{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:47:21Z","timestamp":1768340841859,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,25]],"date-time":"2023-02-25T00:00:00Z","timestamp":1677283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Regional Development Fund (ERDF) through the Interreg VA Spain-Portugal Programme (POCTEP) 2014\u20132020","award":["0551_PSL_6_E"],"award-info":[{"award-number":["0551_PSL_6_E"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Although the health literacy level of the general population was described recently, little is known about its specific levels among older adults in Portugal. Therefore, this cross-sectional study aimed to investigate the levels of health literacy demonstrated by older adults in Portugal and explore associated factors. Using a randomly generated list of telephone numbers, adults aged 65 years or more living in mainland Portugal were contacted in September and October 2022. Sociodemographic, health and healthcare-related variables were collected, and the 12-item version of the European Health Literacy Survey Project 2019\u20132021 was used to measure health literacy. Then, binary logistic regression models were used to investigate factors associated with limited general health literacy. In total, 613 participants were surveyed. The mean level of general health literacy was (59.15 \u00b1 13.05; n = 563), whereas health promotion (65.82 \u00b1 13.19; n = 568) and appraising health information (65.16 \u00b1 13.26; n = 517) were the highest scores in the health literacy domain and the dimension of health information processing, respectively. Overall, 80.6% of respondents revealed limited general health literacy, which was positively associated with living in a difficult household financial situation (4.17; 95% Confidence Interval (CI): 1.64\u201310.57), perceiving one\u2019s own health status as poorer (7.12; 95% CI: 2.02\u201325.09), and having a fair opinion about a recent interaction with primary healthcare services (2.75; 95% CI: 1.46\u20135.19). The proportion of older adults with limited general health literacy in Portugal is significant. This result should be considered to inform health planning according to the health literacy gap of older adults in Portugal.<\/jats:p>","DOI":"10.3390\/ijerph20054172","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T03:23:36Z","timestamp":1677468216000},"page":"4172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Health Literacy among Older Adults in Portugal and Associated Sociodemographic, Health and Healthcare-Related Factors"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2727-4402","authenticated-orcid":false,"given":"Andreia","family":"Costa","sequence":"first","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"CIDNUR\u2014Centro de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal"},{"name":"CRC-W\u2014Cat\u00f3lica Research Centre for Psychological, Family and Social Wellbeing, Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5780-2288","authenticated-orcid":false,"given":"Rodrigo","family":"Feteira-Santos","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"\u00c1rea Disciplinar Aut\u00f3noma de Bioestat\u00edstica (Laborat\u00f3rio de Biomatem\u00e1tica), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4807-5904","authenticated-orcid":false,"given":"Violeta","family":"Alarc\u00e3o","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o e Estudos de Sociologia (CIES-Iscte), Instituto Universit\u00e1rio de Lisboa (Iscte), 1649-026 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0288-6653","authenticated-orcid":false,"given":"Adriana","family":"Henriques","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"CIDNUR\u2014Centro de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Teresa","family":"Madeira","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio de Nutri\u00e7\u00e3o, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0428-6643","authenticated-orcid":false,"given":"Ana","family":"Virgolino","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-9121","authenticated-orcid":false,"given":"Miguel","family":"Arriaga","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"CIDNUR\u2014Centro de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal"},{"name":"CRC-W\u2014Cat\u00f3lica Research Centre for Psychological, Family and Social Wellbeing, Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-5035","authenticated-orcid":false,"given":"Paulo J.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"\u00c1rea Disciplinar Aut\u00f3noma de Bioestat\u00edstica (Laborat\u00f3rio de Biomatem\u00e1tica), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade P\u00fablica, Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal"},{"name":"Comprehensive Health Research Center, Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,25]]},"reference":[{"key":"ref_1","unstructured":"Eurostat (2022, December 30). Ageing Europe\u2014Looking at the Lives of Older People in the EU, 2020 ed.; Products Statistical Books\u2013Eurostat. Ageing Europe\u2013Looking at the Lives of Older People in the EU, 1\u2013184. Available online: https:\/\/ec.europa.eu\/eurostat\/en\/web\/products-statistical-books\/-\/ks-02-20-655."},{"key":"ref_2","first-page":"e068208","article-title":"Global, regional, and national burden of diseases and injuries for adults 70 years and older: Systematic analysis for the Global Burden of Disease 2019 Study","volume":"376","author":"Kassebaum","year":"2022","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"886","DOI":"10.3389\/fpubh.2021.700279","article-title":"Active and Healthy Aging After COVID-19 Pandemic in Portugal and Other European Countries: Time to Rethink Strategies and Foster Action","volume":"9","author":"Costa","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1016\/S2468-2667(19)30026-X","article-title":"Age-related disease burden as a measure of population ageing","volume":"4","author":"Kehler","year":"2019","journal-title":"Lancet Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/S2468-2667(19)30019-2","article-title":"Measuring population ageing: An analysis of the Global Burden of Disease Study 2017","volume":"4","author":"Chang","year":"2019","journal-title":"Lancet Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1016\/S0140-6736(15)00516-4","article-title":"The World report on ageing and health: A policy framework for healthy ageing","volume":"387","author":"Beard","year":"2016","journal-title":"Lancet"},{"key":"ref_7","first-page":"1215","article-title":"Determinants of healthy ageing: A systematic review of contemporary literature. Aging Clin","volume":"34","author":"Abud","year":"2022","journal-title":"Exp. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., and (HLS-EU) Consortium Health Literacy Project European (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3928\/19404921-20211117-01","article-title":"Associated Factors and Health Outcomes of Health Literacy and Physical Frailty Among Older Adults: A Systematic Review","volume":"15","author":"Lee","year":"2022","journal-title":"Res. Gerontol. Nurs."},{"key":"ref_10","first-page":"E3","article-title":"Beyond the tip of the iceberg: Health literacy in older people","volume":"31","author":"Smith","year":"2021","journal-title":"J. Clin. Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1159\/000500247","article-title":"A Strategy for the Promotion of Health Literacy in Portugal, Centered around the Life-Course Approach: The Importance of Digital Tools","volume":"37","author":"Costa","year":"2019","journal-title":"Port. J. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/eurpub\/ckv043","article-title":"Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU)","volume":"25","author":"Pelikan","year":"2015","journal-title":"Eur. J. Public Health"},{"key":"ref_13","unstructured":"The HLS19 Consortium of the WHO Action Network M-POHL (2022, December 30). International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. Vienna. Available online: https:\/\/m-pohl.net\/Results."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low Health Literacy and Health Outcomes: An Updated Systematic Review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3928\/00989134-20110503-02","article-title":"Health Literacy Among Older Adults: A Systematic Literature Review","volume":"37","author":"Zamora","year":"2011","journal-title":"J. Gerontol. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2333721416630492","DOI":"10.1177\/2333721416630492","article-title":"Health Literacy and Older Adults: A Systematic Review","volume":"2","author":"Chesser","year":"2016","journal-title":"Gerontol. Geriatr. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"581746","DOI":"10.3389\/fpubh.2020.581746","article-title":"Determinants of Health Literacy and Its Associations With Health-Related Behaviors, Depression Among the Older People With and Without Suspected COVID-19 Symptoms: A Multi-Institutional Study","volume":"8","author":"Do","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_18","first-page":"3490635","article-title":"Factors Associated with Health Literacy among the Elderly People in Vietnam","volume":"2020","author":"Giang","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9714","DOI":"10.3390\/ijerph120809714","article-title":"Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese","volume":"12","author":"Liu","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Arriaga, M., Francisco, R., Nogueira, P., Oliveira, J., Silva, C., C\u00e2mara, G., S\u00f8rensen, K., Dietscher, C., and Costa, A. (2022). Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019\u20132021. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074225"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_22","unstructured":"Dean, A., Sullivan, K., and Soe, M. (2023, February 14). OpenEpi: Open Source Epidemiologic Statistics for Public Health, Vers\u00e3o 3.01. Available online: https:\/\/www.openepi.com."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pelikan, J.M., Link, T., Stra\u00dfmayr, C., Waldherr, K., Alfers, T., B\u00f8ggild, H., Griebler, R., Lopatina, M., Mik\u0161ov\u00e1, D., and Nielsen, M.G. (2022). Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192114129"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/1757975918788300","article-title":"Health literacy as a determinant, mediator and\/or moderator of health: Empirical models using the European Health Literacy Survey dataset","volume":"25","author":"Pelikan","year":"2018","journal-title":"Glob. Health Promot."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Gibney, S., Bruton, L., Ryan, C., Doyle, G., and Rowlands, G. (2020). Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17165891"},{"key":"ref_26","unstructured":"Espanha, R., \u00c1vila, P., Mendes, R.V., and CIES\/IUL Centro de Investiga\u00e7\u00e3o e Estudos de Sociologia (2023, January 30). Literacia em Sa\u00fade em Portugal. Relat\u00f3rio S\u00edntese. Lisboa. Available online: https:\/\/cdn.gulbenkian.pt\/wp-content\/uploads\/2021\/05\/87Est_Lieracia_Saude.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"w30158","DOI":"10.4414\/SMW.2022.w30158","article-title":"Health literacy among older adults in Switzerland: Cross-sectional evidence from a nationally representative population-based observational study","volume":"152","author":"Meier","year":"2022","journal-title":"Swiss Med Wkly."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gustafsdottir, S.S., Sigurdardottir, A.K., M\u00e5rtensson, L., and Arnadottir, S.A. (2022). Making Europe health literate: Including older adults in sparsely populated Arctic areas. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-12935-1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/13685538.2018.1437901","article-title":"Health literacy among older persons in Turkey","volume":"22","author":"Bozkurt","year":"2018","journal-title":"Aging Male"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"57","DOI":"10.17116\/profmed20212412157","article-title":"Determinants of health literacy: The results of the first population survey in the Russian Federation","volume":"24","author":"Lopatina","year":"2021","journal-title":"Profil. Meditsina"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Garcia-Codina, O., Juviny\u00e0-Canal, D., Amil-Bujan, P., Bertran-Noguer, C., Gonz\u00e1lez-Mestre, M.A., Masachs-Fatjo, E., Santaeug\u00e8nia, S.J., Magriny\u00e0-Rull, P., and Salt\u00f3-Cerezuela, E. (2019). Determinants of health literacy in the general population: Results of the Catalan health survey. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7381-1"},{"key":"ref_32","first-page":"723","article-title":"Health Literacy in Germany\u2014Findings of a Representative Follow-up Survey","volume":"118","author":"Schaeffer","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1136\/jech.2006.053967","article-title":"Functional health literacy and health-promoting behaviour in a national sample of British adults","volume":"61","author":"Knight","year":"2007","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_34","first-page":"3061","article-title":"Health Literacy, Social Determinants of Health, and Disease Prevention and Control","volume":"6","author":"Coughlin","year":"2020","journal-title":"J. Environ. Health Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1093\/ije\/dyz248","article-title":"Reducing socioeconomic inequalities in all-cause mortality: A counterfactual mediation approach","volume":"49","author":"Laine","year":"2020","journal-title":"Int. J. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.amepre.2016.09.010","article-title":"The Social Determinants of Chronic Disease","volume":"52","author":"Cockerham","year":"2017","journal-title":"Am. J. Prev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1056\/NEJMsa044316","article-title":"Gradient of Disability across the Socioeconomic Spectrum in the United States","volume":"355","author":"Minkler","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_38","unstructured":"Public Health England (2015). Local Action on Health Inequalities: Improving Health Literacy to Reduce Health Inequalities, Public Health England. Available online: https:\/\/www.instituteofhealthequity.org\/resources-reports\/local-action-on-health-inequalities-health-literacy-to-reduce-health-inequalities\/health-literacy-improving-health-literacy-to-reduce-health-inequalities-full.pdf."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/10810730.2016.1201174","article-title":"Health Literacy Is Associated With Health Behaviors and Social Factors Among Older Adults: Results from the LifeLines Cohort Study","volume":"21","author":"Geboers","year":"2016","journal-title":"J. Health Commun."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10929","DOI":"10.1073\/pnas.162086599","article-title":"Can patient self-management help explain the SES health gradient?","volume":"99","author":"Goldman","year":"2002","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.socscimed.2009.08.043","article-title":"Can patient self-management explain the health gradient? Goldman and Smith\u2019s \u201cCan patient self-management help explain the SES health gradient?\u201d (2002) revisited","volume":"70","author":"Maitra","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_43","unstructured":"WHO Regional Office for Europe (2013). Health Literacy: The Solid Facts, WHO Regional Office for Europe."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"861","DOI":"10.20344\/amp.9135","article-title":"Limited Health Literacy in Portugal Assessed with the Newest Vital Sign","volume":"30","author":"Paiva","year":"2017","journal-title":"Acta Med. Port."},{"key":"ref_45","unstructured":"Instituto Nacional de Estat\u00edstica (2023, January 20). Censos 2021. XVI Recenseamento Geral da Popula\u00e7\u00e3o. VI Recenseamento Geral da Habita\u00e7\u00e3o: Resultados definitivos. Lisboa. Available online: https:\/\/www.ine.pt\/xurl\/pub\/65586079."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4172\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:42:47Z","timestamp":1760121767000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,25]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054172"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054172","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,25]]}}}