Molecular Signatures of Senescence in Periodontitis: Clinical Insights
Most of the elderly population is afflicted by periodontal diseases, creating a health burden worldwide. Cellular senescence is one of the hallmarks of aging and associated with several chronic comorbidities. Senescent cells produce a variety of deleterious secretions, collectively termed the senesc...
Gespeichert in:
Veröffentlicht in: | Journal of dental research 2024-07, Vol.103 (8), p.800-808 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 808 |
---|---|
container_issue | 8 |
container_start_page | 800 |
container_title | Journal of dental research |
container_volume | 103 |
creator | Rattanaprukskul, K. Xia, X.-J. Jiang, M. Albuquerque-Souza, E. Bandyopadhyay, D. Sahingur, S.E. |
description | Most of the elderly population is afflicted by periodontal diseases, creating a health burden worldwide. Cellular senescence is one of the hallmarks of aging and associated with several chronic comorbidities. Senescent cells produce a variety of deleterious secretions, collectively termed the senescence-associated secretory phenotype (SASP). This disrupts neighboring cells, leading to further senescence propagation and inciting chronic inflammation, known as “inflammaging.” Detrimental repercussions within the tissue microenvironment can trigger senescence at a younger age, accelerate biological aging, and drive the initiation or progression of diseases. Here, we investigated the biological signatures of senescence in healthy and diseased gingival tissues by assessing the levels of key senescence markers (p16, lipofuscin, and β-galactosidase) and inflammatory mediators (interleukin [IL]–1β, IL-6, IL-8, matrix metalloproteinase [MMP]–1, MMP-3, and tumor necrosis factor–α). Our results showed significantly increased senescence features including p16, lipofuscin, and β-galactosidase in both epithelial and connective tissues of periodontitis patients compared with healthy sites in all age groups, indicating that an inflammatory microenvironment can trigger senescence-like alterations in younger diseased gingival tissues as well. Subsequent analyses using double staining with specific cell markers noted the enrichment of β-galactosidase in fibroblasts and macrophages. Concurrently, inflammatory mediators consistent with SASP were increased in the gingival biopsies obtained from periodontitis lesions. Together, our findings provide the first clinical report revealing susceptibility to elevated senescence and inflammatory milieu consistent with senescence secretome in gingival tissues, thus introducing senescence as one of the drivers of pathological events in the oral mucosa and a novel strategy for targeted interventions. |
doi_str_mv | 10.1177/00220345241255325 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11308264</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_00220345241255325</sage_id><sourcerecordid>3090973742</sourcerecordid><originalsourceid>FETCH-LOGICAL-c349t-e1178570fd6c2604cfef7c69fc6d7a0f8001e78df8d5c70c8a11d9754b2abef03</originalsourceid><addsrcrecordid>eNp1kUtPGzEUha2KCkLaH9ANGolNN0P9HHvYIBTxiETVSrRry_FcB0cTG-wZpP57HCVAW8TqLu53zz1HB6EvBJ8QIuU3jCnFjAvKCRWCUfEBTYjgvMaiJXtostnXG-AAHea8wpi0VLF9dMCUklJyNkGX32MPduxNqm79MphhTJCr6KpbCJAtBAuVD9VPSD52MQx-8Pm0mvU-eGv6ah6yX94N-RP66Eyf4fNuTtHvy4tfs-v65sfVfHZ-U1vG26GGYlsJiV3XWNpgbh04aZvW2aaTBjtVLIJUnVOdsBJbZQjpWin4gpoFOMym6Gyrez8u1tAVf0Myvb5Pfm3SHx2N1_9ugr_Ty_ioCWFY0YYXha87hRQfRsiDXvuSs-9NgDhmzXCjpJCENwU9_g9dxTGFkq9QLW4lk5wWimwpm2LOCdyLG4L1pib9pqZyc_R3jJeL514KcLIFslnC69v3FZ8AfeWajQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3090973742</pqid></control><display><type>article</type><title>Molecular Signatures of Senescence in Periodontitis: Clinical Insights</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><creator>Rattanaprukskul, K. ; Xia, X.-J. ; Jiang, M. ; Albuquerque-Souza, E. ; Bandyopadhyay, D. ; Sahingur, S.E.</creator><creatorcontrib>Rattanaprukskul, K. ; Xia, X.-J. ; Jiang, M. ; Albuquerque-Souza, E. ; Bandyopadhyay, D. ; Sahingur, S.E.</creatorcontrib><description>Most of the elderly population is afflicted by periodontal diseases, creating a health burden worldwide. Cellular senescence is one of the hallmarks of aging and associated with several chronic comorbidities. Senescent cells produce a variety of deleterious secretions, collectively termed the senescence-associated secretory phenotype (SASP). This disrupts neighboring cells, leading to further senescence propagation and inciting chronic inflammation, known as “inflammaging.” Detrimental repercussions within the tissue microenvironment can trigger senescence at a younger age, accelerate biological aging, and drive the initiation or progression of diseases. Here, we investigated the biological signatures of senescence in healthy and diseased gingival tissues by assessing the levels of key senescence markers (p16, lipofuscin, and β-galactosidase) and inflammatory mediators (interleukin [IL]–1β, IL-6, IL-8, matrix metalloproteinase [MMP]–1, MMP-3, and tumor necrosis factor–α). Our results showed significantly increased senescence features including p16, lipofuscin, and β-galactosidase in both epithelial and connective tissues of periodontitis patients compared with healthy sites in all age groups, indicating that an inflammatory microenvironment can trigger senescence-like alterations in younger diseased gingival tissues as well. Subsequent analyses using double staining with specific cell markers noted the enrichment of β-galactosidase in fibroblasts and macrophages. Concurrently, inflammatory mediators consistent with SASP were increased in the gingival biopsies obtained from periodontitis lesions. Together, our findings provide the first clinical report revealing susceptibility to elevated senescence and inflammatory milieu consistent with senescence secretome in gingival tissues, thus introducing senescence as one of the drivers of pathological events in the oral mucosa and a novel strategy for targeted interventions.</description><identifier>ISSN: 0022-0345</identifier><identifier>ISSN: 1544-0591</identifier><identifier>EISSN: 1544-0591</identifier><identifier>DOI: 10.1177/00220345241255325</identifier><identifier>PMID: 38877743</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Aged ; Aging ; beta-Galactosidase - analysis ; beta-Galactosidase - metabolism ; Biomarkers ; Biomarkers - analysis ; Biopsy ; Cellular Senescence - physiology ; Comorbidity ; Connective tissues ; Cyclin-Dependent Kinase Inhibitor p16 - analysis ; Cyclin-Dependent Kinase Inhibitor p16 - metabolism ; Female ; Geriatrics ; Gingiva ; Gingiva - metabolism ; Gingiva - pathology ; Gum disease ; Humans ; Inflammation Mediators - metabolism ; Interleukin-1beta - analysis ; Interleukin-6 - analysis ; Interleukin-8 - analysis ; Interleukin-8 - metabolism ; Lipofuscin - analysis ; Lipofuscin - metabolism ; Macrophages ; Male ; Matrix metalloproteinase ; Matrix Metalloproteinase 1 - analysis ; Matrix Metalloproteinase 1 - metabolism ; Matrix Metalloproteinase 3 - analysis ; Metalloproteinase ; Middle Aged ; Older people ; Periodontal diseases ; Periodontitis ; Periodontitis - metabolism ; Phenotypes ; Research Reports ; Secretome ; Senescence ; Senescence-Associated Secretory Phenotype ; Stromelysin 1 ; Tumor Necrosis Factor-alpha - analysis ; Tumor Necrosis Factor-alpha - metabolism ; Young Adult ; β-Galactosidase</subject><ispartof>Journal of dental research, 2024-07, Vol.103 (8), p.800-808</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024 2024 International & American Associations for Dental Research</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c349t-e1178570fd6c2604cfef7c69fc6d7a0f8001e78df8d5c70c8a11d9754b2abef03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00220345241255325$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00220345241255325$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38877743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rattanaprukskul, K.</creatorcontrib><creatorcontrib>Xia, X.-J.</creatorcontrib><creatorcontrib>Jiang, M.</creatorcontrib><creatorcontrib>Albuquerque-Souza, E.</creatorcontrib><creatorcontrib>Bandyopadhyay, D.</creatorcontrib><creatorcontrib>Sahingur, S.E.</creatorcontrib><title>Molecular Signatures of Senescence in Periodontitis: Clinical Insights</title><title>Journal of dental research</title><addtitle>J Dent Res</addtitle><description>Most of the elderly population is afflicted by periodontal diseases, creating a health burden worldwide. Cellular senescence is one of the hallmarks of aging and associated with several chronic comorbidities. Senescent cells produce a variety of deleterious secretions, collectively termed the senescence-associated secretory phenotype (SASP). This disrupts neighboring cells, leading to further senescence propagation and inciting chronic inflammation, known as “inflammaging.” Detrimental repercussions within the tissue microenvironment can trigger senescence at a younger age, accelerate biological aging, and drive the initiation or progression of diseases. Here, we investigated the biological signatures of senescence in healthy and diseased gingival tissues by assessing the levels of key senescence markers (p16, lipofuscin, and β-galactosidase) and inflammatory mediators (interleukin [IL]–1β, IL-6, IL-8, matrix metalloproteinase [MMP]–1, MMP-3, and tumor necrosis factor–α). Our results showed significantly increased senescence features including p16, lipofuscin, and β-galactosidase in both epithelial and connective tissues of periodontitis patients compared with healthy sites in all age groups, indicating that an inflammatory microenvironment can trigger senescence-like alterations in younger diseased gingival tissues as well. Subsequent analyses using double staining with specific cell markers noted the enrichment of β-galactosidase in fibroblasts and macrophages. Concurrently, inflammatory mediators consistent with SASP were increased in the gingival biopsies obtained from periodontitis lesions. Together, our findings provide the first clinical report revealing susceptibility to elevated senescence and inflammatory milieu consistent with senescence secretome in gingival tissues, thus introducing senescence as one of the drivers of pathological events in the oral mucosa and a novel strategy for targeted interventions.</description><subject>Adult</subject><subject>Aged</subject><subject>Aging</subject><subject>beta-Galactosidase - analysis</subject><subject>beta-Galactosidase - metabolism</subject><subject>Biomarkers</subject><subject>Biomarkers - analysis</subject><subject>Biopsy</subject><subject>Cellular Senescence - physiology</subject><subject>Comorbidity</subject><subject>Connective tissues</subject><subject>Cyclin-Dependent Kinase Inhibitor p16 - analysis</subject><subject>Cyclin-Dependent Kinase Inhibitor p16 - metabolism</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Gingiva</subject><subject>Gingiva - metabolism</subject><subject>Gingiva - pathology</subject><subject>Gum disease</subject><subject>Humans</subject><subject>Inflammation Mediators - metabolism</subject><subject>Interleukin-1beta - analysis</subject><subject>Interleukin-6 - analysis</subject><subject>Interleukin-8 - analysis</subject><subject>Interleukin-8 - metabolism</subject><subject>Lipofuscin - analysis</subject><subject>Lipofuscin - metabolism</subject><subject>Macrophages</subject><subject>Male</subject><subject>Matrix metalloproteinase</subject><subject>Matrix Metalloproteinase 1 - analysis</subject><subject>Matrix Metalloproteinase 1 - metabolism</subject><subject>Matrix Metalloproteinase 3 - analysis</subject><subject>Metalloproteinase</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Periodontal diseases</subject><subject>Periodontitis</subject><subject>Periodontitis - metabolism</subject><subject>Phenotypes</subject><subject>Research Reports</subject><subject>Secretome</subject><subject>Senescence</subject><subject>Senescence-Associated Secretory Phenotype</subject><subject>Stromelysin 1</subject><subject>Tumor Necrosis Factor-alpha - analysis</subject><subject>Tumor Necrosis Factor-alpha - metabolism</subject><subject>Young Adult</subject><subject>β-Galactosidase</subject><issn>0022-0345</issn><issn>1544-0591</issn><issn>1544-0591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>EIF</sourceid><recordid>eNp1kUtPGzEUha2KCkLaH9ANGolNN0P9HHvYIBTxiETVSrRry_FcB0cTG-wZpP57HCVAW8TqLu53zz1HB6EvBJ8QIuU3jCnFjAvKCRWCUfEBTYjgvMaiJXtostnXG-AAHea8wpi0VLF9dMCUklJyNkGX32MPduxNqm79MphhTJCr6KpbCJAtBAuVD9VPSD52MQx-8Pm0mvU-eGv6ah6yX94N-RP66Eyf4fNuTtHvy4tfs-v65sfVfHZ-U1vG26GGYlsJiV3XWNpgbh04aZvW2aaTBjtVLIJUnVOdsBJbZQjpWin4gpoFOMym6Gyrez8u1tAVf0Myvb5Pfm3SHx2N1_9ugr_Ty_ioCWFY0YYXha87hRQfRsiDXvuSs-9NgDhmzXCjpJCENwU9_g9dxTGFkq9QLW4lk5wWimwpm2LOCdyLG4L1pib9pqZyc_R3jJeL514KcLIFslnC69v3FZ8AfeWajQ</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Rattanaprukskul, K.</creator><creator>Xia, X.-J.</creator><creator>Jiang, M.</creator><creator>Albuquerque-Souza, E.</creator><creator>Bandyopadhyay, D.</creator><creator>Sahingur, S.E.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240701</creationdate><title>Molecular Signatures of Senescence in Periodontitis: Clinical Insights</title><author>Rattanaprukskul, K. ; Xia, X.-J. ; Jiang, M. ; Albuquerque-Souza, E. ; Bandyopadhyay, D. ; Sahingur, S.E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c349t-e1178570fd6c2604cfef7c69fc6d7a0f8001e78df8d5c70c8a11d9754b2abef03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aging</topic><topic>beta-Galactosidase - analysis</topic><topic>beta-Galactosidase - metabolism</topic><topic>Biomarkers</topic><topic>Biomarkers - analysis</topic><topic>Biopsy</topic><topic>Cellular Senescence - physiology</topic><topic>Comorbidity</topic><topic>Connective tissues</topic><topic>Cyclin-Dependent Kinase Inhibitor p16 - analysis</topic><topic>Cyclin-Dependent Kinase Inhibitor p16 - metabolism</topic><topic>Female</topic><topic>Geriatrics</topic><topic>Gingiva</topic><topic>Gingiva - metabolism</topic><topic>Gingiva - pathology</topic><topic>Gum disease</topic><topic>Humans</topic><topic>Inflammation Mediators - metabolism</topic><topic>Interleukin-1beta - analysis</topic><topic>Interleukin-6 - analysis</topic><topic>Interleukin-8 - analysis</topic><topic>Interleukin-8 - metabolism</topic><topic>Lipofuscin - analysis</topic><topic>Lipofuscin - metabolism</topic><topic>Macrophages</topic><topic>Male</topic><topic>Matrix metalloproteinase</topic><topic>Matrix Metalloproteinase 1 - analysis</topic><topic>Matrix Metalloproteinase 1 - metabolism</topic><topic>Matrix Metalloproteinase 3 - analysis</topic><topic>Metalloproteinase</topic><topic>Middle Aged</topic><topic>Older people</topic><topic>Periodontal diseases</topic><topic>Periodontitis</topic><topic>Periodontitis - metabolism</topic><topic>Phenotypes</topic><topic>Research Reports</topic><topic>Secretome</topic><topic>Senescence</topic><topic>Senescence-Associated Secretory Phenotype</topic><topic>Stromelysin 1</topic><topic>Tumor Necrosis Factor-alpha - analysis</topic><topic>Tumor Necrosis Factor-alpha - metabolism</topic><topic>Young Adult</topic><topic>β-Galactosidase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rattanaprukskul, K.</creatorcontrib><creatorcontrib>Xia, X.-J.</creatorcontrib><creatorcontrib>Jiang, M.</creatorcontrib><creatorcontrib>Albuquerque-Souza, E.</creatorcontrib><creatorcontrib>Bandyopadhyay, D.</creatorcontrib><creatorcontrib>Sahingur, S.E.</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of dental research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rattanaprukskul, K.</au><au>Xia, X.-J.</au><au>Jiang, M.</au><au>Albuquerque-Souza, E.</au><au>Bandyopadhyay, D.</au><au>Sahingur, S.E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Molecular Signatures of Senescence in Periodontitis: Clinical Insights</atitle><jtitle>Journal of dental research</jtitle><addtitle>J Dent Res</addtitle><date>2024-07-01</date><risdate>2024</risdate><volume>103</volume><issue>8</issue><spage>800</spage><epage>808</epage><pages>800-808</pages><issn>0022-0345</issn><issn>1544-0591</issn><eissn>1544-0591</eissn><abstract>Most of the elderly population is afflicted by periodontal diseases, creating a health burden worldwide. Cellular senescence is one of the hallmarks of aging and associated with several chronic comorbidities. Senescent cells produce a variety of deleterious secretions, collectively termed the senescence-associated secretory phenotype (SASP). This disrupts neighboring cells, leading to further senescence propagation and inciting chronic inflammation, known as “inflammaging.” Detrimental repercussions within the tissue microenvironment can trigger senescence at a younger age, accelerate biological aging, and drive the initiation or progression of diseases. Here, we investigated the biological signatures of senescence in healthy and diseased gingival tissues by assessing the levels of key senescence markers (p16, lipofuscin, and β-galactosidase) and inflammatory mediators (interleukin [IL]–1β, IL-6, IL-8, matrix metalloproteinase [MMP]–1, MMP-3, and tumor necrosis factor–α). Our results showed significantly increased senescence features including p16, lipofuscin, and β-galactosidase in both epithelial and connective tissues of periodontitis patients compared with healthy sites in all age groups, indicating that an inflammatory microenvironment can trigger senescence-like alterations in younger diseased gingival tissues as well. Subsequent analyses using double staining with specific cell markers noted the enrichment of β-galactosidase in fibroblasts and macrophages. Concurrently, inflammatory mediators consistent with SASP were increased in the gingival biopsies obtained from periodontitis lesions. Together, our findings provide the first clinical report revealing susceptibility to elevated senescence and inflammatory milieu consistent with senescence secretome in gingival tissues, thus introducing senescence as one of the drivers of pathological events in the oral mucosa and a novel strategy for targeted interventions.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38877743</pmid><doi>10.1177/00220345241255325</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0022-0345 |
ispartof | Journal of dental research, 2024-07, Vol.103 (8), p.800-808 |
issn | 0022-0345 1544-0591 1544-0591 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11308264 |
source | MEDLINE; SAGE Complete A-Z List |
subjects | Adult Aged Aging beta-Galactosidase - analysis beta-Galactosidase - metabolism Biomarkers Biomarkers - analysis Biopsy Cellular Senescence - physiology Comorbidity Connective tissues Cyclin-Dependent Kinase Inhibitor p16 - analysis Cyclin-Dependent Kinase Inhibitor p16 - metabolism Female Geriatrics Gingiva Gingiva - metabolism Gingiva - pathology Gum disease Humans Inflammation Mediators - metabolism Interleukin-1beta - analysis Interleukin-6 - analysis Interleukin-8 - analysis Interleukin-8 - metabolism Lipofuscin - analysis Lipofuscin - metabolism Macrophages Male Matrix metalloproteinase Matrix Metalloproteinase 1 - analysis Matrix Metalloproteinase 1 - metabolism Matrix Metalloproteinase 3 - analysis Metalloproteinase Middle Aged Older people Periodontal diseases Periodontitis Periodontitis - metabolism Phenotypes Research Reports Secretome Senescence Senescence-Associated Secretory Phenotype Stromelysin 1 Tumor Necrosis Factor-alpha - analysis Tumor Necrosis Factor-alpha - metabolism Young Adult β-Galactosidase |
title | Molecular Signatures of Senescence in Periodontitis: Clinical Insights |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T22%3A54%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Molecular%20Signatures%20of%20Senescence%20in%20Periodontitis:%20Clinical%20Insights&rft.jtitle=Journal%20of%20dental%20research&rft.au=Rattanaprukskul,%20K.&rft.date=2024-07-01&rft.volume=103&rft.issue=8&rft.spage=800&rft.epage=808&rft.pages=800-808&rft.issn=0022-0345&rft.eissn=1544-0591&rft_id=info:doi/10.1177/00220345241255325&rft_dat=%3Cproquest_pubme%3E3090973742%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3090973742&rft_id=info:pmid/38877743&rft_sage_id=10.1177_00220345241255325&rfr_iscdi=true |