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Consent for publication
Not applicable.
PMC10024023
Competing interests
The authors declare that they have no conflicts of interests.
PMC10024023
References
PMC10024023
Keywords
One-carbon nutrients play an important role in epigenetic mechanisms and cellular methylation reactions. Inadequate intake of these nutrients is linked to metabolic perturbations, yet the current intake levels of these nutrients have rarely been studied in Asia. This cross-sectional study surveyed the usual dietary int...
PMC10131051
Introduction
SPONTANEOUS ABORTION, FOLATE DEFICIENCY
One-carbon (1C) metabolism is a complex network of biochemical reactions that activates and transfers methyl groups. This network consists of folate, choline and methionine. The folate cycle produces nucleic acids that are used for DNA and RNA synthesisThe roles of vitamins B2, B6 and B12, folate and choline in one-car...
PMC10131051
Materials and methods
PMC10131051
Study design and population
A cross-sectional descriptive study design was used to survey the usual intake levels of 1C nutrients in 246 healthy adults (82 male and 164 female) 19–30 years of age. Sample size was determined to differentiate mean choline intake levels between sex using data from our pilot study with the effect size of 60 mg/d,
PMC10131051
Study protocol
CREST, RECRUITMENT
Participants were recruited from Chiang Mai University, Chiang Mai, Thailand via flyers and online postings. Study enrolments were regularly monitored for diversity of participants from various departments, and recruitment efforts were focused on under-represented groups, such as those who did not frequent the main cam...
PMC10131051
Dietary intake assessment
Cancer
CANCER
Dietary intake information was assessed via 24 h dietary recall interviews. Study personnel collected information on all food items that the participants consumed during the past 24 h (midnight to midnight) using the validated Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) developed by the National...
PMC10131051
Usual intake of one-carbon nutrients
MSM
Dietary recall data were linked to the USDA food composition database, which contains data from the Food and Nutrient Database for Dietary Studies, Food Patterns Equivalents Database and NHANES Dietary Supplement DatabaseThe ASA24 nutrient intake data were used to calculate the usual intake of each 1C nutrient followin...
PMC10131051
Statistical analyses
Dietary data were inspected for outliers and extreme values. Health habit information was either categorised or used as a continuous variable. Specifically, smoking status was categorised into current or non-smokers based on smoking activity in the past 12 months. Vigorous physical activity was defined as an activity t...
PMC10131051
Results
PMC10131051
Participants socioeconomic status, health characteristics and dietary intake
±
ADIPOSITY
The study participants had a mean age of 21 years, with most being undergraduate students who had not worked part-time and were living alone (Participant characteristics, health patterns and dietary intake (Values are mean ± Missing values are Visceral adiposity risk categories were based on wait-to-hip ratios as follo...
PMC10131051
Usual intake and prevalence of inadequacy of one-carbon nutrients
±
ADIPOSITY
Mean and median usual intakes of vitamins B2, B6 and B12 among participants were higher than the EAR set by the U.S. National Academy of Medicine, which is also used for Thai Dietary Reference Intake (Usual intake distribution of one-carbon nutrients by sex: vitamins B2 (a–male, b–female), B6 (c–male, d–female) and B12...
PMC10131051
Relationships between one-carbon nutrient intake and obesity measures
REGRESSION
Usual 1C intake levels were not associated with BMI, WC or WHR in the multiple linear regression models adjusted for sex, education, smoking, family income, age and energy intake (Associations between usual intake levels of one-carbon nutrients and body mass index, waist circumference and waist-to-hip ratiosLinear regr...
PMC10131051
Discussion
PMC10131051
Folate intake
The findings in the present study revealed that the majority of participants had inadequate folate intake. This is consistent with a previous study in Thai women of childbearing age, which reported that 65⋅5 % of women had low dietary folate levels and 18 % had low serum folate
PMC10131051
Choline intake
To our knowledge, this is the first study to estimate choline intake in a Thai population. Our results indicated that the mean choline intake was well below the AI levels for both men and women. This was likely due to the low consumption of choline food sources and not due to inadequate caloric intake, since most parti...
PMC10131051
Intake of other B vitamins
obesity
OBESITY
The intake of vitamins B2, B6 and B12 was adequate among study participants and was higher in men than in women. This is expected, as men also consume more calories than women. The intake of these B vitamins was not associated with socioeconomic backgrounds and health behaviours, suggesting that the overall dietary qua...
PMC10131051
Conclusion
Usual intake of 1C nutrients in male and female young Thai adults was adequate for vitamins B2, B6 and B12. The majority of participants had inadequate folate intake and did not achieve recommended intake levels for choline. The intake levels of vitamin B2 and choline were inversely associated with BMI in men. These fi...
PMC10131051
Acknowledgements
The authors would like to thank the Faculty of Agro-Industry and the Faculty of Medicine, Chiang Mai University, as well as all participants who contributed to this research.P. J.: Investigation, Data curation, Formal Analysis, Writing – Original draft; W. J.: Funding acquisition, Writing – Review & Editing; J. K.: Wri...
PMC10131051
References
PMC10131051
Background
Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health.
PMC10144884
Methods
We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3–15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children receiv...
PMC10144884
Results
In the baseline survey, 482 children participated (group A:
PMC10144884
Conclusions
Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting.
PMC10144884
Trial registration
ISRCTN 15177479.
PMC10144884
Supplementary Information
The online version contains supplementary material available at 10.1186/s12916-023-02862-2.
PMC10144884
Keywords
PMC10144884
Background
carious lesions, respiratory and cardiovascular diseases, cancer, AIDS-related, HIV infections, diabetes
DENTAL CARIES, CANCER, CHRONIC DISEASES, HIV INFECTIONS, DIABETES
In 2021, 1.7 million children were living with HIV worldwide [In children without HIV, oral health is associated with overall and long-term health. In general adult populations, poor oral health has been associated with chronic diseases, such as diabetes, respiratory and cardiovascular diseases, and cancer [An associat...
PMC10144884
Methods
PMC10144884
Study design
coronavirus disease 2019, NPH
NPH, CORONAVIRUS DISEASE 2019
This randomized controlled trial was conducted from February 2018 to April 2021 in the HIV clinic of the National Pediatric Hospital (NPH) in Phnom Penh, Cambodia. The original research plan included a 2-year intervention. However, owing to the coronavirus disease 2019 (COVID-19) pandemic, the endline study was postpon...
PMC10144884
Participants
NPH
NPH
The study population comprised children living with and without HIV. Of the 1113 eligible children in NPH, 482 were randomly included in the baseline survey (Fig. Flow diagram of the participants
PMC10144884
Sample size
Before the intervention, the minimum required sample size was 260 per group based on the decayed, missing, and filled permanent teeth (DMFT) score obtained from other studies [
PMC10144884
Recruitment and randomization
NPH
NPH
Children living with HIV were identified from the patient list of the NPH HIV clinic. The participants were randomly assigned to either the intervention or control group, allowing equal allocation of same-aged children. A computerized algorithm was used to perform randomization by a data analyst who was not a primary m...
PMC10144884
Interventions
DENTAL CARIES
The children in group A and their caregivers received oral health education sessions every four months, with a total of six sessions during the intervention period. During the sessions presentation materials and videos (e.g., how to prevent dental caries and what food is good or bad for the teeth) were used (Additional...
PMC10144884
Outcome measures
DISEASE PROGRESSION, SECONDARY
The primary outcome associated with oral health was the change in DMFT or the decayed, missing, and filled deciduous teeth (dmft) scores, and the secondary outcome was the viral load. Initially, the CD4 count was considered the secondary outcome. However, after initiating the study, only viral load was used to measure ...
PMC10144884
Data collection
NPH
NPH
We conducted the baseline surveys from February to April 2018 and the endline survey from February to April 2021. The children and their caregivers were interviewed using a structured questionnaire. We also collected data on children’s oral health status, weight, and height. For children in groups A and B, data regardi...
PMC10144884
Questionnaire
pain
Trained research assistants interviewed children and caregivers. The questionnaires collected information regarding the sociodemographic, oral care behavior, overall health-related QOL, and OHQOL.Regarding oral healthcare behaviors, the participants were asked whether they had visited a dentist over the last 12 months ...
PMC10144884
Registered medical records
NPH
NPH
Data regarding viral load were collected from the registered medical records of the NPH by research assistants. The latest information regarding viral load was obtained before the baseline survey and after the endline survey.
PMC10144884
Oral status examination
NPH
To evaluate children’s oral health status, we collected data regarding the number of DMFT/dmft, debris index, salivary pH, and salivary flow rate. A lower DMFT/dmft score and debris index, and a higher salivary flow rate and salivary pH indicated better oral health status. The dentists of NPH collected the complete ora...
PMC10144884
Body weight and height
Data regarding children’s body weight and height were collected and converted to the
PMC10144884
Statistical analyses
teeth dentition
First, we conducted descriptive analyses of the basic characteristics of the participants. The outcomes were examined for data with normal distribution, and skewed data were log-transformed. Second, bivariate analyses were performed to identify differences in variables in the baseline survey between groups A and B and ...
PMC10144884
Results
PMC10144884
Retention rate at the endline survey
We started recruiting baseline survey participants in February 2018 and followed up with them until April 2021. The mean attendance of group A in six oral health education sessions was 83.3%. Finally, 86.3% (
PMC10144884
Discussion
infections, HIV exhibited better oral hygiene
DENTAL CARIES, INFECTIONS
To the best of our knowledge, this was the first randomized controlled trial that evaluated the effectiveness of oral health interventions in improving oral health outcomes among children living with HIV. We compared outcome indicators between children living with HIV receiving and not receiving the intervention and be...
PMC10144884
Conclusions
HIV in low- and middle-income countries.
Oral health education improved the oral care behaviors of children living with HIV in a resource-constrained setting. In addition, over time, improved oral hygiene outcomes were associated with improved overall health outcomes, such as viral load, BMI for age, and QOL, among children living with HIV. Therefore, oral in...
PMC10144884
Supplementary Information
HIV and without HIV
APPENDIX
Additional file 1: Appendix 1. Training Schedule. Appendix 2. Outcome measures. Appendix 3. Participants’ characteristics at the baseline and endline surveys. Appendix 4. Followed-up and lost-to-follow up participants. Appendix 5. Differences of baseline and endline oral hygiene status in each participant group. Appen...
PMC10144884
Acknowledgements
The authors acknowledge all the children and their caregivers, the staff at the National Pediatric Hospital, Cambodia, and the research staff for their contributions to this study. This research was supported by JSPS KAKENHI Grant Number JP17H04658. The content of the article is solely the responsibility of the authors...
PMC10144884
Authors’ contributions
SE
Conceptualization: KK, JY, ST, MM, SY. Data curation: ST, SE. Formal analysis: KK, AS. Funding acquisition: KK. Investigation: CH, ST, SO, MM. Methodology: KK. Project administration: ST, SE. Supervision: SY, MM. Writing – original draft: KK. Writing – review and editing: JY, ST, MM, SO, CH, SY, KN, AS, SE. The authors...
PMC10144884
Funding
This research was supported by JSPS KAKENHI Grant Number JP17H04658.
PMC10144884
Availability of data and materials
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
PMC10144884
Declarations
PMC10144884
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of Kyushu University, Japan (approval/29067), and the National Ethics Committee for Health Research, Ministry of Health, Cambodia (approval/289NECHR). The participants joined voluntarily and written informed consent was obtained from all caregivers.
PMC10144884
Consent for publication
Not required.
PMC10144884
Competing interests
The authors declare that they have no competing interests.
PMC10144884
References
PMC10144884
Background
cardiovascular disease
EVENTS, SECONDARY, CARDIOVASCULAR DISEASE
A complete list of the REVEAL Collaborative Group members can be found in the Supplemental Material.Despite optimized risk factor control, people with prior cardiovascular disease remain at high cardiovascular disease risk. We assess the immediate‐ and longer‐term impacts of new vascular and nonvascular events on quali...
PMC7615160
Methods and Results
myocardial infarction, cancer, −0.067, Myocardial infarction, nonhemorrhagic stroke, heart failure
MYOCARDIAL INFARCTION, ADVERSE EVENTS, CANCER, EVENT, MYOCARDIAL INFARCTION, REGRESSION, EVENTS, HEART FAILURE
Data on demographic and clinical characteristics, health‐related quality of life (QoL: EuroQoL 5‐Dimension‐5‐Level), adverse events, and hospital admissions during the 4‐year follow‐up of the 21 820 participants recruited in Europe and North America informed assessments of the impacts of new adverse events on QoL and h...
PMC7615160
Conclusions
cardiovascular disease, Stroke
CARDIOVASCULAR DISEASE, STROKE, SECONDARY, EVENTS, HEART FAILURE
Stroke, heart failure, and noncoronary revascularization procedures substantially reduce QoL, and all cardiovascular disease events increase hospital costs. These estimates are useful in informing cost‐effectiveness of interventions to reduce cardiovascular disease risk in secondary prevention.
PMC7615160
Registration
URL:
PMC7615160
Subject Categories
This article was sent to Saket Girotra, MD, SM, Associate Editor, for review by expert referees, editorial decision, and final disposition.Supplemental Material is available at For Sources of Funding and Disclosures, see page 11.
PMC7615160
Nonstandard Abbreviations and Acronyms
coronary revascularizationgeneralized linear modelRandomized Evaluation of the Effects of Anacetrapib Through Lipid Modification
PMC7615160
Clinical Perspective
PMC7615160
What Is New?
stroke, heart failure, myocardial infarction, cardiovascular disease
MYOCARDIAL INFARCTION, CARDIOVASCULAR DISEASE, STROKE, EVENT, SECONDARY, EVENTS, HEART FAILURE
The study estimates the impacts of new major cardiovascular events on quality of life and hospital care costs in contemporary patients with well‐managed secondary cardiovascular disease from the perspectives of the UK and US health systems.In the year of event occurrence, nonhemorrhagic stroke, heart failure admission...
PMC7615160
What Are the Clinical Implications?
cardiovascular disease, stroke, CVD, heart failure, deaths
MYOCARDIAL INFARCTION (MI), CARDIOVASCULAR DISEASE, CARDIOVASCULAR DISEASE, CVD, STROKE, SECONDARY, EVENTS, HEART FAILURE
The contemporary impacts of new cardiovascular events on quality of life and costs reported in this study could inform cost‐effectiveness evaluations of newer interventions for secondary cardiovascular disease prevention in the United Kingdom and United States.Cardiovascular disease (CVD) is the leading cause of morbi...
PMC7615160
Methods
EVENTS
The data underlying this article are available in the article and in its online A total of 21 820 REVEAL participants, recruited in Europe and North America from 2011 to 2013 and followed for an average of 4 years until 2017, contributed to the main analyses in the current study. Data on the 8629 participants recruited...
PMC7615160
Key Disease Events
vascular death, death, stroke, cancer, diabetes
ADVERSE EVENTS, STROKE, DISEASE, CANCER, EVENTS, HEART FAILURE, DIABETES
After randomization, follow‐up assessments in the study were conducted at 2 months, 6 months, and every 6 months thereafter, and information was sought for serious adverse events including those resulting in hospital admissions. Key disease events considered in the present study were postrandomization MI, nonhemorrhagi...
PMC7615160
Health‐Related QoL
ADVERSE EVENTS
Participants' health‐related QoL was assessed using the EQ‐5D‐5‐Level (5L) questionnaire,Previous research has indicated that an individual's QoL was affected most by recent experiences of adverse events with impact on QoL diminishing thereafter.
PMC7615160
Hospital Costs
EVENTS, DISEASE, EVENT
For each study participant, hospital episodes were defined using the hospital admissions data during follow‐up; hospital admissions with overlapping lengths of stay were combined. For UK perspective, hospital episodes were mapped to Healthcare Resource GroupsTo evaluate the immediate and longer‐term impacts of new key ...
PMC7615160
Statistical Analysis
PMC7615160
Specification of Regression Models
heart failure
INTERACTIONS, EVENT, DISEASE, REGRESSION, EVENTS, HEART FAILURE
The generalized linear model (GLM) framework was adopted to facilitate modeling the QoL and annual hospital costs. For the QoL analysis, QoL utility at final follow‐up was modeled using the GLM with a Gaussian family distribution and linear link function, adjusting for participant QoL at randomization. Study participan...
PMC7615160
Scenario Analyses
ADVERSE EVENTS, REGRESSION
In scenario analyses, the QoL reductions and additional annual hospital costs associated with adverse events were reestimated by only including the UK study participants in analysis from the UK perspective, and separately, only including the participants recruited in North America in the analysis from the US perspectiv...
PMC7615160
Results
PMC7615160
Study Participants
PAD, cancer, stroke, peripheral artery disease, diabetes
MYOCARDIAL INFARCTION, PERIPHERAL ARTERY DISEASE, STROKE, DISEASE, CANCER, PAD, CHRONIC KIDNEY DISEASE, HEART FAILURE, CEREBROVASCULAR DISEASE, DIABETES
At randomization, the mean age across the 21 820 participants contributing to the main analyses was 67 years, 85.7% were men, 62.6% reported history of MI alone, 11.1% cerebrovascular disease alone, 5.7% peripheral artery disease alone; and the remaining participants reported prior disease histories in 2 or more of the...
PMC7615160
EVENTS, EVENT
The QoL analysis included 19 321 participants (88.5%) who completed both the baseline and final follow‐up EQ‐5D‐5L questionnaires. At the final study follow‐up, the mean QoL utility was 0.81 (SD 0.20) (UK perspective) and 0.83 (SD 0.21) (US perspective), with 6312 of the 19 321 participants (32.7%) reporting full healt...
PMC7615160
Quality of life utility of participants by category of new adverse event and time since event occurrence.
nonfatal adverse events, SD, diabetes
EVENTS, EVENT, DIABETES
UK (All 21 820 participants contributed to the cost analyses. The average annual hospital costs across all participants were £607 (SD £2402) and $2114 (SD $6188) from the UK and US health care systems perspectives, respectively. Hospital costs were reported in 20% of the 96 962 person‐years of follow‐up during the stud...
PMC7615160
Mean annual hospital costs before, in year of, and in subsequent years of first new adverse event occurrence.
UK (
PMC7615160
REGRESSION
The linear regression models of QoL at final follow‐up for the UK and US health care perspectives respectively, are presented in Figure
PMC7615160
Quality of life (QoL) reductions associated with new adverse events in secondary prevention of CVD, UK and US perspectives.
death, anxiety/depression, cancer, nonhemorrhagic stroke, heart failure, diabetes
MYOCARDIAL INFARCTION, OBESE, CARDIOVASCULAR DISEASE, ADVERSE EVENTS, CVD, EVENT, CANCER, ATRIAL FIBRILLATION, ADVERSE EVENT, REGRESSION, EVENTS, HEART FAILURE, DIABETES
Data of the 19 321 REVEAL participants randomized in Europe and North America was used in both analyses from the UK and US perspectives. EQ‐5D utility values for all 19 321 contributing participants were calculated using the UK or US EQ‐5D value sets, respectively. EQ‐5D is a standardized instrument used to measure hea...
PMC7615160
Hospital Care Costs Models and Impacts of Adverse Events on Hospital Care Costs
vascular death, death, stroke, cancer, heart failure
ADVERSE EVENT, ADVERSE EVENTS, CANCER, STROKE, EVENTS, EVENTS, HEART FAILURE
The results from the specification tests and comparison of predictive performance of different model specifications are reported in Table Additional Annual Hospital Costs Associated With Selected New Adverse Events From the UK and US (Medicare) Health Care PerspectivesData of 21 820 REVEAL study participants recruited ...
PMC7615160
Discussion
death, stroke, cancer, coronary and cerebrovascular diseases, cognitive decline, cardiovascular adverse
CVD, STROKE, EVENT, CANCER, ADVERSE EVENTS, DISEASE, SECONDARY, OTHER CARDIOVASCULAR CONDITIONS, EVENTS, HEART FAILURE
In this study, a number of key vascular and nonvascular events experienced by patients with a history of CVD were found to have important and long‐lasting impacts on QoL and hospital costs. These impacts were derived using high‐quality data from a large study with adjudicated event end points and about 4 years of follo...
PMC7615160
Conclusions
CVD
CVD, EVENTS
In conclusion, the impacts of vascular and nonvascular events on QoL and hospital costs reported in this study could inform assessments of net effects and cost‐effectiveness of further CVD therapies to reduce CVD risk in people with history of CVD. To assist such applications, an Excel program for the implementation of...
PMC7615160
Sources of Funding
Myocardial Infarction, Thrombolysis
HEART, MYOCARDIAL INFARCTION
This work was supported by grants from Merck & Co., Inc. to the University of Oxford. Support was also provided by the British Heart Foundation (including direct support for Professor Hopewell through grant FS/14/55/30806), the UK Medical Research Council (which funds the Medical Research Council Population Health Rese...
PMC7615160
Disclosures
Drs Lui, Williams, Keng, Sammons, and Chen; Professors Hopewell, Gray, Bowman, and Mihaylova; and Professor Sir Landray are employed by the Nuffield Department of Population Health, University of Oxford. The Nuffield Department of Population Health has a staff policy of not taking any personal payments directly or indi...
PMC7615160
Supporting information
Data S1–S3Tables S1–S9References 41–44Click here for additional data file.
PMC7615160
Acknowledgments
The authors thank the REVEAL trial participants, the local clinical center staff, regional and national coordinators, and members of the steering committee, lipid monitoring committee, and data monitoring committee.
PMC7615160
References
PMC7615160
Methods
This pilot study was a single site randomised, double-blind, placebo-controlled, crossover study. Testosterone (exercise and testosterone cream) and placebo (exercise and placebo cream) were each delivered for 12 weeks, with a two-week wash-out between the two periods. The primary outcome measure was improvement in qua...
PMC10089314
Results
DISEASE, SECONDARY, ADVERSE EVENTS
14 men completed the trial. There were no significant improvements in quadriceps extension strength or lean body mass, nor any of the secondary outcomes. Improvement in the RAND Short Form 36 patient reported outcome questionnaire ‘emotional wellbeing’ sub-category was reported during the testosterone arm compared to t...
PMC10089314
Conclusions
DISEASE
Adding testosterone supplementation to exercise training did not significantly improve muscle strength or physical function over a 12-week intervention period, compared to exercise alone. However, the combination improved emotional well-being over this period, and relative stabilisation of disease was found during the ...
PMC10089314
Data Availability
INFECTIOUS DISEASES
The data cannot be shared publicly due to the small sample size meaning that the data contains potentially identifying or sensitive patient information. The participants of the study could easily identify themselves and other participants. This is particularly the case in Perth, where the community of individuals with ...
PMC10089314
Introduction
muscle hypertrophy
DISEASE, ACQUIRED SKELETAL MUSCLE DISEASE, INCLUSION BODY MYOSITIS, INFLAMMATORY MYOPATHIES
Inclusion body myositis (IBM) is the most commonly acquired skeletal muscle disease associated with ageing, with men three times more likely than females to be diagnosed [Exercise has long been considered a vital component of the therapeutic approach in inflammatory myopathies, improving overall quality of life and ass...
PMC10089314
Participants and methods
PMC10089314
Study design
INFECTIOUS DISEASES
This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000755235), and approved by the Human Research Ethics Committee at Murdoch University (approval number 2017/262). Data was collected at the Academic Medical Centre, Institute for Immunology and Infectious Diseases (IIID), ...
PMC10089314
Trial design.
BLIND
All participants underwent randomisation and were allocated to either the placebo or testosterone arm.Block randomisation was used to allocate treatment kits 1:1 to either testosterone or placebo at the central pharmacy. Randomised treatment kits were then allocated to participants in consecutive order at their Baselin...
PMC10089314
Outcome measures
BBS
SECONDARY
Outcome measurements were performed at the baseline, placebo (either week 12 or 26) and testosterone (either week 12 or 26) arms. The primary outcome measure was improvement in quadriceps isokinetic muscle strength assessed using a HUMACNORM isokinetic dynamometer (Stoughton, Massachusetts, USA) on the right leg at 30 ...
PMC10089314
Data analysis
Data analysis was conducted in R statistical program using the package ggplot2 [
PMC10089314
Results
PMC10089314
Participant characteristics
In total, 20 males were assessed for eligibility for the study and six were excluded as they did not meet the selection criteria (
PMC10089314