic Stroke","volume":"30","author":"Man","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_38","unstructured":"Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade (OPAS) (2023). La Situaci\u00f3n de Los Cuidados a Largo Plazo en Am\u00e9rica Latina y el Caribe, OPAS."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e3197","DOI":"10.1590\/1518-8345.3118.3197","article-title":"Preditores de Interna\u00e7\u00e3o Prolongada Em Unidade de Acidente Vascular Cerebral (AVC)","volume":"27","author":"Gaspari","year":"2019","journal-title":"Rev. Lat.-Am. Enferm."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e00118816","DOI":"10.1590\/0102-311x00118816","article-title":"Aten\u00e7\u00e3o Prim\u00e1ria Integral e Sistemas Segmentados de Sa\u00fade Na Am\u00e9rica Do Sul","volume":"33","author":"Giovanella","year":"2017","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_41","first-page":"1374","article-title":"Sistemas de Salud En Latinoam\u00e9rica Durante El Periodo 2020 al 2023","volume":"24","year":"2024","journal-title":"Rev. Climatol."},{"key":"ref_42","first-page":"e03792024","article-title":"Perspectivas Para Las Pol\u00edticas P\u00fablicas de Atenci\u00f3n Primaria En Salud En Suram\u00e9rica","volume":"29","author":"Almeida","year":"2024","journal-title":"Ci\u00eanc. Sa\u00fade Coletiva"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104","DOI":"10.11606\/s1518-8787.2019053000859","article-title":"Effect of the Melhor Em Casa Program on Hospital Costs","volume":"53","author":"Nishimura","year":"2019","journal-title":"Rev. Sa\u00fade P\u00fablica"},{"key":"ref_44","first-page":"e146","article-title":"Cuidados de larga duraci\u00f3n en Costa Rica: Ense\u00f1anzas para Am\u00e9rica Latina desde la evidencia internacional","volume":"45","year":"2021","journal-title":"Rev. Panam. Salud P\u00fablica"},{"key":"ref_45","unstructured":"S\u00e1nchez, Y.C.A. (2021). Recomendaciones Para la Articulaci\u00f3n de los Programas de Atenci\u00f3n Domiciliaria en Paciente Cr\u00f3nico de la Red P\u00fablica y Privada En Bogot\u00e1: Una Reflexi\u00f3n Desde las Ciencias Contempor\u00e1neas. [Master\u2019s Thesis, Facultad de Medicina, Universidad El Bosque]."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:28:28Z","timestamp":1763011708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijerph22111705"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22111705","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}