REVIEW ARTICLE | May 19, 2025
Maternal and Fetal Risk Factors Associated with Stillbirth: A Scoping Review
Fawzia Salman Ahmed Alfaify, Ahlam Al-Zahrani, Hanan Badr
Page no 196-210 |
https://doi.org/10.36348/sjls.2025.v10i05.006
Stillbirth is most commonly caused by problems that arise during pregnancy. Some of the major causes of stillbirth include infections within the uterus, lack of oxygen during birth, high blood pressure, eclampsia, premature labor, and inadequate prenatal care. The study aimed to examine whether Maternal and Fetal Risk Factors are associated with stillbirth. A six-stage scoping review framework was utilized by the Saudi Digital Library SDL, which includes a variety of databases such as ScienceDirect, EBSCO, PUBMED, BIOMED CENTRAL, CINAHL, and Google Scholar, and was searched for studies examining the association of Maternal Risk Factors and Fetal Risk Factors associated with stillbirth. The studies addressed maternal and fetal risk factors for stillbirth and conditions among pregnant women with dead fetuses. There was a spectrum of risks; Obesity, maternal medical history, anemia, hypertension, and diabetes mellitus, placentas, and pathology of the placenta were the most common risks of stillbirth. Further research attempts to conceptualize stillbirth risk factors and explore them. perspective is needed to help inform stillbirth reduction strategies and efforts to prevent and reduce the scale of stillbirth. 19 studies met the inclusion criteria for this review, Pregnancy complications are the main cause of stillbirth. Maternal health conditions, birth asphyxia, eclampsia, preterm labor, and insufficient prenatal care are significant contributors to stillbirth.
ORIGINAL RESEARCH ARTICLE | May 19, 2025
Impact of IFRS on Information Asymmetry: An Applied Study on Companies Listed in the Saudi Stock Market
Atheer Khaled Alhamwan, Ahmed Alsalman
Page no 182-193 |
https://doi.org/10.36348/sjef.2025.v09i05.004
The rise of multinational corporations and the globalization of global capital markets have led to a growing need for a unified set of accounting standards that can be used internationally. In line with these global trends, implementing consistent and clear financial reporting has become more important than ever in the Kingdom of Saudi Arabia. This study aims to analyze the impact of adopting International Financial Reporting Standards (IFRS) on information asymmetry in the Kingdom of Saudi Arabia. To evaluate this impact, the study employs quantitative proxies—namely, bid-ask spreads and cost of capital—as measures of information asymmetry, assessing how financial reporting has changed following IFRS implementation. Based on a sample of 30 companies according to specific criteria, the analysis focuses on two distinct time periods: the pre-IFRS period (2014-2016) and the post-IFRS period (2018-2020). By covering all sectors, this study provides a comprehensive assessment of the impacts of IFRS on a broad economic scale. The findings reveal a statistically significant reduction in information asymmetry following the adoption of IFRS. Specifically, the cost of capital decreased by 1.2%, while bid-ask spreads narrowed by approximately 0.1%. These results indicate improved financial reporting transparency and increased market efficiency following the adoption of the standards. The impact was more pronounced and direct in market metrics, highlighting investors' response to higher reporting quality. The results remain robust after controlling for firm-specific financial variables and applying the necessary model diagnostics.
ORIGINAL RESEARCH ARTICLE | May 19, 2025
Assessing the Perceptions, Usage Patterns, and Health Outcomes of Vaping as a Harm Reduction Strategy among Current and Former Smokers in the United Arab Emirates: A Cross-Sectional Study
Areej Alkhalil AlHurh, Nashwa Essam Dyab
Page no 247-255 |
https://doi.org/10.36348/sjm.2025.v10i05.005
Background: Smoking remains a significant public health concern in the UAE, with efforts to reduce its prevalence facing various challenges. Vaping has emerged as a potential harm reduction strategy, yet little is known about its perceptions, usage patterns, and health outcomes among smokers and ex-smokers in the country. This study aims to assess the perceptions of vaping, its usage patterns, and self-reported health outcomes among current and former smokers in the UAE. Methods: A cross-sectional survey was conducted among adults and ex-smokers across the UAE. A structured questionnaire will collect data on demographics, smoking and vaping history, perceived harm reduction, usage patterns, and self-reported health effects. Descriptive statistics, chi-square tests, and logistic regression models were analyzed for the data. Results: In the research, 290 participants identified as male (93.1%), with their mean age at 34.7 years (±9.2). Most individuals who started vaping were between 19 and 25 years of age (52.8%). Current smokers evaluated vaping more favorably than former smokers on all key dimensions, although harm reduction, harm reduction support, and social approval ratings proved particularly significant (p < 0.01). Former smokers provided evidence showing they consider vaping to be a substance with addictive properties (p < 0.001) aimed at youth (p < 0.01) and dangerous to use occasionally (p < 0.01). A significant number of 41.4% of participants showed better respiratory symptom improvement following vaping, yet this response was more prominent among former smokers at 58.3% than current smokers at 39.0% (p < 0.005). Commitment to conventional smoking increased the risk of adverse effects between 21.65% for active smokers and 16.7% for previous users (p < 0.001). Multivariate logistic regression identified former smoking status (AOR = 2.8, p < 0.001), strong belief in vaping as a cessation aid (AOR = 1.9, p < 0.001), and higher education (AOR = 1.6, p = 0.04) as significant predictors of exclusive e-cigarette use. Conclusion: Ex-smokers gain greater advantages from vaping, but existing cigarette users mostly suffer additional negative consequences and reduced positive outcomes. Vaping behavior strongly depends on how much individuals believe vaping harms them, works as a substitute, or fits into their social environment based on their smoking status. The promotion of exclusive e-cigarette usage for cessation requires complete educational programs, together with strict regulation measures and persistent assessment of health results.
ORIGINAL RESEARCH ARTICLE | May 19, 2025
Rainfall-River Discharge Modelling Using Artificial Neural Network – A Case Study of Oramiriukwa River in Owerri, Imo State Nigeria
Alerechi K, Dike B. U, Nwoke H. U
Page no 120-130 |
https://doi.org/10.36348/sjce.2025.v09i05.002
This study investigates the application of Artificial Neural Networks (ANNs) for rainfall-river modelling in the Oramiriukwa River, located in Owerri, Imo State, Nigeria. The study utilizes daily streamflow data from the Ulakwo station (1978–1988) alongside corresponding rainfall and temperature data for Imo State, obtained from the Nigerian Meteorological Agency (NiMet). A series of Feedforward Multi-Layer Perceptron (MLP) models were developed and tested using MATLAB, with performance evaluated using Mean Squared Error (MSE), Root Mean Squared Error (RMSE), and Coefficient of Determination (R²). Among the models, Model 4 ([15]) delivered the best results, achieving an R² of 0.9158, MSE of 0.1294, and RMSE of 0.3597, demonstrating its effectiveness for streamflow prediction in the Oramiriukwa River. Model 2 ([30, 15, 5]) also showed good performance (R² = 0.9029), but its increased complexity suggested a potential risk of overfitting. Model 1 ([20, 10]) yielded lower predictive accuracy, highlighting the need for more complex architectures or additional input features to improve ANN performance for hydrological applications. These results confirm the effectiveness of ANNs in modelling nonlinear hydrological processes and suggest their potential for improving streamflow prediction in similar river basins. This study contributes to the growing use of data-driven methods in hydrological modelling in Nigeria and offers a foundation for future work aimed at enhancing the accuracy and robustness of ANN models.
ORIGINAL RESEARCH ARTICLE | May 17, 2025
Correlation of 25-Hydroxyvitamin D with Lipid Profiles (TG, TC, LDL, HDL) in Type 2 Diabetic Individuals
Nusrat Jahan, Fatema Sarker, Anzuman Akter, Samira, Sadia Hassan, Mohammad Rafiqul Islam
Page no 77-82 |
https://doi.org/10.36348/sijb.2025.v08i02.005
Background: Vitamin D deficiency and dyslipidemia are both common in individuals with type 2 diabetes and may contribute to increased cardiovascular risk. This study aims to assess the correlation between serum 25-hydroxyvitamin D levels and lipid profile parameters in patients with type 2 diabetes mellitus. Aim of the study: The aim of the study was to evaluate the correlation between 25-Hydroxyvitamin D levels and lipid profiles (TG, TC, LDL, HDL) in individuals with Type 2 diabetes. Methods: This cross-sectional study was conducted at the Department of Clinical Biochemistry and the Department of Biochemistry and Cell Biology, BIRDEM General Hospital, Dhaka, Bangladesh, from July 2014 to June 2015, including 200 participants (130 with type 2 diabetes, 70 healthy controls). After informed consent, demographic data and blood samples were collected for fasting plasma glucose, lipid profile, 25-hydroxyvitamin D, HbA1C, and postprandial glucose analysis. Biochemical tests were performed using standard methods, and data were analyzed with SPSS v21, with statistical significance set at p ≤ 0.05. Results: Type 2 diabetics had significantly lower vitamin D levels and higher BMI compared to non-diabetics. Hypovitaminosis-D was more common in diabetics (44.6% vs. 22.9%, p = 0.002). Diabetics also had higher total cholesterol, LDL, and triglycerides (all p < 0.001). In diabetics, vitamin D levels were inversely correlated with cholesterol, LDL, and triglycerides, and positively correlated with HDL. Conclusion: Vitamin D deficiency is significantly associated with dyslipidemia in type 2 diabetic patients, showing strong negative correlations with LDL and triglycerides and a positive correlation with HDL.
ORIGINAL RESEARCH ARTICLE | May 17, 2025
Observation of Hematocrit Level among Dengue Fever Patients in a Tertiary Care Hospital
Mst. Salina Akhtar, Md. Mobinur Rahman, Mst. Sabina Akhter
Page no 67-72 |
https://doi.org/10.36348/sijap.2025.v08i03.001
Background: Dengue fever is a significant global health concern, particularly in tropical and subtropical regions, including Bangladesh. Hematocrit levels play a crucial role in monitoring plasma leakage and disease severity in Dengue patients. This study aims to observe the hematocrit levels and other hematological parameters among Dengue fever patients admitted to a tertiary care hospital. Methods: This cross-sectional observational study was conducted at Tairunnessa Memorial Medical College Hospital from March 2022 to August 2022. A total of 80 confirmed Dengue patients were included in the study. Daily hematocrit levels, hemoglobin levels, and white blood cell counts were recorded over a 10-day monitoring period. Data analysis included descriptive statistics to assess trends and variations in these hematological parameters. Result: The majority of participants (27.5%) belonged to the 18-27 years age group, with a nearly equal gender distribution (52.5% males, 47.5% females). Dengue fever with and without warning signs accounted for 93.75% of cases, while severe Dengue was observed in only 6-25% of cases. Fever was present in all patients, with headache (65%) and myalgia (47.5%) being the most common associated symptoms. The mean hematocrit level peaked on Day 3 (47.58±5.22%) before progressively declining, while hemoglobin levels followed a similar trend, peaking on Day 3 (16.02±1.92 g/dL) and reaching the lowest on Day 9 (12.82±1.42 g/dL). White blood cell counts declined until Day 4 (3333.52±24.11 per cu.mm) and then showed a gradual increase. Recovery was observed in 93.75% of cases, with a mortality rate of 1.25%. Conclusion: The study highlights the importance of monitoring hematocrit and other hematological parameters in Dengue fever patients for early detection of complications and effective management. While the majority of cases were Dengue fever with and without warning signs; the observed hematological trends underscore the need for vigilant monitoring to prevent severe outcomes. Further large-scale studies are warranted to strengthen clinical guidelines for Dengue management.
ORIGINAL RESEARCH ARTICLE | May 16, 2025
Evaluation of the Quality of CPN in a Community Health Centre in Rural Area (CSCom/Sido) in Mali
Sylla Mala, Traoré Soumaila A, Traoré K, Cissé M, Coulibaly O, Goita D, Coulibaly M, Diallo S, Sidibé Assitan B, Cissouma A, Touré O, Coulibaly M, Cissé A, Kanté M, Traoré B, Diassana M, Diallo A, Dembélé Y, Traoré S, Diassana M, Camara F
Page no 167-172 |
https://doi.org/10.36348/sijog.2025.v08i05.005
Introduction: Prenatal consultation is a preventive medical act used to detect and treat possible complications arising during pregnancy. The aim of our study was to evaluate the quality of prenatal consultations in a rural community health center. To do this, we assessed the quality of services, determined prenatal consultation procedures and determined the degree of satisfaction of pregnant women who come to this community health center for prenatal consultations. Methodology: This was a prospective, descriptive study in 2022, involving 98 pregnant women systematically surveyed from October 1 to December 31, 2022, to assess the quality of care and services. All pregnant women who came to the Sido Community Health Center for a prenatal consultation during the study period and who agreed to take part in the study were included in the study. Pregnant women who refused to comply with the recruitment conditions, and those who came for reasons other than a prenatal consultation, were not included in the study. Results: At the end of our study, we found that the majority of our pregnant women were aged between 20-29 years, i.e. 56.8%, with an average age of 23.23 years. Antenatal consultation activities were carried out by midwives in 50% of cases, obstetric nurses in 19.4% of cases and matrons (unqualified personnel) in 36.6% of cases. Hand washing before examining a new gestational carrier was 18.36%, and gestational carrier satisfaction was 94.9%. Conclusion: There are certain areas for improvement, such as the omission of certain procedures, either through ignorance of their importance, or through negligence and inadequate technical facilities, in this case the absence of an ultrasound scanner in the health area.
ORIGINAL RESEARCH ARTICLE | May 16, 2025
Qualitative Determination of Sildenafil and Tadalafil Adulterants in Selected Herbal Aphrodisiac Products
Adesegun J. Kashimawo, Miller E. Emmanuel, Samuel J. Bunu
Page no 64-71 |
https://doi.org10.36348/sijtcm.2025.v08i05.002
The increasing global demand for herbal aphrodisiac products has raised concerns regarding their safety and quality due to potential adulteration with synthetic or conventional pharmaceutical active ingredients. This study investigates the presence of sildenafil and tadalafil in selected herbal mixtures marketed for sexual enhancement available in Nigeria, including Mai Sulhu, Mai Rahusa, Mai Sasangi, Jaolin, Saigari Jawaye, and Manisa. A combination of preliminary phytochemical screening, Thin-Layer Chromatography (TLC), and Fourier Transform Infrared Spectroscopy (FTIR) analysis was used to analyze the samples. Phytochemical screening using Dragendorff’s reagent indicated the presence of alkaloids in five of the samples, except Jaolin, suggesting the inclusion of bioactive compounds. TLC analysis revealed that four herbal mixtures had Retention Factor (Rf) values matching those of tadalafil, 0.60 (Mai Salhu and Mai Rahusa), and sildenafil citrate, 0.47 (Saigari yawaye and Manisa), indicating possible adulteration. FTIR spectroscopy further confirmed the presence of these synthetic phosphodiesterase-5 (PDE-5) inhibitors, as spectral peaks in some samples closely correlate with those of sildenafil and tadalafil. The detection of these undeclared pharmaceuticals poses significant health risks, including cardiovascular complications and hazardous drug interactions, as well as potential erectile dysfunction. These findings emphasize the need for stricter regulatory oversight, improved quality control measures, and public awareness regarding the risks associated with adulterated herbal aphrodisiacs. Routine screening using advanced analytical techniques such as High-Performance Liquid Chromatography and Mass Spectrometry is recommended to enhance detection accuracy and precision.
This study aims to apply Behaviorist Theory to the analysis of language errors made by Hausa students learning Arabic. Although language teaching and learning have long been subjects of interest, they often lack a scientific framework grounded in applied linguistics. Over time, several theories have emerged to explain how language is acquired, among which the Behaviorist Theory remains one of the most prominent. Drawing on their teaching experience, the researchers observe that this theory can significantly enhance both language teaching and learning processes. The relevance of this study lies in the continued scarcity of applied linguistic data concerning second language acquisition, particularly among Hausa learners. This research adopts a descriptive-analytical approach to explore the types and causes of errors. The findings indicate that the language errors made by Hausa students in learning Arabic include spelling, morphological, and grammatical mistakes - with spelling errors being the most prevalent and obstructive. The study suggests that these errors can be effectively addressed within the framework of Behaviorist Theory.
ORIGINAL RESEARCH ARTICLE | May 16, 2025
A Study of Patient Relationship Management in Continuum of Care: A Case Study in Government Hospitals of Chhattisgarh
Varun Kumar Sahu, Sumita Dave
Page no 214-219 |
https://doi.org/10.36348/sjbms.2025.v10i05.002
This research investigates the role of Patient Relationship Management (PRM) in enhancing patient satisfaction in government hospitals of Chhattisgarh, India, emphasizing the contributions of Information Technology (IT) and the Continuum of Care (CoC). A quantitative research design was employed, collecting data from 440 patients across district hospitals, community health centers, and medical colleges using a structured questionnaire adapted from validated scales (PAM, SERVQUAL, PSQ-18). Descriptive statistics indicated that 59.3% of respondents were aged 25-34 years, with 69.2% female. Inferential analyses, including Chi-square tests (χ²=18.92, p<0.01), t-tests (p>0.05 for gender), ANOVA (F=4.62, p<0.01), Pearson correlations (loyalty: r=0.631; trust: r=0.598; IT: r=0.453), and regression analysis (R²=0.532, β for IT=0.312, p<0.01), confirmed significant relationships between PRM, IT, CoC, and patient satisfaction. IT was a strong predictor of satisfaction (β=0.586, p<0.01), explaining 34.2% of the variance, and structured care plans significantly enhanced outcomes (χ²=18.92, p<0.01). The findings highlight the need for integrating advanced IT solutions (e.g., Electronic Health Records, telemedicine) and structured CoC plans to improve patient experiences and health outcomes in public healthcare settings, particularly for younger and rural populations. Policy implications include investing in IT infrastructure and CoC frameworks to advance universal healthcare goals in resource-constrained environments.
ORIGINAL RESEARCH ARTICLE | May 15, 2025
An Experimental Investigation of Fe2O3 Additives Effect on Viscosity and Steam Flooding Oil Recovery for a Sudanese Heavy Oil Field
Shiehab Eltyeb, Quosay Awad, Mustafa Alhadari
Page no 228-235 |
https://doi.org/10.36348/sjet.2025.v10i05.002
Heavy oil represents the greatest portion of the remaining oil and with the increasing demand for energy sources, the interest and efforts are directed toward producing from reservoirs with such kind of oil. The common method to produce the heavy oil is the thermal recovery method, but recently a new technology applied for enhancing the heavy oil recovery which is using Nano additives due to their ability to alter certain factors in the formation and in oil properties. In this study the catalytic effect of Nano-Fe2O3 in the viscosity of Sudanese heavy oil was studied and the result indicate that the Fe2O3 decreases the viscosity considerably at certain concentration and temperature, for this study 0.25% wt additive gave the maximum reduction in the viscosity. Also, this work investigated experimentally the effect of Nano-Fe2O3 in the oil recovery by steam injection and the result showed that when injecting a mixture of steam and Nano-Fe2O3 there is an increase in the oil recovery factor due to cracking reactions which convert the heavy component to lighter components, in this experiment there was an increase of 8% in the recovery factor.
ORIGINAL RESEARCH ARTICLE | May 15, 2025
Antioxidants and Antiulcer Activity of Aqueous Unripe Fruits Extract of Musa Acuminata in Indomethacin-Induced Ulcer in Rats
Zayyanu Abdullahi, Shamsu Nasiru, Usman Abubakar
Page no 66-76 |
https://doi.org/10.36348/sijb.2025.v08i02.004
Ulcer remains a public health problem associated with high incidence and mortality rate worldwide. Musa acuminata is widely available plant used in local management of many diseases including gastrointestinal disorders, constipation, piles, and hemorrhoids. The aim of this study was to evaluate the antioxidants and antiulcer activity of aqueous unripe fruits extract of Musa acuminata in indomethacin-induced ulcer in rats. The gastric ulcer was induced by intra-peritoneal injection of indomethacin (60 mg/kg, i.p.). Ulcer index and percentage ulcer inhibition was calculated using standard equations. The Lipid Peroxidation (Malondialdehyde) marker was determined using Thiobarbituric acid Reactive Substances (TBARS) method. The superoxide dismutase activity (SOD) and catalase (CAT) level was determined using standard ELISA kits. The antioxidant vitamins (Vit A, C, and E) were assayed by spectrophotometric technique. The extract (100 mg/kg, 200 mg/kg) demonstrated significant (p < 0.05) gastroprotective effect with high ulcer inhibition (95.49 %) at 200 mg/dL more than the reference standard drug, omeprazole (91.67 %). The extract (100 mg/kg, 200 mg/kg) demonstrated significant (p < 0.05) decrease in the level of lipid peroxidation marker (MDA) coupled with the significant (p < 0.05) increase in the level of SOD and CAT comparable to the reference standard drug, omeprazole. The results also showed a significant (p < 0.05) increase in vitamins A and E level significant (p < 0.05) decrease in vitamins C level in the gastric tissue homogenates of the rats treated with 100 mg/kg and 200 mg/kg of the extract. The aqueous unripe fruits extract of Musa acuminata demonstrated gastroprotective effect in indomethacin-induced ulcer in rats and might be attributed to increase in prostaglandins synthesis and cellular antioxidant activity.
ORIGINAL RESEARCH ARTICLE | May 15, 2025
Differences in Students’ Attitudes Towards Jordanian and Qatari Cybercrime Laws
Diab M. Al-Badayne, Hussen Alkubaisi, Abdulla Alsulaiti, Saleh Alkhowar, Ali Alkildi, Salman Almohannadi
Page no 99-104 |
https://doi.org/10.36348/sijlcj.2025.v08i05.002
The study examines country and gender differences in attitudes toward Jordanian and Qatari cybercrime laws. The study sample comprised 704 participants from Jordan and Qatar, with 494 (70%) Jordanian and 210 (30%) Qatari. Of them, 377 (53.6%) were males, and 327 (46.4%) were females. Participants (143, 20%) reported being victims of cybercrimes, and 37 (5%) were perpetrators. The study developed a research questionnaire as its tool. As estimated by Cronbach’s α, reliability was 0.956 for all scales. The validity, measured by the correlation between the attitude scale and knowledge index, was r = 0.180, α = 0.00. The ANOVA analysis comparing attitudes toward cybercrime law (ATCL) showed that students from Qatar had more negative views than those from Jordan (66 compared to 30); there were significant differences in ATCL between Jordan and Qatar (F = 237.579, α = .036). An ANOVA analysis of the mean gender differences in ATCL revealed that males were more negative about it than females (45 vs. 35). Significant differences were found between males and females in ATCL (F = 14.917, α < .000).
Patent valuation plays a critical role in the creative economy; particularly as intellectual property assets are increasingly utilized as collateral in financial transactions. However, significant challenges remain in the valuation process, particularly for patents, which are intangible assets with high economic potential but complex valuation methods. This study aims to address the legal and valuation challenges surrounding patents in IP-based financing and provide recommendations to enhance legal certainty. The research adopts a normative juridical approach, analyzing relevant regulations and cases. The results highlight the need for a comprehensive legal framework in Indonesia to mitigate uncertainties in patent valuation. Addressing the uncertainty in patent valuation requires a proactive legal framework that ensures predictability, transparency, and consistency. By strengthening regulations and learning from international best practices, Indonesia can unlock the potential of its creative economy and position itself as a competitive player in the global IP market. By addressing these challenges, Indonesia can enhance the credibility and effectiveness of IP-based financing, fostering innovation and economic growth in the creative economy sector.
ORIGINAL RESEARCH ARTICLE | May 15, 2025
Depression, Anxiety, and Stress among Nurses: A Multi-Level Comparison Across Hospital High-Stress, Medium-Stress, and Low-Stress Units at KFMC
Naif F. Al-Shawaf, Nadia AL-Tamimi, Buhaiseh S. Owaishiz
Page no 125-132 |
https://doi.org/10.36348/sjnhc.2025.v08i05.002
Due to their difficult profession, nurses often experience stress, anxiety, and sadness. High-stress units like the ICU and ER are especially stressful, although medium and low-stress departments such as Outpatient, and general hospital in patient wards may have their own pressures. This study compared nurses' stress, anxiety, and depression in high, medium, and low-stress hospital units in King Fahad Medical City. The study used the Depression, Anxiety, and Stress Scale (DASS-21) to measure psychological distress and a demographic and workplace questionnaire to measure workload, shift patterns, and sleep duration. SPSS was used for descriptive and inferential statistics like chi-square testing and regression analysis. Key findings showed that high-stress nurses reported significantly higher depression and stress than low-stress nurses. Interestingly, medium-stress departments had higher anxiety levels, defying stress preconceptions. Nationality and shift patterns affected mental health outcomes, with non-Saudi nurses and those working rotating shifts suffering more stress and anxiety. Mental health programs customized to each hospital unit's pressures are needed, according to the report. Workload management, stress-reduction, and sleep hygiene can reduce the psychological burden of nursing, especially in high-stress conditions.