{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:30:45Z","timestamp":1793370645484,"version":"4.5.0"},"reference-count":60,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research, Qassim University","id":[{"id":"https:\/\/ror.org\/01wsfe280","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Menstruation is a natural occurrence marked by the periodic release of endometrial cells within the uterine lining from the female genital area. Menstruation knowledge remains highly essential for young adolescents. Inadequate awareness and understanding of menstruation have far-reaching consequences on the overall wellbeing and health outcomes of young adults worldwide. Adolescent girls make up a large percentage of high school students in Nigeria. Girls in countries with low to middle incomes are frequently misled or uneducated regarding menstruation. Menstrual health literacy (MHL) is the level of knowledge concerning matters related to menstrual health. It is observed that a lack of menstrual health literacy is seen among young adults. This systematic review aimed to examine menstruation literacy, attitudes, and adolescent girls\u2019 practices in Nigeria. Materials and Methods: This systematic review included quantitative, cross-sectional, quasi-experimental, and qualitative primary research studies relating to menstruation literacy, attitudes, and practices of adolescents in Nigeria. Articles for this study were searched for on databases such as PubMed and BioMed Central using keywords. These studies were subjected to stringent inclusion and exclusion criteria where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and 13 articles were included after critical appraisal. Data extracted were analysed using narrative synthesis. Results: Findings indicated that knowledge regarding menstruation among adolescents (82.6%) was poor. Menstruation information was obtained from mothers, which was positive as some adolescents reported their closeness to their mothers. Regarding attitudes towards menstruation among adolescents, it was reported that more respondents (70.3%) had negative attitudes towards menstruation. Conclusions: Most of the respondents in Nigeria were not adequately prepared for the onset of their first menstrual period. Knowledge and attitude levels were low regarding periods for adolescents. The only exception was their positive attitude towards using water and soap to wash their hands during menstruation. The review shows a significant gap between adolescents\u2019 menstruation knowledge and actual hygienic methods during menstruation. It is therefore required for educational awareness programmes and campaigns to be put in place to educate adolescents about menstruation.<\/jats:p>","DOI":"10.3390\/medicina59122073","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T06:51:28Z","timestamp":1700808688000},"page":"2073","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Menstruation among In-School Adolescent Girls and Its Literacy and Practices in Nigeria: A Systematic Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9930-7859","authenticated-orcid":false,"given":"Chinomso Adanma","family":"Uzoechi","sequence":"first","affiliation":[{"name":"School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7390-4308","authenticated-orcid":false,"given":"Ali Davod","family":"Parsa","sequence":"additional","affiliation":[{"name":"School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1330-7813","authenticated-orcid":false,"given":"Ilias","family":"Mahmud","sequence":"additional","affiliation":[{"name":"School of Health, University of New England, Armidale, NSW 2351, Australia"},{"name":"BRAC James P Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0316-1374","authenticated-orcid":false,"given":"Ibrahim","family":"Alasqah","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9257-2775","authenticated-orcid":false,"given":"Russell","family":"Kabir","sequence":"additional","affiliation":[{"name":"School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"ref_1","unstructured":"Abbas, A.K., Lichtman, A.H., and Pillai, S. (2014). Cellular and Molecular Immunology, Elsevier. [8th ed.]."},{"key":"ref_2","first-page":"20","article-title":"Nursing Intervention on Knowledge of Menstruation and Menstrual Hygiene Among Adolescents in Irepodun-Ifelodun Local Government of Ekiti State","volume":"2","author":"Ogunleye","year":"2020","journal-title":"Int. J. Acad. Res. Bus. Arts Sci."},{"key":"ref_3","unstructured":"World Health Organization (2023, May 09). Education and Provisions for Adequate Menstrual Hygiene Management at School can Prevent Adverse Health Consequences. Available online: https:\/\/www.who.int\/europe\/news\/item\/27-05-2022-education-and-provisions-for-adequate-menstrual-hygiene-management-at-school-can-prevent-adverse-health-consequences."},{"key":"ref_4","first-page":"88","article-title":"Menstrual Hygiene Practices and Sources of Menstrual Hygiene Information among Adolescent Secondary School Girls in Abakaliki Education Zone of Ebonyi State","volume":"7","author":"Ilo","year":"2016","journal-title":"J. Educ. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.47604\/ijgs.1732","article-title":"Knowledge, Attitude and Practices of Menstrual Hygiene Management among Orphan and Vulnerable Adolescents in Lagos State","volume":"8","author":"Jimin","year":"2023","journal-title":"Int. J. Gend. Stud."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"214","DOI":"10.11604\/pamj.2021.40.214.30601","article-title":"An outcome of educational intervention on the menstrual hygiene practices among schoolgirls in Ogun State, Nigeria: A quasi-experimental study","volume":"40","author":"Agbede","year":"2021","journal-title":"Pan Afr. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"838961","DOI":"10.3389\/fgwh.2022.838961","article-title":"Improving Menstrual Health Literacy Through Life-Skills Programming in Rural Ethiopia","volume":"3","author":"Baird","year":"2022","journal-title":"Front. Glob. Women\u2019s Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"859797","DOI":"10.3389\/fgwh.2022.859797","article-title":"The More You Know, the Less You Stress: Menstrual Health Literacy in Schools Reduces Menstruation-Related Stress and Increases Self-Efficacy for Very Young Adolescent Girls in Mexico","volume":"3","author":"Long","year":"2022","journal-title":"Front. Glob. Women\u2019s Health"},{"key":"ref_9","unstructured":"Ekoko, O.N., and Ikolo, V.E. (2021). Menstrual Hygiene Literacy Campaign Among Secondary School Girls in Rural Areas of Delta State, Nigeria. Libr. Philos. Pract., 5904. Available online: https:\/\/digitalcommons.unl.edu\/libphilprac\/5904."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jsams.2023.06.007","article-title":"Improving menstrual health literacy in sport","volume":"26","author":"Mcgawley","year":"2023","journal-title":"J. Sci. Med. Sport"},{"key":"ref_11","first-page":"e010290","article-title":"Menstrual hygiene management among adolescent girls in India: A systematic review and meta-analysis","volume":"6","author":"Sivakami","year":"2016","journal-title":"Br. Med. J. Open"},{"key":"ref_12","first-page":"e0188456","article-title":"Menstruation and the cycle of poverty: A cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda","volume":"12","author":"Hennegan","year":"2017","journal-title":"Public Libr. Sci. One"},{"key":"ref_13","first-page":"e1002302","article-title":"A time for global action: Addressing girls\u2019 menstrual hygiene management needs in schools","volume":"14","author":"Sommer","year":"2017","journal-title":"Public Libr. Sci. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mohammed, S., and Larsen-Reindorf, R.E. (2020). Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0241106"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"842","DOI":"10.4314\/ahs.v21i2.45","article-title":"Menstrual hygiene management among adolescent schoolgirls in Taraba State, Nigeria","volume":"21","author":"Atinge","year":"2021","journal-title":"Afr. Health Sci."},{"key":"ref_16","first-page":"e057204","article-title":"Systematic review of educational interventions to improve the menstrual health of young adolescent girls","volume":"12","author":"Evans","year":"2022","journal-title":"Br. Med. J. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2147\/RMHP.S296670","article-title":"Knowledge on Menstruation and Practice of Menstrual Hygiene Management Among School Adolescent Girls in Central Ethiopia: A Cross-Sectional Study","volume":"14","author":"Bulto","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.18203\/2320-1770.ijrcog20171932","article-title":"Assessment of knowledge, attitude and practice about menstruation and menstrual hygiene among secondary high school girls in Ogbomoso, Oyo state, Nigeria","volume":"6","author":"Fehintola","year":"2017","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_19","first-page":"321","article-title":"An exploratory study of menstruation and menstrual hygiene knowledge among adolescents in urban and rural secondary schools in cross river State, Nigeria","volume":"23","author":"Edet","year":"2020","journal-title":"Afr. J. Biomed. Res."},{"key":"ref_20","first-page":"365","article-title":"Knowledge, Attitudes and Practices of Menstrual Hygiene Management of Female Students in Bokkos Local Government Area of Plateau State; Nigeria","volume":"6","author":"Gorah","year":"2020","journal-title":"KIU J. Soc. Sci."},{"key":"ref_21","first-page":"1","article-title":"Knowledge, Attitude and Practice of Menstrual Hygiene Among Public Secondary School Students in Akinyele Local Government Area of Oyo State","volume":"29","author":"Ibeagha","year":"2022","journal-title":"Niger. Acad. Forum"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/TJOG.TJOG_81_17","article-title":"Menstrual hygiene among adolescent schoolgirls in Kano, Nigeria","volume":"35","author":"Garba","year":"2018","journal-title":"Trop. J. Obstet. Gynaecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.18203\/2394-6040.ijcmph20222003","article-title":"Knowledge and menstrual hygiene practices among adolescent secondary school girls in Ebonyi State, Nigeria","volume":"9","author":"Chikezie","year":"2022","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.4103\/jfmpc.jfmpc_80_18","article-title":"Menstrual hygiene among adolescent girls\u2014A study from urban slum area","volume":"7","author":"Patil","year":"2018","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Holmes, K., Curry, C., Sherry Ferfolja, T., Parry, K., Smith, C., Hyman, M., and Armour, M. (2021). Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A Narrative Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.20944\/preprints202101.0427.v1"},{"key":"ref_26","first-page":"35","article-title":"Maternal and Adolescent Factors Associated with Menstrual Hygiene of Girls in Senior Secondary Schools in Lagos, Nigeria","volume":"6","author":"Rasheed","year":"2021","journal-title":"J. Matern. Child Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Barnett-Page, E., and Thomas, J. (2019). Methods for the synthesis of qualitative research: A critical review. BMC Med. Res. Methodol., 9.","DOI":"10.1186\/1471-2288-9-59"},{"key":"ref_28","unstructured":"Tomlinson, M.M. (2023, June 12). A Mixed Methods Assessment of Menstrual Hygiene Management and School Attendance among Schoolgirls in Edo State, Nigeria. Available online: https:\/\/ir.library.louisville.edu\/cgi\/viewcontent.cgi?article=5284&context=etd."},{"key":"ref_29","unstructured":"Obioma, N., Nkadi, O., Temitayo, O., and Femi, A. (2023, August 15). An Assessment of Menstrual Hygiene Management in Secondary Schools. Available online: https:\/\/www.unicef.org\/nigeria\/media\/1256\/file\/Assessment-menstrual-hygiene-management-in-secondary-schools-2.jpg.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/1059840517727831","article-title":"Pubertal Communication Between School Nurses and Adolescent Girls in Ile-Ife, Nigeria","volume":"35","author":"Salau","year":"2019","journal-title":"J. Sch. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20170023","DOI":"10.1515\/ijamh-2017-0023","article-title":"Blood, joy and tears: Menarche narratives of undergraduate females in a selected in Nigeria Private University","volume":"31","author":"Adegbayi","year":"2017","journal-title":"Int. J. Adolesc. Med. Health"},{"key":"ref_32","first-page":"179","article-title":"Knowledge, belief and practice of menstrual hygiene management among in-school adolescents in Katsina state, Nigeria","volume":"31","author":"Chuemchit","year":"2017","journal-title":"J. Health Res."},{"key":"ref_33","first-page":"1","article-title":"Assessment of Knowledge, Attitude, and Practice of Menstrual Hygiene Management Among Adolescent Girls And Young Women In An Internally Displaced Person Camp In Federal Capital Territory, Nigeria","volume":"11","author":"Nkemdilim","year":"2023","journal-title":"J. Res. Hum. Soc. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"397","DOI":"10.4314\/ahs.v22i2.46","article-title":"Menstrual hygiene management practices and menstrual distress among adolescent secondary school girls: A questionnaire-based study in Nigeria","volume":"22","author":"Nwimo","year":"2022","journal-title":"Afr. Health Sci."},{"key":"ref_35","first-page":"10","article-title":"Attitude Towards Menstrual Hygiene Practices Among Female Secondary School Students In Khana, Rivers State, Nigeria","volume":"19","author":"Emmanuel","year":"2020","journal-title":"Int. J. Pure App. Sci."},{"key":"ref_36","first-page":"76","article-title":"Relationship between Knowledge of Health Consequences and Practice of Menstrual Hygiene among Female Students of Selected Secondary Schools in Bauchi State","volume":"8","author":"Isah","year":"2022","journal-title":"Afr. J. Hum. Contem. Edu. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.9734\/jesbs\/2021\/v34i530325","article-title":"Knowledge and Menstrual Hygiene Practices among Adolescent Female Apprentices in Lagelu Local Government Area, Ibadan, Nigeria","volume":"34","author":"Bolanle","year":"2021","journal-title":"J. Educ. Soc. Behav. Sci."},{"key":"ref_38","first-page":"1","article-title":"Knowledge of Menstrual Hygiene Among Female Secondary School Students in Khana, Rivers State, Nigeria","volume":"8","author":"Buradum","year":"2020","journal-title":"Int. J. Innov. Healthc. Res."},{"key":"ref_39","first-page":"1","article-title":"Knowledge, Attitude and Practice of Menstrual Hygiene Amongst Female Secondary School Students in Kaduna State","volume":"6","author":"Popoola","year":"2021","journal-title":"J. Med. Women\u2019s Assoc. Niger."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"292","DOI":"10.4236\/ojog.2022.124028","article-title":"Knowledge and Practice of Menstrual Health and Hygiene among Young People in Jos, Plateau State, Nigeria","volume":"12","author":"Idoko","year":"2022","journal-title":"Open J. Obstet. Gynecol."},{"key":"ref_41","first-page":"1","article-title":"Menstrual Hygiene Practices among Secondary School Girls in Owerri Municipal Council of Imo State, Nigeria","volume":"6","author":"Okeke","year":"2021","journal-title":"Int. J. Hum. Kinet. Health Educ."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.52589\/IJPHP-DJSHA0UN","article-title":"Effect of Peer-Led and Parent-Led Education Interventions on Menstrual Hygiene-Related Knowledge of In-School Adolescent Girls in Ogun State, Nigeria","volume":"2","author":"Chinasa","year":"2021","journal-title":"Int. J. Public Health Pharmacol."},{"key":"ref_43","first-page":"215","article-title":"Intervention Study on Practice of Menstrual Hygiene Among Adolescents in Two Selected Secondary Schools, Lagos State","volume":"3","author":"Adegoke","year":"2022","journal-title":"Int. J. Med."},{"key":"ref_44","first-page":"16","article-title":"Effectiveness of Structured-Teaching-Programme on Adolescents\u2019 Knowledge of Early Pubertal Changes and Menstrual Hygiene in Selected Secondary Schools in Sapele, Delta State, Nigeria","volume":"6","author":"Omovie","year":"2021","journal-title":"Int. J. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1080\/17441692.2014.908230","article-title":"Investing in very young adolescents\u2019 sexual and reproductive health","volume":"9","author":"Igras","year":"2014","journal-title":"Glob. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12978-017-0293-6","article-title":"Mapping the knowledge and understanding of menarche, menstrual hygiene, and menstrual health among adolescent girls in low-and middle-income countries","volume":"14","author":"Patel","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/gwao.12546","article-title":"Exist or exit? Women business-owners in Bangladesh during COVID-19","volume":"28","author":"Jaim","year":"2021","journal-title":"Gend. Work. Organ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12978-019-0758-x","article-title":"Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, North Shewa, Ethiopia","volume":"16","author":"Demisse","year":"2019","journal-title":"Reprod. Health"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sully, E.A., Biddlecom, A., Darroch, J.E., Riley, T., Ashford, L.S., Lince-Deroche, N., and Murro, R. (2020). Adding It up: Investing in Sexual and Reproductive Health, Guttmacher Institute.","DOI":"10.1363\/2020.31593"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/26895269.2022.2100644","article-title":"Standards of care for the health of transgender and gender diverse people, version 8","volume":"23","author":"Coleman","year":"2022","journal-title":"Int. J. Transgender Health"},{"key":"ref_51","unstructured":"World Health Organization (2022). World Mental Health Report: Transforming Mental Health for All, World Health Organization."},{"key":"ref_52","first-page":"1","article-title":"Knowledge, practices and socio-cultural restrictions associated with menstruation and menstrual hygiene among in-school adolescents in South Africa","volume":"16","author":"Olabanjo","year":"2018","journal-title":"Int. J. Public Health"},{"key":"ref_53","first-page":"201","article-title":"Menstruation and Menstrual Hygiene amongst Adolescent School Girls in Kano, Northwestern Nigeria","volume":"3","author":"Lawan","year":"2018","journal-title":"Afr. J. Reprod. Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.18203\/2394-6040.ijcmph20192310","article-title":"Knowledge, attitude, practice and perception about menstruation and menstrual hygiene among adolescent schoolgirls in rural areas of Raigad district","volume":"6","author":"Parle","year":"2019","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12889-022-14942-8","article-title":"Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis","volume":"23","author":"Anbesu","year":"2023","journal-title":"BioMed Cent. Public Health"},{"key":"ref_56","first-page":"8938615","article-title":"Menstrual hygiene management practices and associated factors among secondary school girls in East Hararghe Zone, Eastern Ethiopia","volume":"2020","author":"Mohammed","year":"2020","journal-title":"Adv. Public Health"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Shah, V., Nabwera, H.M., Sosseh, F., Jallow, Y., Comma, E., Keita, O., and Torondel, B. (2019). A rite of passage: A mixed methodology study about knowledge, perceptions, and practices of menstrual hygiene management in rural Gambia. BioMed Cent. Public Health, 19.","DOI":"10.1186\/s12889-019-6599-2"},{"key":"ref_58","first-page":"e0248825","article-title":"Menstrual hygiene practices among high school girls in urban areas in Northeastern Ethiopia: A neglected issue in water, sanitation, and hygiene research","volume":"16","author":"Habtegiorgis","year":"2021","journal-title":"Public Libr. Sci. One"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ajari, E., Abass, T., Ilesanmi, E., and Adebisi, Y. (2021). Cost Implications of Menstrual Hygiene Management in Nigeria and Its Associated Impacts. Preprints, 2021050349.","DOI":"10.20944\/preprints202105.0349.v2"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.2147\/RMHP.S267534","article-title":"Factors affecting menstrual hygiene management practice among school adolescents in Ambo, Western Ethiopia, 2018: A cross-sectional mixed-method study","volume":"13","author":"Ahmed","year":"2020","journal-title":"Risk Manag. Healthc. Policy"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2073\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:29:15Z","timestamp":1760131755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":60,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["medicina59122073"],"URL":"https:\/\/doi.org\/10.3390\/medicina59122073","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,24]]}}}