scholarly journals Association between Time of Residence and OQ-45.2 and Self-Perception of Distress, Interpersonal Relationships, and Social Role in Venezuelan Immigrants in Lima, Peru 2018-19: Mixed-methods Study.

2022 ◽  
Author(s):  
Frank Milton Delgado-Cáceres ◽  
Kevin Angel Silva-Parra ◽  
Alejandra Torres-Slimming
Keyword(s):  
Mixed Methods ◽  
Interpersonal Relationships ◽  
Social Role ◽  
Cross Sectional Study ◽  
Mixed Methods Study ◽  
Central Component ◽  
Self Perception ◽  
Cross Sectional ◽  
Clinically Significant ◽  
Migratory Status

Abstract BackgroundImmigrants arriving in a new country face changes that affect their social, employment, and migratory status. We carried out a mixed methods study in the rapidly growing Venezuelan immigrant population in Lima, Peru. The objective was to determine whether there was an association between time in Peru and self-perception of symptom distress (SD), interpersonal relationships (IR), and social role (SR). MethodsThe quantitative central component consisted of a cross-sectional study, surveying 152 participants using the Outcome Questionnaire 45.2 (OQ-45.2). The qualitative component, based on phenomenology, explored experiences and challenges during the migration process. Semi-structured in-depth interviews were done in 16 informants.ResultsAn association that was observed was the increase in the risk of clinically significant SR score with additional years of age. All informants mentioned having witnessed or experienced xenophobia in Peru. Every informant stated that significant labor differences existed between the countries. The most reported somatic symptoms were symptoms of anxiety and alterations of sleep. Additionally, no informant expressed a desire to remain in Peru long term. ConclusionsA minority of participants registered a clinically significant total and domain score. No association between months in Lima and the self-perception of distress was found. However, this could be due to the short amount of time spent in Peru and any change in self-perception might only be perceived after years or decades spent in Peru. This study is one of the first to use mixed methods to explore the mental health of the immigrant Venezuelan population.

scholarly journals Why women choose at-home abortion via teleconsultation in France: drivers of telemedicine abortion during and beyond the COVID-19 pandemic

2021 ◽  
pp. bmjsrh-2021-201176
Author(s):  
Hazal Atay ◽  
Helene Perivier ◽  
Kristina Gemzell-Danielsson ◽  
Jean Guilleminot ◽  
Danielle Hassoun ◽  
...  
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Medical Abortion ◽  
Cross Sectional Study ◽  
Mixed Methods Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Individual Level ◽  
Manifest Content ◽  
At Home

ObjectivesIn an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel, convergent, mixed-methods study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with the WoW helpdesk from France.FindingsWe found that women encounter macro-level, individual-level and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (n=356, 46.2%), privacy (n=295, 38.3%) and comfort (n=269, 34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (n=236, 30.6%). The lockdowns had a significant impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multidimensional and go beyond the conditions unique to the pandemic.

scholarly journals Concepções sobre o envelhecimento na ótica de discentes e docentes universitários/ Conceptions on aging from the views of university students and teachers

2020 ◽  
Vol 4 (6) ◽  
pp. 950-967
Author(s):  
Janayna De Almeida Andrade ◽  
Julia Guimaraes Reis da Costa ◽  
Andrezza Marques Duque
Keyword(s):  
Healthy Aging ◽  
Social Role ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Self Perception ◽  
Cross Sectional ◽  
University Professors ◽  
The Social ◽  
Las Mujeres ◽  
Structured Questionnaire

Introdução: O aumento constante da população brasileira traz desafios para toda a sociedade, considerando o papel social que antes o idoso não tinha. Sendo essa discussão imprescindível principalmente pela demanda, que tende a crescer cada vez mais, em relação aos idosos no ambiente da saúde. Objetivo: Analisar a concepção de discentes e docentes universitários sobre aspectos do envelhecimento. Metodologia: Estudo descritivo, quantitativo, de corte transversal. A coleta foi realizada através de um questionário estruturado e um instrumento padronizado, de natureza multidimensional que verifica a autopercepção do envelhecimento a partir de dimensões que envolvem características do envelhecimento. Resultados: Dos entrevistados, 79,67% eram discentes e 20,33% docentes. Dos docentes, predominou mulheres, média de idade 36,02 anos, católicos e casados. Quanto aos discentes, mulheres, idade média 24,20 anos, católicos, solteiros e renda de 1-2 salários mínimos. Foi possível perceber que os participantes tiveram uma autopercepção positiva acerca do processo de envelhecimento. Todas as mudanças foram experimentadas pelos participantes, tendo evidência ansiedade, problemas com o peso e o sono, no entanto, a maioria não foi associada especificamente ao fato de estar envelhecendo. Conclusões: Os participantes apresentaram uma boa autopercepção sobre aspectos do envelhecimento, o que é relevante por ser um bom preditor do envelhecimento saudável. Esse estudo ratifica a necessidade de pesquisas sobre o envelhecimento nos cursos de graduação em saúde, tal como previsto nas principais diretrizes e políticas brasileiras.Palavras-chave: Envelhecimento, Percepção, Docentes, Estudantes, Estudos Transversais.Abstract: Introduction: The constant increase of the Brazilian population brings challenges for the whole society, considering the social role that the elderly did not have before. This discussion being essential mainly due to the demand, which tends to grow more and more, in relation to the elderly in the health environment. Objective: To analyze the conception of students and university professors about aspects of aging. Methodology: Descriptive, quantitative, cross-sectional study. The collection was carried out through a structured questionnaire and a standardized instrument, of a multidimensional nature that verifies the self perception of aging from dimensions that involve characteristics of aging. Results: Of the interviewees, 79.67% were students and 20.33% were teachers. Among the teachers, women predominated, with an average age of 36.02 years, Catholics and married people. As for students, women, average age 24.20 years, Catholics, singles and income of 1-2 minimum wages. It was possible to notice that the participants had a positive self perception about the aging process. All changes were experienced by the participants, with evidence of anxiety, problems with weight and sleep, however, most were not specifically associated with the fact of aging. Conclusions: The participants had a good perception of aspects of aging, which is relevant for being a good predictor of healthy aging. This study confirms the need for research on aging in undergraduate health courses, as provided for in the main Brazilian guidelines and policies.Keywords: Aging, Perception, Teachers, Students, Cross-Sectional Studies.Resumen: Ntroducción: El aumento constante de la población brasileña presenta desafíos para toda la sociedad, considerando el papel social que los ancianos no tenían antes. Esta discusión es esencial principalmente debido a la demanda, que tiende a crecer cada vez más, en relación con las personas mayores en el entorno de la salud. Objetivo: Analizar la concepción de estudiantes y profesores universitarios sobre aspectos del envejecimiento. Metodología: Estudio descriptivo, cuantitativo, transversal. La recolección se realizó a través de un cuestionario estructurado y un instrumento estandarizado, de naturaleza multidimensional que verifica la autopercepción del envejecimiento a partir de dimensiones que involucran características del envejecimiento. Resultados: De los entrevistados, el 79.67% eran estudiantes y el 20.33% eran maestros. Entre los maestros, predominaban las mujeres, con una edad promedio de 36.02 años, católicos y casados. En cuanto a estudiantes, mujeres, edad promedio 24.20 años, católicos, solteros e ingresos de 1-2 salarios mínimos. Fue posible notar que los participantes tenían una autopercepción positiva sobre el proceso de envejecimiento. Todos los cambios fueron experimentados por los participantes, con evidencia de ansiedad, problemas con el peso y el sueño, sin embargo, la mayoría no se asociaron específicamente con el hecho del envejecimiento. Conclusiones: Los participantes tenían una buena autopercepción de los aspectos del envejecimiento, lo cual es relevante para ser un buen predictor del envejecimiento saludable. Este estudio confirma la necesidad de investigación sobre el envejecimiento en los cursos de pregrado en salud, como se prevé en las principales directrices y políticas brasileñas.Palabras clave: Envejecimiento, Percepción, Maestros, Estudiantes, Estudios transversales.

scholarly journals Satisfaction of Malaria Patients with Care by Community Health Workers Trained in Microscopy: A Mixed-Methods Study in Palawan, the Philippines

2021 ◽  
Author(s):  
Emilie Louise Akiko Matsumoto-Takahashi ◽  
Pilarita Tongol-Rivera ◽  
Elena Andino Villacorte ◽  
Ray Uyaan Angluben ◽  
Masamine Jimba ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Household Wealth ◽  
Cross Sectional Study ◽  
The Philippines ◽  
Mixed Methods Study ◽  
Sectional Study ◽  
Cross Sectional

Palawan is the malaria-endemic province with the highest prevalence of malaria in the Philippines, and microscopists (community health workers) have been allowed to deliver early diagnosis and prompt treatment of malaria throughout the province since 1999. To improve the quality of care, the present mixed-methods study attempted to identify the factors associated with satisfaction of patients in Palawan with their microscopists by analyzing the patients’ perspectives. First, a quantitative cross-sectional study was conducted among 48 ex-patients and their nine microscopists. Ex-patients were asked about their satisfaction with care, and microscopists were asked about their job satisfaction and ability. Structural equation modeling was conducted for data analysis. Second, a qualitative cross-sectional study was performed using narrative interviews. Data were analyzed using the NVivo 10 software program. As a result, both studies revealed high patient satisfaction with microscopists. The quantitative study showed that ex-patients’ satisfaction with their microscopists was independently enhanced by two factors: high ability in malaria microscopic observation and low household wealth of the patients. Particularly, specific subpopulations (those with lower household wealth, relatively old people, and ethnic minorities) were more satisfied with the microscopists’ care. The qualitative study strengthens this finding by showing that their microscopists offered prompt and precise diagnosis and effective treatment for free. In conclusion, microscopists were shown to have an important role in narrowing the disparities in malaria care in Palawan. It is important to maintain/enhance the ability of microscopists in malaria microscopy to satisfy their patients.

scholarly journals The Cultural Diversity of Dementia Patients and Caregivers in Primary Care Case Management: a Pilot Mixed Methods Study

2021 ◽  
Vol 24 (3) ◽  
pp. 184-194
Author(s):  
Xin Qiang Yang ◽  
Isabelle Vedel ◽  
Vladimir Khanassov
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Case Management ◽  
Cultural Diversity ◽  
Cross Sectional Study ◽  
Mixed Methods Study ◽  
Foreign Born ◽  
Cross Sectional ◽  
Dementia Patients ◽  
Qualitative Descriptive

Context The Canadian reality of dementia care may be complicated by the cultural diversity of patients and their informal caregivers. Objectives To what extent do needs differ between Canadian- and foreign-born patients and caregivers? What are their experiences with the illness in primary care case management? Methods Mixed methods, sequential explanatory design (a cross-sectional study, followed by a qualitative descriptive study), involving 15 pairs of patients and caregivers. Results Foreign-born patients had more needs compared to their Canadian-born counterparts. Foreign-born caregivers reported more stress, more problems, and increased need for services. However, the reported experiences of Canadian- vs. foreign-born individuals were similar. Conclusion The results remain hypothesis-generating. The present pilot illustrated the suitability of mixed methods to this area of study, which deserves further investigation to better serve all mem­bers of a population already vulnerable by age and disease.

Gambling-like video game practices: A cross-sectional study of links with problem gambling and disordered gaming

2019 ◽  
Author(s):  
David Zendle
Keyword(s):  
Video Games ◽  
Problem Gambling ◽  
Video Game ◽  
Large Scale ◽  
Significant Degree ◽  
Cross Sectional Study ◽  
Video Gaming ◽  
Cross Sectional ◽  
Streaming Services ◽  
Clinically Significant

A variety of practices have recently emerged which are related to both video games and gambling. Most prominent of these are loot boxes. However, a broad range of other activities have recently emerged which are also related to both gambling and video games: esports betting, real-money video gaming, token wagering, social casino play, and watching videos of both loot box opening and gambling on game streaming services like Twitch.Whilst a nascent body of research has established the robust existence of a relationship between loot box spending and both problem gambling and disordered gaming, little research exists which examines whether similar links may exist for the diverse practices outlined above. Furthermore, no research has thus far attempted to estimate the prevalence of these activities.A large-scale survey of a representative sample of UK adults (n=1081) was therefore conducted in order to investigate these issues. Engagement in all measured forms of gambling-like video game practices were significantly associated with both problem gambling and disordered gaming. An aggregate measure of engagement was associated with both these outcomes to a clinically significant degree (r=0.23 and r=0.43). Engagement in gambling-like video game practices appeared widespread, with a 95% confidence interval estimating that 16.3% – 20.9% of the population engaged in these activities at least once in the last year. Engagement in these practices was highly inter-correlated: Individuals who engaged in one practice were likely to engage in several more.Overall, these results suggest that the potential effects of the blurring of lines between video games and gambling should not primarily be understood to be due to the presence of loot boxes in video games. They suggest the existence of a convergent ecosystem of gambling-like video game practices, whose causal relationships with problem gambling and disordered gaming are currently unclear but must urgently be investigated.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

Hubungan Budaya Organisasi dengan Intensi Turnover di Rumah Sakit Awal Bros Batam

2019 ◽  
Vol 4 (3) ◽  
pp. 464
Author(s):  
Endang Sulastri ◽  
Yulastri Arif ◽  
Utari Christhya Wardhani
Keyword(s):  
Organizational Culture ◽  
Interpersonal Relationships ◽  
Turnover Intention ◽  
Random Sampling ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Good Communication

<p>Intensi turnover pada institusi pelayanan kesehatan merupakan masalah serius dan harus segera ditindaklanjuti, karena akan berdampak terhadap kualitas sumber daya manusia yang dapat mempengaruhi dalam pemberian pelayanan kesehatan kepada pasien. Intensi turnover di Rumah Sakit  Awal Bros Batam sejak lima tahun terakhir diatas standar rata-rata turnover dan Rumah Sakit belum mempunyai stategi yang efektif untuk mencegahnya. Tujuan penelitian ini untuk menganalisis hubungan budaya organisasi dengan risiko intensi turnover di Rumah Sakit Awal Bros Batam. Metode penelitian menggunakan desain kuantitatif dengan cross sectional study. Pengambilan sampel kuantitatif menggunakan kuesioner berdasarkan proposional random sampling, Chi Square dan Uji Regresi Logistic Berganda (Binary Logistic). Hasil penelitian menunjukkan bahwa budaya organisasi di Rumah Sakit Awal Bros Batam  mempunyai hubungan yang bermakna dengan intensi turnover dengan nilai pValue 0.005. Saran yang dapat diberikan peneliti adalah  menciptakan suasana kerja yang kondusif dengan menjaga hubungan interpersonal dan komunikasi yang baik antar karyawan maupun atasan.</p><p> </p><p>The intention of turnover in health care institutions is a serious problem and must be followed up immediately, because it will have an impact on the quality of human resources that can affect the delivery of health services to patients. The intention of the turnover in Batam Awal Bros Hospital since the last five years is above the average turnover standard and the Hospital does not yet have an effective strategy to prevent it. The purpose of this study was to analyze the relationship between organizational culture and risk of turnover intention at Awal Bros Batam Hospital. The research method uses quantitative design with cross sectional study. Quantitative sampling using a questionnaire based on proportional random sampling, data processing using the mean, Chi Square and Binary Logistic Regression Test. The results showed that the organizational culture in Batam Awal Bros Hospital had a significant relationship with turnover intention with a pValue 0.005. Suggestions that can be given by researchers is establish a conducive work atmosphere by maintaining interpersonal relationships and good communication between employees and superiors</p>

scholarly journals The Pandemic and Changes in the Self-Perception of Teacher Digital Competences of Infant Grade Students: A Cross Sectional Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4756
Author(s):  
Rosalía Romero-Tena ◽  
Carmen Llorente-Cejudo ◽  
María Puig-Gutiérrez ◽  
Raquel Barragán-Sánchez
Keyword(s):  
Intervention Group ◽  
Cross Sectional Study ◽  
Self Perception ◽  
Digital Competence ◽  
Cross Sectional ◽  
Self Perceptions ◽  
Group A ◽  
Different Dimensions ◽  
The Difference ◽  
Group B

Without having a reaction time, the pandemic has caused an unprecedented transformation in universities around the world, leading to a revolution from structured models anchored in the conception of transmission of training towards a teaching approach-learning saved thanks to the incorporation of technology. This study aims to verify whether the pandemic situation has influenced the digital competence self-perception of students. Comparing two groups during the academic years 2019/2020 and 2020/2021, the instrument used is the questionnaire for digital competence “DigCompEdu Check-In” for future teachers. After the educational intervention, group A (before COVID-19) presented higher self-perceptions of competence than group B (during COVID-19); the pandemic situation caused by COVID-19 has negatively influenced students’ self-perception of their digital skills in the pretest in the different dimensions under study. Before receiving the training, the group that did not experience the pandemic enjoyed a higher self-perception of their competencies than the group that experienced the pandemic. The data obtained indicate that the difference exists, and that it is statistically significant, and may be a consequence of the clear relationship between self-perception and the way in which students face reality through their personal and subjective vision.

scholarly journals Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christophe Millien ◽  
Anatole Manzi ◽  
Arlene M. Katz ◽  
Hannah Gilbert ◽  
Mary C. Smith Fawzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Methods ◽  
Black Women ◽  
Uterine Fibroids ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Cross Sectional ◽  
Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

scholarly journals Exploring anhedonia in adolescents with Chronic Fatigue Syndrome (CFS): A mixed-methods study

2021 ◽  
pp. 135910452110055
Author(s):  
Lucie Smith ◽  
Esther Crawley ◽  
Madeleine Riley ◽  
Megan McManus ◽  
Maria Elizabeth Loades
Keyword(s):  
Mixed Methods ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Diagnostic Interview ◽  
Mixed Methods Study ◽  
Mixed Methods Approach ◽  
Fatigue Syndrome ◽  
Core Symptom ◽  
Clinically Significant ◽  
The Way

Background: Chronic Fatigue Syndrome (CFS/ME) may get in the way of enjoying activities. A substantial minority of adolescents with CFS/ME are depressed. Anhedonia is a core symptom of depression. Anhedonia in adolescents with CFS/ME has not been previously investigated. Method: One hundred and sixty-four adolescents, age 12 to 18, with CFS/ME completed a diagnostic interview (K-SADS) and questionnaires (HADS, RCADS). We used a mixed-methods approach to explore the experience of anhedonia and examine how common it is, comparing those with clinically significant anhedonia to those without. Results: Forty-two percent of adolescents with CFS/ME reported subclinical or clinical levels of anhedonia. Fifteen percent had clinically significant anhedonia. Thematic analysis generated two themes: (1) stopping activities that they previously enjoyed and (2) CFS/ME obstructs enjoyment. Most (72%) of those who reported clinically significant anhedonia met the depression diagnostic criteria. Those who were depressed used more negative language to describe their experience of activities than in those who were not depressed, although the themes were broadly similar. Conclusions: Experiencing pleasure from activities may be affected in CFS/ME, particularly in those who are depressed. Anhedonia may get in the way of behavioural strategies used within CFS/ME treatments.

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