{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:02:44Z","timestamp":1779685364445,"version":"3.53.1"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cesumar Institute of Science, Technology and Innovation (ICETI) of Cesumar University"},{"DOI":"10.13039\/501100004612","name":"Arauc\u00e1ria Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004612","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>We evaluated the effects of a 12-week multidisciplinary program on health-related physical fitness and depressive symptoms in overweight and obese women (aged 45\u201364 years) diagnosed with noncommunicable diseases (NCDs). Methods: A longitudinal, pre-experimental, proof-of-concept study was conducted. Thirty-one women completed multidisciplinary interventions [nutritional education or psychoeducation (each once a week), and resistance training (twice a week)]. Body composition (bioelectrical impedance), physical fitness (maximal isometric strength, lower limb strength\u2013endurance, flexibility, and aerobic fitness), and depressive symptoms (PHQ-9) were measured at baseline and post-intervention. Results: Significant improvements in body composition were observed in terms of lean mass (\u0394% = 3.7; p &lt; 0.001), fat-free mass (\u0394% = 3.6; p &lt; 0.001), skeletal muscle mass (\u0394% = 5.2; p &lt; 0.001), fat mass (\u0394% = \u22123.5; p &lt; 0.001), body fat percentage (\u0394% = \u22124.7; p &lt; 0.001), and visceral fat level (\u0394% = \u22122.9; p = 0.012). Physical fitness exhibited a large effect size in the chair stand test (d = 0.91) and the 6 min walk test (d = 1.22). Depressive symptom scores substantially decreased (p &lt; 0.001). Conclusion: The program demonstrated potential efficacy in mitigating sarcopenic obesity, enhancing functional capacity, and reducing depressive symptoms, indicating potential clinical viability for the integrated management of multimorbidity.<\/jats:p>","DOI":"10.3390\/ijerph23060690","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T02:32:28Z","timestamp":1779676348000},"page":"690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of a 12-Week Multidisciplinary Program on Health-Related Physical Fitness and Depressive Symptoms in Overweight and Obese Women Aged Between 45 and 64 Years with Noncommunicable Chronic Diseases"],"prefix":"10.3390","volume":"23","author":[{"given":"Maria Luiza Amaro","family":"Camilo","sequence":"first","affiliation":[{"name":"Graduate Program in Health Promotion, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-1750","authenticated-orcid":false,"given":"Enzo","family":"Berbery","sequence":"additional","affiliation":[{"name":"Research Group in Health and Education (GESE), Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Interdisciplinary Laboratory of Health Promotion Intervention, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endriw Domingues","family":"Noronha","sequence":"additional","affiliation":[{"name":"Graduate Program in Health Promotion, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Research Group in Health and Education (GESE), Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Interdisciplinary Laboratory of Health Promotion Intervention, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-4265","authenticated-orcid":false,"given":"Leonardo","family":"Vidal Andreato","sequence":"additional","affiliation":[{"name":"Graduate Program in Health Promotion, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Research Group in Health and Education (GESE), Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Interdisciplinary Laboratory of Health Promotion Intervention, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Lozza de Moraes","family":"Marchiori","sequence":"additional","affiliation":[{"name":"Graduate Program in Health Promotion, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Research Group in Health and Education (GESE), Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Interdisciplinary Laboratory of Health Promotion Intervention, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3948-8280","authenticated-orcid":false,"given":"Pablo","family":"Vald\u00e9s-Badilla","sequence":"additional","affiliation":[{"name":"Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Cat\u00f3lica del Maule, Talca 3530000, Chile"},{"name":"Sports Coach Career, Faculty of Life Sciences, Universidad Vi\u00f1a del Mar, Vi\u00f1a del Mar 2520000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4625-9128","authenticated-orcid":false,"given":"Braulio Henrique Magnani","family":"Branco","sequence":"additional","affiliation":[{"name":"Graduate Program in Health Promotion, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Research Group in Health and Education (GESE), Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Interdisciplinary Laboratory of Health Promotion Intervention, Cesumar University, Maringa 87050-900, Parana, Brazil"},{"name":"Cesumar Institute of Science, Technology and Innovation, Cesumar University, Maringa 87050-900, Parana, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, February 08). Noncommunicable Diseases, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e20211065","DOI":"10.1590\/ss2237-9622202200016.especial","article-title":"Inequalities and Chronic Non-Communicable Diseases in Brazil","volume":"31","author":"Wehrmeister","year":"2022","journal-title":"Epidemiol. Serv. Saude"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Santos, E.M., Canhestro, A.M., Ros\u00e1rio, J.M., Fonseca, C.J., Pinho, L.M., and Arco, H.M. (2023). Efficacy of Health Promotion Interventions Aimed to Improve Health Gains in Middle-Aged Adults: A Systematic Review. Geriatrics, 8.","DOI":"10.3390\/geriatrics8030050"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/s41392-022-01251-0","article-title":"Aging and Aging-Related Diseases: From Molecular Mechanisms to Interventions and Treatments","volume":"7","author":"Guo","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100155","DOI":"10.1016\/j.fochms.2022.100155","article-title":"Dietary Polyphenols and Their Relationship to the Modulation of Non-Communicable Chronic Diseases and Epigenetic Mechanisms: A Mini-Review","volume":"6","author":"Borsoi","year":"2022","journal-title":"Food Chem. Mol. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Jakovljevic, M., Kumagai, N., and Ogura, S. (2023). Editorial: Global Population Aging\u2014Health Care, Social and Economic Consequences, Volume II. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1184950"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1001\/archpediatrics.2012.797","article-title":"Cost-Effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees","volume":"166","author":"Stearns","year":"2012","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_8","first-page":"e20250122","article-title":"Prevention Is Less Expensive than Treatment in Chronic Kidney Disease: A Descriptive Analysis","volume":"48","author":"Alcalde","year":"2025","journal-title":"Braz. J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e3805","DOI":"10.1002\/dmrr.3805","article-title":"Cost-Effectiveness of Temperature Monitoring to Help Prevent Foot Ulcer Recurrence in People with Diabetes: A Multicenter Randomized Controlled Trial","volume":"40","author":"Dijkgraaf","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_10","first-page":"100746","article-title":"The 2023 Latin America Report of the Lancet Countdown on Health and Climate Change: The Imperative for Health-Centred Climate-Resilient Development","volume":"33","author":"Hartinger","year":"2024","journal-title":"Lancet Reg. Health Am."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Barb\u00e3o, K.E.G., Pavanello, A., Oliveira, F.M., Santos, N.Q., Vald\u00e9s-Badilla, P., Marchiori, L.L.M., Franchini, E., and Branco, B.H.M. (2025). Variation in Body Composition Components Across Different Age Groups and Proposal of Age-Specific Normative Tables: A Cross-Sectional Study. Nutrients, 17.","DOI":"10.3390\/nu17091435"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(18)32822-8","article-title":"The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission Report","volume":"393","author":"Swinburn","year":"2019","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1007\/s00204-023-03562-9","article-title":"Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging","volume":"97","author":"Jomova","year":"2023","journal-title":"Arch. Toxicol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Schwartz, J., Oh, P., Perotto, M.B., Rhodes, R.E., Firth, W., Bredin, S.S.D., Gayt\u00e1n-Gonz\u00e1lez, A., and Warburton, D.E.R. (2021). A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.730373"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/GME.0000000000002320","article-title":"Prevalence and Risk Factors Associated with Diabetes Mellitus among Middle-Aged Women in Southern Brazil: A Population-Based Study","volume":"31","author":"Oppermann","year":"2024","journal-title":"Menopause"},{"key":"ref_16","first-page":"e210204","article-title":"Chronic Non-Communicable Diseases Considering Sociodemographic Determinants in a Cohort of Older Adults","volume":"25","author":"Silva","year":"2022","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11892-022-01458-z","article-title":"Integrated Behavioral Interventions for Adults with Comorbid Obesity and Depression: A Systematic Review","volume":"22","author":"Lv","year":"2022","journal-title":"Curr. Diab. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Prats-Arimon, M., Puig-Llobet, M., Barcel\u00f3-Peir\u00f3, O., Ribot-Dom\u00e8nech, I., Vilalta-Sererols, C., Fontecha-Valero, B., Heras-Ojeda, M., Ag\u00fcera, Z., Lluch-Canut, T., and Moreno-Poyato, A. (2024). An Interdisciplinary Intervention Based on Prescription of Physical Activity, Diet, and Positive Mental Health to Promote Healthy Lifestyle in Patients with Obesity: A Randomized Control Trial. Nutrients, 16.","DOI":"10.3390\/nu16162776"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rusowicz, J., Serweta, A., Idzikowski, W., and Szczepa\u0144ska-Gieracha, J. (2021). Multimodal Therapeutic Approach in Women with High Risk of Metabolic Syndrome\u2014A Single Group One Center Pre-Post Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214915"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bolognese, M.A., Franco, C.B., Ferrari, A., Bennemann, R.M., Lopes, S.M.A., Bertolini, S.M.M.G., J\u00fanior, N.N., and Branco, B.H.M. (2020). Group Nutrition Counseling or Individualized Prescription for Women with Obesity? A Clinical Trial. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00127"},{"key":"ref_21","first-page":"8","article-title":"Efecto de un Programa Multiprofesional en la Promoci\u00f3n de la Salud Alimentaria de las Personas Mayores: Un Estudio Longitudinal","volume":"26","author":"Marques","year":"2022","journal-title":"Rev. Esp. Nutr. Hum. Diet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2105\/AJPH.94.3.361","article-title":"Improving the Reporting Quality of Nonrandomized Evaluations of Behavioral and Public Health Interventions: The TREND Statement","volume":"94","author":"Lyles","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-Country Reliability and Validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a Brief Depression Severity Measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_25","first-page":"338","article-title":"Revision of the Physical Activity Readiness Questionnaire (PAR-Q)","volume":"17","author":"Thomas","year":"1992","journal-title":"Can. J. Sport Sci."},{"key":"ref_26","unstructured":"Ministry of Health of Brazil (2025, March 10). Dietary Guidelines for the Brazilian Population, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/dietary_guidelines_brazilian_population.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lores, T., Musker, M., Collins, K., Burke, A., Perry, S.W., Wong, M.L., and Licinio, J. (2020). Pilot Trial of a Group Cognitive Behavioural Therapy Program for Comorbid Depression and Obesity. BMC Psychol., 8.","DOI":"10.1186\/s40359-020-00400-w"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s10880-023-10000-6","article-title":"Comparative Effectiveness of Cognitive Behavioral Therapy and Behavioral Therapy in Obesity: A Systematic Review and Network Meta-Analysis","volume":"32","author":"Cha","year":"2025","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1519\/JSC.0b013e3181c69ec6","article-title":"A Practical Approach to Monitoring Recovery: Development of a Perceived Recovery Status Scale","volume":"25","author":"Laurent","year":"2011","journal-title":"J. Strength Cond. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fleck, S.J., and Kraemer, W.J. (2014). Designing Resistance Training Programs, Human Kinetics. [4th ed.].","DOI":"10.5040\/9781718225107"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s00421-025-05966-0","article-title":"Resistance Exercise Training Similarly Improves Work Efficiency and Measured Submaximal Oxygen Consumption during the 6-min Walk Test","volume":"126","author":"Sapunar","year":"2026","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_32","unstructured":"Gibson, A.L., Wagner, D.R., and Heyward, V.H. (2024). Advanced Fitness Assessment and Exercise Prescription, Human Kinetics. [9th ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1089\/152091599317206","article-title":"Assessing Body Composition of Adults with Diabetes","volume":"1","author":"Stolarczyk","year":"1999","journal-title":"Diabetes Technol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s11332-018-0469-7","article-title":"Development of Tables for Classifying Judo Athletes According to Maximal Isometric Strength and Muscular Power","volume":"14","author":"Branco","year":"2018","journal-title":"Sport Sci. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.2147\/CIA.S194543","article-title":"Grip Strength: An Indispensable Biomarker for Older Adults","volume":"14","author":"Bohannon","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/geront\/gns071","article-title":"Development and Validation of Criterion-Referenced Clinically Relevant Fitness Standards","volume":"53","author":"Rikli","year":"2013","journal-title":"Gerontologist"},{"key":"ref_37","first-page":"115","article-title":"The Sit and Reach\u2014A Test of Back and Leg Flexibility","volume":"23","author":"Wells","year":"1952","journal-title":"Res. Q. Am. Assoc. Health Phys. Educ. Recreat."},{"key":"ref_38","unstructured":"American College of Sports Medicine (2013). ACSM\u2019s Guidelines for Exercise Testing and Prescription, Lippincott Williams & Wilkins. [9th ed.]."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS Statement: Guidelines for the Six-Minute Walk Test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1161\/HYP.0000000000000087","article-title":"Measurement of Blood Pressure in Humans: A Scientific Statement from the American Heart Association","volume":"73","author":"Muntner","year":"2019","journal-title":"Hypertension"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1590\/S0102-311X2013001200006","article-title":"Sensibilidade e Especificidade do Patient Health Questionnaire-9 (PHQ-9)","volume":"29","author":"Santos","year":"2013","journal-title":"Cad. Saude Publica"},{"key":"ref_42","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]. Available online: https:\/\/www.taylorfrancis.com\/books\/mono\/10.4324\/9780203771587\/statistical-power-analysis-behavioral-sciences-jacob-cohen."},{"key":"ref_43","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_44","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1123\/jpah.2024-0848","article-title":"Effects of Concurrent Neuromuscular Training on Body Composition","volume":"22","author":"Cavaggioni","year":"2025","journal-title":"J. Phys. Act. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1159\/000501203","article-title":"Effects of Exercise Training on Handgrip Strength in Older Adults: A Systematic Review and Meta-Analysis","volume":"65","author":"Labott","year":"2019","journal-title":"Gerontology."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1002\/oby.21977","article-title":"Effect of Exercise Type during Intentional Weight Loss on Body Composition in Older Adults with Obesity","volume":"25","author":"Beavers","year":"2017","journal-title":"Obesity"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.clnu.2004.06.004","article-title":"Bioelectrical impedance analysis\u2014Part I: Review of principles and methods","volume":"23","author":"Kyle","year":"2004","journal-title":"Clin. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S0899-9007(00)00471-8","article-title":"Limits of body mass index to detect obesity and predict body composition","volume":"17","author":"Frankenfield","year":"2001","journal-title":"Nutrition"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1475-2891-7-26","article-title":"Is bioelectrical impedance accurate for use in large epidemiological studies?","volume":"7","author":"Dehghan","year":"2008","journal-title":"Nutr. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5007\/1980-0037.2013v15n1p113","article-title":"Procedimentos cl\u00ednicos utilizados para an\u00e1lise da composi\u00e7\u00e3o corporal","volume":"15","author":"Guedes","year":"2013","journal-title":"Rev. Bras. Cineantropom. Desempenho Hum."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/690\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:14:53Z","timestamp":1779682493000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,23]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060690"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060690","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,23]]}}}