Structural Factors Research Articles

Genetic and neurobiological aspects of psychosis in major neurocognitive disorder.

Psychiatric symptoms are frequent in neurocognitive disorders and dementias. Psychotic symptoms, mainly hallucinations and delusions, may appear in up to 50% of cases, influencing morbidity and mortality. Genetic, neurobiological, and environmental factors are involved in their onset. We conducted a narrative review of primary articles developed in humans that analyzed the genetic and neurobiological basis of psychosis in dementias. Evidence suggests that there are genetic risk variants for presenting psychosis in dementia. How genetic variants are related to schizophrenia, dementia, and other neurodegenerative disorders is under discussion. Candidate gene studies have found and genetic variants are associated with psychosis in dementia while genome-wide association studies have shown variants located in y . Epigenetic studies are scarce but have detected differences in the methylome of people with dementia and psychosis. On the other hand, alterations of the cholinergic, serotonergic, dopaminergic, and gabaergic neurotransmitter systems and the excitatory-inhibitory balance have been described in dementia. From a functional and anatomical point of view, there are alterations in several regions, mainly in the frontal area and other sensory processing and integration areas. Finally, we describe the influence of cognitive alterations in the genesis and maintenance of delusions and discuss the phenomenological overlap with confabulations. Multiple genetic, neurobiological, structural, and cognitive factors influence the occurrence of delusions and hallucinations in persons with dementia. Further research is needed to understand the pathophysiology of psychosis in dementias. This approach would support the understanding of psychosis as a transdiagnostic entity.

Characteristics and Influencing Factors of Soil Particulate and Mineral-associated Organic Carbon in Cropland Soil across Sichuan Basin

Exploring the composition of regional soil organic carbon （SOC） components and identifying their influencing factors are of utmost importance to deeply understand the potential mechanisms of SOC change in cropland soil. Based on data from 871 soil sampling points, this study explored the characteristics of soil particulate and mineral-associated organic carbon （POC and MAOC） in the surface soil of cropland and the relationships with climate, terrain, soil texture, agricultural land-use type, and fertilization across the Sichuan basin using analysis of variance, correlation analysis, and a random forest model. The results showed that the average content of POC and MAOC in the surface soil of cropland was 5.01 g·kg-1 and 9.79 g·kg-1, respectively, accounting for 32.5% and 67.5% of the total SOC； the proportion of POC increased with SOC. The two SOC fractions showed a similar spatial distribution pattern, with the content being higher in peripheral areas and lower in the middle of the basin, which were determined together by structural and random factors. The results of the random forest model showed that the relative importance of agricultural land-use type was much more important than other factors. NPP, mean annual temperature, and soil texture showed the largest correlations with the two SOC fractions in dryland； mean annual temperature and slope had larger correlations with POC and mean annual temperature and soil texture in the dryland-paddy rotation land； and soil texture was the most relevant factor to POC and MAOC in the paddy field. The above results suggested that MAOC was the main component of SOC, and agricultural land-use type was the dominant control and regulated the effects of other factors on the two SOC fractions.

Designing social behaviour change in households: sustainable mobility intervention and follow-up study

Limiting global warming to 1.5 degrees requires consistent action by people to change their lifestyles in order to limit annual household-related carbon emissions to 2.5 tonnes per person by 2030. As the required mobility reduction measures have already been identified, the challenge remains in scaling up the changes into a mainstream practice. Our study explored whether the involvement of close social communities, especially households, in the change process could be effective in achieving the required measures. Through a Climate Puzzle game intervention and a six-month follow-up study with 12 households in Espoo, Finland, we investigated the role of close social communities in implementing the planned sustainable mobility behaviour change. The findings are presented through 12 household narratives. These narratives show that the adoption of new sustainable mobility behaviours is influenced by both (infra)structural and social relationship factors and that close social communities can hinder or facilitate the shift of everyday mobility behaviours towards being more sustainable in diverse ways. The findings suggest that design interventions should target larger social communities rather than just individuals in order to achieve the 2.5 tonne target. The study also indicates that socially tailored interventions and low-carbon solutions should be developed and targeted at city districts to help households create and maintain lifestyle changes.

Stabilization of oxygen vacancy ordering and electrochemical-proton-insertion-and-extraction-induced large resistance modulation in strontium iron cobalt oxides Sr(Fe,Co)Oy

Electrochemically inserting and extracting hydrogen into and from solids are promising ways to explore materials’ phases and properties. However, it is still challenging to identify the structural factors that promote hydrogen insertion and extraction and to develop materials whose functional properties can be largely modulated by inserting and extracting hydrogen through solid-state reactions at room temperature. In this study, guided by theoretical calculations on the energies of oxygen reduction and hydrogen insertion reactions with oxygen-deficient perovskite oxides, we demonstrated that the oxygen vacancy ordering in Sr(Fe1−xCox)Oy (SFCO) epitaxial films can be stabilized by increasing the Co content (x ≥ 0.3) and revealed that it plays a key role in promoting proton accommodation into the SFCO lattice. We also show that the electrical resistance of SFCO films can be reversibly modulated by electrochemical proton insertion and extraction, and the modulation exceeds three orders of magnitude for Sr(Fe0.5Co0.5)O2.5 epitaxial films. Our results provide guidelines for controlling material properties through the insertion and extraction of hydrogen and for designing and exploring hydrogen-insertion materials.

System Dynamics Modeling of Caries Severity States in Long-Term Care

Dental caries among long-term care (LTC) residents is a persistent and complex problem driven by social and structural factors. Systems thinking may be useful in considering novel approaches to reducing disease. This study aimed to develop a system dynamics model to simulate the progression of dentate older adults in LTC through caries severity states and estimate the effects of 3 intervention scenarios on the progression of caries: preventive topical fluoride (TF), arrest of caries with silver diamine fluoride (SDF), and a combination of TF and SDF. Dentate older adults in LTC were categorized into 4 caries severity states by their number of untreated carious lesions. The model assumed that changes in severity states were consistent with incidence rates reported in the literature and available billing data for dental care and that individuals move in and out of the system by entering and exiting the facility or experiencing edentulism. For all scenarios, the proportion of dentate older adults in LTC with 1 or more untreated lesions stays stable, the distribution of disease shifts from a high severity state, and the system approaches equilibrium after 4 y. The TF intervention predicts minimal impacts on decreasing the proportion of dentate older adults with 1 or more untreated lesions (2.5% decrease), while the SDF intervention and the combination interventions were most disruptive. There was a 29.6% and 33.6% decrease, respectively. Given the specific population dynamics in LTC, these findings suggest that long-term (greater than 4 y) interventions should be designed to address both the management of existing lesions and their incidence. This system dynamics model allows researchers to render institution-specific data points from LTCs to estimate the effects of proposed interventions at the respective site.

Lattice engineering for enhancing the stability of CsPbI3/CsxFA1–xPbI3 quantum dots synthesized via a direct arrangement

This study synthesizes CsPbI3/CsxFA1–xPbI3 QDs using a spontaneous in situ injection method, enhancing stability and efficiency. Our findings highlight the influence of FA distribution and structural factors on the optical properties of the system.

Exploring barriers to accessing treatment for Lymphatic Filariasis through a socio-ecological lens in Buvuma and Napak districts, Uganda.

The World Health Organization launched the Global Programme to Eliminate Lymphatic Filariasis in 2000, which aimed at eradicating the disease by 2030. This goal depends on community mass drug administration and essential care. Despite these efforts, many rural communities still face untreated lymphatic filariasis and lack access to treatment and self-management. Using a socioecological model, this study examined barriers to treatment and support for people living with lymphatic filariasis in Uganda's Buvuma and Napak districts. We conducted 12 key informant interviews with health facility officials, district health officers, and village health team members. Additionally, 19 focus group discussions were held with community members, and nine in-depth interviews were conducted with people living with lymphatic filariasis. This study explored knowledge gaps among those living with lymphatic filariasis and health providers that affect morbidity management and disability prevention, as well as challenges in accessing treatment. Audio recordings were transcribed and managed via ATLAS ti software version 6. Thematic analysis was conducted via the socioecological model framework. This study identified multiple complex factors affecting healthcare providers and individuals living with lymphatic filariasis, spanning individual, interpersonal, organisational, community, and policy levels. The key themes included stigma and social isolation, healthcare disparities, and healthcare dynamics. Stigma and social isolation result in emotional distress, neglect, exclusion, and self-isolation, which are influenced by community beliefs. Health systems and policy barriers included poverty, inadequate personnel, and insufficient equipment. Structural factors such as geographical remoteness, environmental harshness, and lack of healthcare infrastructure were prominent obstacles to seeking care for lymphatic filariasis management. This study provides insights into the multilevel factors influencing the understanding and availability of treatment for lymphatic filariasis in Uganda. Addressing sociocultural beliefs, social and interpersonal dynamics, and healthcare disparities is crucial for improving the outcomes and well-being of these rural communities. These findings can aid in managing lymphatic filariasis in Uganda and similar low-resource settings.

Restoration patterns and influencing factors for the vegetation structure and carbon storage in mangroves converted from abandoned ponds

Restoration patterns and influencing factors for the vegetation structure and carbon storage in mangroves converted from abandoned ponds

Shaking Table Tests of Underground Substation Considering Soil–Structure–Equipment Interaction

ABSTRACTTo investigate the seismic dynamic response characteristics of underground substations, considering the interaction among soil, structure, and equipment, a model soil field shaking table test with a similarity ratio of 1:25 was conducted. Detailed analysis was conducted on the acceleration amplification factors, Fourier amplitude spectra, and displacements of soil, structure, and equipment during the experimental process. The experimental study revealed the following findings: It was concluded that the seismic excitation had a significant impact on the acceleration response of equipment near the edges of the structure, demonstrating an amplification effect. Both the acceleration amplification factors of the station structure and the site generally decreased with increasing input seismic intensity. As the seismic intensity increased, this decreasing trend gradually weakened. Additionally, the peak values of acceleration Fourier spectra often decrease with increasing burial depth. The examination of the postearthquake model system revealed the presence of surface cracks in the soil, which exhibited varying degrees of severity. These cracks were observed both parallel and perpendicular to the direction of excitation, with a significant concentration of soil fissures occurring directly above the structural elements.

"They are not HIV treatments drugs; they are preventive drugs (PrEP)". Experiences of PrEP uptake among vulnerable adolescent girls and young women in Tanzania.

HIV poses a significant global health concern, affecting adolescents among other populations. This is attributed to various vulnerabilities including biological factors, gender inequalities and limited access to comprehensive sexual and reproductive health services in sub-Saharan Africa. In Tanzania, adolescent girls, and young women (AGYW) face double the risk of HIV infection compared to their male counterparts. The introduction of pre-exposure prophylaxis (PrEP) in early 2018 brought hope for changing the HIV cascade in the country. However, numerous challenges still hinder PrEP uptake. Therefore, this study explored experiences of PrEP uptake among vulnerable AGYW in Tanzania. This study employed a phenomenological qualitative approach; 52 semi-structured interviews were carried out between May to November 2022 in the selected healthcare facilities in Tanzania. The study adopted inductive-deductive thematic analysis guided by the Social Ecological Model (SEM) to elicit the views of AGYW aged 15-24. Nvivo software was utilised to organise data. This study has uplifted barriers and facilitators on PrEP uptake among AGYW in Tanzania. The barriers are categorized at individual, interpersonal, and institutional levels. The individual level barriers included pre-requisites for initiating PrEP, disbelief in the effectiveness of PrEP, interference of refill hours with working hours, financial constraints, and adherence to the pills. The interpersonal level barriers included misconceptions about PrEP pills, and labelling of PrEP users. The institutional level barriers included inadequate privacy, PrEP drug stockout, being turned away by health care facilities (HCF), long waiting times, and distance to the HCF. Facilitators included factors at individual level (experienced benefit of PrEP, adequate PrEP knowledge, having multiple partners, perceived risk due to the nature of the work, PrEP ensuring privacy), interpersonal level (support from social networks), and institutional level (Free availability of PrEP, receiving refill reminders). To overcome barriers to PrEP uptake among AGYW, it is crucial to develop multi-level interventions that consider personal, social, and structural factors hindering PrEP uptake. Implementing strategies like prioritizing off-site PrEP delivery and expanding community outreach for PrEP awareness can help dispel misconceptions and enhance uptake.

Comparative thermo- and piezostability study of photosynthetic core complexes containing bacteriochlorophyll a or b

The resilience of biological systems to fluctuating environmental conditions is a crucial evolutionary advantage. In this study, we examine the thermo- and piezo-stability of the LH1-RC pigment-protein complex, the simplest photosynthetic unit, in three species of phototropic purple bacteria, each containing only this core complex. Among these species, Blastochloris viridis and Blastochloris tepida utilize bacteriochlorophyll b as the main light-harvesting pigment, while Rhodospirillum rubrum relies on bacteriochlorophyll a. Through spectroscopic analyses, we observed limited reversibility in the effects of temperature and pressure, likely due to the malleability of pigment binding sites within the light-harvesting LH1 complex. In terms of thermal robustness, LH1 complexes in a detergent environment progressively dissociate into dimeric (B820) and monomeric (B777) subunits. However, in the native membrane, degradation primarily occurs directly into B777 without the intermediate formation of B820. Interestingly, while high-pressure compression of core complexes from Blastochloris viridis and Blastochloris tepida caused significant changes in compressibility around 1.3 kbar and the formation of B777 and B820 subunits upon decompression, no such compressibility changes or pressure-induced dissociation were observed in Rhodospirillum rubrum complexes, even at pressures as high as 11 kbar. This study reveals significant differences in the piezo- and thermal properties of phototrophs containing either BChl a or BChl b, underscoring the critical role of structural factors in understanding the temperature- and pressure-induced denaturation phenomena in photosynthetic complexes. Rhodospirillum rubrum, in particular, stands out as one of the most thermodynamically stable systems among phototrophic microorganisms, capable of withstanding temperatures up to 70 °C and pressures exceeding 11 kbar.

Controlling orbital ordering of intergrowth structures with flat [Ag(II)F2] layers to mimic oxocuprates(II).

Based on density functional theory calculations, we propose a new pathway toward compounds featuring flat [AgF2] layers which mimic [CuO2] layers in high-temperature oxocuprate superconductor precursors. Calculations predict the dynamic (phonon) and energetic stability of the new phases over diverse substrates. For some compounds with ferro orbital ordering, we find a gigantic intrasheet superexchange constant of up to -211 meV (DFT+U) and -256 meV (SCAN), calculated for hypothetical (CsMgF3)2KAgF3 intergrowth. Semiempirical calculations show that at optimum doping, the expected superconducting critical temperature should reach 200 K. The partial substitution of K+ with Ba2+ leads to noticeable electron doping of the [AgF2] sublattice, as revealed by progressive population of the upper-Hubbard band. On the other hand, modest 10-15% hole-doping through partial substitution of Mg2+ with Li+, primarily leads to the depopulation of p(z) orbitals of apical F atoms. We also find structures with an undesired antiferrodistortive structural ordering and discuss the structural factors that determine the transition from buckled to flat planes and from different types of orbital ordering using the Landau theory of phase transitions.

Empowering soft conductive elastomers with self-reinforcement and remarkable resilience via phase-locking ions.

Endowing soft and long-range stretchable elastomers with exceptional strength, resilience, and ion-conductivity is crucial for high-performance flexible sensors. However, achieving this entails significant challenges due to intrinsic yet mutually exclusive structural factors. In this work, a series of self-reinforcing ion-conductive elastomers (SRICEs) is thus designed to meet the advanced but challenging requirements. The SRICEs behave like a soft/hard dual-phase separated micro-structure, which is optimized through a straightforward preferential assembly strategy (PAS) to ensure that the subsequently introduced ions are locked in the soft phase. Meanwhile, the interaction between ions and soft segments is meticulously tailored to achieve self-reinforcement through strain-induced crystallization. Consequently, an outstanding ultimate strength of approximately ∼51.0 MPa and an exceptional instant resilient efficiency of ∼92.9% are attained. To the best knowledge of the authors, these are the record-high values achieved simultaneously in one ion-conductive elastomer. Furthermore, the resultant toughness of ∼202.4 MJ m-3 is significantly higher, while the modulus of ∼5.0 MPa is lower than that of most reported robust ion-conductive elastomers. This unique combination of properties makes it suitable for advanced flexible applications, e.g. grid-free position recognition sensors. This work provides guidance for designing soft yet robust ion-conductive elastomers and optimizing their mechanical properties.

The Impact of Inflation and GDP Growth Rate on Nepal’s Stock Market: An Analytical Study

This study explores the impact of macroeconomic variables, particularly the inflation rate and GDP growth rate, and their influence on Nepal’s stock market, as measured by the NEPSE Index by using regression analysis. The NEPSE Index as a measure of economic performance, reflects market dynamics and investor sentiment, which are influenced by inflation and GDP growth rates. The regression model explains 50.78% of the variation in the NEPSE index, as indicated by the R Square value. The analysis reveals a significant negative relationship between GDP growth rate and the NEPSE index, with a coefficient of -154.43 and a p-value of 0.0258. Conversely, the inflation rate exhibits a negative but statistically insignificant impact, with a coefficient of -149.83 and a p-value of 0.0630. These findings suggest that while the GDP growth rate significantly affects stock market performance, inflation's influence may be less pronounced or mediated by other factors. The results also highlight the presence of unexplained variance, indicating the role of additional factors not captured in the model. Based on the findings, the study recommends incorporating more macroeconomic variables, increasing sample size, and conducting sectoral analyses to enhance the robustness of future research. Policymakers and investors are advised to consider broader economic and structural factors when making decisions to foster a resilient and efficient stock market in Nepal. Overall, this analysis provides essential knowledge for decision-making in investment strategies and economic policy making.

EMPLOYMENT OF TRAUMA INFORMED PRINCIPLES IN HEALTH SERVICES RESEARCH WITH OLDER LATINX COMMUNITIES

Abstract Engaging older Latinx adults in research is critical to advancing understanding and addressing common challenges in aging. However, older Latinx communities are disproportionately exposed to social, health, and historical challenges that may include potentially traumatic events (e.g. discrimination, violence, grief, etc.) and hinder study participation. There is growing recognition for adoption of Trauma Informed (TI) principles for use in non-trauma specific research. There are limited examples of the implementation of TI principles in gerontological research with Latinx communities. We encourage the adoption of TI principles to facilitate engagement research participation. TI principles may include: 1) building relationships with trusted community agencies and providers; 2) conducting open forums where researchers acknowledge community mistrust and fear, present personal and institutional motivations for the project and discuss benefits for community members; 3)incorporation of study questions that explore Latinx diversity and facilitate discussions about similarities and differences across subgroups; and 4) planning to address structural factors (poverty, violence, migratory status) that influence health and research participation. Second, we draw examples of TI guided practices we employed in two recent studies including the: 1) Dolores and Soledad: a narrative study of older English and Spanish speaking Latinx adults living with chronic pain or loneliness in New York and Los Angeles, and 2) Programa Dolores: An adaptation of the evidence based psychosocial intervention (PATH-Pain) for use with older Latinx adults living with chronic pain in New York. Finally, based on these experiences, we provide recommendations for incorporating TI into future research with older Latinx communities.

Design of attitude-adjustable chassis and dynamic stress analysis of key components for crawler combine harvester

To address the issues of leveling difficulties and poor stability of crawler combine harvesters in hilly and mountainous regions, this research analyzed the mechanical causes of overturning instability in crawler combine harvesters and designed an omnidirectional attitude adjustment chassis based on a five-bar mechanism. A 3D model was developed in SolidWorks, and coupled rigid-flexible simulations were performed using RecurDyn. Results showed that the chassis could achieve an overall lift, lateral adjustments and longitudinal adjustments (0-100 mm, -5.18° to 5.55° and -4.06° to 5.15° respectively), with maximum dynamic stress occurring on the left front and left rear rotational arms. A dynamic stress testing system was established to conduct response surface experiments. Field test results revealed that the primary factors affecting the maximum stress of the left front rotational arm were the grain tank loading mass, lateral adjustment angle, and longitudinal adjustment angle. For the left rear rotational arm, the order was the longitudinal adjustment angle, lateral adjustment angle, and grain tank loading mass. Validation tests showed that at a lateral adjustment angle of 3.61°, a longitudinal adjustment angle of 3.20°, and a grain tank load of 350 kg, the average maximum stresses were 483.19 MPa for the left front rotational arm and 188.95 MPa for the left rear rotational arm, with corresponding structural safety factors of 1.61 and 4.31, meeting strength requirements. This work provides methods for optimizing the design and reliability testing of agricultural machinery chassis with attitude adjustment functions in hilly terrains.

Effect of thermal-kinetic conditions of austenite transformation on the structural-phase state of low-carbon steel sheets

The structure and mechanical properties of rolled sheets with a thickness of 40 mm made of lowcarbon low-alloyed steel after thermomechanical treatment of different modes are investigated. The structural factors that affect obtaining high mechanical properties are established. It is shown that a complex treatment including quenching from the rolling temperature and high-temperature tempering with a subsequent additional cycle of quenching and tempering leads to formation of rolled sheet uniform over the cross section with a fragmented bainite structure with disperse niobium carbides and carbides of cementite type. Such structure provides a yield strength of no less than 630 MPa in combination with high values of the impact energy at negative temperatures and a level of plasticity of δ ≈ 20%.

Carbapenem-induced β-lactamase-isoform expression trends in Acinetobacter baumannii

Carbapenem-resistant Acinetobacter baumannii (CRAb) is an urgent bacterial threat to public health, with only a few treatment options and a > 50% fatality rate. Although several resistance mechanisms are understood, it is still impossible to predict which mutations are most likely to occur. Here, we demonstrate that independent samples of Ab, exposed to different carbapenems with escalating concentrations, show concentration- and carbapenem-dependent trends in β-lactamase-isoform expression. This result, based on the isoforms identified through label-free-quantification LC-MS/MS measurements of cell-free, gel-separated β-lactamases, suggests that the appearance of antibiotic resistance may be have some predictability based on structural factors. Additionally, the identified minor isoforms also have high sequence similarity to major expressed isoforms, indicating a potential path over which resistance occurred in independent samples. Antibiotic resistance maybe therefore somewhat predictable based on specific structural properties and further investigation may lead to new strategies for mitigating antibiotic resistance.

Analysis of Pre-Exposure Prophylaxis (PrEP) Program in Preventing HIV/AIDS Based on the Health Policy Triangle

Background: Pre-exposure prophylaxis (PrEP) is an action to prevent HIV transmission using antiretroviral (ARV) drugs. During 2022, the PrEP program was implemented in 21 districts/cities as a trial limited to MSM and sex worker populations. This study aims to analyze the PrEP program in preventing HIV/AIDS using a health policy triangle approach that assesses the aspects of actor, context, content, and process. Methods: The study was performed using qualitative methods from electronic document searches. Results: The results of the analysis show that the actors in the PrEP program as HIV/AIDS prevention are the President, Legislative, Ministry of Health, Ministry of Education, Ministry of Internal Affairs, health office, community health centers, hospitals, non-governmental organization (NGOs)/HIV and AIDS care groups, HIV/AIDS key populations, correctional institutions, the Indonesian Ulema Council (MUI), and the Food and Drug Monitoring Agency (BPOM). The context of PrEP implementation in the form of situational factors is high HIV transmission within at-risk populations, structural factors are legal bases, cultural factors are patriarchal culture and MSM and sex workers which are still taboo, as well as international factors in the form of WHO policy. The policy process consists of problem identification, policy analysis, policy formulation, implementation, and program monitoring and evaluation. Conclusion: PrEP content regarding the aim of PrEP, targets, types of drugs used, how to get PrEP services, how to use the drugs, and how to monitor has been explained in the Technical Guidelines for PrEP Services made by WHO and adapted by the Indonesian Ministry of Health.

Community Mental Health in Türkiye and Europe: Data and Influencing Factors

Human is an entity that can be completed with the combination of biological, psychological and social factors. The concept of health is defined as being in a state of complete mental, social and physical well-being. The term "community mental health" defines mental health care in relation to the individual and the environment in which the individual interacts. If the factors affecting mental health are known and intervened, it is predicted that community mental health will make positive progress. The aim of this study is to examine and compare the factors affecting community mental health by analysing community mental health data in Türkiye and Europe. The World Health Organisation (WHO) examines these factors in three groups as individual, family and community and structural factors. In order to analyse the degree to which these factors affect mental health, data from Türkiye and Europe were analysed by examining the reports of the World Health Organization, European Commission, European Parliament, OECD, Institute for Health Metrics and Evaluation and Turkish Statistical Institute. It is seen that community mental health is affected by the community's understanding of health and illness, access to mental health services, gender, age, education, the concept of loneliness, unemployment, diseases affecting the world such as pandemics and the economy. As a result of mental health reports and analyses, not much difference was observed between the factors affecting public mental health in Türkiye and Europe. In general, it is seen that there are country-based evaluations in mental health data. Differences between countries are generally interpreted with the development levels of countries. However, cultural differences between countries are not emphasised. For an accurate comparison, multicentre studies should be conducted involving researchers from different countries who know the culture of the society.