{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T14:48:40Z","timestamp":1764859720237,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Aging is a global phenomenon closely associated with changes in cognitive function and mental health. These conditions substantially burden public health systems and adversely affect the quality of life of older adults. This study aimed to examine changes in depressive symptoms and cognitive function over a 12-month follow-up period in a cohort of Brazilian older adults attending primary care. Methods: This observational longitudinal study included a randomized sample of individuals aged \u226560 years residing in S\u00e3o Paulo, Brazil, and registered at a Primary Healthcare Unit (PHU). Data collection involved administering a sociodemographic and health questionnaire along with two validated instruments: the Geriatric Depression Scale-15 (GDS-15) and the Mini-Mental State Examination (MMSE). Linear regression models were used for the analyses. Results: A total of 368 older adults were included, with 63% being men and a mean age of 74.65 years. After one year, depressive symptoms showed a notable increase, with the mean GDS-15 score rising from 5.97 to 7.48 (Cohen-d = 0.542). Likewise, there was a decrease in the mean MMSE score ranging from 19.11 to 18.88 (Cohen-d = 0.216). Adjusted regression analyses revealed that depressive symptoms at baseline (B = 0.696; p = 0.048; R2 = 0.19) and cognitive function at baseline (B = 0.444; p &lt; 0.001; R2 = 0.26) were predictive of their respective deteriorations over the follow-up period. Conclusions: Depressive symptoms and cognitive decline place a significant burden on public health systems in aging societies. These findings underscore the importance of continuous monitoring and early intervention strategies to mitigate their impact and enhance the quality of life for older adults.<\/jats:p>","DOI":"10.3390\/healthcare13070807","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T05:51:26Z","timestamp":1743659486000},"page":"807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["One-Year Changes in Depressive Symptoms and Cognitive Function Among Brazilian Older Adults Attending Primary Care"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0712-6420","authenticated-orcid":false,"given":"Fernanda Maria Silva","family":"Rivoli","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Itajub\u00e1, Itajub\u00e1 37502-138, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6592-2150","authenticated-orcid":false,"given":"Antonio Pedro Gabriel Monteiro","family":"Galhardo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Itajub\u00e1, Itajub\u00e1 37502-138, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-9476","authenticated-orcid":false,"given":"Giancarlo","family":"Lucchetti","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora 36038-330, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2050-8132","authenticated-orcid":false,"given":"L\u00edzia Abreu","family":"Esper","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Itajub\u00e1, Itajub\u00e1 37502-138, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4835-5794","authenticated-orcid":false,"given":"Yan Lyncon","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Itajub\u00e1, Itajub\u00e1 37502-138, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6084-7313","authenticated-orcid":false,"given":"Gerson","family":"de Souza Santos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro Universit\u00e1rio Ages, Paripiranga 48430-000, BA, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-8561","authenticated-orcid":false,"given":"Helena","family":"Jos\u00e9","sequence":"additional","affiliation":[{"name":"Atl\u00e2ntica School of Health, 2730-036 Barcarena, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3004-011 Coimbra, Portugal"},{"name":"RISE-Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9708-5690","authenticated-orcid":false,"given":"Lu\u00eds","family":"Sousa","sequence":"additional","affiliation":[{"name":"Atl\u00e2ntica School of Health, 2730-036 Barcarena, Portugal"},{"name":"RISE-Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Comprehensive Health Research Centre, University of \u00c9vora, 7000-801 \u00c9vora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5004-3549","authenticated-orcid":false,"given":"Gail","family":"Low","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, MacEwan University, Edmonton, AB T5J 4S2, Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1023-8488","authenticated-orcid":false,"given":"Luciano Magalh\u00e3es","family":"Vitorino","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Itajub\u00e1, Itajub\u00e1 37502-138, MG, Brazil"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1377\/hlthaff.2013.0714","article-title":"An Aging Population and Growing Disease Burden Will Require a Large and Specialized Health Care Workforce by 2025","volume":"32","author":"Dall","year":"2013","journal-title":"Health Aff."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/geront\/gny019","article-title":"Aging in Brazil","volume":"58","author":"Albert","year":"2018","journal-title":"Gerontologist"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/S0140-6736(14)61347-7","article-title":"The Burden of Disease in Older People and Implications for Health Policy and Practice","volume":"385","author":"Prince","year":"2015","journal-title":"Lancet"},{"key":"ref_4","unstructured":"GBD 2019 Dementia Forecasting Collaborators (2022). Estimation of the Global Prevalence of Dementia in 2019 and Forecasted Prevalence in 2050: An Analysis for the Global Burden of Disease Study 2019. Lancet Public Health, 7, e105\u2013e125."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114511","DOI":"10.1016\/j.psychres.2022.114511","article-title":"Prevalence of Depression in Older Adults: A Systematic Review and Meta-Analysis","volume":"311","author":"Hu","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/s41398-023-02361-1","article-title":"Global Prevalence of Mild Cognitive Impairment among Older Adults Living in Nursing Homes: A Meta-Analysis and Systematic Review of Epidemiological Surveys","volume":"13","author":"Chen","year":"2023","journal-title":"Transl. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/ageing\/afs184","article-title":"Incidence and Predictors of Depression in Non-Demented Primary Care Attenders Aged 75 Years and Older: Results from a 3-Year Follow-up Study","volume":"42","author":"Weyerer","year":"2013","journal-title":"Age Ageing"},{"key":"ref_8","first-page":"e12368","article-title":"Subjective Cognitive Decline in Brazil: Prevalence and Association with Dementia Modifiable Risk Factors in a Population-Based Study","volume":"14","author":"Borelli","year":"2022","journal-title":"Alzheimer\u2019s Dement. Diagn. Assess. Dis. Monit."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12991-021-00375-x","article-title":"Prevalence and Determinants of Depression among Old Age: A Systematic Review and Meta-Analysis","volume":"20","author":"Zenebe","year":"2021","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12963-020-00204-5","article-title":"Depressive Disorders in Brazil: Results from the Global Burden of Disease Study 2017","volume":"18","author":"Bonadiman","year":"2020","journal-title":"Popul. Health Metr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1590\/0103-110420151050002020","article-title":"Fatores Associados \u00e0 Depress\u00e3o Em Idosos Institucionalizados: Revis\u00e3o Integrativa","volume":"39","author":"Leal","year":"2015","journal-title":"Sa\u00fade Debate"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Pe\u00f1a, C., Guti\u00e9rrez-Robledo, L.M., and P\u00e9rez-Zepeda, M.U. (2018). Longitudinal Studies and Older Adults Cohorts. Aging Research\u2014Methodological Issues, Springer International Publishing.","DOI":"10.1007\/978-3-319-95387-8"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pereira, M.E.A., Santos, G.d.S., Almeida, C.R.d., Nunes, K.C.S., Silva, M.C.M.d., Jos\u00e9, H., Sousa, L., and Vitorino, L.M. (2024). Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults. Healthcare, 12.","DOI":"10.3390\/healthcare12161638"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1136\/adc.2007.127316","article-title":"How much loss to follow-up is acceptable in long-term randomised trials and prospective studies?","volume":"93","author":"Fewtrell","year":"2008","journal-title":"Arch. Dis. Child."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1590\/S0034-89102005000600008","article-title":"Valida\u00e7\u00e3o Da Escala de Depress\u00e3o Geri\u00e1trica Em Um Ambulat\u00f3rio Geral","volume":"39","author":"Paradela","year":"2005","journal-title":"Rev. Sa\u00fade P\u00fablica"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-Mental State\u201d. A Practical Method for Grading the Cognitive State of Patients for the Clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1590\/S0102-311X2007000200007","article-title":"Mini-Mental State Examination Norms in a Community-Dwelling Sample of Elderly with Low Schooling in Brazil","volume":"23","author":"Laks","year":"2007","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/S0004-282X1994000100001","article-title":"The Mini-Mental State Examination in a General Population: Impact of Educational Status","volume":"52","author":"Bertolucci","year":"1994","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1017\/S0033291716002579","article-title":"Age-Related Variability in the Presentation of Symptoms of Major Depressive Disorder","volume":"47","author":"Schaakxs","year":"2017","journal-title":"Psychol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s11606-020-06447-0","article-title":"The Impact of Social Determinants of Health on Medication Adherence: A Systematic Review and Meta-Analysis","volume":"36","author":"Wilder","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Comijs, H.C., Nieuwesteeg, J., Kok, R., van Marwijk, H.W., van der Mast, R.C., Naarding, P., Voshaar, R.C.O., Verhaak, P., de Waal, M.W., and Stek, M.L. (2015). The Two-Year Course of Late-Life Depression; Results from the Netherlands Study of Depression in Older Persons. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0401-5"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Vitorino, L.M., Lopes, J., Souza Santos, G., Oliveira, C., Helena, J., and Sousa, L. (2023). Prevalence of Polypharmacy of Older People in a Large Brazilian Urban Center and its Associated Factors. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20095730"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.gerinurse.2024.07.005","article-title":"Association between Polypharmacy and Cognitive Impairment in Older Adults: A Systematic Review and Meta-Analysis","volume":"59","author":"Yu","year":"2024","journal-title":"Geriatr. Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Xue, L., Boudreau, R.M., Donohue, J.M., Zgibor, J.C., Marcum, Z.A., Costacou, T., Newman, A.B., Waters, T.M., and Strotmeyer, E.S. (2021). Persistent Polypharmacy and Fall Injury Risk: The Health, Aging and Body Composition Study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02695-9"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1002\/jppr.1749","article-title":"Association between Polypharmacy and Depression: A Systematic Review and Meta-Analysis","volume":"51","author":"Palapinyo","year":"2021","journal-title":"J. Pharm. Pract. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/acps.13435","article-title":"Determinants and Consequences of Polypharmacy in Patients with a Depressive Disorder in Later Life","volume":"146","author":"Wiersema","year":"2022","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_28","unstructured":"World Health Organization (2025, March 03). WHO Launches Commission to Foster Social Connection. Available online: https:\/\/www.who.int\/news\/item\/15-11-2023-who-launches-commission-to-foster-social-connection."},{"key":"ref_29","unstructured":"Maese, E. (2025, March 03). Almost a Quarter of the World Feels Lonely. Available online: https:\/\/news.gallup.com\/opinion\/gallup\/512618\/almost-quarter-world-feels-lonely.aspx."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1001\/archpsyc.59.7.605","article-title":"The Natural History of Late-Life Depression: A 6-year prospective study in the community","volume":"59","author":"Beekman","year":"2002","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1037\/pag0000054","article-title":"Trajectories of Depressive Symptoms in Old Age: Integrating Age-, Pathology-, and Mortality-Related Changes","volume":"30","author":"Chui","year":"2015","journal-title":"Psychol. Aging G"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Zhao, M., Chen, Z., Xu, T., Ping, F., and Tian, F. (2023). Global Prevalence of Polypharmacy and Potentially Inappropriate Medication in Older Patients with Dementia: A Systematic Review and Meta-Analysis. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1221069"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Scheel, J., Luttenberger, K., Graessel, E., Kratzer, A., and Donath, C. (2022). Predictors of Falls and Hospital Admissions in People with Cognitive Impairment in Day-Care: Role of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03346-3"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"igab001","DOI":"10.1093\/geroni\/igab001","article-title":"Fall Risk-Increasing Drugs, Polypharmacy, and Falls among Low-Income Community-Dwelling Older Adults","volume":"5","author":"Ie","year":"2021","journal-title":"Innov. Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1080\/13607863.2018.1468411","article-title":"Association between Polypharmacy and Dementia\u2014A Systematic Review and Metaanalysis","volume":"23","author":"Leelakanok","year":"2018","journal-title":"Aging Ment. Health"},{"key":"ref_36","first-page":"428","article-title":"Association of Polypharmacy with Cognitive Impairment in Older Trauma Patients: A Cross-Sectional Study","volume":"31","author":"Mantegazza","year":"2023","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e080101","DOI":"10.1136\/bmjopen-2023-080101","article-title":"Primary Care Detection of Cognitive Impairment Leveraging Health and Consumer Technologies in Underserved US Communities: Protocol for a Pragmatic Randomised Controlled Trial of the MyCog Paradigm","volume":"13","author":"Lovett","year":"2023","journal-title":"BMJ Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11910-019-0917-z","article-title":"Defining Cognitive Reserve and Implications for Cognitive Aging","volume":"19","author":"Pettigrew","year":"2019","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/ggi.14245","article-title":"Association of Polypharmacy with Falls among Older Chinese Inpatients: A Nationwide Cohort Study","volume":"21","author":"Zhang","year":"2021","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.3233\/JAD-201601","article-title":"Associations between Polypharmacy and Gait Speed according to Cognitive Impairment Status: Cross-Sectional Study in a Japanese Memory Clinic","volume":"82","author":"Watanabe","year":"2021","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Adam, C.E., Fitzpatrick, A.L., Leary, C.S., Hajat, A., Ilango, S.D., Park, C., Phelan, E.A., and Semmens, E.O. (2023). Change in Gait Speed and Fall Risk among Community-Dwelling Older Adults with and without Mild Cognitive Impairment: A Retrospective Cohort Analysis. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-03890-6"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.mayocp.2020.06.012","article-title":"Polypharmacy Management in Older Patients","volume":"96","author":"Hoel","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_43","first-page":"1000","article-title":"Prevention of Falls in the Elderly: A Challenge in Patient Safety","volume":"4","author":"Sousa","year":"2024","journal-title":"Salud Sci. Technol."},{"key":"ref_44","first-page":"afac173","article-title":"Worldwide Prevalence of Mild Cognitive Impairment among Community Dwellers Aged 50 Years and Older: A Meta-Analysis and Systematic Review of Epidemiology Studies","volume":"51","author":"Bai","year":"2022","journal-title":"Age Ageing"},{"key":"ref_45","unstructured":"World Health Organization (2025, March 03). WHOQOL: Measuring Quality of Life. Available online: https:\/\/www.who.int\/tools\/whoqol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jagp.2022.10.005","article-title":"Effects of Longitudinal Changes in Neuroticism and Stress on Cognitive Decline","volume":"31","author":"Steffens","year":"2023","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"afab191","DOI":"10.1093\/ageing\/afab191","article-title":"Trajectories of Depressive Symptoms and Subsequent Cognitive Decline in Older Adults: A Pooled Analysis of Two Longitudinal Cohorts","volume":"51","author":"Zhu","year":"2021","journal-title":"Age Ageing"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1192\/bjp.bp.112.118307","article-title":"Late-life depression and risk of vascular dementia and Alzheimer\u2019s disease: Systematic review and meta-analysis of community-based cohort studies","volume":"202","author":"Diniz","year":"2013","journal-title":"Br. J. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jagp.2016.10.003","article-title":"Perceived Stress and Cognitive Decline in Different Cognitive Domains in a Cohort of Older African Americans","volume":"25","author":"Turner","year":"2017","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11136-005-7380-9","article-title":"Development of the WHOQOL-Old Module","volume":"14","author":"Power","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_51","unstructured":"World Health Organization (2025, March 03). World Mental Health Report: Transforming Mental Health for All. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240049338."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/07317115.2020.1839992","article-title":"Performance of the Geriatric Depression Scale-15 with Older Adults Aged over 65 Years: An Updated Review 2000\u20132019","volume":"44","author":"Park","year":"2020","journal-title":"Clin. Gerontol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e190023","DOI":"10.1590\/1981-22562019022.190023","article-title":"Depressive Symptoms in Older Adults in Basic Health Care","volume":"22","author":"Souza","year":"2019","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"215013192311527","DOI":"10.1177\/21501319231152758","article-title":"Increasing Identification and Follow-up of Older Adult Depression in Primary Care","volume":"14","author":"Uomoto","year":"2023","journal-title":"J. Prim. Care Community Health"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/7\/807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:09:18Z","timestamp":1760029758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/7\/807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["healthcare13070807"],"URL":"https:\/\/doi.org\/10.3390\/healthcare13070807","relation":{},"ISSN":["2227-9032"],"issn-type":[{"type":"electronic","value":"2227-9032"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}