Yiziphi Izimo Okufanele Zithathwe Njengezinkinga Ekuhlukanisweni Kwezifo Ngamazwe Ngamazwe (ICD-11) Ukuqokwa “Kokunye Ukuphazamiseka Okucacisiwe Ngenxa Yezithintelo Zokulutha”? (2020)

COMMENTS: Ukubuyekezwa kochwepheshe bokulutha kungaphetha ngokuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kutholakala nesigaba se-ICD-11 “okunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo”. Ngamanye amagama, ukusetshenziswa kwe-porn okuphoqayo kubukeka njengeminye imikhuba yokuziphatha eyaziwayo, efaka ukugembula nokuphazamiseka kwemidlalo. Izicashuniselo ezivela ephepheni:

Qaphela ukuthi asiphakamisi ukufakwa kwezifo ezintsha ku-ICD-11. Esikhundleni salokho, sihlose ukugcizelela ukuthi ezinye izindlela zokuziphatha ezingaba umlutha kuxoxwa ngazo ezincwadini, okwamanje ezingafakwanga njengeziphazamiso ezithile kwi-ICD-11, kepha ezingafanelana nesigaba "sokunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo" futhi ngenxa yalokho ingafakwa ikhodi njenge-6C5Y ekusebenzeni komtholampilo. (kugcizelelwa)

Ngokusekelwa ebufakazini obuhlaziwe maqondana nezinqubo ezintathu zokuphakanyiswa kwe-meta, siphakamisa ukuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kungumbandela ongatholakala ngesigaba se-ICD-11 "okunye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo" kususelwa kulokho okuthathu okungukhiye Izindlela zokuphazamiseka kwemidlalo, eziguquliwe maqondana nokubukwa kwezithombe zocansi (Umkhiqizo, uBlycker, et al., 2019) ....

Ukuxilongwa kokuphazamiseka kokusetshenziswa kwezithombe zobulili ezingcolile njengokunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo kungaba ngokwanele kubantu abahlushwa kuphela ukubukwa kwezithombe zocansi okungalawulwa kahle (ezimeni eziningi ezihambisana nokushaya indlwabu).

Lapha sinikeza isigaba mayelana nokusetshenziswa okuyinkinga kwe-porn:

Ukuphazamiseka kwezithombe zobulili ezingcolile

Ukubandakanyeka kokuziphatha kobulili okuphoqelekile, njengoba kufakiwe esigabeni se-ICD-11 sokuphazamiseka kokulawulwa kokuthatheka, kungahle kube nezindlela eziningi zokuziphatha zocansi kufaka nokubukwa ngokweqile kwezithombe zocansi okwenzeka into efanelekile emtholampilo (Umkhiqizo, iBlycker, & Potenza, 2019; I-Kraus et al., I-2018). Ukuhlukaniswa kokwehlukaniswa kokuziphatha kobulili okuphoqelekile kuye kwaxoxwa ngakho (IDerbyshire & Grant, 2015), nababhali abathile bephakamisa ukuthi uhlaka lomlutha lufaneleke kakhulu (IGola & Potenza, 2018), okungaba ikakhulukazi ikakhulukazi kubantu abahlupheka ngokuqondile ezinkingeni ezihlobene nokusetshenziswa kwezithombe zocansi hhayi kwezinye izindlela zokuziphatha zocansi eziphoqayo noma ezingaphoqelekile (IGola, iLeccukuk, neSkorko, 2016; IKraus, Martino, & Potenza, 2016).

Imihlahlandlela yokuxilonga yokuphazamiseka kwemidlalo yabelana ngezici ezimbalwa nalezo zokuziphatha kokuya ocansini okuphoqayo futhi zingase zamukelwe ngokuguqula "umdlalo" ube "ukusetshenziswa kwezithombe zocansi." Lezi zici ezintathu ezibalulekile zithathwe njengemaphakathi nokusetshenziswa okuyinkinga kokusebenzisa izithombe zocansi (Umkhiqizo, uBlycker, et al., 2019) futhi zibonakale zilingana ngokufanele ukucatshangelwa okuyisisekelo (I-Fig. 1). Ucwaningo oluningi lukhombise ukuhambisana kwemitholampilo (umbandela 1) wokusebenzisa kabi izithombe zobulili ezingcolile, okuholele ekuphazamisekeni okusebenzayo empilweni yansuku zonke kufaka nengcuphe umsebenzi nobudlelwano bomuntu siqu, kanye nokwenza izizathu zokwelashwa (IGola & Potenza, 2016; IKraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015; IKraus, Voon, & Potenza, 2016). Ezifundweni eziningi nasezihlokweni zokubukeza, amamodeli kusuka ocwaningweni lomlutha (inqubo 2) asetshenziselwe ukuthola izithonjana nokuchaza imiphumela (Umkhiqizo, ama-Antons, Wegmann, & Potenza, 2019; Umkhiqizo, Wegmann, et al., 2019; Brand, Young, et al., 2016; I-Stark et al., I-2017; I-Wéry, i-Deleuze, iCanale, neBillieux, i-2018). Imininingwane evela ekuzibonakaliseni ngokwakho, ekuziphatheni, ku-electrophysiological, kanye nasezinkulumweni ze-neuroimaging zibonisa ukubandakanyeka kwezinqubo zokusebenza kwengqondo kanye nokuqondiswa okungaphansi kwe-neural okuye kwaphenywa futhi kwasungulwa ukuthi kube namazinga ahlukahlukene wokuphazamiseka kokusebenzisa izidakamizwa kanye nokuphazamiseka kokugembula / imidlalo (inkomba 3). Izimo zezomnotho eziphawulwe ocwaningweni lwangaphambilini zifaka ukwenziwa kabusha kwengqondo nokunxanela okuhambisana nokwanda komsebenzi ezindaweni ezihlobene nomvuzo ezihlobene nokuthola umvuzo, ukunakwa kokunaka, ukwenza izinqumo ezingathandekiyo, kanye (nokulawula okuthize) kokuthintela (isib. I-Antons & Brand, 2018; I-Antons, Mueller, et al., 2019; I-Antons, iTrotzke, Wegmann, neBrand, 2019; UBothe et al., 2019; Umkhiqizo, uSnagowski, uLaier, noMaderwald, 2016; I-Gola et al., 2017; IKlucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Kowalewska et al., 2018; I-Mechelmans et al., 2014; I-Stark, i-Klucken, i-Potenza, i-Brand, ne-Strahler, i-2018; I-Voon et al., I-2014).

Ngokusekelwa ebufakazini obuhlaziwe maqondana nezinqubo ezintathu zokuphakanyiswa kwe-meta, siphakamisa ukuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kungumbandela ongatholakala ngesigaba se-ICD-11 "okunye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo" kususelwa kulokho okuthathu okungukhiye Izindlela zokuphazamiseka kwemidlalo, eziguquliwe maqondana nokubukwa kwezithombe zocansi (Umkhiqizo, uBlycker, et al., 2019). Eyodwa conditio sine qua non uma ubheka inkinga yokusebenzisa izithombe zobulili ezingcolile ngaphakathi kwalesi sigaba kungaba ukuthi umuntu lowo uhlupheka kuphela futhi ikakhulukazi ekunciphiseni kokulawulwa kokusetshenziswa kwezithombe zocansi (kulezi zinsuku ezitholakala ezingcolile ezikwi-inthanethi ezimweni eziningi), ezingahambelani nokunye ukuziphatha okucindezelayo kokuya ocansini (I-Kraus et al., I-2018). Ngaphezu kwalokho, lokhu kuziphatha kufanele kubhekwe njengokuziphatha okuluthayo kuphela uma kuhlobene nokulimazeka kokusebenza futhi uthola nemiphumela emibi empilweni yansuku zonke, njengoba kunjalo nangengxaki yokudlala (Billieux et al., 2017; I-World Health Organization, i-2019). Kodwa-ke, siphawula ukuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kungenzeka kutholakale ukuthi kunesifo samanje se-ICD-11 senkinga yokuziphatha kokuya ocansini okucatshangwa ukuthi ukubuka izithombe zobulili ezingcolile kanye nokuziphatha okuhambisana njalo nokuziphatha kocansi (ukushaya indlwabu kaningi kepha okungenzeka kube neminye imisebenzi yezocansi kubandakanya ucansi oluhlanganyelwayo) uhlangabezane nenqubo yokuphazamiseka kokuziphatha kokuya ocansini okuphoqayo (IKraus & Sweeney, 2019). Ukuxilongwa kokukhubazeka kokuziphatha kobulili okucindezelayo kungahle kulungele abantu abangasebenzisi nje kuphela izithombe zobulili ezingcolile, kodwa futhi abahlushwa ezinye izinto zokuziphatha zocansi ezihlobene nobulili ezingcolile. Ukuxilongwa kokuphazamiseka kokusetshenziswa kwezithombe zobulili ezingcolile njengokunye ukuphazamiseka okucacile ngenxa yokuziphatha okuluthayo kungaba ngokwanele kubantu abahlushwa kuphela ukubukwa kwezithombe zocansi okungalawulwa kahle (ezimeni eziningi ezihambisana nokushaya indlwabu). Ukuthi noma umehluko phakathi kokusetshenziswa kwezithombe zocansi ku-inthanethi nokungaxhunyiwe ku-inthanethi kungasiza okwamanje, okubuye kube yindaba yokudlala online / okungaxhunyiwe ku-inthanethi (IKirály & Demetrovics, 2017).

J Behav Umlutha. 2020 Jun 30.

i-doi: 10.1556 / 2006.2020.00035.I-Brand Matthias  1   2 , UHans-JÜrgen Rumpf  3 , IZsolt Demetrovics  4 , I-Astrid MÜller  5 , Rudolf Stark  6   7 , UDaniel L King  8 , Anna E Goudriaan  9   10   11 , UKarl Mann  12 , UPatrick Trotzke  1   2 , UNaomi A Fineberg  13   14   15 , USamuel R Chamberlain  16   17 , Shane W Kraus  18 , Elisa Wegmann  1 , UJoËl Billieux  19   20 , UMarc N Potenza  21   22   23

abstract

Background

Izinkinga zokugembula nezokugembula zifakiwe njenge- "ukuphazamiseka ngenxa yezimilo zokuziphatha" ku Ukuhlukaniswa Kwezifo Zomhlaba Wonke (ICD-11). Enye indlela yokuziphatha enenkinga ingabhekwa njenge "okunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo (6C5Y)."

izindlela

Ukubuyekezwa okulandisayo, imibono yochwepheshe.

Imiphumela

Siphakamisa le nqubo elandelayo yezinga le-meta yokucabanga ngokuziphatha okungaba umlutha njengokugcwalisa isigaba sezinye "izinkinga eziphawuliwe ngenxa yokuziphatha okuluthayo":

1. Ukuhambelana komtholampilo: Ubufakazi obunamandla obuvela ezifundweni eziningi zesayensi zibonisa ukuthi indlela yokuziphatha ethile eyimilutha engahle ibe khona ngokomtholampilo futhi abantu bathola imiphumela emibi kanye nokulimazeka kokusebenza empilweni yansuku zonke ngenxa yokuziphatha okunenkinga futhi kungaba umlutha.

2. Ukushumeka kwethiyori: Ithiyori yamanje kanye nezinhlobo zemibono ezikulo mkhakha wokucwaninga ngokuziphatha okuluthayo ichaza futhi ichaze kahle into eyenzelwa ukhetho lokuziphatha okubi.

3. Ubufakazi obunamandla: Idatha esekwe emibikweni yokuzenzela, izingxoxo ezenziwa emtholampilo, ucwaningo, izindlela zokuziphatha, futhi, uma ikhona, uphenyo lwezinto eziphilayo (i-neural, ngokomzimba, ufuzo) luveza ukuthi izindlela zengqondo (kanye ne-neurobiological) ezibandakanyeka kwezinye izindlela zokulutha ziyasebenza ngesimo sokhetho. Amadigri wokushintshanisa wokusekela izinhlobo eziyinkinga zokusebenzisa izithombe ezingcolile, ukuthenga nokuthenga, nokusebenzisa amanethiwekhi omphakathi ayatholakala. Lezi zimo zingafanelana nesigaba "sokunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo".

Isiphetho

Kubalulekile ukuthi ungagcini ngokuziphatha ngokweqile kwempilo yansuku zonke ngenkathi kwangaxeshanye kungazibekeli izimo ezibalulekile emtholampilo futhi ezifanele ukucatshangelwa kwezempilo yomphakathi. Izindlela ezihlongozwayo ze-meta-level zingasiza ekuqondiseni zombili imizamo yokucwaninga nokuzilolonga.

Isingeniso

Izinkinga zokugembula nezemidlalo ziye zaqokwa ngokuthi “ukuphazamiseka ngenxa yokuziphatha okuluthayo” kuhlelo lweshumi nanye Ukuhlukaniswa Kwezifo Zomhlaba Wonke (ICD-11) (I-World Health Organization, i-2019). Yize kube nengxoxo mpikiswano mayelana nokuthi ngabe kufanelekile yini ukufaka inkinga yokugembula ku-ICD-11 (I-Dullur & Starcevic, 2018; van Rooij et al., 2018), odokotela abaningi nabaphenyi ekuluthweni kwengqondo okuluthayo kanye ne-neuroscience bayasekela ukufakwa kwayo (Umkhiqizo, uRumpf, et al., 2019; UFineberg et al., 2018; King et al., 2018; Rumpf et al., 2018; UStein et al., 2018). Njengoba kunikezwe ukuthi ukuphazamiseka ngenxa yokusetshenziswa kwezidakamizwa nokuziphatha okuluthayo kufakiwe ku-ICD-11, igama lelo labizwa ngokuthi “ezinye iziphazamiso ezicacisiwe ngenxa yokuziphatha okuluthayo” (okubhalwe njenge-6C5Y) izizathu ezengeziwe zokuncika kobungqina. Le ncazelo ikhombisa umbono wokuthi ezinye izindlela zokuziphatha ezingalawulwa kahle nezingalunganga ezingabhekwa njengokuphazamiseka ngenxa yokuziphatha okuluthayo (ngale kokugembula nokugembula) kufanele kubhekwe (IPotenza, iHiguchi, neBrand, i-2018). Kodwa-ke, akukho ncazelo yokuziphatha noma inqubo ethile. Sithi kubalulekile ukuthi silondolozwe ngokwanele lapho sicabangela ukufakwa kweziphazamiso ezingaba khona kulesi sigaba ukuze sigweme ukuzungeza ngokweqile kokuziphatha kwempilo yansuku zonke (UBillieux, uSchimmenti, uKhazaal, uMaurage, noHeeren, 2015; I-Starcevic, uBillieux, neSchimmenti, 2018). Lapha siphakamisa amazinga ezinga le-meta-kubhekelwa ekuziphatheni kokuziphatha okuyinkinga njengokuphazamiseka okuchaziwe ngenxa yokuziphatha okuluthayo futhi sixoxa ngokuba semthethweni kwezindlela eziphathelene nemibandela emithathu engenzeka: ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile, ukuphazamiseka kokuthenga, kanye nokusebenzisa-ukuxhumana nomphakathi ukuphazamiseka.

Izinga lokulinganisa le-Meta lokucabanga ngokuziphatha okuluthayo njengelinye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo

Njengezinye zokuziphatha ezingaba umlutha ezingabhekwa ngokuqokwa kwe-6C5Y, ukudlala okungaphazamiseki kuvame ukwenziwa kwi-Intanethi. Imihlahlandlela emithathu yokuxilonga yokuphazamiseka kwemidlalo e-ICD-11 ifaka phakathi ukulawulwa okungahambi kahle kumidlalo, ukubeka phambili ukubeka phambili (kanye nokuxakeka kakhulu) ngokudlala, nokuqhubeka noma ukwanda kwegeyimu yize uhlangabezana nemiphumela emibi (I-World Health Organization, i-2019). Ngaphezu kwalokho, iphethini yokuziphatha kufanele iholele ekulimazeni okukhulu kumuntu, umndeni, ezenhlalo, ezemfundo, zomsebenzi, noma ezinye izizinda ezibalulekile zempilo. Le mihlahlandlela yokuxilonga kufanele futhi isetshenziswe ekuziphatheni okungaba umlutha okungaphezulu kokuphazamiseka kwemidlalo (kanye nokuphazamiseka kokugembula, okuhambisana nemihlahlandlela yokuxilonga ne-gaming disorder). Ngaphezu kwale mihlahlandlela yokuxilonga, siphakamisa izindlela ezintathu zemeta kusuka kumbono wesayensi wokucabanga ngokuziphatha okungaba umlutha njengokugcwalisa isigaba se-ICD-11 "okunye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo". Siphakamisa lezi zindlela ezisezingeni eliphezulu zemeta ukuze sisize ekuqondiseni zombili imizamo yokucwaninga nokuzilolonga.

Ubufakazi besayensi bokuhlobana kwemitholampilo

Isifundo 1: Ubufakazi obunamandla obuvela ezifundweni eziningi zesayensi, kufaka phakathi okubandakanya abantu abafuna ukwelashwa, kukhombisa ukuthi indlela ethile yokuziphatha engaba umlutha efanelekile ngokomtholampilo futhi abantu bathola imiphumela emibi nokulimazeka kokusebenza empilweni yansuku zonke ngenxa yokuziphatha okunenkinga futhi okungahle kumenze umlutha.

Isizathu: Ukulimazeka okusebenzayo kuyisihluthulelo esiyisisekelo ekuphazamisekeni kwengqondo okuningi, kufaka phakathi ukuphazamiseka kwemidlalo nokugembula (Billieux et al., 2017; I-World Health Organization, i-2019). Ngakho-ke, izifundo zesayensi kufanele zibonise ukuthi kungenzeka ukuthi umlutha wokuziphatha uhlobene nokulimazeka kokusebenza okuvumela ukwelashwa (UStein et al., 2010). Umcimbi kufanele ucaciswe, okusho ukuthi izinkinga ezitholakala empilweni yansuku zonke kumele zibe yimiphumela etholakala ekuziphatheni okuthile okungaba umlutha futhi hhayi ngenxa yohla olubanzi lokuziphatha okuyinkinga noma kuchazwe okunye ukuphazamiseka kwengqondo (isib. Ngenxa yesiqephu sendatshana ).

Ukushumeka kwethiyori

Isifundo 2: Imibono yamanje kanye nezinhlobo zemibono ezikulo mkhakha wokucwaninga ngokuziphatha okuluthayo ichaza futhi ichaze kahle into eyenzelwa ukhetho lokuziphatha okubi.

Umqondo: Uma into ethile yokuziphatha ibhekwa njengokuphazamiseka ngenxa yokuziphatha okuluthayo, imibono (ye-neurosciology) echaza ukuthi umkhuba wokuziphatha umlutha kufanele isebenze kumcimbi wokuphakanyiswa. Ngaphandle kwalokho, bekungeke kube nesizathu sokubiza lo mkhuba ngokuthi umlutha, kodwa mhlawumbe kunalokho kube yinkinga yokulawula umthelela noma ukuphazamiseka okuphoqayo. Amathiyori akhona njengamanje abhekwa njengokufanelekile ngaphakathi kokuphazamiseka kokusebenzisa izidakamizwa nocwaningo lokuluthwa kokuziphatha afaka i-thethi yesifiso sokuzwa (URobinson neBerridge, ngo-2008), imodeli yokuphendula engasebenzi kahle kanye nemodeli ye-salience (iRISA) (IGoldstein neVolkow, ngo-2011), umvuzo wokuntuleka komvuzo (I-Blum et al., 1996), izindlela ezimbili zenqubo yokulutha (U-Bechara, i-2005; I-Everitt neRobbins, 2016) kufaka phakathi lezo ezigxile ekuqondweni okusobala (UStacy noWiers, 2010; I-Wiers & Stacy, 2006), kanye namamodeli acacisiwe wokulutha kokuziphatha. Leli qembu lokugcina lifaka amamodeli afana nemodeli yokuqala kaDavis yezinkinga zokusebenzisa i-Intanethi (UDavis, 2001), imodeli yokucabanga yokuziphatha kwengqondo yokudlala (UDong & Potenza, 2014), imodeli kathathu yokuphazamiseka kwemidlalo (Wei, Zhang, Turel, Bechara, & He, 2017), kanye nokuxhumana kokuphazanyiswa kwe-ezithinta abantu-ukuthinta (i-I-PACE) yezinkinga ezithile zokusebenzisa i-Intanethi (Umkhiqizo, Omncane, uLaier, uWölfling, noPotenza, 2016) nezindlela zokuziphatha eziyimilutha ngokubanzi (Umkhiqizo, Wegmann, et al., 2019). Ezincwadini zesayensi ezixoxa ngesimo sokhetho, imibono yezindlela zokuziphatha umlutha kufanele isetshenziswe futhi izifundo kufanele zikhombise ukuthi izinqubo eziyisisekelo zokuziphatha okuluthayo ziyabandakanyeka futhi endabeni yommeli (bona inqubo elandelayo). Lesi simo sibalulekile ukuze kulandelwe indlela eqhutshwa ngokomqondo kanye nokuhlolwa kwama-hypotheses esikhundleni sokumane nje sibhekane nezixhumanisi ezithile zokuziphatha okungaba umlutha.

Ubufakazi obunamandla bezindlela ezingaphansi

Isifundo 3: Imininingwane esekwe emibikweni yokuziveza, izingxoxo ezenziwa emtholampilo, inhlolovo yokuziphatha, ukuhlolwa kokuziphatha, futhi, uma ikhona, uphenyo lwezinto eziphilayo (i-neural, ngokomzimba, ufuzo) lubonisa ukuthi izindlela zengqondo (kanye ne-neurobiological) ezibandakanyeka kwezinye izindlela zokulutha (cf., Potenza, i-2017) nazo zisebenza kumcimbi wokungenela ukhetho.

Umqondo: Siphikisana nokuthi kubalulekile ukuba nedatha evela ezifundweni eziningi ezisebenzise izindlela ezahlukahlukene zokuhlola izinqubo ezithile zesisekelo sokhetho ngaphambi kokuba umuntu acabangele ukuhlukaniswa kwesimo sokuziphatha njengokuphazamiseka ngenxa yokuziphatha okuluthayo. Izifundo kufanele ziqinisekise ukuthi ukucatshangelwa kwemibono yokuziphatha okuluthayo kubonakala kuvumelekile kumcimbi wokungenela ukhetho. Lokhu futhi kusho ukuthi akwanele uma ngabe izifundo ezimbalwa kakhulu, ngokwesibonelo usebenzisa ithuluzi lokuhlonza okusha, zibhekane nokuziphatha okusha okungenza kube umlutha ukusebenzisa igama elithi “ukuphazamiseka ngenxa yokuziphatha okuluthayo.” Ngaphezu kwalokho, izifundo kumele zifake izindlela ezanele nezinamandla maqondana namasampula nezinsimbi zokuhlola (Rumpf et al., 2019). Kuphela uma isethi yedatha ethembekile futhi evumelekile yedatha evela ezifundweni eziningi (nakumaqembu ahlukile wokusebenza) - njengoba kubhekwe njengesiqinisekiso sokwethenjwa kwamathuluzi wokuhlola emkhakheni (King et al., 2020) - kuyatholakala kukhombisa ukuthi ama-hypotheses aqhutshwa yinkolelo-mbono ezicini ezithile zokuziphatha umlutha aqinisekisiwe, incazelo eqondile njengokuziphatha umlutha ingasebenza. Lokhu kubalulekile futhi maqondana nokugwema ukwenza ngokweqile kokuziphatha kwansuku zonke njengezinto eziluthayo (UBillieux, uSchimmenti, et al., 2015) njengoba kushiwo ngenhla esigabeni sokulimazeka kokusebenza. Isifinyezo salezi zindlela ezintathu eziphakeme zemeta eziphakanyisiwe, kufaka phakathi inhlangano yezikhundla kanye nemibuzo okufanele iphendulwe lapho kubhekwa ukuhlukaniswa komcimbi wokuphakanyiswa njengenye “inkinga ethile ebekiwe ngenxa yokuziphatha okuluthayo” ibonakala ku I-Fig. 1.

I-Fig. 1.
I-Fig. 1.

Ukubuka konke kwezinga le-meta-level-criteria ehlongozwayo uma kucatshangelwa ukuhlukaniswa kwento yokomeletha njengenye “isifo esithile esibekiwe ngenxa yokuziphatha okuhle”.

Isikhombo: I-Journal of Behaisheral Addictions J Behav Addict I-2020; 10.1556/2006.2020.00035

Ukuhlolwa kobufakazi besayensi obuxhasa ukufaneleka kwezinhlobo ezithile zokuluthwa kokuziphatha okukhona esigabeni se-ICD-11 "okunye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo"

Amadigri wokushintshanisa wokusekela izinhlobo eziyinkinga zokusebenzisa izithombe ezingcolile, ukuthenga nokuthenga, nokusebenzisa amanethiwekhi wokuxhumana nabantu kuyatholakala. Ubufakazi buzofingqwa ezigabeni ezilandelayo. Qaphela ukuthi asiphakamisi ukufakwa kokuphazamiseka okusha ku-ICD-11. Esikhundleni salokho, sihlose ukugcizelela ukuthi ezinye izindlela zokuziphatha ezinamandla okulutha ziyaxoxwa ezincwadini, okwamanje ezingafakwanga njengokuphazamiseka okuthile ku-ICD-11, kepha ezingalingana nesigaba "sokunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuluthayo" futhi ngenxa yalokho ingahle ibe namakhodi njenge-6C5Y ekusebenzeni ngokomtholampilo. Ngokuchaza kahle impela ingqinamba yokucabanga kwalezi zenzo ezintathu ezingaba umlutha, sihlose futhi ukuveza ukuthi kwezinye izehlakalo, kungenzeka kungabikho bufakazi obanele bokuzibiza ngokuthi “izimilo” zokuziphatha.

Ukuphazamiseka kwezithombe zobulili ezingcolile

Ukubandakanyeka kokuziphatha kobulili okuphoqelekile, njengoba kufakiwe esigabeni se-ICD-11 sokuphazamiseka kokulawulwa kokuthatheka, kungahle kube nezindlela eziningi zokuziphatha zocansi kufaka nokubukwa ngokweqile kwezithombe zocansi okwenzeka into efanelekile emtholampilo (Umkhiqizo, iBlycker, & Potenza, 2019; I-Kraus et al., I-2018). Ukuhlukaniswa kokwehlukaniswa kokuziphatha kobulili okuphoqelekile kuye kwaxoxwa ngakho (IDerbyshire & Grant, 2015), nababhali abathile bephakamisa ukuthi uhlaka lomlutha lufaneleke kakhulu (IGola & Potenza, 2018), okungaba ikakhulukazi ikakhulukazi kubantu abahlupheka ngokuqondile ezinkingeni ezihlobene nokusetshenziswa kwezithombe zocansi hhayi kwezinye izindlela zokuziphatha zocansi eziphoqayo noma ezingaphoqelekile (IGola, iLeccukuk, neSkorko, 2016; IKraus, Martino, & Potenza, 2016).

Imihlahlandlela yokuxilonga yokuphazamiseka kwemidlalo yabelana ngezici ezimbalwa nalezo zokuziphatha kokuya ocansini okuphoqayo futhi zingase zamukelwe ngokuguqula "umdlalo" ube "ukusetshenziswa kwezithombe zocansi." Lezi zici ezintathu ezibalulekile zithathwe njengemaphakathi nokusetshenziswa okuyinkinga kokusebenzisa izithombe zocansi (Umkhiqizo, uBlycker, et al., 2019) futhi zibonakale zilingana ngokufanele ukucatshangelwa okuyisisekelo (I-Fig. 1). Ucwaningo oluningi lukhombise ukuhambisana kwemitholampilo (umbandela 1) wokusebenzisa kabi izithombe zobulili ezingcolile, okuholele ekuphazamisekeni okusebenzayo empilweni yansuku zonke kufaka nengcuphe umsebenzi nobudlelwano bomuntu siqu, kanye nokwenza izizathu zokwelashwa (IGola & Potenza, 2016; IKraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015; IKraus, Voon, & Potenza, 2016). Ezifundweni eziningi nasezihlokweni zokubukeza, amamodeli kusuka ocwaningweni lomlutha (inqubo 2) asetshenziselwe ukuthola izithonjana nokuchaza imiphumela (Umkhiqizo, ama-Antons, Wegmann, & Potenza, 2019; Umkhiqizo, Wegmann, et al., 2019; Brand, Young, et al., 2016; I-Stark et al., I-2017; I-Wéry, i-Deleuze, iCanale, neBillieux, i-2018). Imininingwane evela ekuzibonakaliseni ngokwakho, ekuziphatheni, ku-electrophysiological, kanye nasezinkulumweni ze-neuroimaging zibonisa ukubandakanyeka kwezinqubo zokusebenza kwengqondo kanye nokuqondiswa okungaphansi kwe-neural okuye kwaphenywa futhi kwasungulwa ukuthi kube namazinga ahlukahlukene wokuphazamiseka kokusebenzisa izidakamizwa kanye nokuphazamiseka kokugembula / imidlalo (inkomba 3). Izimo zezomnotho eziphawulwe ocwaningweni lwangaphambilini zifaka ukwenziwa kabusha kwengqondo nokunxanela okuhambisana nokwanda komsebenzi ezindaweni ezihlobene nomvuzo ezihlobene nokuthola umvuzo, ukunakwa kokunaka, ukwenza izinqumo ezingathandekiyo, kanye (nokulawula okuthize) kokuthintela (isib. I-Antons & Brand, 2018; I-Antons, Mueller, et al., 2019; I-Antons, iTrotzke, Wegmann, neBrand, 2019; UBothe et al., 2019; Umkhiqizo, uSnagowski, uLaier, noMaderwald, 2016; I-Gola et al., 2017; IKlucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016; Kowalewska et al., 2018; I-Mechelmans et al., 2014; I-Stark, i-Klucken, i-Potenza, i-Brand, ne-Strahler, i-2018; I-Voon et al., I-2014).

Ngokusekelwa ebufakazini obuhlaziwe maqondana nezinqubo ezintathu zokuphakanyiswa kwe-meta, siphakamisa ukuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kungumbandela ongatholakala ngesigaba se-ICD-11 "okunye ukuphazamiseka okubekiwe ngenxa yokuziphatha okuluthayo" kususelwa kulokho okuthathu okungukhiye Izindlela zokuphazamiseka kwemidlalo, eziguquliwe maqondana nokubukwa kwezithombe zocansi (Umkhiqizo, uBlycker, et al., 2019). Eyodwa conditio sine qua non uma ubheka inkinga yokusebenzisa izithombe zobulili ezingcolile ngaphakathi kwalesi sigaba kungaba ukuthi umuntu lowo uhlupheka kuphela futhi ikakhulukazi ekunciphiseni kokulawulwa kokusetshenziswa kwezithombe zocansi (kulezi zinsuku ezitholakala ezingcolile ezikwi-inthanethi ezimweni eziningi), ezingahambelani nokunye ukuziphatha okucindezelayo kokuya ocansini (I-Kraus et al., I-2018). Ngaphezu kwalokho, lokhu kuziphatha kufanele kubhekwe njengokuziphatha okuluthayo kuphela uma kuhlobene nokulimazeka kokusebenza futhi uthola nemiphumela emibi empilweni yansuku zonke, njengoba kunjalo nangengxaki yokudlala (Billieux et al., 2017; I-World Health Organization, i-2019). Kodwa-ke, siphawula ukuthi ukuphazamiseka kokusebenzisa izithombe zobulili ezingcolile kungenzeka kutholakale ukuthi kunesifo samanje se-ICD-11 senkinga yokuziphatha kokuya ocansini okucatshangwa ukuthi ukubuka izithombe zobulili ezingcolile kanye nokuziphatha okuhambisana njalo nokuziphatha kocansi (ukushaya indlwabu kaningi kepha okungenzeka kube neminye imisebenzi yezocansi kubandakanya ucansi oluhlanganyelwayo) uhlangabezane nenqubo yokuphazamiseka kokuziphatha kokuya ocansini okuphoqayo (IKraus & Sweeney, 2019). Ukuxilongwa kokukhubazeka kokuziphatha kobulili okucindezelayo kungahle kulungele abantu abangasebenzisi nje kuphela izithombe zobulili ezingcolile, kodwa futhi abahlushwa ezinye izinto zokuziphatha zocansi ezihlobene nobulili ezingcolile. Ukuxilongwa kokuphazamiseka kokusetshenziswa kwezithombe zobulili ezingcolile njengokunye ukuphazamiseka okucacile ngenxa yokuziphatha okuluthayo kungaba ngokwanele kubantu abahlushwa kuphela ukubukwa kwezithombe zocansi okungalawulwa kahle (ezimeni eziningi ezihambisana nokushaya indlwabu). Ukuthi noma umehluko phakathi kokusetshenziswa kwezithombe zocansi ku-inthanethi nokungaxhunyiwe ku-inthanethi kungasiza okwamanje, okubuye kube yindaba yokudlala online / okungaxhunyiwe ku-inthanethi (IKirály & Demetrovics, 2017).

Ukuthenga-ukuphazamiseka ukuthenga

Ukuthenga-ukuphazamiseka kokuthenga kuchazwe ngokuxakaniseka nokuthenga-ukuthenga, ukuncipha kokulawula ukuthengwa ngokweqile kwezinto, okuvame ukungadingeki futhi kungasetshenziswa, kanye nokuziphatha okungalungile kokuthenga okungaqondile. Ukucatshangelwa okuyisisekelo (njengoba kusikiselwe ku I-Fig. 1) kungabhekwa njengokufezekile uma kulawula ukuncipha kokuthenga, ukuthenga okubekwa kuqala ekuthengeni-ukuthenga, nokuqhubeka noma ukwanda kokuthenga kuchazwe njengezici eziyinhloko zokuphazamiseka kokuthenga (UGuerrero-Vaca et al., 2019; I-Weinstein, Maraz, Griffiths, Lejoyeux, ne-Demetrovics, ngo-2016). Uhlobo lokuziphatha luholela ekucindezelekeni okuphambili komtholampilo kanye nokulimazeleka ezindaweni ezibalulekile zokusebenza (inqubo 1) kufaka phakathi ukuncishiswa okukhulu kwekhwalithi yempilo nobudlelwano bomuntu kanye nokuqongelela isikweletu (cf., UMüller, uBrand, et al., 2019). Ezihlokweni zakamuva ezikhathazayo ngokuthenga, ukuthenga imibono, imiqondo nemiqondo yocwaningo lokulutha (i-2), kufaka phakathi, isibonelo, izindlela ezihambisana nezinqubo ezibandakanya ukubuyiselwa emuva nokulangazelela kanye nokucekelwa phansi kokulawulwa okuphezulu kanye nokwenza izinqumo ezingezinhle. (Umkhiqizo, Wegmann, et al., 2019; UKyrios et al., 2018; I-Trotzke, i-Brand, ne-Starcke, i-2017). Ubufakazi bokuba semthethweni kwemibono yocwaningo lokulutha (inkomba 3) ekuthengeni ukuphazamiseka kokuthenga luvela ezifundweni ezinkulu (IMaraz, i-Urban, neDemetrovics, ngo-2016; UMaraz, van den Brink, namaDemetrovics, 2015), izifundo zokuhlola (Jiang, Zhao, & Li, 2017; UNicolai, uDarancó, noMoshagen, 2016), izifundo ezihlola (zifuna ukwelashwa) abantu abanezinyathelo zokubika nezokuziphatha (UDerbyshire, uChamberlain, u-Odlaug, uSchreiber, noGrant, ngo-2014; IGranero et al., 2016; UMüller et al., 2012; UTrotzke, uStarcke, uPedersen, uMüller, noBrand, 2015; UVoth et al., 2014), izimpendulo zokuziphatha kwesikhumba kokuthena izinto zokuthenga (I-Trotzke, i-Starcke, i-Pedersen, ne-Brand, i-2014), nesifundo esisodwa se-neuroimaging (URaab, Elger, Neuner, noWeber, 2011). Ngokusekelwa kobufakazi obubuyekeziwe maqondana nenqubo emithathu yokuphakanyiswa kwe-meta ehlongozwayo, siphakamisa ukuthi ukuphazamiseka kokuthenga kungathathwa njengenye “inkinga echaziwe ngenxa yokuziphatha okuhle” (UMüller, uBrand, et al., 2019), kuze kuthathwe njengebhizinisi lakho ekubuyekezweni okuzayo kwe-ICD. Ngokunikezwe ukuthi kukhona futhi ubufakazi bokuthi umehluko ku-phenomenology phakathi kokuziphatha okungaxhunyiwe ku-inthanethi nokuthenga online (UMüller, uSteins-Loeber, et al., 2019; I-Trotzke, i-Starcke, i-Müller, ne-Brand, i-2015), lapho ukuthenga kokugula kubhekwa njengokuziphatha okuluthayo, kungahle kube usizo ukuhlukanisa phakathi kokugula okuthenga, okungaxhunyiwe ku-inthanethi noma online, ukuhambisana nokuphazamiseka kokugembula kanye nemidlalo e-ICD-11, yize le ndlela ibilokhu kupikiswane, njengoba kushiwo ngenhla (IKirály & Demetrovics, 2017).

Ukuphazamiseka kokusetshenziswa kwenethiwekhi

Ukucatshangelwa kokusetshenziswa okuyinkinga kwamanethiwekhi okuxhumana nomphakathi kanye nezinye izinhlelo zokusebenza zokuxhumana njengesimo esingahambisana nenqubo "yokuphazamiseka okuchaziwe ngenxa yokuziphatha okuluthayo" kufanelekile futhi kusenesikhathi. Ukulawulwa okunqunyelwe ukusetshenziswa kwamanethiwekhi wokuxhumana nabantu, ukwandisa okubekwe kuqala ekusebenziseni amanethiwekhi omphakathi, nokuqhubeka kokusebenzisa amanethiwekhi omphakathi yize uhlangabezana nemiphumela emibi (ukucatshangelwa okuyisisekelo I-Fig. 1) kubhekwe njengezici eziyinhloko zokusebenzisa okuyinkinga zokuxhumana nomphakathi (U-Andreassen, i-2015), noma bukhona ubufakazi obuqakathekile maqondana nezici ezithile zokusetshenziswa okuyinkinga kwenethiwekhi yokuxhumana nabantu kuxubile futhi kusalokhu kuqhathaniswa, ngokwesibonelo, ukuphazamiseka kwemidlalo (I-Wegmann & Brand, 2020). Ukulimazeka okusebenzayo empilweni yansuku zonke ngenxa yokuziphatha (umbandela 1) kusabhalwe phansi ngokuqinile kakhulu kunakwezinye izimilo zokuziphatha. Olunye ucwaningo lubika imiphumela emibi ezizindeni ezahlukahlukene zokuphila ezivela ekusetshenzisweni kabi kwezilawuliwe, njengezingosi zokuxhumana nabantu, ngabantu abathile (IGuedes, iNardi, iGuimarães, iMachado, neKing, ngo-2016; IKuss & Griffiths, 2011). Ngokusho kokuhlaziywa kwe-meta, ukubuyekezwa okuhleliwe, kanye nezifundo ezimele izwe lonke, ukusetshenziswa ngokweqile kwezingosi zokuxhumana nabantu nge-inthanethi kungahle kuhlotshaniswe nokuphazamiseka kwempilo yengqondo, ukuhlupheka kwengqondo, kanye nokuncipha kwenhlala-kahle (Bányai et al., 2017; UFrost noRickwood, 2017; IMarino, iGini, iVieno, neSpada, ngo-2018). Yize imiphumela emibi yokusetshenziswa okungalawulwa kahle kwenethiwekhi yokuxhumana nomphakathi ingabaluleka futhi ixhumeke ekulimazelweni kokusebenza (IKaraiskos, iTzavellas, iBalta, nePaparrigopoulos, ngo-2010). Ukushumeka kwethiyori (isihlokwana 2), kepha, ngaphakathi kohlaka lomlutha (UBillieux, uMaurage, uLopez-Fernandez, uKuss, noGriffiths, 2015; UTurel noQahri-Saremi, 2016; I-Wegmann & Brand, 2019). Izifundo eziningana ze-neuroimaging kanye nokuziphatha (inkomba 3) zibonisa ukufana phakathi kokusetshenziswa ngokweqile kwezingosi zokuxhumana nabantu nokusebenzisa kabi izidakamizwa, ukugembula nezinkinga zemidlalo (cf., Wegmann, Mueller, Ostendorf, & Brand, 2018), kufaka phakathi okutholakele ocwaningweni lokuhlola kokusebenza kwe-cue (Wegmann, Stodt, & Brand, 2018), control inhibitory (Wegmann, Müller, Turel, & Brand, 2020), nokukhetha okubambekayo (I-Nikolaidou, iStanton, neHinvest, 2019) kanye nemiphumela yokuqala evela kusampula yezempilo (Leménager et al., 2016). Ngokuphambene nalokho, ezinye izifundo zabika idatha yokuqala esekela ukugcinwa kwe-lobe esebenza phambili kubantu ababonisa ukusetshenziswa ngokweqile kwe-network yokuxhumana nabantu (Yena, Turel, & Bechara, 2017; UTurel, He, Xue, Xiao, & Bechara, 2014). Ngaphandle kobufakazi obungenakucaciswa kanye nokutholakele okuxubile (isib. Izifundo ze-neuroscience), kungenzeka ukuthi izindlela ezibalulekile ezibandakanyeka ekusebenzeni kwe-pathological zokuxhumana nomphakathi kungenzeka zifaniswe nalezi ezibandakanyeka ekuphazamisekeni kwemidlalo, yize lokhu kudinga ukuphenywa okuqondile. Ubufakazi maqondana nokulimazeka okusebenzayo empilweni yansuku zonke nokutholakele ocwaningweni oluyindlela ezahlukahlukene kubandakanya amasampula emitholampilo okwamanje akukholakali ngokuqhathaniswa nenkinga yokusebenzisa kabi izithombe zobulili ezingcolile kanye nokuphazamiseka kokuthenga. Noma kunjalo, isigaba se-ICD-11 "okunye ukuphazamiseka okucacisiwe ngenxa yokuziphatha okuhle” ukusetshenziswa okungalawulwa kahle kwezokuxhumana nabantu. Kodwa-ke, izifundo eziningi, ezibandakanya amasampula emitholampilo, ziyadingeka ngaphambi kokuba kufinyelelwe esivumelwaneni sokugcina mayelana nokuqina kwesigaba 6C5Y sokungalawulwa kahle kwezingosi zokuxhumana nabantu.

Isiphetho

Ukusungula izindlela ezivunyelwe lapho kucatshangwa ukuthi yiziphi izindlela zokuziphatha ezingabonakala njengezinye “izinkinga ezichaziwe ngenxa yokuziphatha okuluthayo” kuyasiza ocwaningweni kanye nasenkambisweni yemitholampilo. Kubalulekile ukuthi ungaziphathi ngokweqile kokuziphatha kwansuku zonke (UBillieux, uSchimmenti, et al., 2015; Kardefelt-Winther et al., 2017) ngenkathi ucubungula kanyekanye izimo ezingaba khona ezihambisana nokukhubazeka (Billieux et al., 2017). Ngalesi sizathu, lapha sibheke izimo ezihambisana nesigaba se-ICD-11 esibhalwe njengo-6C5Y futhi esingaphakamisanga ukuphazamiseka okusha. Amacala emhlabeni jikelele cishe azothatha isinqumo ngokuhlukile ukuthi angayisebenzisa kanjani i-ICD-11 ngakho-ke angacacisa ukufakwa kwamakhodi ngaphakathi kwezigaba ezithile ze-ICD-11. Ocwaningweni, kubalulekile ukufinyelela esivumelwaneni samazwe omhlaba maqondana nokubhekelelwa kwezifo ezithile. Ngakho-ke siphakamisa lezi zindlela ezisezingeni eliphakeme ze-meta zokubheka ukuphazamiseka okungalungela isigaba 6C5Y. Siyaphinda futhi, sithi kubalulekile ukuthi siqaphele ngokwanele lapho sisebenzisa igama elithi “izimilo zokuziphatha,” okusho ukusebenzisa leli gama kuphela ezimeni zokuziphatha lapho kunobufakazi obuqinile besayensi. Kuzo zonke izimo, kubalulekile ukucubungula ukulimala okusebenzayo empilweni yansuku zonke, ukuhlukanisa ukubandakanyeka kokuziphatha okujwayelekile emaphethini wokuziphatha okugcwalisa imibandela yokuphazamiseka ngenxa yokuziphatha okuluthayo. Lokhu kubaluleke kakhulu ukuze kunganciphisi izimo ezibalulekile emtholampilo futhi ezifanele ukucatshangelwa kwezempilo yomphakathi. Sigqugquzela ukuqhutshwa kwezifundo ezengeziwe ngemibandela ebhekwe kumasampula abamele ngezinyathelo ezizwakalayo zezimo ezithile kanye nokusetshenziswa kokuhlola umsindo kokuncipha kanye nokuhambelana komtholampilo. Ngaphezu kwalokho, siphakamisa ucwaningo olwengeziwe oluqhathanisa ngqo izinqubo zengqondo nezokusebenza kwengqondo ezinobungozi ezibandakanyeka ezinhlotsheni ezihlukile zokuziphatha okuluthayo okuhlongozwayo.

Izingxabano zezintshisekelo

I-JB, ZD, NAF, DLK, i-SWK, i-KM, i-MNP, ne-HJR babe ngamalungu e-WHO noma amanye amanethiwekhi, amaqembu ochwepheshe noma amaqembu okueluleka ngokuziphatha okuluthayo. I-ZD, NAF, DLK, MNP, ne-HJR zingamalungu noma izibukeli ze-COST Action 16207 "I-European Network for Mathematics Use of Internet". I-AEG, NAF, ne-MNP ithole izibonelelo / uxhaso / ukusekelwa kwabamabhizinisi, abezomthetho noma ezinye izinhlaka (zebhizinisi) ezibandakanya ukubonisana.

Iminikelo yabalobi

I-MB ne-MNP babhala lo mbhalo wesandla. Bonke ababhali ababambisene nabo banikele ngezimvo kusalungiswa. Okuqukethwe kwalo mbhalo kudingidwe ngakho futhi kwavunywa yibo bonke ababhali.

UkuvumaLe ndatshana / ukushicilelwa kusekwe phezu komsebenzi kusuka ku-COST Action CA16207 "Inethiwekhi YaseYurophu Yokusebenzisa Inkinga ye-Inthanethi", esekelwa yi-COST (I-European Cooperation in Science and Technology), www.cost.eu/.

Okubhekwayo

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  • Antons, S., & Brand, M. (2018). Isici kanye nokugxila kwesimo kwabesilisa abathanda ukuthambekela ekusetshenzisweni kwe-inthanethi-ngezithombe zocansi. Izithako zokulutha, 79, 171-177. https://doi.org/10.1016/j.addbeh.2017.12.029.

  • Antons, S., Mueller, SM, Wegmann, E., I-Trotzke, P., Schulte, MM, & Brand, M. (2019). Izici zokuxoshwa kanye nezici ezihlobene ziyahlukanisa phakathi kokuzijabulisa nokungalawulwa kokusebenzisa izithombe zobulili ezingcolile kwe-Intanethi. I-Journal of Addictions of Behavioral, 8, 223-233. https://doi.org/10.1556/2006.8.2019.22..

  • Antons, S., I-Trotzke, P., Wegmann, E., & Brand, M. (2019). Ukuxhumana kokunxanela nezitayela ezisebenzayo zokukopisha emadodeni angathandani naye ngamazinga ahlukile wokusetshenziswa okungalawulwa kwe-Intanethi-nezithombe zocansi. Ubuntu kanye nokuhluka komuntu ngamunye, 149, 237-243. https://doi.org/10.1016/j.paid.2019.05.051.

  • Bányai, F., UZsila, Á., I-Király, O., maraz, A., Ama-Elekes, Z., Griffiths, MD, (2017). Ukusetshenziswa okuyinkinga kwemidiya yezenhlalo: Imiphumela evela kusampula yonyaka yabamele isizwana esikhulu. PloS One, 12, e0169839. https://doi.org/10.1371/journal.pone.0169839.

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