Investigating the effects of exposure to office noise types on cognitive function and noise annoyance based on personality characteristics: An experimental study

Abstract

No comparative research has investigated the effect of tonal noise and background speech on cognitive functions. Therefore, this study aims to determine the impacts of tonal noise and background speech noise on cognitive function and noise annoyance based on personality traits. Twenty-five male students of Hamadan University of Medical Sciences with normal and healthy hearing participated in 4 simulated 50-min scenarios in an indoor environment. The cognitive functions including reaction time, sustained attention, and working memory were measured by PVT, CPT, and n-Back tests respectively. At the end of each test session, the noise annoyance was evaluated by the ISO-15666 questionnaire. According to the results of the repeated measures ANOVA test, a significant difference in mean reaction time in the n-Back and PVT tests was observed (p < .05). The significant difference in mean correct response in the n-Back test was not observed. The highest rate of perceived noise annoyance has been observed in exposure to 65 dB tonal noise with a mean and standard deviation of 41.52 ± 7.56. A positive correlation was observed between the reaction time of PVT and CPT tests and the neuroticism dimension, and its values were reported as 0.410 and 0.423, respectively. Tonal noise and background speech can reduce cognitive performance and acoustic comfort considering noise sensitivity and age of participants. These have special rules for causes of employees’ distraction in office room.

Keywords

Tonal noise background speech personality traits noise annoyance

Introduction

The presence of noise in indoor environments (including office environments) and its effects on cognitive function have been studied over the last decades.¹ Noise as an environmental stress factor can impair cognitive performance and mental fatigue.^2–4 It is estimated that the costs of inadequate employee productivity (excluding illness) in indoor environments due to poor indoor air quality in terms of noise and other environmental factors are around US$20-160 billion dollars.⁵ This lack of productivity and concentration reduction is the consequence of absenteeism in the UK, leads to loss £15 million per year.⁶ The noise of heating, ventilation, and air conditioning (HVAC) systems and conversations between people can be distractive and annoyable for mental performance.^7,8 The noise levels below the occupational exposure limit (OEL) can also reduce concentration in the short term and lead to job stress.⁹ Irrelevant speech, keyboard, printer, phone ringing, etc… in the office environment significantly affect the accuracy and efficiency of concentration and attention. The effects of noise levels less than 70 dB that can also lead to noise annoyance have been proven.¹⁰ The higher perceived noise annoyance may cause worse cognitive performance and well-being.¹¹

Several studies have demonstrated that mechanical equipment, such as HVAC systems, can generate low-frequency tonal noise that can interfere with cognitive functions.^7,12 Tonal noise has the highest noise power density in a narrow frequency band compared with adjacent frequency bands.¹³ Some studies have examined the effects of tonal noise on cognitive performance. The research conducted by Sadeghian et al. has shown that tonal noise could increase the number of errors along with the complexity of cognitive tasks.¹⁴ Also, the Lee et al. study found that cognitive performance could be reduced due to exposure to high-level tonal noise. Even exposure to low-frequency tonal noise can be annoying for individuals.¹⁵ Renz et al. research aimed to investigate the noises with different tonal ratings on cognitive performance using the rating level method in German offices, proving the noise annoyance with tone components.¹⁶ Also, another Sadeghian et al. study revealed that higher tone levels in low frequencies concerning psychoacoustic parameters can increase perceived noise annoyance.¹⁷

The impact of irrelevant speech (such as conversations between 2 or more people) as a source of mental distraction has been investigated in many studies.¹⁸ A cross-sectional study conducted by Blasio et al. showed that irrelevant speech increased disturbance and reduced work performance in open-plan offices.¹⁹ Furthermore, the Varjo et al. study examined the effect of irrelevant speech, temperature, and ventilation rate on cognitive performance and found that mental workload and cognitive disorders increased.²⁰ An experimental study investigating the effects of office noise on cognitive performance showed that participants performed lower scores in exposure to office noise than in other noise conditions (no noise, white noise, and spring water).²¹ Kang et al. study aimed to investigate the effect of Speech Transmission Index (STI) on cognitive performance in the simulated open-plan office and revealed that background speech has a strong negative impact on the participant’s satisfaction with their workplace and perceived work performance; this negative impact is getting more powerful according to the STI increase.²²

Studies have established that individual differences can influence mental performance in exposure to background noise.²³ Specific personal characteristics such as personality traits, the hand of superiority, and some neuroticism factors can affect human cognitive functions in exposure to environmental noise.²⁴ The study by Rossi et al. has shown that exposure to low-frequency noise increased stress levels in introverts, as opposed to extroverts.²⁵ Furthermore, Beheshti et al. study observed that the perceived noise annoyance level was similar for extroverts and introverts below 1000 Hz; however, above 1000 Hz, introverts experienced higher annoyance levels than extroverts.²⁶ Another study conducted by Abbasi et al. showed that the cognitive functions can affected by neuroticism and introversion.²⁷

The presence of tonal noise sources (air conditioning systems) and irrelevant background speech in some indoor environments (closed offices and open-plan offices) can cause destructive effects on cognitive function. These noise sources can also cause people to lose acoustic comfort. It should be noted that the influence of individual differences and personality traits may impact cognitive function and perceived noise annoyance. Although some studies have been conducted to investigate the effect of tonal noise and background speech on cognitive performance, the influence of personality traits and their various dimensions is still ignored in these studies. Also, some individual differences such as age and sensitivity of people to noise could be considered. Furthermore, no comparative study has been conducted to show the differences between the effects of tonal noise and background speech on cognitive functions such as working memory, attention, and concentration. Therefore, this study aims to determine the effects of tonal noise and background speech on cognitive performance and noise annoyance levels according to personality traits.

Materials and methods

Participants

Twenty-five healthy male students of Hamadan University of Medical Sciences with normal and healthy hearing participated in this study. The mean age of participants in the experiment was 24.92 ± 1.99. To increase the accuracy of the study, the participants were screened using a self-reported questionnaire in terms of their state of mental and physical health. Before initiation of the tests, a written informed consent form was signed by the subjects participating in this research. The participants were notified and asked to have adequate rest and sleep, follow their usual diet, and not take medicine or caffeine before the day of experimentation.

All participants were paid to facilitate motivation. Individuals who had little exposure to tonal noise and background speech as much as possible were chosen for the experiment. Also, the eye health of the participants was checked to confirm their competence in performing cognitive tests. They were also told to come to the test location between 8 a.m. and 12 p.m. This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (ethic code: IR.UMSHA.REC.1402.595).

Experimental design

The study was performed in the Physiology of Work Laboratory in the Faculty of Health at Hamadan University of Medical Sciences. The internal surfaces are covered with plaster on the walls and ceiling. The ambient lighting intensity was measured using a meter manufactured by Hagner Company, which is about 315 lx.

The study was designed to measure the effect of different noise levels on the cognitive function of participants in 4 steps of exposure:

1- Noise level 55 dB broadband (noise content includes printers, phone ringing, typing, people’s conversation, etc.)

2- Noise level 55 dB with tonal component (composition of broadband sound with tonal component at 250 Hz)

3- Noise level 65 dB tonal

4- 55 dB Background Speech (Podcast play with speech skill subject)

Figure 1 shows the 55 dB broadband and tonal noise frequency analysis. To generate noise with the component tone, the frequency of 250 Hz tone was dropped on broadband sound, and the difference in sound pressure level at 250 Hz compared to the adjacent frequency bands is estimated to be about 8.3 dB. Following ISO 1996-2, the noise is considered to be tonal. Figure 2 shows the tonal sound frequency analysis produced with a sound level of 55 dB.

Figure 1.

55 dB broadband and tonal noise frequency analysis.

Figure 2.

Schematic experiment process.

All noise levels used in the experiment were adjusted using Goldwave editing software version 6.77. The noise was played by a spherical, all-directional speaker of the model OS003-BSWA Technology Co from behind the participants with a height of 1.5 m and a 1-m distance. After participants had been exposed to noise for a certain time, cognitive performance was assessed using cognitive task tests embedded as a file installed into the laboratory PC.

Apparatus

Weinstein Noise Sensitivity Scale (WNSS)

Sensitivity to noise was assessed using the Weinstein Noise Sensitivity Scale. The questionnaire consists of 21 6-choice questions, graded by the Likert scale ranging from totally agreeable (zero) to opposite (5).²⁸

Noise annoyance questionnaire

The noise annoyance rate was evaluated using the ISO/TS 15666 scale, from zero to one hundred points.²⁹

10-Item personality questionnaire (NEO)

The questionnaire measures five personality dimensions: neuroticism, extroversion, openness, conscientiousness, and agreeability. The validity of the questionnaire was approved by Rammstedt et al.³⁰

In this study, the extroversion and neuroticism dimensions of the questionnaire were used to measure personality traits.

Working memory assessment

The n-Back test was performed to assess working memory performance. In this test, a series of 120 actuators (numbers one to 9) appear one after another with a time interval of 1500 milliseconds in the center of the computer screen. Subjects are to compare the last number that appeared with the two preceding it. If the compared values are equal, the “?” button on the keyboard must be pressed. Otherwise, one must press the “z” button.

Simple reaction time assessment

The Psychomotor Vigilance test (PVT) was performed to evaluate reaction time. This test contains red circles displayed on the screen randomly with distributed intervals. Participants were trained to press the Space button on the keyboard as soon as possible with their dominant hand when they observe the circles. The actuators are displayed for 300 milliseconds and randomly displayed at intervals every 2 to 10 seconds. The software records a participant’s reaction time in milliseconds.

Continuous performance assessment

The Continuous performance test (CPT) was performed to evaluate sustained attention. In this test, 150 visual stimuli were presented. These stimuli appear on the computer screen, and the participant must press the Space button if the target stimulus is observed as soon as possible. In this study, the target stimulus is number 4. The display time of each stimulus is 200 milliseconds, and the time interval between two stimuli is one second.

Procedures

The present study was performed within-subjects design and the participants were considered as their own controls. The cognitive tests were trained to participants in order to remove learning effects and lasts between 10 and 15 minutes before starting the first session. All participants were informed about test conditions and obtained the required consent. Also, they were asked to complete the WNSS Questionnaire and the 10-item personality questionnaire before entry into the test sessions. Before each session, participants were also asked to stay in the laboratory for 10 minutes to comply with the environment. Then, participants spent 10 minutes searching and reading scientific content, when they were exposed to noise at the same time. The noise levels were measured using SVAN 971 sound level meter at the participants’ hearing range. After 10 minutes of activity, participants were asked to perform cognitive tests. The order of cognitive tests in each session of noise exposure has changed so that participants do not notice the process of each test and the learning effect will be disappeared. Also, after each cognitive test, participants are given enough rest time to avoid cumulative fatigue during other tests. At the end of each session, participants were also asked to score in terms of the amount of perceived noise annoyance. Figure 2 shows the process of the experiment.

Data analysis

The statistical analysis was carried out using SPSS software version 24. The normality of the data was tested using the Kolmogorov-Smirnov test. The repeated measure ANOVA was applied to determine significant differences between the exposure sessions and the p-values were reported based on Mauchly’s test. The effect size (ES) was also reported to show the effect of noise levels as an independent variable on cognitive functions, such as average response time and correct responses. The relationships between noise annoyance and two personality trait dimensions (Extraversion and Neuroticism) were reported using bar charts. Also, the correlation between personality specifics with cognitive parameters was determined. The linear mixed model was used to analyze the effects of noise levels on cognitive functions according to personality and individual roles. The significance level for all the tests was set to be 0.05 for all statistical analysis.

Results

Table 1 shows the average response time to stimuli of cognitive tests under conditions of exposure to different noises in the laboratory. The results of repeated measure ANOVA for the response time of the CPT test have not been statistically significant (p > .05).

Table 1.

Average response time to stimulants of cognitive tests in different scenarios.

Parameter	Scenario	Average response tine	p-value	Effect size (Cohen’s d)
CPT	55 dB broadband noise	400.2 ± 22.76	0.137	-
	55 dB tonal noise	403 ± 20.81		0.232
	65 dB tonal noise	405.68 ± 23.86		0.429
	55 dB background speech	405.92 ± 26.78		0.412
n-Back	55 dB broadband noise	613.04 ± 141.56	<0.001	-
	55 dB tonal noise	581.6 ± 131.78		0.281
	65 dB tonal noise	489.16 ± 119.87		0.963
	55 dB background speech	493.12 ± 134.96		0.898
PVT	55 dB broadband noise	312.92 ± 16.95	0.013	-
	55 dB tonal noise	307.72 ± 17.4		0.582
	65 dB tonal noise	314.16 ± 24.15		0.086
	55 dB background speech	316.88 ± 22.38		0.284

Table 2 shows the average correct response to the stimuli of cognitive tests in different scenarios of noise exposure. The repeated measure ANOVA results for the correct response percentage of the n-Back test have not been statistically significant (p > .05).

Table 2.

Average correct response to stimuli of cognitive tests in different scenarios.

Parameter	Scenario	Average correct response	p-value	Effect size (Cohen’s d)
CPT	55 dB broadband noise	149.68 ± 0.47	<0.001	-
	55 dB tonal noise	148.96 ± 0.79		1.062
	65 dB tonal noise	148.48 ± 1.19		1.115
	55 dB background speech	148.56 ± 1.55		0.844
n-Back	55 dB broadband noise	86.13 ± 4.87	0.078	-
	55 dB tonal noise	84.2 ± 4.57		0.401
	65 dB tonal noise	84.9 ± 3.93		0.325
	55 dB background speech	84.07 ± 4.27		0.463
PVT	55 dB broadband noise	44.76 ± 0.43	<0.001	-
	55 dB tonal noise	44.12 ± 0.92		0.846
	65 dB tonal noise	44.2 ± 0.7		0.729
	55 dB background speech	43.92 ± 0.9		0.936

Figure 3 shows the average noise annoyance in different scenarios of noise exposure. According to the chart, the highest level of perceived noise annoyance was observed in exposure to the 65 dB tonal noise, and the least perceived noise annoyance was observed in exposure to the 55 dB broadband noise (reference scenario)

Figure 3.

Perceived mean noise annoyance in different scenarios of noise exposure.

Figure 4 shows the response times to stimuli of cognitive tests. The mean reaction time measured in the n-Back test reduced due to the different levels of tonal noise loudness. In contrast, an increasing trend of reaction times was observed in both the PVT and CPT tests.

Figure 4.

The response time of cognitive tests under different noise conditions with regard to neuroticism.

Figure 5 shows the correct responses to stimuli in cognitive tests under different noise exposures. The results showed that as the extraversion score grew, the participants’ correct responses to stimuli in cognitive tests increased. This trend is better observed in the n-Back test.

Figure 5.

The correct response in cognitive tests under different noise conditions with regard to extraversion.

Table 3 presents the findings from the analysis of linear mixed models, examining the impact of tonal noise and background speech on the correct response rate in cognitive performance tests. According to the results, the effect of tonal noise and background speech on the percentage of correct responses in cognitive tests is statistically significant (p < .05), except for exposure to 65 dB tonal noise during the n-Back test. Based on the reported average margin of confidence and standard error, a significant association was recognized between extroversion and the average correct responses in the PVT and n-Back tests (p < .05).

Table 3.

Effect of tonal noise and background speech on the correct response in cognitive performance tests using a mixed linear model.

Acoustic, individual and personality variables	Correct response rate in cognitive tests
	CPT			PVT			n-Back
	Estimate	SE	p-value	Estimate	SE	p-value	Estimate	SE	p-value
Intercept	152.66	1.92	<0.001	44.31	1.36	<0.001	108.99	11.58	<0.001
55 dB broadband noise	Ref	-	-	Ref	-	-	Ref	-	-
55 dB tonal noise	−0.72	0.24	0.004	−0.64	0.17	0.001	−1.93	0.79	0.018
65 dB tonal noise	−1.2	0.24	<0.001	−0.64	0.17	0.003	−1.23	0.79	0.12
55 dB background speech	−1.12	0.24	<0.001	−0.84	0.17	<0.001	−2.06	0.79	0.011
Age	−0.124	0.079	0.13	−0.068	0.048	0.174	−0.68	0.41	0.106
Noise sensitivity	−0.012	0.015	0.413	0.01	0.0092	0.255	0.044	0.079	0.577
Extraversion	0.039	0.048	0.427	0.12	0.054	0.034	1.01	0.47	0.042
Neuroticism	−0.028	0.089	0.749	−0.081	0.052	0.128	−0.45	0.44	0.326

The bold values show significant differences.

Table 4 presents the findings from the analysis of linear mixed models, examining the impact of tonal noise and background speech on the average response time in cognitive performance tests. According to the results, the effects of tonal noise and background speech on average response time in the PVT test were not statistically significant (p > .05). Also, the effect of neuroticism on average response time in CPT and PVT tests were statistically significant (p < .05). In other words, with the rising of neuroticism points, the response time to the stimuli of these tests will be increased.

Table 4.

Effect of tonal noise and background speech on the average response time in cognitive performance tests using a mixed linear model.

Acoustic, individual and personality variables	Average response time in cognitive tests
	CPT			PVT			n-Back
	Estimate	SE	p-value	Estimate	SE	p-value	Estimate	SE	p-value
Intercept	458.27	48.83	0.001	310.34	37.95	0.001	903.25	249.6	0.001
55 dB broadband noise	Ref	-	-	Ref	-	-	Ref	-	-
55 dB tonal noise	2.8	2.69	0.302	−5.2	2.72	0.06	−30.56	22.76	0.184
65 dB tonal noise	5.48	2.69	0.046	1.24	2.72	0.65	−121.2	22.76	<0.001
55 dB background speech	5.72	2.69	0.037	3.96	2.72	0.15	−117.24	22.76	<0.001
Age	−3.71	2.45	0.144	−2.7	1.91	0.17	−22.96	12.56	0.079
Noise sensitivity	0.24	0.47	0.621	0.68	0.37	0.079	5.50	2.55	0.041
Extraversion	−0.62	2.72	0.82	1.46	2.11	0.495	4.82	13.91	0.732
Neuroticism	6.56	2.66	0.021	6.59	2.07	0.004	−7.36	13.63	0.594

The bold values show significant differences.

Table 5 shows the relation between individual and personality specifics with cognitive function variables. The correlation between noise sensitivity, age, and extraversion was significant at 0.01 confidence level (p < .05). Also, the extroverted participants respond more correctly to the stimuli of an n-Back test than those who report lower extraversion scores (p < .05). However, when the age of the participants grew, the reaction time in CPT and n-Back tests declined, but a significant correlation was not observed (p > .05).

Table 5.

The correlation between the personality traits dimensions, individual differences, and cognitive functions tests.

Parameter	Noise sensitivity	Age	Extraversion	Neuroticism
Noise sensitivity	-	-	-	-
Age	0.41^**	-	-	0.077
Extraversion	−0.307^**	-	-	0.004
Neuroticism	0.111	-	-	-
CPT response time	0.084	−0.157	−0.181	0.423^**
PVT response time	0.299^**	0.03	−0.06	0.410^**
n-Back response time	0.201^*	−0.212	−0.166	−0.053
CPT correct response	−0.135	−0.264	0.067	0.018
PVT correct response	−0.039	−0.033	0.171	−0.138
n-Back correct response	−0.125	−0.102	0.273*	−0.131

*Correlation is significant at 0.05 confidence level.

**Correlation is significant at 0.01 confidence level.

Discussion

The current study intended to investigate the role of some personality trait dimensions on noise annoyance perceptions and the effects of tonal noise and background speech on cognitive performance.

The findings showed that cognitive performance can be affected by exposure to tonal noise and background speech regarding their characteristics and personality traits. Several studies have investigated the impact of tonal noise at specific frequencies and sound pressure levels on cognitive performance. The research conducted by Sadeghian et al. demonstrated a significant decline in mental function during the n-Back test due to the task’s difficulty and the intensity of tonality at particular frequencies.¹⁴ The Radosz study showed that the response time increased in exposure to 55 dB tonal noise consisting of three tonalities (125, 6,000, and 8000 Hz) compared to the response time under background noise conditions. This finding consists of the results of the present study.³¹ The findings of the Love et al. study aimed to investigate the impact of noise from HVAC systems with tonal components on mental performance and its related workload, found that the working memory performance in the n-Back test experienced a significant decline with rising sensihvacactivity to noise.⁷ The Ryherd et al. study indicated the relationship between perceived noise annoyance and distraction in exposure to low-frequency tonal noise.³²

The results of the present study showed that background speech can impair cognitive performance, reduce average reaction time (except in the n-Back test), and decline correct responses during cognitive tests. Specifically, the research by Kostallari et al. aimed to examine the impact of irrelevant speech on cognitive functioning in open-plan offices and found that a higher STI negatively affects cognitive abilities, such as short-term memory.³³ The Liu et al. study showed that the results of the cognitive tests (such as reading a piece) were not statistically significant in exposure to irrelevant speech.³⁴ The Murphy et al. study found that background speech can affect mental activities such as reading comprehension.³⁵ The Radun et al. study showed that cognitive performance had been decreased in the n-Back test and Serial recall in the exposure of 50 dB irrelevant speech.³⁶

The present study showed that the tonal noise level and background speech could raise the average noise annoyance scores significantly. Similarly, the investigation conducted by Qing Di et al., aimed to assess perceived noise annoyance by workers exposed to transformer noise containing tonal components, revealed that an increase in tonal noise pressure levels correspondingly heightened perceived noise annoyance.³⁷ The Lee et al. study showed a significant correlation between perceived noise annoyance and tonal noise, which is consistent with the results of the present study.¹⁵ Also, this study revealed a positive significant correlation between noise sensitivity and extraversion score, which may influence reaction time. The Song et al. study approves this subject. In other words, noise sensitivity had a significant correlation with extraversion and led to an influence on the correct response rate.³⁸ Golmohammadi et al. study evaluated the noise annoyance experienced by employees exposed to different noise sources in a bank. The findings revealed that irrelevant speech was more annoyable than other noises, such as ventilation system noise, phone alarms, or traffic noise outside the bank.³⁹

This study investigated the effect of personality traits on cognitive performance under noise exposure. The results showed that the neuroticism dimension increased the reaction time to stimuli in both the CPT and PVT tests. On the other hand, the extroversion dimension increased the accuracy of responses in the n-Back and PVT tests. Research by Wöstmann et al. sought to establish a subtle connection between personality characteristics with subjective and objective aspects of noise perception. Their findings revealed that the ability to understand speech is linked to personality factors like neuroticism and extraversion.⁴⁰ A study conducted by Paranjpe et al. also found that the lowest cognitive performance was in the exposure to simulation office noise, such as irrelevant speech, and the highest rate was during silence. The role of anxiety and extroversion has been significant.⁴¹ The Moradi et al. study showed a significant relation between extraversion and mean correct response in exposure to 80 dB noise level.⁴²

The Golmohammadi et al. study revealed a significant relationship between personality traits, such as extroversion and neuroticism, and the psychological effects experienced when exposed to occupational noise.⁴³ The study conducted by Derakhshan et al. indicated that low-frequency noise exposure had a more substantial impact on the cognitive performance of introverts compared to extroverts.²⁴

The present study had some limitations. The sex and age range of participants were limiting factors and were not representative the whole of office employee population. In addition, the tonality detection method is simple, and specialized methods should be used to identify the tone components. The limited number of sessions was one of the main limitation of the study. In studies of the effect of tonal noise on cognitive performance, it is recommended to investigate the role of psychoacoustic parameters taking into account personality type. The effects of tonal noise in different frequency tones with different tonalities can be studied in future studies. In the present experimental study, a podcast in which one person talked continuously was used to simulate background speech. However, in a real environment, a conversation between two or more people is heard. Also, the role of the STI index was not considered due to the limitation of the number of sessions. investigating the effect of STI on how background speech affects cognitive performance could provide valuable insights for future research.

Conclusion

This study offers evidence regarding the impact of tonal noise and background speech on cognitive performance. The findings of this research are as follows:

1- Tonal noise can cause negative effects on sustained attention and reaction rate by increasing the reaction time and declining the average correct response when accomplishing the cognitive tasks.

2- Background speech can impair working memory by decreasing the reaction time. Moreover, it can cause negative effects on sustained attention and reaction rate tasks.

3- Tonal noise and background speech can cause noise annoyance in proportion to exposure to broadband noise, regardless of their characteristics and personality traits.

4- Some personality trait dimensions, such as extraversion and neuroticism, may affect cognitive functions as intermediate variables. An extraversion dimension can cause working memory and reaction rate tasks. Instead, the neuroticism dimension can increase the average reaction time in Psychomotor vigilance tasks.

5- The reaction time was affected more than sustained attention and working memory during exposure to tonal noise and background speech according to the reported effect sizes.

Footnotes

Acknowledgments

We would like to appreciate the students of Hamadan University of Medical Sciences for their participation in this project.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was financially supported by Research Deputy of Hamadan University of Medical Sciences (Grant number: 140209077918).

Ethical statement

ORCID iD

Mohsen Aliabadi

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