Health Experiences Research Articles

Transitioning Perspectives in Digital Health Through Phenomenology Integration.

The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who "speak" different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care.

Exploring the lived experience of performance-related health and wellbeing among flautists.

The study has investigated the lived experience of flautists, focusing on their experiences and perceptions of performance-related physical discomfort, injury and related mental health challenges that they might have encountered in practice and performance. The aims of the research have been to provide flautists with an opportunity to reflect on any physical or psychological performance issues in their own words, and to understand the subjective meaning of these experiences. A basic qualitative approach was used for gathering data. All the fieldwork was undertaken during or immediately after the Covid-19 pandemic. Consequently, the participating flautists were deliberately selected using professional networks on the basis of their answers to a pre-interview initial questionnaire related to the characteristics of their personal backgrounds and their experiences, as well as being able to participate remotely. There have been two data collection phases. Phase 1 was a specially designed pre-interview questionnaire drawing on themes from appropriate literature. Phase 2 built on the pre-interview questionnaire responses and was designed as semi-structured interviews, undertaken on Zoom, and included a 'River of Flute-playing Experience' activity during the interview. The 'River of Experience' method is an autobiographical research tool in which participants were asked to annotate key biographical experiences and challenges at various points along their drawing of a meandering river. The combined data analyses drew on thematic analysis. The eight participants reported a personal history of performance-related health and wellbeing challenges that they had faced at some point in their lives. The findings reveal that flautists encounter health-related challenges associated with their practice and performances, and the data suggest that they each require an understanding of likely performance-related health challenges and supportive resources to assist them in managing these challenges. The participants' diverse experiences highlight the importance of managing health and the value of supportive social connections. They cope with health challenges by integrating passion, resilience, and adaptability into their lives, finding ways to grow and continue to thrive in their flute-playing journey. The study underscores the need for comprehensive health education and support resources for flautists, emphasising the significance of resilience and adaptability in fostering health, wellbeing, and success.

'It's a Horrible Place to Have a Period': A Survivor-Led Investigation of Experiences of Menstrual Health in Psychiatric Inpatient Settings in England.

This study examined patients' experiences of menstrual health in psychiatric inpatient settings in England as reported by staff and patients. Questionnaires were conducted with 67 staff members and 101 people with lived experience of menstruation and treatment on a psychiatric ward. 10 semi-structured interviews were conducted with people with lived experience. Data were analysed using reflexive thematic analysis. Grouped into overarching themes of institutional and interpersonal environments, four themes were identified: access to menstrual materials; the lack of privacy when menstruating in psychiatric inpatient settings; attitudes and approaches to menstruation; and menstrual support needs and care provision. There was variation among the experiences reported, with some patients receiving dignified care, whilst others described facing 'degrading' and 'dehumanising' treatments and enhanced feelings of shame and embarrassment around menstruation, in comparison with what they usually experience. This appeared to arise due to the interplay between mental health services overlooking menstruation and the overreliance on restrictive practices. These experiences may be understood as menstrual injustices, period poverty,potentially amounting to neglect and posing iatrogenic harms. Participants also discussed how their mental illness and distress, particularly within the context of trauma and/or eating disorders, shaped their menstrual experiences. However, many patients did not receive adequate support in relation to this. Patients' pain and disorder related to menstruation, or gynaecological conditions, was often described as being dismissed by staff or being viewed as beyond the responsibility of mental health services. This study highlighted the urgency for actions to be taken to provide greater support for patients who menstruate in psychiatric inpatient settings.

Self-Attitude Parameters as Predictors of Psychological Well-Being in Students with Limited Health Capacities.

Psychological well-being is a system of optimal psychological qualities and states manifested as life strategy and a system of personal attitude to the world and oneself. Self-attitude is an intrapersonal phenomenon of individual projections in the field of self-awareness. In assessing psychological well-being, it acts as a guiding vector for self-development and self-actualization. In case of people with disabilities, psychological well-being largely depends on self-attitude as a predictor. This study featured the effect of self-attitude on psychological well-being in university students with limited health capacities. The study involved 60 students aged 18–25. The list of methodological tools involved Sentence Completion (J. M. Sacks, S. Levy), Subjective Well-Being Scale (adapted by M. V. Sokolova), and Personal Self-Attitude (V. V. Stolin, S. R. Pantileev). The study established differences in the assessment of psychological well-being by students with and without disabilities. Physically challenged students tended to demonstrate low self-esteem, associated with negative emotional and health experience. They also had specific parameters of self-attitude with a vector of positivity and trends towards personal growth. These parameters are a motivating component of social behavior that determines the general perception of psychological well-being by students with disabilities.

Modifying the Refuse Chute Design to Prevent Infection Spread: Engineering Analysis and Optimization

Considering the presence of airborne viruses, there is a need for renovation in refuse chutes, regarded as the first step in recycling household waste in buildings. This study aimed to revise the design of existing refuse chutes in light of the challenging experiences in waste management and public health during the coronavirus pandemic. This research primarily focused on the risks posed by various types of coronaviruses, such as the novel coronavirus (COVID-19) and acute respiratory syndrome (SARS and SARS-CoV), on stainless steel surfaces, with evidence of their survival under certain conditions. Refuse chutes are manufactured from stainless steel to resist the corrosive effects of waste. In examining the existing studies, it was observed that Casanova et al. and Chowdhury et al. found that the survival time of coronaviruses on stainless steel surfaces decreases as the temperature increases. Based on these studies, mechanical revisions have been made to the sanitation system of the refuse chute, thus increasing the washing water temperature. Additionally, through mechanical improvements, an automatic solution spray entry is provided before the intake doors are opened. Furthermore, to understand airflow and clarify flow parameters related to airborne infection transmission on residential floors in buildings equipped with refuse chutes, a computational fluid dynamics (CFD) analysis was conducted using a sample three-story refuse chute system. Based on the simulation results, a fan motor was integrated into the system to prevent pathogens from affecting users on other floors through airflow. Thus, airborne pathogens were periodically expelled into the atmosphere via a fan shortly before the intake doors were opened, supported by a PLC unit. Additionally, the intake doors were electronically interlocked, ensuring that all other intake doors remained locked while any single door was in use, thereby ensuring user safety. In a sample refuse chute, numerical calculations were performed to evaluate parameters such as the static suitability of the chute body thickness, static compliance of the chute support dimensions, chute diameter, chute thickness, fan airflow rate, ventilation duct diameter, minimum rock wool thickness for human contact safety, and the required number of spare containers. Additionally, a MATLAB code was developed to facilitate these numerical calculations, with values optimized using the Fmincon function. This allowed for the easy calculation of outputs for the new refuse chute systems and enabled the conversion of existing systems, evaluating compatibility with the new design for cost-effective upgrades. This refuse chute design aims to serve as a resource for readers in case of infection risks and contribute to the literature. The new refuse chute design supports the global circular economy (CE) model by enabling waste disinfection under pandemic conditions and ensuring cleaner source separation and collection for recycling. Due to its adaptability to different pandemic conditions including pathogens beyond coronavirus and potential new virus strains, the designed system is intended to contribute to the global health framework. In addition to the health measures described, this study calls for future research on how evolving global health conditions might impact refuse chute design.

"I don't feel fully prepared": a qualitative study of recently graduated students' mental health experiences of the transition out of university.

This study aimed to better understand the mental health experiences of students as they prepared to transition out of university. Participants included 18 recently graduated students from a Canadian university. Virtual one-on-one semi-structured qualitative interviews were conducted and analyzed following the protocol for content analysis and using QSR NVivo. Four main themes were identified, including: distress and feelings of doubt, the importance of connections, the impact of the COVID-19 pandemic, and experiences with mental health service use. Participants discussed feeling pressured to succeed and a fear of failure, uncertainty and unpreparedness for next steps, the importance of connections to peers and professors, a lack of motivation and feeling 'unfinished' due to the COVID-19 pandemic response, and the need for flexible and accessible mental health services to address immediate and longer-term needs. Results have implications for better support of students as they prepare for graduation.

Experiences of mental health and poverty in high-income countries during COVID-19: A systematic review and meta-aggregation

Systematic reviews have been published that explore the experiences of living in poverty, yet there are no known studies that have synthesized the findings of research exploring the experiences of mental health and wellbeing of persons living in poverty during COVID-19. To address this gap, we conducted a systematic review and meta-aggregation of qualitative evidence using the method described by the Joanna Briggs Institute (JBI) following the PRISMA guidelines. Of 8391 titles and abstracts screened, we included 23 studies in our review and meta-aggregation. In conducting our meta-aggregation, we generated three synthesized findings: 1) magnification of inequities and marginalization during COVID-19; 2) difficulty accessing resources during the lockdown; and 3) the lockdown causing changes in mental health and wellbeing. The findings of this review suggest that persons living in poverty experienced increased difficulties with mental health and well-being during COVID-19. This was largely influenced by the presence of pandemic restrictions and increasing financial precarity that resulted in rising levels of psychosocial distress. Research regarding the plight of persons living in low income is needed to inform policy and practice for future pandemics in order to decrease the vulnerability of this population. Implementing evidence-informed policies and practices that mitigate the negative psychological effects of physical distancing restrictions on persons living in poverty are needed, and these can be identified through future research efforts.

Entering civic space: youth experiences in sexual and reproductive health and rights advocacy in Ethiopia, Mali and Mozambique

ABSTRACT Young people are increasingly involved in advocacy on sexual and reproductive health and rights (SRHR), but research documenting their experiences remains limited. This article explores how young people advocate for SRHR in Ethiopia, Mali and Mozambique, what motivates them, what barriers they face, and how they overcome them. Building on in-depth interviews and focus group discussions, the findings show that across the three countries, youth are motivated to advocate for SRHR because it resonates with their direct realities, but experience challenges throughout. This is linked to a need for accessible and flexible funding for youth initiatives, trust from established organisations acting as allies, and freedom to establish advocacy agendas. Young people furthermore recommended more diverse youth perspectives should be represented in initiatives. Insights from this study are relevant to youth-led organisations, non-governmental organisations and governments interested in equal partnerships with young people in decision-making, and funders supporting international development aid.

Exploring mental health experiences and supports among international engineering undergraduate students – insights to inform university support

ABSTRACT This study explores the mental health perceptions, expectations for mental healthcare, and use of existing mental health services among international engineering students at a Western Canadian university. Employing a phenomenological qualitative approach, semi-structured interviews were conducted with 18 international undergraduate engineering students to understand their mental health challenges and service usage. The thematic analysis revealed three significant themes: students’ understanding of mental health; their experiences within the engineering programme, and recommendations to enhance and facilitate a positive mental health experience at the university. Findings suggest that mental healthcare for international engineering students should be responsive to the students’ unique needs, providing support and accessible services during their transition from their home countries and recognising the impact of the environmental and cultural factors on their experiences as members of the Faculty of Engineering and the broader university community.

Hidden in plain text: Uncovering hidden heterogeneity and social stratification in Ireland AD 1150-1800.

Between the Irish late medieval (AD 1150-c.1550) (LMP) and post-medieval (AD c.1550-1800) (PMP) periods, colonial practices changed land ownership. Contextualizing these periods within a biocultural political economy framework supports increasing social inequality in the PMP, which we expect to be reflected in different skeletal markers of longevity and stress. Therefore, we hypothesized that widespread exposure to stressors and resource deprivation contributed to lower longevity in the PMP compared to the LMP, and that there would be greater variation between sites in the frequency of linear enamel hypoplasias (LEH) in the PMP. We estimated age and counted matched pairs of LEH on 526 adult skeletons from the Irish counties of Dublin, Kildare, Louth, and Meath. Age-at-death was compared through Kaplan-Meier survival functions and non-parametric tests. Linear enamel hypoplasias prevalences were analyzed with Mann-Whitney U tests and Generalized Linear Models. Age-at-death distribution changed between the LMP and PMP for males, with males experiencing an increase in median-age-at-death. The same was untrue for females, who show no changes in median age-at-death. Analysis of LEH frequency per individual showed that variation between sites was significant in the post-medieval period but not in the late medieval period. These results suggest that social organization contributed to embodied health experiences that varied across time periods. Specifically, populations from the PMP appear to have embodied greater social inequality in their more varied susceptibility to stress. Our work demonstrates the strength of pairing historical texts with the analysis of skeletal remains to evaluate the impact of social structures on biological frailty.

"Hanging on by a Thread": The Lived Experience of Parents of Children with Medical Complexity.

Families with children with medical complexity endure high levels of chronic and toxic stress, impacting the overall health and wellbeing of all family members and the system as a whole. The purpose of this study was to examine the lived experiences of parents/caregivers with children with medical complexity. The lived experiences of 15 parents of children with complex medical needs were explored using focus group discussions. Focus group discussions were recorded, transcribed, and analyzed using van Manen's 6-step process for hermeneutic phenomenology. Aligned with the research questions, the analysis draws on van Manen's four lived existential analytical categories. Themes include: (1) lived body, the psychological and physiological effect; (2) lived time and space, the immediate impact on the there, now, and then; (3) lived relationships, social life and family relational effect; (4) risk factors; and (5) protective factors. Caregivers of children with medical complexity have a unique experience of trauma and resilience. This study will inform interdisciplinary medical providers about the mental health and resiliency experiences of this population to support more effective healthcare practices.

Substance use recovery: Global health perspectives and experiences

Addictive behavior treatment networks comprise harm-reduction services and recovery programs. Recovery is an approach toward interventions for addictive behavior that focuses on the individual’s empowerment, abilities, and life skills. Rehabilitation-oriented programs have evolved from traditional therapeutic communities to comprehensive services that are integrated into social and health networks and delivered by multidisciplinary professionals. This paper aims to analyze the development of recovery programs, drawing from quantitative and qualitative data from an action research approach. It also presents theoretical models and best practices for recovery. In summary, recovery-oriented programs must be integrated with harm-reduction networks, social and employment services, and health systems. Furthermore, as recovery is based on empowerment and peer social support, there is an urgent need to develop structured programs to address these issues. Moreover, there is a need to design and implement specific interventions for a broad range of populations and develop evaluation systems to assess the effectiveness and relevance of recovery-oriented programs.

Pandemic scars: long-term impact of COVID-19 on work stress among healthcare workers in China.

This study mainly focused on the long-term effect of different risk exposure levels and prior anti-epidemic experience of healthcare workers in mitigating COVID-19 on their work stress in the post-COVID era. The study sample included 359 physicians, 619 nurses, 229 technicians and 212 administrators, for a total of 1,419 healthcare workers working in the Lanzhou area during the investigation. Data were analyzed by multivariate regression models. Our findings indicated that the interaction between pandemic effect mitigation experience and high-risk exposure significantly affected healthcare workers in the post-COVID era by increasing their work stress (p<0.001) and reducing their rest time (p<0.001). Healthcare workers may have experienced worse outcomes in the long term if they had higher levels of risk exposure and more experience in fighting epidemics. Furthermore, poor mental health (p<0.001) and prior experience with SARS (p<0.001) further amplified these adverse effects. However, surprisingly, we did not observe any effect of prior anti-epidemic experience or high-risk exposure on the mental health of healthcare workers in the post-COVID era (p>0.1). The adverse impact of COVID-19 may have left long-lasting effects on Health professionals (HPs), particularly those with high Risk exposure (RE) and more mitigation experience. Poor Mental health (MH) and previous experience in mitigating previous similar outbreaks (such as SARS) are risk factors that should be considered. Support programs must be designed and promoted to help HPs respond and improve their performance. Our study presents compelling evidence that the COVID-19 pandemic will have long-term detrimental effects on the work stress of healthcare workers.

Work Disparities and the Health of Nurses in Long-Term Care: A Scoping Review.

Work disparities, such as unfairness in pay or unequal distribution of work experienced by nurses in long-term care (LTC), can impact the retention and health of this workforce. Background: Despite the significant impact of disparities on nurses' health in LTC, a literature review on work disparities of nurses in LTC has not been conducted. Method: This scoping review aimed to explore the nature and extent of research on meso-level work disparities experienced by nurses in LTC and its links with nurse health and well-being. Five databases were searched: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), SCOPUS, and CINAHL (EBSCO host). Results: Of the 5652 articles retrieved, 16 studies (14 quantitative and 2 qualitative) published between 1997 and 2024 met the inclusion criteria. A total of 53 work disparities were identified. Only four articles investigated the association of a work disparity with a variable of health (e.g., physical, mental, or poor general health). Conclusions: The results suggest that more attention to how disparities impact nurses' health and lived experiences is warranted. Meso-level disparities from this review provide an initial basis to consider possibilities in the workplace, especially in supporting equity and opportunities for health and well-being at work (e.g., through fair access to professional growth opportunities and a more equitable balance of work expectations and demands of nursing staff). Future studies of the intersection of macro- and meso-level factors are needed to inform better workplace practices and social and economic policies to support the well-being, health, and safety of nurses at work in LTC.

Investigating College Student Mental Health Needs and Barriers Using Natural Language Processing

College students’s mental health has been declining, despite efforts by universities to improve outreach and programming. Though a variety of resources are available, students, especially those who experience marginalization, often do not engage with them. LGBTQ+ students in Florida, in particular, may face unique challenges. To understand marginalized college students’s mental health experiences, we conducted ten focus group interviews (N = 65) with students with various marginalized identities. Using Natural Language Processing (NLP) techniques, we conducted sentiment analysis with respect to students’s responses on interview questions (e.g., mental health needs, how needs are met/not met) among LGBTQ+ and other minority groups. Overall, LGBTQ+ students yielded a more negative sentiment than the other groups, with a marginally significant (at 0.1 level) difference suggested by Wilcoxon rank sum test. This project presents a novel approach to leveraging traditional qualitative methods and AI, provides deeper understanding of the mental-health-related needs of marginalized college students, and practical implications for prevention and intervention efforts to promote college students’s mental health.

Women’s exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

ABSTRACT Background Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda. Objective We aimed to investigate the association between Rwandan women’s exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age. Methods In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women’s Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy. Results Of 601 women, 47.4% (n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01–2.03) and 1.25 (95% CI, 1.04–2.01), respectively. Conclusion Women’s exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women’s exposure to IPV and adverse effects on child growth.

The process of developing an augmented reality (AR) tool for knowledge translation on climate change-related experiences among youth in Kenya

This report details a qualitative methodological approach of developing an Augmented Reality (AR) tool which integrates digital storytelling for context-specific, accessible, scalable participatory research knowledge translation on climate-related sexual health experiences among youth (aged 16-25 years) in Kenya. AR, which engages audiences through virtual images overlayed on the real world in real-time, enhances learning and knowledge retention. This suggests the potential for using this increasingly accessible technology in knowledge translation, despite such use being understudied. Our AR tool meaningfully incorporates seven digital storytelling videos made by youth in Kenya through a study in 2023, to amplify youth voices while illustrating complex pathways between four climate-related factors (drought, floods, extreme heat, and excess winds) and three HIV vulnerabilities (gender-based violence, early marriage, and transactional sex). The aim of this paper is to describe the design of an AR tool for knowledge translation, youth empowerment, and health promotion, and to outline how it can be harnessed for sexual health and climate change education to inform future knowledge translation approaches with youth climate-affected issues.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Evaluating the impact of the Health Access for Refugees Project on people who are refugees or seeking asylum in Northern England.

Evidence demonstrates that people who are seeking asylum and refugees face individual, institutional and system-level barriers when accessing health services. Health Access for Refugees' Project (HARP) is a UK initiative increasing access to health care within this community through a series of interventions. This study explored the impact of HARP on health service access, experiences and outcomes for clients, and how volunteers and staff addressed institutional and system-level barriers. In summer 2020, we conducted qualitative telephone interviews with four HARP clients, eight clients who became volunteers, seven further volunteers and three staff members. The educational aspect of the interventions supported clients navigating the complex UK health care system while promoting independence in accessing health care. Advocacy by volunteers and staff was important in challenging barriers at individual and institutional levels. Staff challenged the asylum system, by improving information around entitlement to health care and addressing barriers to registering with a General Practitioner (GP). Interventions such as those provided by HARP can address different levels of barriers to support people accessing health care provision. This can be achieved through training health professionals and working with peers to support access to care and to develop self-advocacy. However, stable long-term funding is essential to ensure the sustainability of these initiative.

Spiritual Healing: Ragam Bahasa Balian Sebagai Salah Satu Pelestarian Tradisi Lokal di Bali

This research aims to identify the language varieties of Balian and the factors that influence these language varieties. This research is descriptive qualitative with a linguistic and pragmatic theory approach used by Balian. Data collection was done by in-depth interviews with Balians in the hotel. The collected data were then transcribed and thematically coded to identify patterns in language use, such as the use of language, the use of metaphorical language styles, and the sentence structure used. The results found that the balian language variety when communicating with clients is the use of affirmative language, the use of spiritual metaphor style, and the use of imperative sentence structure to direct the client's experience and emotional response during the healing process. Meanwhile, the factors that influence balian language varieties are cultural, spiritual, social, economic, and personal factors. An understanding of these factors helps explain how balians navigate between local traditions and the needs of their clients, as well as how they integrate different elements of language to create effective and meaningful healing experiences. Future studies go more in-depth into analyzing balian language use when viewed pragmatically and therapeutically.