scholarly journals Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Tiago Ricardo Moreira ◽  
Luana Giatti ◽  
Cibele Comini Cesar ◽  
Eli Iola Gurgel Andrade ◽  
Francisco de Assis Acurcio ◽  
...  
Keyword(s):  
Health System ◽  
Marital Status ◽  
Formal Education ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Poor Health ◽  
Self Assessment ◽  
Cross Sectional ◽  
Unified Health System ◽  
Falling Asleep

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

scholarly journals Use of generic medicines by the Brazilian population: an evaluation of PNAUM 2014

2016 ◽  
Vol 50 (suppl 2) ◽  
Author(s):  
Andréa Dâmaso Bertoldi ◽  
Paulo Sergio Dourado Arrais ◽  
Noemia Urruth Leão Tavares ◽  
Luiz Roberto Ramos ◽  
Vera Lucia Luiza ◽  
...  
Keyword(s):  
Health System ◽  
Statistical Significance ◽  
Population Based ◽  
Cross Sectional Study ◽  
Education Level ◽  
Generic Medicines ◽  
Cross Sectional ◽  
Significance Level ◽  
Economic Class ◽  
Unified Health System

ABSTRACT OBJECTIVE To analyze the existence of differences in the use of generic medicines in Brazil according to demographic and socioeconomic variables and acquisition sources of the medicines. METHODS Population-based cross-sectional study, conducted with data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines). Data collection took place between September, 2013 and February, 2014 in homes of Brazilian cities (urban area). The use of medicines has been investigated in relation to the treatment of chronic diseases and, in the case of acute events, regarding use over the previous 15 days. Generics were identified by visualization of packaging presented by the users of the medicines. The independent variables used were sex, age, education level, economic class, and region of the Country. The statistical significance of differences between the groups was evaluated by Pearson’s Chi-squared test, considering a 5% significance level. RESULTS The prevalence of generic medicines use was 45.5% (95%CI 43.7–47.3). There was no difference considering education level. The prevalence was higher in females (47.0%; 95%CI 44.9–49.0) than in males (43.1%; 95%CI 40.5–45.8), and were higher with increasing age. Generic medicines were more used in the economic class C (47.0%; 95%CI 44.9–49.1) and in the South (50.6%; 95%CI 46.6–54.6) and Southeast (49.9%; 95%CI 46.8–53.0) regions. Generics accounted for 37.3% of the medicines provided by the Brazilian Unified Health System. CONCLUSIONS Currently, there is a choice of purchase or free provision by the Brazilian Unified Health System, characterized by quality assurance and reduced price regarding branded medicines considered as reference. In the private market, a considerable part of the population is choosing generic medicines thanks to the availability of this option for virtually all medicines most used by the population.

scholarly journals Prevalence and Associated Factors of Hypertension: A Community-Based Cross-Sectional Study in Municipalities of Kathmandu, Nepal

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Raja Ram Dhungana ◽  
Achyut Raj Pandey ◽  
Bihungum Bista ◽  
Suira Joshi ◽  
Surya Devkota
Keyword(s):  
Physical Activity ◽  
Alcohol Consumption ◽  
Associated Factors ◽  
Formal Education ◽  
Lifestyle Modification ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional

Objective. This study aimed to assess the prevalence and associated factors of hypertension in newly declared municipalities of Kathmandu, Nepal.Design, Settings, and Participants. This was a community-based cross-sectional study conducted in the municipalities of Kathmandu District, Nepal, between January and July 2015. Study participants were aged 18 to 70 years, residing permanently in the study sites. Municipalities, Wards, households, and respondents were selected randomly.Results. Of the 587 participants, 58.8% were females, mean (SD) age was 42.3 (13.5) years, 29.3% had no formal education, 35.1% were Brahmins, and 41.2% were homemakers. Prevalence of hypertension was 32.5% (95% CI: 28.7–36.3). Age, gender, education, ethnicity, occupation, smoking, alcohol consumption, physical activity, diabetes, menopausal history, and family history of cardiovascular disease (CVD) and hypertension were significantly associated with hypertension. In multivariable analysis, smoking, alcohol consumption, physical activity, body mass index, and diabetes were identified as significant explanatory variables for hypertension.Conclusion. This study demonstrated that the people living in newly established municipalities of Kathmandu, Nepal, have a high burden of hypertension as well as its associated factors. Therefore, community-based preventive approaches like lifestyle modification and early detection and treatment of hypertension might bring a substantial change in tackling the burden effectively.

scholarly journals Perception on Oral Health and Recommendations for Improvement of Public Service Dental

2019 ◽  
Vol 21 (1) ◽  
pp. 65
Author(s):  
Suzely Adas Saliba Moimaz ◽  
Carlos Ayach ◽  
Léa Lofego ◽  
Cléa Adas Saliba Garbin ◽  
Orlando Saliba
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health System ◽  
The Self ◽  
Service Improvement ◽  
Health Evaluation ◽  
Self Assessment ◽  
Cross Sectional ◽  
Significance Level ◽  
Unified Health System

A participação social é uma importante ferramenta para o aprimoramento do Sistema Único de Saúde (SUS), fortalece a instituição de processos de avaliação do desempenho e contribui para a ampliação do acesso e qualidade dos serviços prestados. O objetivo foi avaliar a percepção dos usuários sobre a saúde bucal e as recomendações para melhoria do serviço público odontológico. Trata-se de um estudo transversal, tipo inquérito, com 390 usuários do SUS. As variáveis analisadas foram: autoavaliação da saúde bucal; avaliação da equipe e do serviço odontológico prestado. Realizou-se análise qualitativa das questões discursivas e teste estatístico de associação Qui-Quadrado ou Teste G, ao nível de significância de 5%. A autoavaliação da saúde bucal foi categorizada em muito boa/boa, regular, ruim/muito ruim e os motivos identificados da classificação foram: presença de doença, cuidado com a saúde, dor, educação em saúde, negligência com a saúde, tempo e medo. Quanto à avaliação da equipe e do serviço foram feitas sugestões para a melhoria, relacionadas à: infraestrutura, acesso, humanização e educação em saúde. Constatou-se associação significativa entre o cuidado com a saúde e a percepção positiva da saúde bucal. A presença de doença, negligência, tempo e medo influenciaram negativamente na autoavaliação. Como recomendações para melhoria do atendimento, 15,4% dos entrevistados apontou a infraestrutura; 8,2% o acesso; 6,9% a humanização e 1% a educação em saúde. Conclui-se que o cuidado com a saúde foi o fator mais relacionado a uma boa saúde bucal. Houve poucas recomendações para o aprimoramento da qualidade e resolutividade do serviço prestado. Palavras-chave: Avaliação em Saúde. Autoavaliação. Saúde Bucal. Abstract Social participation is an important tool for the improvement of the Brazilian Unified Health System, strengthens the institution of performance evaluation processes and contributes to the expansion of access and quality of services provided. This study evaluated user’s perceptions on oral health and recommendations for improvement of public dental services. This is a cross-sectional study, type inquiry, with 390 users of the Brazilian Unified Health System. The analyzed variables were self-assessment of oral health, evaluation of the team and the dental service provided. A qualitative analysis of the discursive questions was performed and Chi-square or G-test statistical association test, at a significance level of 5%. The self-assessment of oral health was categorized as very good/good, regular, bad/very bad and the identified reasons for the classification were: presence of disease, health care, pain, health education, negligence in health, time and fear. As for team and service evaluation, suggestions for improvement concerning infrastructure, access, humanization and education in health were made. It was found a significant association between health care and positive perception of oral health. The presence of disease, neglect, time and fear  affected negatively the  self-assessment. The recommendations for service improvement, 15.4% interviewed users pointed to infrastructure; 8.2% access; 6.9% humanization and 1% education in health. It is concluded that healthcare was the most frequent factor associated with good oral health. There were few recommendations for quality improvement and outcome of service provided.Keywords: Health Evaluation. Self-Assessment. Oral Health.

scholarly journals Pregnancy complications in Brazilian puerperal women treated in the public and private health systems

2018 ◽  
Vol 25 (0) ◽  
Author(s):  
Patrícia Louise Rodrigues Varela ◽  
Rosana Rosseto de Oliveira ◽  
Emiliana Cristina Melo ◽  
Thais Aidar de Freitas Mathias
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Health System ◽  
Pregnancy Complications ◽  
White Women ◽  
Cross Sectional Study ◽  
Health Plans ◽  
Cross Sectional ◽  
Unified Health System

ABSTRACT Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System). The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%) were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection (23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001). Conclusion: the high prevalence of complications indicates the need for monitoring and preventing diseases during pregnancy, especially in the case of pregnant women with unfavorable sociodemographic characteristics.

scholarly journals Availability of dental treatment is associated with satisfaction derived from Primary Health Care Services accessed by elderly

2016 ◽  
Vol 45 (6) ◽  
pp. 344-350 ◽  
Author(s):  
Aline Blaya MARTINS ◽  
Creta SEIBT ◽  
Matheus NEVES ◽  
Juliana Balbinot HILGERT ◽  
Fernando Neves HUGO
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Care Services ◽  
Dental Treatment ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

Abstract Objective This research evaluated whether having dental treatment available in the primary health care centers of the Brazilian Unified Health System was associated with greater satisfaction with the services accessed. The offering of dental care within the health service that elders usually access may improve their satisfaction with the services as a whole. Material and method In this cross-sectional study, 401 elders living in the districts of Lomba do Pinheiro and Partenon in Porto Alegre, Brazil were interviewed. Elders were selected using a cluster sampling design process from census tract drawings. Result Poisson Regression revealed that age and dental treatment supply were associated with outcome, and age, number of teeth, and the presence of dental treatment were associated with a higher prevalence of satisfaction with health services. Conclusion These results provide new contributions for health system qualification because this study demonstrated the importance of having dental treatment available to improve the satisfaction of older people with the Primary Health Care (PHC) services accessed.

scholarly journals Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda Laitinen ◽  
Miina Nurmi ◽  
Päivi Rautava ◽  
Mari Koivisto ◽  
Päivi Polo-Kantola
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbances ◽  
Multivariable Analysis ◽  
Close Relation ◽  
Early Morning ◽  
Cross Sectional Study ◽  
Nausea And Vomiting ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
Falling Asleep

Abstract Background Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality. Methods Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011–2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis. Results According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79–8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20–9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep . Conclusions More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

scholarly journals COVID-19 hospitalizations in Brazil's Unified Health System (SUS)

2020 ◽  
Author(s):  
Carla Lourenço Tavares de Andrade ◽  
Claudia Cristina de Aguiar Pereira ◽  
Mônica Martins ◽  
Sheyla Maria Lemos Lima ◽  
Margareth Crisóstomo Portela
Keyword(s):  
Health System ◽  
Protective Factor ◽  
Secondary Data ◽  
Cross Sectional Study ◽  
Care Process ◽  
Independent Effect ◽  
Hospital Death ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Unified Health System

Objective: To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with hospital mortality related to the disease. Methods: Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in SUS, between the last days of February and June. Patients aged 18 years or older, with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization. Results: 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in SUS were predominantly male (56.5%), with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (STD=6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The chances of hospital death among men were 16.8% higher than among women and increased with age. Black individuals had a higher chance of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states had a higher risk of hospital death from COVID-19, such as Amazonas and Rio de Janeiro. The chances of hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants and being hospitalized in the municipality of residence was a protective factor. Conclusion: There was wide variation in hospital COVID-19 mortality in the SUS, associated with demographic and clinical factors, social inequality and differences in the structure of services and quality of health care.

scholarly journals Prevalence and factors associated to cervical changes in units from the Single Health System

2021 ◽  
Vol 42 ◽  
Author(s):  
Indianara Carlotto Treco ◽  
Valquíria Kulig Vieira ◽  
Janaína Carla da Silva ◽  
Fernando Rodrigo Treco ◽  
Lirane Elize Defante Ferreto ◽  
...  
Keyword(s):  
Health System ◽  
Oral Contraceptives ◽  
Pap Smear ◽  
Cross Sectional Study ◽  
Low Grade ◽  
Cross Sectional ◽  
Factors Associated ◽  
Unified Health System ◽  
Cervical Intraepithelial Lesion ◽  
Intraepithelial Lesion

ABSTRACT Objective: To estimate the prevalence and risk factors associated with cytopathological changes in the uterine cervix of women treated by the Unified Health System. Method: This is a cross-sectional study carried out with 350 women, between 14 and 79 years old who underwent pap smear tests in heath units in Francisco Beltrão, Paraná. Cervical cytopathological analyses and a questionnaire were applied to obtain socioeconomic information, as well as data on sexual behavior, gynecological aspects, and life habits. Chi-square test and logistic regression with p <0.05 were applied for statistical analysis. Results: The prevalence of cervical changes was 3.4% and the main categories found were low-grade cervical intraepithelial lesion, high-grade cervical intraepithelial lesion, and atypical cells of undetermined significance. From these, the first were present in 16.6% of women under 25 years old. The multivariate analysis pointed at associations between previous results of the cytopathology test (OR = 25.693), smoking (OR = 7.576), and oral contraceptives (OR = 5.265) and the outcome. Conclusion: Women with a history of previous cervical cytopathological abnormality, use of oral contraceptives, and smokers were more likely to have an abnormal result in the pap smear test.

scholarly journals Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM – Services data

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Silvana Nair Leite ◽  
Fernanda Manzini ◽  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Ediná Alves Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
System Analysis ◽  
Cross Sectional Study ◽  
Physical Structure ◽  
Pharmacy Services ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS: This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS: The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2 , while in 46.2% these areas were superior to 10m2 . Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION: Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities

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