Predictors of Occupational Burnout: A Systematic Review
We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of...
Gespeichert in:
| Veröffentlicht in: | International journal of environmental research and public health 2021-08, Vol.18 (17), p.9188 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 17 |
| container_start_page | 9188 |
| container_title | International journal of environmental research and public health |
| container_volume | 18 |
| creator | Shoman, Yara El May, Emna Marca, Sandy Wild, Pascal Bianchi, Renzo Bugge, Merete Caglayan, Cigdem Cheptea, Dimitru Gnesi, Marco Godderis, Lode Kiran, Sibel McElvenny, Damien Mediouni, Zakia Mehlum, Ingrid Mijakoski, Dragan Minov, Jordan van der Molen, Henk Nena, Evangelia Otelea, Marina Guseva Canu, Irina |
| description | We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of occupational burnout among workers. We arranged predictors in four families and 13 subfamilies of homogenous constructs. The plots of z-scores per predictor type enabled graphical discrimination of the effects. The vote-counting and binomial test enabled discrimination of the effect direction. The size of the effect was estimated using Cohen’s formula. The risk of bias and the overall evidence were assessed using the MEVORECH and GRADE methods, respectively. Eighty-five studies examining 261 predictors were included. We found a moderate quality of evidence for the harmful effects of the job demands subfamily (six predictors), and negative job attitudes, with effect sizes from small to medium. We also found a moderate quality of evidence for the protective effect of adaptive coping (small effect sizes) and leisure (small to medium effect sizes). Preventive interventions for occupational burnout might benefit from intervening on the established predictors regarding reducing job demands and negative job attitudes and promoting adaptive coping and leisure. |
| doi_str_mv | 10.3390/ijerph18179188 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8430894</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2571097174</sourcerecordid><originalsourceid>FETCH-LOGICAL-c461t-84d2bc7a30495af3af0e99b79650f4bd6bfe4b3a63150dd3b896b52b6ae78b313</originalsourceid><addsrcrecordid>eNpdkd1LwzAUxYMobk5ffS744ktn0qT58EGYwy8YTPx4Dkmauo62qUk72X9v54Y4n-6F8-Nw7zkAnCM4xljAq2JpfbNAHDGBOD8AQ0QpjAmF6PDPPgAnISwhxJxQcQwGmKQQMZ4MAXv2NitM63yIXB7Njeka1RauVmV02_nade11NIle16G1VS-Y6MWuCvt1Co5yVQZ7tpsj8H5_9zZ9jGfzh6fpZBYbQlEbc5Il2jCFIRGpyrHKoRVCM0FTmBOdUZ1borGiGKUwy7Dmguo00VRZxjVGeARutr5NpyubGVu3XpWy8UWl_Fo6Vch9pS4W8sOtJCcYckF6g8udgXefnQ2trIpgbFmq2rouyCRlSCQY4g168Q9duj6C_r0fCgqG2IYabynjXQje5r_HICg3ncj9TvA3izF-2w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2571097174</pqid></control><display><type>article</type><title>Predictors of Occupational Burnout: A Systematic Review</title><source>PubMed Central Open Access</source><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Shoman, Yara ; El May, Emna ; Marca, Sandy ; Wild, Pascal ; Bianchi, Renzo ; Bugge, Merete ; Caglayan, Cigdem ; Cheptea, Dimitru ; Gnesi, Marco ; Godderis, Lode ; Kiran, Sibel ; McElvenny, Damien ; Mediouni, Zakia ; Mehlum, Ingrid ; Mijakoski, Dragan ; Minov, Jordan ; van der Molen, Henk ; Nena, Evangelia ; Otelea, Marina ; Guseva Canu, Irina</creator><creatorcontrib>Shoman, Yara ; El May, Emna ; Marca, Sandy ; Wild, Pascal ; Bianchi, Renzo ; Bugge, Merete ; Caglayan, Cigdem ; Cheptea, Dimitru ; Gnesi, Marco ; Godderis, Lode ; Kiran, Sibel ; McElvenny, Damien ; Mediouni, Zakia ; Mehlum, Ingrid ; Mijakoski, Dragan ; Minov, Jordan ; van der Molen, Henk ; Nena, Evangelia ; Otelea, Marina ; Guseva Canu, Irina</creatorcontrib><description>We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of occupational burnout among workers. We arranged predictors in four families and 13 subfamilies of homogenous constructs. The plots of z-scores per predictor type enabled graphical discrimination of the effects. The vote-counting and binomial test enabled discrimination of the effect direction. The size of the effect was estimated using Cohen’s formula. The risk of bias and the overall evidence were assessed using the MEVORECH and GRADE methods, respectively. Eighty-five studies examining 261 predictors were included. We found a moderate quality of evidence for the harmful effects of the job demands subfamily (six predictors), and negative job attitudes, with effect sizes from small to medium. We also found a moderate quality of evidence for the protective effect of adaptive coping (small effect sizes) and leisure (small to medium effect sizes). Preventive interventions for occupational burnout might benefit from intervening on the established predictors regarding reducing job demands and negative job attitudes and promoting adaptive coping and leisure.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph18179188</identifier><identifier>PMID: 34501782</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Attitudes ; Burnout ; Confidence intervals ; Coping ; Discrimination ; Longitudinal studies ; Mental health ; Systematic Review</subject><ispartof>International journal of environmental research and public health, 2021-08, Vol.18 (17), p.9188</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-84d2bc7a30495af3af0e99b79650f4bd6bfe4b3a63150dd3b896b52b6ae78b313</citedby><cites>FETCH-LOGICAL-c461t-84d2bc7a30495af3af0e99b79650f4bd6bfe4b3a63150dd3b896b52b6ae78b313</cites><orcidid>0000-0002-2229-0286 ; 0000-0002-3291-0661 ; 0000-0003-0953-8336 ; 0000-0003-4764-8835 ; 0000-0002-0719-2020 ; 0000-0003-0381-4715 ; 0000-0002-5331-4535 ; 0000-0003-3165-3808 ; 0000-0002-4191-113X ; 0000-0003-2336-0407 ; 0000-0002-0829-0562</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430894/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430894/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,53772,53774</link.rule.ids></links><search><creatorcontrib>Shoman, Yara</creatorcontrib><creatorcontrib>El May, Emna</creatorcontrib><creatorcontrib>Marca, Sandy</creatorcontrib><creatorcontrib>Wild, Pascal</creatorcontrib><creatorcontrib>Bianchi, Renzo</creatorcontrib><creatorcontrib>Bugge, Merete</creatorcontrib><creatorcontrib>Caglayan, Cigdem</creatorcontrib><creatorcontrib>Cheptea, Dimitru</creatorcontrib><creatorcontrib>Gnesi, Marco</creatorcontrib><creatorcontrib>Godderis, Lode</creatorcontrib><creatorcontrib>Kiran, Sibel</creatorcontrib><creatorcontrib>McElvenny, Damien</creatorcontrib><creatorcontrib>Mediouni, Zakia</creatorcontrib><creatorcontrib>Mehlum, Ingrid</creatorcontrib><creatorcontrib>Mijakoski, Dragan</creatorcontrib><creatorcontrib>Minov, Jordan</creatorcontrib><creatorcontrib>van der Molen, Henk</creatorcontrib><creatorcontrib>Nena, Evangelia</creatorcontrib><creatorcontrib>Otelea, Marina</creatorcontrib><creatorcontrib>Guseva Canu, Irina</creatorcontrib><title>Predictors of Occupational Burnout: A Systematic Review</title><title>International journal of environmental research and public health</title><description>We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of occupational burnout among workers. We arranged predictors in four families and 13 subfamilies of homogenous constructs. The plots of z-scores per predictor type enabled graphical discrimination of the effects. The vote-counting and binomial test enabled discrimination of the effect direction. The size of the effect was estimated using Cohen’s formula. The risk of bias and the overall evidence were assessed using the MEVORECH and GRADE methods, respectively. Eighty-five studies examining 261 predictors were included. We found a moderate quality of evidence for the harmful effects of the job demands subfamily (six predictors), and negative job attitudes, with effect sizes from small to medium. We also found a moderate quality of evidence for the protective effect of adaptive coping (small effect sizes) and leisure (small to medium effect sizes). Preventive interventions for occupational burnout might benefit from intervening on the established predictors regarding reducing job demands and negative job attitudes and promoting adaptive coping and leisure.</description><subject>Attitudes</subject><subject>Burnout</subject><subject>Confidence intervals</subject><subject>Coping</subject><subject>Discrimination</subject><subject>Longitudinal studies</subject><subject>Mental health</subject><subject>Systematic Review</subject><issn>1660-4601</issn><issn>1661-7827</issn><issn>1660-4601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkd1LwzAUxYMobk5ffS744ktn0qT58EGYwy8YTPx4Dkmauo62qUk72X9v54Y4n-6F8-Nw7zkAnCM4xljAq2JpfbNAHDGBOD8AQ0QpjAmF6PDPPgAnISwhxJxQcQwGmKQQMZ4MAXv2NitM63yIXB7Njeka1RauVmV02_nade11NIle16G1VS-Y6MWuCvt1Co5yVQZ7tpsj8H5_9zZ9jGfzh6fpZBYbQlEbc5Il2jCFIRGpyrHKoRVCM0FTmBOdUZ1borGiGKUwy7Dmguo00VRZxjVGeARutr5NpyubGVu3XpWy8UWl_Fo6Vch9pS4W8sOtJCcYckF6g8udgXefnQ2trIpgbFmq2rouyCRlSCQY4g168Q9duj6C_r0fCgqG2IYabynjXQje5r_HICg3ncj9TvA3izF-2w</recordid><startdate>20210831</startdate><enddate>20210831</enddate><creator>Shoman, Yara</creator><creator>El May, Emna</creator><creator>Marca, Sandy</creator><creator>Wild, Pascal</creator><creator>Bianchi, Renzo</creator><creator>Bugge, Merete</creator><creator>Caglayan, Cigdem</creator><creator>Cheptea, Dimitru</creator><creator>Gnesi, Marco</creator><creator>Godderis, Lode</creator><creator>Kiran, Sibel</creator><creator>McElvenny, Damien</creator><creator>Mediouni, Zakia</creator><creator>Mehlum, Ingrid</creator><creator>Mijakoski, Dragan</creator><creator>Minov, Jordan</creator><creator>van der Molen, Henk</creator><creator>Nena, Evangelia</creator><creator>Otelea, Marina</creator><creator>Guseva Canu, Irina</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2229-0286</orcidid><orcidid>https://orcid.org/0000-0002-3291-0661</orcidid><orcidid>https://orcid.org/0000-0003-0953-8336</orcidid><orcidid>https://orcid.org/0000-0003-4764-8835</orcidid><orcidid>https://orcid.org/0000-0002-0719-2020</orcidid><orcidid>https://orcid.org/0000-0003-0381-4715</orcidid><orcidid>https://orcid.org/0000-0002-5331-4535</orcidid><orcidid>https://orcid.org/0000-0003-3165-3808</orcidid><orcidid>https://orcid.org/0000-0002-4191-113X</orcidid><orcidid>https://orcid.org/0000-0003-2336-0407</orcidid><orcidid>https://orcid.org/0000-0002-0829-0562</orcidid></search><sort><creationdate>20210831</creationdate><title>Predictors of Occupational Burnout: A Systematic Review</title><author>Shoman, Yara ; El May, Emna ; Marca, Sandy ; Wild, Pascal ; Bianchi, Renzo ; Bugge, Merete ; Caglayan, Cigdem ; Cheptea, Dimitru ; Gnesi, Marco ; Godderis, Lode ; Kiran, Sibel ; McElvenny, Damien ; Mediouni, Zakia ; Mehlum, Ingrid ; Mijakoski, Dragan ; Minov, Jordan ; van der Molen, Henk ; Nena, Evangelia ; Otelea, Marina ; Guseva Canu, Irina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-84d2bc7a30495af3af0e99b79650f4bd6bfe4b3a63150dd3b896b52b6ae78b313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Attitudes</topic><topic>Burnout</topic><topic>Confidence intervals</topic><topic>Coping</topic><topic>Discrimination</topic><topic>Longitudinal studies</topic><topic>Mental health</topic><topic>Systematic Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shoman, Yara</creatorcontrib><creatorcontrib>El May, Emna</creatorcontrib><creatorcontrib>Marca, Sandy</creatorcontrib><creatorcontrib>Wild, Pascal</creatorcontrib><creatorcontrib>Bianchi, Renzo</creatorcontrib><creatorcontrib>Bugge, Merete</creatorcontrib><creatorcontrib>Caglayan, Cigdem</creatorcontrib><creatorcontrib>Cheptea, Dimitru</creatorcontrib><creatorcontrib>Gnesi, Marco</creatorcontrib><creatorcontrib>Godderis, Lode</creatorcontrib><creatorcontrib>Kiran, Sibel</creatorcontrib><creatorcontrib>McElvenny, Damien</creatorcontrib><creatorcontrib>Mediouni, Zakia</creatorcontrib><creatorcontrib>Mehlum, Ingrid</creatorcontrib><creatorcontrib>Mijakoski, Dragan</creatorcontrib><creatorcontrib>Minov, Jordan</creatorcontrib><creatorcontrib>van der Molen, Henk</creatorcontrib><creatorcontrib>Nena, Evangelia</creatorcontrib><creatorcontrib>Otelea, Marina</creatorcontrib><creatorcontrib>Guseva Canu, Irina</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of environmental research and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shoman, Yara</au><au>El May, Emna</au><au>Marca, Sandy</au><au>Wild, Pascal</au><au>Bianchi, Renzo</au><au>Bugge, Merete</au><au>Caglayan, Cigdem</au><au>Cheptea, Dimitru</au><au>Gnesi, Marco</au><au>Godderis, Lode</au><au>Kiran, Sibel</au><au>McElvenny, Damien</au><au>Mediouni, Zakia</au><au>Mehlum, Ingrid</au><au>Mijakoski, Dragan</au><au>Minov, Jordan</au><au>van der Molen, Henk</au><au>Nena, Evangelia</au><au>Otelea, Marina</au><au>Guseva Canu, Irina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Occupational Burnout: A Systematic Review</atitle><jtitle>International journal of environmental research and public health</jtitle><date>2021-08-31</date><risdate>2021</risdate><volume>18</volume><issue>17</issue><spage>9188</spage><pages>9188-</pages><issn>1660-4601</issn><issn>1661-7827</issn><eissn>1660-4601</eissn><abstract>We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of occupational burnout among workers. We arranged predictors in four families and 13 subfamilies of homogenous constructs. The plots of z-scores per predictor type enabled graphical discrimination of the effects. The vote-counting and binomial test enabled discrimination of the effect direction. The size of the effect was estimated using Cohen’s formula. The risk of bias and the overall evidence were assessed using the MEVORECH and GRADE methods, respectively. Eighty-five studies examining 261 predictors were included. We found a moderate quality of evidence for the harmful effects of the job demands subfamily (six predictors), and negative job attitudes, with effect sizes from small to medium. We also found a moderate quality of evidence for the protective effect of adaptive coping (small effect sizes) and leisure (small to medium effect sizes). Preventive interventions for occupational burnout might benefit from intervening on the established predictors regarding reducing job demands and negative job attitudes and promoting adaptive coping and leisure.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34501782</pmid><doi>10.3390/ijerph18179188</doi><orcidid>https://orcid.org/0000-0002-2229-0286</orcidid><orcidid>https://orcid.org/0000-0002-3291-0661</orcidid><orcidid>https://orcid.org/0000-0003-0953-8336</orcidid><orcidid>https://orcid.org/0000-0003-4764-8835</orcidid><orcidid>https://orcid.org/0000-0002-0719-2020</orcidid><orcidid>https://orcid.org/0000-0003-0381-4715</orcidid><orcidid>https://orcid.org/0000-0002-5331-4535</orcidid><orcidid>https://orcid.org/0000-0003-3165-3808</orcidid><orcidid>https://orcid.org/0000-0002-4191-113X</orcidid><orcidid>https://orcid.org/0000-0003-2336-0407</orcidid><orcidid>https://orcid.org/0000-0002-0829-0562</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1660-4601 |
| ispartof | International journal of environmental research and public health, 2021-08, Vol.18 (17), p.9188 |
| issn | 1660-4601 1661-7827 1660-4601 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8430894 |
| source | PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Attitudes Burnout Confidence intervals Coping Discrimination Longitudinal studies Mental health Systematic Review |
| title | Predictors of Occupational Burnout: A Systematic Review |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T05%3A12%3A11IST&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=Predictors%20of%20Occupational%20Burnout:%20A%20Systematic%20Review&rft.jtitle=International%20journal%20of%20environmental%20research%20and%20public%20health&rft.au=Shoman,%20Yara&rft.date=2021-08-31&rft.volume=18&rft.issue=17&rft.spage=9188&rft.pages=9188-&rft.issn=1660-4601&rft.eissn=1660-4601&rft_id=info:doi/10.3390/ijerph18179188&rft_dat=%3Cproquest_pubme%3E2571097174%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=2571097174&rft_id=info:pmid/34501782&rfr_iscdi=true |