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Article History

Accepted: 5 October 2025

First Online: 24 October 2025

Declarations

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: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study design was approved by the Ethics Committee of Kermanshah University of Medical Sciences (IR.KUMS.REC.1401.150). Additionally, at the beginning of the study, the researchers introduced themselves to the research units, explained the methodology and purpose of the study, and assured that all information would remain confidential and that participants could withdraw at any time. To gain the trust of the research units, names, surnames, and addresses were not asked or recorded. Finally, after providing sufficient information about the study, written informed consent was obtained from all participants.

: The authors declare that they have no conflict of interest and All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.