Research Article
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Investigation of the dentists’ fear of coronavirus disease and psychological status during coronavirus pandemic

Year 2022, , 323 - 336, 27.09.2022
https://doi.org/10.21673/anadoluklin.1038361

Abstract

Aim: Our study aimed to examine the fear of coronavirus, depression, anxiety and stress levels (along with their associated factors); in dentists who continued to work in close contact with their patients during the COVID-19 pandemic.

Methods: This research, which uses a descriptive and cross-sectional design, includes dentists who are actively working during the COVID-19 pandemic and volunteer to participate in the study. Due to pandemic, 376 dentists, who were included in the study by convenience sampling, participated remotely via an online survey. A Sociodemographic Information Form, The Fear of COVID-19 Scale and The Depression Anxiety Stress-21 Scale (DASS-21) were used.

Results: 226 (60.1%) of the participants had fear of contamination and death during the pandemic. Fear of Covid-19, DASS-21 scales and DASS total score were found to be significantly higher in the female group(p<0.001). It was observed that the depression, anxiety, stress and the DASS total scale scores of the dentists who did not have children were significantly higher than the dentists who have children (p<0.001). The fear of COVID-19 and stress scale scores of dentists who started to work with shifts were also significantly higher than the average of those who continued to work with the same working order as before the pandemic (p<0.05). The depression, stress and DASS total scores of the dentists assigned to the COVID-19 contact tracing were significantly higher than the dentists who continued to work with the same working order as before the pandemic (p<0.05).

Conclusion: According to our findings; it was concluded that the presence of psychiatric disorder history in dentists was an explanatory factor on depression, anxiety and stress. Therefore, it is important to follow up dentists with a history of psychiatric disorder more closely and provide psychological support to them.

References

  • World Health Organization. Removing obstacles to healthy development: report on infectious diseases. World Health Organization; 1999.
  • World Health Organization (WHO). Weekly operational update on COVID-19 - 1 March 2021 [Internet]. who.int. 2021 [cited 2021 Mar 6]. Available from: https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---1-march-2021
  • T.C Sağlık Bakanlığı. Türkiye Covid-19 Hasta Tablosu [Internet]. covid19.saglik.gov.tr. 2021 [cited 2021 Mar 6]. Available from: https://covid19.saglik.gov.tr/
  • Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481–7.
  • Yıldırım M, Çetin M. Bir Salgın Örneği Olarak Covid-19 Salgını ve Bunun Riskli Popülasyonda Yer Alan Sağlık Çalışanları Üzerine Etkileri. Balıkesir Sağlık Bilim Derg. 2020;9(2):121–6.
  • Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res. 2020;290:113130.
  • Kang L, Li Y, Hu S, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14.
  • Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control. 2016;44(9 Suppl):102-8.
  • Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):1–6.
  • Dar Odeh N, Babkair H, Abu-Hammad S, Borzangy S, Abu-Hammad A, Abu-Hammad O. COVID-19: present and future challenges for dental practice. Int J Environ Res Public Health. 2020;17(9):3151.
  • Ahmed MA, Jouhar R, Ahmed N, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health. 2020;17(8):2821.
  • Person B, Sy F, Holton K, Govert B, Liang A. Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10(2):358.
  • Aly MM, Elchaghaby MA. Impact of novel coronavirus disease (COVID-19) on Egyptian dentists’ fear and dental practice (a cross-sectional survey). BDJ open. 2020;6(1):1–5.
  • Duruk G, Gümüşboğa ZŞ, Çolak C. Investigation of Turkish dentists’ clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study. Braz Oral Res. 2020;34:e054.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Farooq I, Ali S. COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Postgrad Med J. 2020;96(1142):791–2.
  • Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335–43.
  • Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Derg. 2018;7(1):19–30.
  • Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020;1–9.
  • Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. Int J Ment Health Addict. 2020;1–9.
  • Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw open. 2020;3(3):e203976–e203976.
  • Yildirim TT, Atas O, Asafov A, Yildirim K, Balibey H. Psychological status of healthcare workers during the Covid-19 pandemic. Age (Omaha). 2020;20(30):31–40.
  • McLean CP, Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev. 2009;29(6):496–505.
  • Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry. 2020;7(4):e15–6.
  • Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245-51.
  • Wu M, Xu W, Yao Y, et al. Mental health status of students’ parents during COVID-19 pandemic and its influence factors. Gen Psychiatr. 2020;33(4):e100250.
  • Russell D, Taylor J. Living alone and depressive symptoms: the influence of gender, physical disability, and social support among Hispanic and non-Hispanic older adults. Journals Gerontol Ser B Psychol Sci Soc Sci. 2009;64(1):95–104.
  • Stahl ST, Beach SR, Musa D, Schulz R. Living alone and depression: the modifying role of the perceived neighborhood environment. Aging Ment Health. 2017;21(10):1065–71.
  • Chambers R, Campbell I. Anxiety and depression in general practitioners: associations with type of practice, fundholding, gender and other personal characteristics. Fam Pract. 1996;13(2):170–3.
  • Iwasaki A. What reinfections mean for COVID-19. Lancet Infect Dis. 2021;21(1):3–5.
  • Lim RCH, Pinto C. Work stress, satisfaction and burnout in New Zealand radiologists: Comparison of public hospital and private practice in New Zealand. J Med Imaging Radiat Oncol. 2009;53(2):194–9.
  • Kuusio H, Heponiemi T, Aalto A, Sinervo T, Elovainio M. Differences in well‐being between GPS, medical specialists, and private physicians: The role of psychosocial factors. Health Serv Res. 2012;47(1pt1):68–85.
  • Chamorro-Petronacci C, Martin Carreras-Presas C, Sanz-Marchena A, et al. Assessment of the economic and health-care impact of COVID-19 (SARS-CoV-2) on public and private dental surgeries in Spain: A pilot study. Int J Environ Res Public Health. 2020;17(14):5139.
  • Mumcu G, Sur H, Yildirim C, Soylemez D, Atli H, Hayran O. Utilisation of dental services in Turkey: a cross-sectional survey. Int Dent J. 2004;54(2):90–6.
  • Hu D, Kong Y, Li W, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020;24:100424.
  • SingH Am, PnDey AK, PAnDey A, SureKA Pa. Comparative Study of Stress among Depressed and Non-depressed Medical Students. J Clin Diagnostic Res. 2020;14(10):1-5.
  • Özdemir D, Arpacıoğlu S. Sosyal Medya Kullanımı, Sağlık Algısı ve Sağlık Arama Davranışının Koronavirüs Korkusu Üzerine Etkisi. Psikiyatr Güncel Yaklaşımlar. 2020;12:364–81.
  • Gao J, Zheng P, Jia Y, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020;15(4):e0231924.
  • Zhong B, Huang Y, Liu Q. Mental health toll from the coronavirus: Social media usage reveals Wuhan residents’ depression and secondary trauma in the COVID-19 outbreak. Comput Human Behav. 2021;114:106524.
  • González-Padilla DA, Tortolero-Blanco L. Social media influence in the COVID-19 Pandemic. Int Braz J Urol. 2020;46(suppl.1):120-4.
  • Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020;51:102076.
  • Beck KD, Jiao X, Pang KCH, Servatius RJ. Vulnerability factors in anxiety determined through differences in active-avoidance behavior. Prog Neuro-Psychopharmacology Biol Psychiatry. 2010;34(6):852–60.
  • Maack DJ, Tull MT, Gratz KL. Experiential avoidance mediates the association between behavioral inhibition and posttraumatic stress disorder. Cognit Ther Res. 2012;36(4):407–16.
  • Pickett SM, Lodis CS, Parkhill MR, Orcutt HK. Personality and experiential avoidance: A model of anxiety sensitivity. Pers Individ Dif. 2012;53(3):246–50.
  • Soroya SH, Farooq A, Mahmood K, Isoaho J, Zara S. From information seeking to information avoidance: Understanding the health information behavior during a global health crisis. Inf Process Manag. 2021;58(2):102440.
  • Bulca Karadem F. Sağlik çalişanlarinda COVID-19 korkusunu belirleyen psikiyatrik değişkenlerin incelenmesi. Süleyman Demirel Üniversitesi; 2020.
  • Kaufman J, Charney D. Comorbidity of mood and anxiety disorders. Depress Anxiety. 2000;12(S1):69–76.
  • Saha S, Lim CCW, Cannon DL, et al. Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depress Anxiety. 2021;38(3):286–306.
  • Williams L, Jacka F, Pasco J, et al. The prevalence of mood and anxiety disorders in Australian women. Australas Psychiatry. 2010;18(3):250–5.

Diş hekimlerinin koronavirüs pandemisi sürecindeki koronavirüs hastalığı korkusu ve psikolojik durumlarının incelenmesi

Year 2022, , 323 - 336, 27.09.2022
https://doi.org/10.21673/anadoluklin.1038361

Abstract

Amaç: Araştırmamızda koronavirüs hastalığı 2019 (COVID-19) salgını sürecinde hastalarıyla yakından temas ederek çalışmaya devam eden diş hekimlerinin koronavirüs korkusu, depresyon, anksiyete ve stres düzeyleri ile bunlarla ilişkili faktörlerin incelenmesi amaçlanmıştır.

Yöntemler: Gözlemsel ve kesitsel tasarımda olan bu araştırma COVID-19 pandemi sürecinde aktif çalışmakta olan ve araştırmaya gönüllü katılan diş hekimlerini kapsamaktadır. Çalışma pandemi tedbirleri nedeni ile elektronik ortamda kolayda örnekleme ile ulaşılan 376 diş hekiminin katılımı ile gerçekleşmiştir. Sosyodemografik Bilgi Formu, COVID-19 Korkusu Ölçeği ve Depresyon Anksiyete Stres-21 Ölçeği (DASS-21) kullanılmıştır.

Bulgular: Katılımcıların 226’sı (%60,1) salgın sürecinde bulaşma ve ölüm korkusu yaşamaktaydı. COVID-19 korkusu, depresyon, anksiyete, stres ölçekleri ve DASS toplam skoru kadın grup ortalamaları erkek grup ortalamasından anlamlı derecede yüksek bulundu (p<0,001). Çocuk sahibi olmayan diş hekimlerinin depresyon, anksiyete, stres ölçekleri ve DASS toplam ölçek skoru ortalamalarının çocuğu olan diş hekimlerinden istatistiksel açıdan anlamlı derecede yüksek olduğu görüldü (p<0,001). Dönüşümlü çalışanların COVID-19 korkusu ve stres ölçek skoru pandemi öncesiyle aynı düzende çalışmaya devam eden diş hekimlerinin ortalamasından anlamlı derecede yüksekti (p<0,05). Filyasyon ekibinde görevlendirilen diş hekimlerinin depresyon, stres ve DASS toplam ölçek skoru ortalaması pandemi öncesiyle aynı düzende çalışmaya devam eden diş hekimlerinin ortalamasından anlamlı derecede yüksekti (p<0,05).

Sonuç: Çalışma bulgularımıza göre; diş hekimlerinde ruhsal hastalık öyküsü varlığının depresyon, anksiyete ve stres üzerinde açıklayıcı faktör olduğu sonucuna ulaşılmıştır. Bu nedenle geçmişinde ruhsal hastalığa sahip olan grubun daha yakından takip edilerek psikolojik destek sağlanması önem taşımaktadır.

References

  • World Health Organization. Removing obstacles to healthy development: report on infectious diseases. World Health Organization; 1999.
  • World Health Organization (WHO). Weekly operational update on COVID-19 - 1 March 2021 [Internet]. who.int. 2021 [cited 2021 Mar 6]. Available from: https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---1-march-2021
  • T.C Sağlık Bakanlığı. Türkiye Covid-19 Hasta Tablosu [Internet]. covid19.saglik.gov.tr. 2021 [cited 2021 Mar 6]. Available from: https://covid19.saglik.gov.tr/
  • Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481–7.
  • Yıldırım M, Çetin M. Bir Salgın Örneği Olarak Covid-19 Salgını ve Bunun Riskli Popülasyonda Yer Alan Sağlık Çalışanları Üzerine Etkileri. Balıkesir Sağlık Bilim Derg. 2020;9(2):121–6.
  • Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res. 2020;290:113130.
  • Kang L, Li Y, Hu S, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14.
  • Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control. 2016;44(9 Suppl):102-8.
  • Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):1–6.
  • Dar Odeh N, Babkair H, Abu-Hammad S, Borzangy S, Abu-Hammad A, Abu-Hammad O. COVID-19: present and future challenges for dental practice. Int J Environ Res Public Health. 2020;17(9):3151.
  • Ahmed MA, Jouhar R, Ahmed N, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health. 2020;17(8):2821.
  • Person B, Sy F, Holton K, Govert B, Liang A. Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10(2):358.
  • Aly MM, Elchaghaby MA. Impact of novel coronavirus disease (COVID-19) on Egyptian dentists’ fear and dental practice (a cross-sectional survey). BDJ open. 2020;6(1):1–5.
  • Duruk G, Gümüşboğa ZŞ, Çolak C. Investigation of Turkish dentists’ clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study. Braz Oral Res. 2020;34:e054.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Farooq I, Ali S. COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Postgrad Med J. 2020;96(1142):791–2.
  • Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335–43.
  • Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Derg. 2018;7(1):19–30.
  • Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020;1–9.
  • Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. Int J Ment Health Addict. 2020;1–9.
  • Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw open. 2020;3(3):e203976–e203976.
  • Yildirim TT, Atas O, Asafov A, Yildirim K, Balibey H. Psychological status of healthcare workers during the Covid-19 pandemic. Age (Omaha). 2020;20(30):31–40.
  • McLean CP, Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev. 2009;29(6):496–505.
  • Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry. 2020;7(4):e15–6.
  • Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245-51.
  • Wu M, Xu W, Yao Y, et al. Mental health status of students’ parents during COVID-19 pandemic and its influence factors. Gen Psychiatr. 2020;33(4):e100250.
  • Russell D, Taylor J. Living alone and depressive symptoms: the influence of gender, physical disability, and social support among Hispanic and non-Hispanic older adults. Journals Gerontol Ser B Psychol Sci Soc Sci. 2009;64(1):95–104.
  • Stahl ST, Beach SR, Musa D, Schulz R. Living alone and depression: the modifying role of the perceived neighborhood environment. Aging Ment Health. 2017;21(10):1065–71.
  • Chambers R, Campbell I. Anxiety and depression in general practitioners: associations with type of practice, fundholding, gender and other personal characteristics. Fam Pract. 1996;13(2):170–3.
  • Iwasaki A. What reinfections mean for COVID-19. Lancet Infect Dis. 2021;21(1):3–5.
  • Lim RCH, Pinto C. Work stress, satisfaction and burnout in New Zealand radiologists: Comparison of public hospital and private practice in New Zealand. J Med Imaging Radiat Oncol. 2009;53(2):194–9.
  • Kuusio H, Heponiemi T, Aalto A, Sinervo T, Elovainio M. Differences in well‐being between GPS, medical specialists, and private physicians: The role of psychosocial factors. Health Serv Res. 2012;47(1pt1):68–85.
  • Chamorro-Petronacci C, Martin Carreras-Presas C, Sanz-Marchena A, et al. Assessment of the economic and health-care impact of COVID-19 (SARS-CoV-2) on public and private dental surgeries in Spain: A pilot study. Int J Environ Res Public Health. 2020;17(14):5139.
  • Mumcu G, Sur H, Yildirim C, Soylemez D, Atli H, Hayran O. Utilisation of dental services in Turkey: a cross-sectional survey. Int Dent J. 2004;54(2):90–6.
  • Hu D, Kong Y, Li W, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020;24:100424.
  • SingH Am, PnDey AK, PAnDey A, SureKA Pa. Comparative Study of Stress among Depressed and Non-depressed Medical Students. J Clin Diagnostic Res. 2020;14(10):1-5.
  • Özdemir D, Arpacıoğlu S. Sosyal Medya Kullanımı, Sağlık Algısı ve Sağlık Arama Davranışının Koronavirüs Korkusu Üzerine Etkisi. Psikiyatr Güncel Yaklaşımlar. 2020;12:364–81.
  • Gao J, Zheng P, Jia Y, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020;15(4):e0231924.
  • Zhong B, Huang Y, Liu Q. Mental health toll from the coronavirus: Social media usage reveals Wuhan residents’ depression and secondary trauma in the COVID-19 outbreak. Comput Human Behav. 2021;114:106524.
  • González-Padilla DA, Tortolero-Blanco L. Social media influence in the COVID-19 Pandemic. Int Braz J Urol. 2020;46(suppl.1):120-4.
  • Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020;51:102076.
  • Beck KD, Jiao X, Pang KCH, Servatius RJ. Vulnerability factors in anxiety determined through differences in active-avoidance behavior. Prog Neuro-Psychopharmacology Biol Psychiatry. 2010;34(6):852–60.
  • Maack DJ, Tull MT, Gratz KL. Experiential avoidance mediates the association between behavioral inhibition and posttraumatic stress disorder. Cognit Ther Res. 2012;36(4):407–16.
  • Pickett SM, Lodis CS, Parkhill MR, Orcutt HK. Personality and experiential avoidance: A model of anxiety sensitivity. Pers Individ Dif. 2012;53(3):246–50.
  • Soroya SH, Farooq A, Mahmood K, Isoaho J, Zara S. From information seeking to information avoidance: Understanding the health information behavior during a global health crisis. Inf Process Manag. 2021;58(2):102440.
  • Bulca Karadem F. Sağlik çalişanlarinda COVID-19 korkusunu belirleyen psikiyatrik değişkenlerin incelenmesi. Süleyman Demirel Üniversitesi; 2020.
  • Kaufman J, Charney D. Comorbidity of mood and anxiety disorders. Depress Anxiety. 2000;12(S1):69–76.
  • Saha S, Lim CCW, Cannon DL, et al. Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depress Anxiety. 2021;38(3):286–306.
  • Williams L, Jacka F, Pasco J, et al. The prevalence of mood and anxiety disorders in Australian women. Australas Psychiatry. 2010;18(3):250–5.
There are 49 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

Tuğçenur Avcı 0000-0002-6946-3308

Selim Arpacıoğlu 0000-0002-1988-506X

Publication Date September 27, 2022
Acceptance Date June 6, 2022
Published in Issue Year 2022

Cite

Vancouver Avcı T, Arpacıoğlu S. Diş hekimlerinin koronavirüs pandemisi sürecindeki koronavirüs hastalığı korkusu ve psikolojik durumlarının incelenmesi. Anadolu Klin. 2022;27(3):323-36.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.