scholarly journals Minor psychiatric disorders and their associations in family caregivers of people with mental disorders

2017 ◽  
Vol 22 (11) ◽  
pp. 3567-3578 ◽  
Author(s):  
Carlos Alberto dos Santos Treichel ◽  
Vanda Maria da Rosa Jardim ◽  
Luciane Prado Kantorski ◽  
Aline dos Santos Neutzling ◽  
Michele Mandagará de Oliveira ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Family Caregivers ◽  
Linear Trend ◽  
Trend Test ◽  
P Value ◽  
Test Statistic ◽  
Cross Sectional ◽  
Self Reporting Questionnaire ◽  
Minor Psychiatric Disorders

Abstract This study aims to analyze the occurrence of minor psychiatric disorder and their associations in relatives of people with mental disorders. This is a cross-sectional study of 1164 relatives. For the tracking of minor psychiatric disorders the Self-Reporting Questionnaire Scale (SRQ20) was used, adopting 6/8 as cut-off point. Bivariate analyzes were conducted using Chi-squared test. Trends among strata of independent variables were investigated in relation to the outcome using nonparametric linear trend test. Statistic significance was defined as p-value < 0.05. Crude and adjusted binary logistic regressions were conducted using as a basis the hierarchical model developed through a systematic literature review. It was observed in the population a prevalence of 46.9% for minor psychiatric disorders. Higher prevalence of minor psychiatric disorders were strongly associated with the female gender, older age, first degree family ties, not having a paid work, lower education level, lower income, health problems, lower quality of life and feeling of burden. Many factors are related to the emotional and mental illness of family caregivers, demanding health services to be prepared to recognize and intervene in these situations.

scholarly journals Clustering of minor psychiatric disorders and burden among family caregivers of individuals with mental illness

2016 ◽  
Vol 21 (2) ◽  
pp. 585-590 ◽  
Author(s):  
Carlos Alberto dos Santos Treichel ◽  
Vanda Maria da Rosa Jardim ◽  
Luciane Prado Kantorski ◽  
Mariana Luchese Vasem ◽  
Aline dos Santos Neutzling
Keyword(s):  
Mental Illness ◽  
Psychiatric Disorders ◽  
Family Caregivers ◽  
Psychosocial Care ◽  
Information Criterion ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Self Reporting Questionnaire ◽  
The Relationship ◽  
Minor Psychiatric Disorders

Abstract The objective of this cross-sectional study is to analyze the relationship between minor psychiatric disorders, burden and other associated factors among family caregivers of people with mental disorders. The study was conducted with 1164 relatives of users of the Centers for Psychosocial Care in southern Brazil, and for screening of minor psychiatric disorders, the Self-Reporting Questionnaire (SRQ20) scale was used, based on its Brazilian validation with an adopted cutoff point of 6/8. Even though previous studies have appointed the burden arising from care as protagonist in the presentation of minor psychiatric disorders, a clustering based on log-likelihood by Bayesian Information Criterion conducted in this study found that burden is not the only possible predictor for emotional/mental illness, suggesting that other factors permeate this relationship. Thus, bivariate analyzes were conducted, in which the influence of variables such as health problems, work issues, among others, can be observed in different groups arranged by the cluster.

scholarly journals Prevalence and factors associated with minor psychiatric disorders in hospital housekeeping workers*

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Cintia da Silva Marconato ◽  
Ana Carolina de Souza Magnago ◽  
Tânia Solange Bosi de Souza Magnago ◽  
Graziele de Lima Dalmolin ◽  
Rafaela Andolhe ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Health Workers ◽  
Leisure Activities ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Factors Associated ◽  
Study Population ◽  
Self Reporting Questionnaire ◽  
Minor Psychiatric Disorders

Abstract OBJECTIVE Investigating the prevalence and factors associated with minor psychiatric disorders (MPDs) in Hospital housekeeping workers. METHOD A cross-sectional study carried out in 2013 with workers from the cleaning service of a public university hospital in Rio Grande do Sul, Brazil. Data were collected through a form containing sociodemographic, occupational, habits and health variables. The Self-Reporting Questionnaire-20 was used in order to evaluate MPDs. RESULTS The study population consisted of 161 workers. The overall prevalence of suspected MPD was 29.3%. The chances of suspected MPDs were higher in workers with Effort-Reward Imbalance, those who did not have time or who occasionally had time for leisure activities, and those taking medications. CONCLUSION The prevalence of MPDs was similar to that found in the literature for health workers. Therefore, we consider it important to include these workers in institutional programs for continuing health education.

scholarly journals Psychosocial stress and minor psychiatric disorders among Agentes Socioeducadores

2012 ◽  
Vol 20 (5) ◽  
pp. 971-979 ◽  
Author(s):  
Patrícia Bitencourt Toscani Greco ◽  
Tânia Solange Bosi de Souza Magnago ◽  
Luis Felipe Dias Lopes ◽  
Andrea Prochnow ◽  
Juliana Petri Tavares ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Psychosocial Stress ◽  
High Strain ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Social ◽  
Self Reporting Questionnaire ◽  
Demand Control ◽  
Minor Psychiatric Disorders

OBJECTIVE: to ascertain the association between psychosocial stress and the occurrence of Minor Psychiatric Disorders in agentes socioeducadores. METHOD: a cross-sectional study with 381 agentes socioeducadores from the Centros de Atendimento Socioeducativo in the Brazilian state of Rio Grande do Sul, in 2011. Brazilian versions of the social demand-control-support at work scale were used, and of the Self Reporting Questionnaire-20. RESULTS: the prevalence of minor psychiatric disorders was 50.1%. The chances of being classified with such a disorder were higher in the high strain work quadrant (OR=2.05; CI95%=1.03-4.09) and active work quadrant (OR=1.99; CI95%=1.09-3.63) when compared to that of low strain, after adjustment for potentially confusing factors. CONCLUSION: there is a positive association between psychosocial stress (high strain and active work) and minor psychiatric disorders among agentes socioeducadores. In order to prevent mental illness among these workers, the planning of health promotion actions is necessary.

scholarly journals Patterns of minor psychiatric disorders among battered women treated at an emergency care unit

2008 ◽  
Vol 24 (9) ◽  
pp. 2103-2114 ◽  
Author(s):  
Iracema Viterbo Silva ◽  
Estela Maria Aquino
Keyword(s):  
Psychiatric Disorders ◽  
Battered Women ◽  
Emergency Care ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Face To Face ◽  
Self Reporting Questionnaire ◽  
Minor Psychiatric Disorders

The aim of this cross-sectional study was to describe the patterns in minor psychiatric disorders among women who suffered different types of violence. Using a version of the Abuse Assessment Screen, face-to-face interviews were conducted in a cluster sample of women ages 15 to 49 years using an emergency care hospital. Women's mental status was assessed with a version of the Self-Reporting Questionnaire (SRQ-20). From a total of 273 women, 77.3% (95%CI: 78.2-82.2) scored 7 or more on the SRQ-20, indicating the presence of psychiatric illness. The findings suggest that women who had experienced more than one type of violence (PR = 1.31; 95%CI: 1.11-1.56) and who had been battered in the previous 12 months (PR = 1.30; 95%CI: 1.08-1.58) were more likely to suffer minor mental disorders. The results show a positive association between violence and mental illness, suggesting the need for more effective measures in the care of victims, such as the creation of institutional nets to guarantee comprehensive care for women.

HUBUNGAN ANTARA UMUR DAN PENDIDIKAN IBU DENGAN KEJADIAN BBLR DI RUMAH SAKIT UMUM PUSAT DR. MOHAMMAD HOESIN PALEMBANG TAHUN 2010

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Yuhemy Zurizah Yuhemy Zurizah ◽  
Rini Mayasari Rini Mayasari
Keyword(s):  
General Hospital ◽  
Maternal Age ◽  
Public Hospitals ◽  
Infant Mortality Rate ◽  
P Value ◽  
Check List ◽  
Test Statistic ◽  
Chi Square ◽  
Cross Sectional ◽  
Live Births

ABSTRACT Low Birth Weight (LBW) was defined as infants born weighing less than 2.500 grams. WHO estimates that nearly all (98%) of the five million neonatal deaths in developing countries. According to City Health if Palembang Departement, infant mortality rate (IMR) in the year 2007 is 3 per 1000 live births, in 2008 four per 1000 live births, and in 2009 approximately 2 per 1000 live births. The cause of LBW is a disease, maternal age, social circumstances, maternal habits factors, fetal factors and environmental factors. LBW prognosis depending on the severity of the perinatal period such as stage of gestation (gestation getting younger or lower the baby's weight, the higher the mortality), asphyxia / ischemia brain, respiratory distress syndromesmetabolic disturbances. This study aims to determine the relationship between maternal age and educations mothers of pregnancy with the incidence of LBW in the General Hospital Dr Center. Mohammad Hoesin Palembang in 2010 This study uses the Analytical Ceoss Sectional Survey. The study population was all mothers who gave birth in public hospitals center Dr. Mohammad Hoesin Palembang in 2010 were 1.476 mothers gave birth with a large sample of 94 studies of maternal taken by systematic random sampling, ie research instument Check List. Data analysis was performed univariate and bivariate. The results of this study show from 94 mothers of LBW was found 45 people (47,9%) Which has a high risk age 26 LBW ( 27,7%) while the distance of low educations LBW (55,3%). From Chi-Square test statistic that compares the p value with significance level α = 0,05 showed a significant correlation between maternal age, where the p value = 0,002, of education mothers of pregnancy p value = 0,003 with LBW. In the general hospital center Dr. Mohammad Hoesin Palembang ini 2010. Expected to researches who will come to examine in more depth.   ABSTRAK Bayi Berat Lahir Rendah (BBLR) telah didefinisikan sebagai bayi lahir kurang dari 2.500 gram. WHO memperkirakan hampir semua (98%) dari 5 juta kematian neonatal di negara berkembang. Menurut Data Dinas Kesehatan Kota Palembang, Angka Kematian Bayi (AKB) pada tahun 2007 yaitu 3 per 1.000 kelahiran hidup, pada tahun 2008 4 per 1.000 kelahiran hidup, dan pada tahun 2009 sekitar 2 per 1.000 kelahiran hidup. Penyebab BBLR adalah penyakit, usia ibu, keadaan sosial, faktor kebiasaan ibu, dan faktor lingkungan. Prognosis BBLR tergantung dari berat ringannya masa perinatal misalnya masa gestasi (makin muda masa gestasi atau makin rendah berat bayi, makin tinggi angka kematian), asfiksia atau iskemia otak, sindrom gangguan pernafasan, gangguan metabolik. Penelitian ini bertujuan untuk mengetahui hubungan antara umur dan pendidikan ibu dengan kejadian BBLR di Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang Tahun 2010. Penelitian ini menggunakan survey analitik Cross sectional. Populasi penelitian ini adalah semua ibu yang melahirkan di Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang tahun 2010 sebanyak 1.476 ibu melahirkan dengan besar sampel penelitian 94 ibu melahirkan yang diambil dengan tehnik acak sistematik, instrumen penelitian yaitu check list. Analisis data dilakukan secara univariat dan bivariat. Hasil penelitian ini menunjukkan dari 94 ibu didapatkan kejadian BBLR 45 orang (47,9%) yang memiliki umur resiko tinggi 26 kejadian BBLR (27,7%) sedangkan yang pendidikan rendah 52 kejadian BBLR (55,3%). Dari statistik uji Chi-square yang membandingkan p value dengan tingkat kemaknaan α = 0,05 menunjukkan bahwa ada hubungan yang bermakna antara umur ibu p value (0,002) , pendidikan p value (0,003) dengan kejadian BBLR di Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang Tahun 2010. Diharapkan bagi peneliti yang akan datang untuk meneliti lebih mendalam.

scholarly journals Psychiatric morbidity among rural and slum female population: A comparative study

2016 ◽  
Vol 6 (2) ◽  
pp. 146 ◽  
Author(s):  
Jhunu Shamsun Nahar ◽  
Monami Haque ◽  
Nafia Farzana Chowdhury ◽  
M. M. A. Shalauddin Qusar ◽  
Wasima Rahman ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Rural Women ◽  
Stressful Life Events ◽  
Psychiatric Morbidity ◽  
Total Duration ◽  
Cross Sectional ◽  
Female Population ◽  
Rural Sample ◽  
Socio Demographic Factors ◽  
Self Reporting Questionnaire

<p><strong>Background:</strong> Psychiatric disorders are more prevalent among women than men worldwide. The lifetime risk of depres­sion and dysthymia are twice as common in women as men. Rural women usually undergoes more stressful situations and also scores more on stress scale than that of urban and slum population. <strong></strong></p><p><strong>Objectives:</strong> The research objectives of this study are: 1) To find out the prevalence of psychiatric disorders among the study population. 2) To compare the disorders among the rural and slum female population. 3) To find out the influence of existing socio-demographic factors on psychiatric disorders. <strong></strong></p><p><strong>Method:</strong> This is a community-based study, which is also cross sectional and descriptive in nature. The sample for the main study constituted 366 randomly selected respondents. A two-staged screening procedure was carried in the study. First, the total population was studied by screening test-Self Reporting Questionnaire (SRQ) to divide the sample into 'screen positive' and 'screen negative' subjects. In the second stage, full assessment of a mixture of all 'screen positive' and 25% 'screen negative' was carried out by structured clinical interview for diagnosis (SCID-NP). Later SCID filled by the respondents was assessed by consultant psychiatrists by using DSMIV in order to put exact clinical diagnosis. Stress was scored according to Presumptive Stressful Life Events Scale (PSLE). The total duration of the study was from July 2010 to June 2011. <strong></strong></p><p><strong>Results:</strong> Higher prevalence of psychiatric morbidity was found among rural sample (22.8%) than slum (10.90%) population. Regarding pattern of psychiatric disorders among rural sample (22.8%) than slum (10.9%) population.</p><p>See the PDF for the rest of the abstract.</p>

Underdiagnosis of psychiatric disorders in people with intellectual disabilities: Differences between psychiatric disorders and challenging behaviour

2018 ◽  
Vol 24 (3) ◽  
pp. 326-338 ◽  
Author(s):  
Carlos Peña-Salazar ◽  
Francesc Arrufat ◽  
Josep Manel Santos ◽  
Abel Fontanet ◽  
Gretel González-Castro ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Psychiatric Diagnosis ◽  
Cross Sectional Study ◽  
Assessment Tools ◽  
Challenging Behaviour ◽  
Cross Sectional ◽  
Intelligence Scale ◽  
Severely Handicapped ◽  
People With Intellectual Disabilities

Background and purpose: The purpose of this study was to assess the level of mental disorders and challenging behaviour in individuals with intellectual disability (ID) supported by specialized services, but without a prior psychiatric diagnosis, and to compare the levels of different disorders depending on the severity of ID. Methods: This is a cross-sectional study ( N = 142) of population with ID. Inclusion criteria were the following: adult patients with ID and with no previous psychiatric diagnosis prior to this survey. The Wechsler Adults Intelligence Scale-II, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist and clinical interview, the Diagnostic Assessment for the Severely Handicapped scale and the Inventory for Client and Agency Planning were the assessment tools. Results: A previously undiagnosed mental disorder was found in 29.6% of the sample. The most prevalent mental disorders were major depressive and anxiety disorders. An association between psychiatric comorbidity and challenging behaviour was found only for mild/moderate ID, especially for affective disorders. Conclusions: The presence of a psychiatric as well as a medical comorbidity is associated with severe ID, unlike challenging behaviour. Clinical limitations of the study have been discussed.

scholarly journals Hubungan Kesiapan Keluarga Menerima Klien Dengan Gangguan Jiwa Terhadap Angka Kekambuhan Pada Klien Gangguan Jiwa Di Poliklinik Rumah Sakit Jiwa Sambang Lihum Tahun 2018

2019 ◽  
Vol 10 (2) ◽  
pp. 745-457
Author(s):  
Muhammad Saputra
Keyword(s):  
Public Health ◽  
Health Care ◽  
Mental Disorders ◽  
P Value ◽  
Mental Impairment ◽  
Cross Sectional ◽  
Spearman Rank ◽  
The Family ◽  
Family Readiness ◽  
To Receive

Latar belakang : Gangguan jiwa merupakan salah satu masalah kesehatan masyarakat di Indonesia. Klien gangguan jiwa dicirikan dengan siklus kekambuhan yang mencapai 60-75% dari keseluruhan penderita. Kekambuhan klien masih tinggi dapat dipengaruhi faktor kesiapan keluarga dalam menerima klien gangguan jiwa.Tujuan Penelitian : Penelitian ini bertujuan untuk mengetahui hubungan kesiapan keluarga menerima klien dengan gangguan jiwa terhadap angka kekambuhan pada klien gangguan jiwa di Poliklinik Rumah Sakit Jiwa Sambang LihumMetode penelitian :  analitik dengan rancangan cross sectional. Populasi adalah seluruh keluarga (keluarga inti) klien gangguan jiwa di Poliklinik Rumah Sakit Jiwa Sambang Lihum yang berjumlah 1.751 orang. Sampel sebagian dari populasi sebanyak 97 orang dengan teknik pengambilan puposive sampling. Analisis data melalui uji Spearman Rank dengan tingkat kepercayaan 95%.Hasil penelitian Didapatkan keluarga klien gangguan jiwa sebagian besar siap dalam menerima klien gangguan jiwa sebanyak 77 orang (79,4%) dan angka kekambuhan klien gangguan jiwa sebagian besar kategori sedang sebanyak 65 orang (67%). Ada hubungan kesiapan keluarga dalam menerima klien dengan angka kekambuhan pada klien gangguan jiwa di Poliklinik Rumah Sakit Jiwa Sambang Lihum Provinsi Kalimantan Selatan (p value = 0,000; r = 0,744).Saran : rumah sakit hendaknya memberikan sosialisasi misalnya melalui kegiatan peningkatan home visite kepada keluarga pasien untuk meningkatkan kesiapan keluarga untuk menerima klien. Kata Kunci : Angka Kekambuhan, Kesiapan Menerima Klien.Background : Mental disorders is one of the problems of public health in Indonesia. The mental impairment client is characterized by a relapse cycle that reaches 60-75% of the sufferer. Client relapse is still high can be influenced by family readiness factor in receiving the client's mental disorders.Research objectives : PEnelitian aims to know the family readiness relationship to receive clients with a mental impairment on the number of relapse in Mental disorders in the clinic of mental illness in Sambang LihumResearch method :       cross sectional analytic. Population is the whole family (core family) of the clients of mental disorders in the polyclinic of the Sambang Lihum psychiatric hospital amounting to 1,751 people. Samples of a portion of the population of 97 people    with        puposive    samplingtechniques. Analysis of data by Test  Spearman Rank    with a trust rate of 95%.The results obtained by the family of mental disorders clients are mostly ready in receiving clients of mental disorders as much as 77 people (79.4%) and the number of mental impairment clients of most categories is currently 65 people (67%). There is a family readiness relationship in accepting clients with a number of relapse on the client's mental disorder in the clinic of health care Sambang Lihum South Kalimantan Province (P  value  = 0.000; r = 0.744).Suggestion : RHospital should provide socialization e.g. through  home visite   Improvement activities to the patient family to improve the family readiness to receive clients. Keywords: number of relapse, readiness of accepting clients

scholarly journals Leptospira spp. seroprevalence in humans involved in a cross-sectional study in Garissa and Tana River Counties, Kenya

2020 ◽  
Author(s):  
Arithi Mutembei ◽  
Festus K. Mutai ◽  
Damaris Mwololo ◽  
John Muriuki ◽  
Mark Obonyo ◽  
...  
Keyword(s):  
Case Fatality ◽  
Cross Sectional Study ◽  
Wilcoxon Test ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Sectional Study ◽  
Test Statistic ◽  
Cross Sectional ◽  
Tana River

AbstractIntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Leptospira genus. Humans get infected through direct or indirect contact with urine of infected animals or environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Costs of diagnosis and treatment for human and animals, disruption of international trade of animals and products, reduced productivity and reproductivity in animals constitute economic importance. In Kenya, leptospirosis burden is significant but under-diagnosis and under-reporting affects the awareness of the disease. This study aimed to determine and compare the sero-prevalence and factors associated with Leptospira spp. in the two counties.MethodsWe conducted a cross-sectional study that involved apparently healthy people of at least 5 years of age in randomly selected households in Garissa and Tana River Counties. Blood samples were collected and tested for Leptospira spp antibodies using IgM ELISA. Standardized structured questionnaires were administered to collect socio-demographic and exposure information. We calculated frequencies and proportions for categorical variables and odds ratios (OR) and 95% confidence interval (CI) to evaluate association between sero-positivity and exposure factors. We used Wilcoxon test to evaluate statistical difference in sero-positivity for continuous variables and calculated test statistic (H) and p-value.ResultsA total of 952 subjects were recruited into the study – these included 482 persons from Garissa and 470 from Tana River. The overall sero-prevalence was 26% [(244/952); (CI: 23% to 29%)]. Garissa County had significantly higher Leptospira spp. seroprevalence (31%, n = 147; CI: 27% to 35%) compared to Tana River County (21 %, n = 97; CI: 17% to 25%). Being a female (OR=1.6, CI: 1.2-2.2) and engaging in pastoralism (OR=2.7, CI: 1.8-3.9) were significantly associated with higher odds of Leptospira spp. seropositivity compared to being a male or working in irrigated areas. The mean altitude of residence of sero-positive patients was 73m ± 21 SD (standard deviation) above sea level and that for sero-negative was 80m ± 22 SD (H=35, p-value = 0.00).ConclusionThis study determined the seroprevalence and risk factors for Leptospira spp. exposure in Garissa and Tana River Counties, Kenya. Females in pastoral communities experience high burden of the disease. Enhanced surveillance in humans and animals and further research is required to understand the complex and multifactorial drivers of leptospirosis transmission in the two Counties.

scholarly journals Hubungan Beban Kerja Perawat Dengan Peran Perawat Anak Dalam Pendampingan Terapi Bermain

JKEP ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 104-113
Author(s):  
Ririn Nur Indah sari ◽  
Sari Windyastuti ◽  
Tri Sakti Widyaningsih
Keyword(s):  
Play Therapy ◽  
Sampling Technique ◽  
Rank Test ◽  
P Value ◽  
Test Statistic ◽  
Cross Sectional ◽  
Test Analysis ◽  
Spearman Rank ◽  
Nurse Workload

Nurse workload is very influential on child play therapy assistance caused by workload excessive workload, lack of facilities and infrastructure, nothing schedule for play therapy and the number of nurses  only 18 nurses, According to theory Gilles with the number of beds 34 needed 29 nurses. The purpose of this research is to know the Relationship of Nurse Workload with The Role of Child’s Nurse in Mentoring Play Therapy in Room Dahlia RSUD Dr. H Sewondo Kendal. This type of research is descriptive correlation with cross sectional. The sampling technique with total sampling, a sample is 18 respondents. Retrieval data using questionnaires and then tested into Spearman Rank test statistic. Based on research found 10 respondents (55,6%) have hard workload and 8 respondents (44,4%) have a light workload. The role of nurses in good categories 5 respondents (27,8%) and categories less is 13 respondents (72,2%). From result of Spearman Rank test analysis, get result of coefficient correlation value -868 in category very strong and obtained p value = 0,000 < 0,05 it’s mean Ha accepted and H0 rejected. There is a relantionship between the nurses workload with the role of child nurses in mentoring play therapy.

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