Oral Health Education Experience Research Articles

일부 대학생의 기능적 구강건강문해력과 구강보건지식 및 구강보건행태에 관한 융합적 관계

본 연구는 대학생을 대상으로 기능적 구강건강문해력과 구강보건지식 및 구강보건행태의 관련성을 조사하였다. K시 대학교에 재학 중인 학생 410명을 대상으로 2015년 6월 22일 부터 26일 까지 설문조사를 하였으며, 398명의 자료를 최종 분석 대상으로 하였다. 그 결과 구강보건교육을 받은 경험이 있는 학생은 281(70.6)명, 교육 받은 경험이 없는 학생은 117(29.4)명으로 나타났으며, 구강보건교육을 받을 때 교육 내용 및 설명이 여러 번 어려웠다는 학생은 194(48.7)명, 간혹 어려웠다는 128(32.2)명으로 나타났다. 기능적 구강건강문해력 점수는 절반 이상의 대학생이 낮게 나타났다. 기능적 구강건강문해력 점수가 높을수록 구강보건지식이 높게 나타나고, 구강보건지식이 기능적 구강건강문해력에 영향을 미치는 것으로 나타났다. 따라서 대학생들의 낮은 기능적 구강건강문해력 향상을 위한 효과적인 구강보건지식 전달 프로그램이 개발되어야 한다. The research had an investigation of relevance between functional oral health literacy, oral health knowledge, and oral health behaviors of college students. Survey of 410 students in K city college done from June 22 to 26, 2015 was analyzed, and the final analysis subject was 398 students. The result were 281(70.6) students with experience of oral health education, 117(29.4) students without experience of education, and there were 194(48.7) students who had difficulty several times with the material and explanation while attending the education, and 128(32.2) students who had difficulty a few times. Scores of functional oral health literacy were low for more than half of the college students. The higher the functional oral health literacy score, the higher oral health knowledge was shown, and oral health knowledge turned out to be affecting functional oral health literacy. Therefore, an effective program for delivering oral health knowledge to improve low functional oral health literacy of college students must be developed.

요양보호사의 노인 구강보건에 대한 지식과 인식도 연구

The study aims to examine the knowledge and awareness of care workers on oral health knowledge at the geriatric care facilities in order to improve and develop oral health services. For the research method, the study carried out a questionnaire survey to 163 care workers working at the geriatric care facilities (10) in D Metropolitan City from May 1~31, 2015 and then the collected data were statistically analyzed. As a result, the oral health knowledge of care workers was 20.09 points out of total 26 points (77.2%). The highest knowledge was 'proper toothbrushing method' with 93.0% and the lowest one was 'knowledge on the use of oral supplementary goods' with 58.1%. Those with experience of oral health education had higher demand on oral health education (P

한국 청소년의 구강건강행태와 구강보건교육 경험의 실태

Objectives: The objective of the study is to investigate oral health behavior and oral health education experience in Korean adolescents from the ninth(2013) web-based survey of Korean youth risk behavior. Methods: The subjects were 72,435 students through the ninth 2013 web-based survey of Korean youth risk behavior conducted by the Ministry of Education, Science, and Technology, the Ministry of Health and Welfare, and the Korea Centers for Disease Control. The questionnaire consisted of socio-demographical characteristics of the subjects, oral health behavior, and oral health education experience. Data were analyzed by SPSS 18.0 program. Results: Oral health education had much influence on tooth brushing after lunch, oral cavity disease prevention, sealants, fluoride application, scaling experience, and consumption of vegetables, milk, carbonated soft drinks, noodles, and snacks. The oral health education had a great impact on those who took good oral health behavior into action. Conclusions: It is very important and necessary to develop the continuing effective oral health education program for the adolescents and make them tale into action.

전라북도 일부 운수종사자의 구강건강신념과 구강보건행태에 관한 연구

The purpose of this study was to examine the relationship between the oral health behavior and oral health belief of transportation workers. The subjects in this study were 270 selected taxi drivers who engaged in the taxi transportation industry in Jeollabuk-do. They were selected by convenience sampling. To determine the influence of their general characteristics and oral health belief on scaling experience and oral health education experience, a logistic regression analysis was made. And a multiple regression analysis was made by selecting general characteristics and oral health behavior as independent variables and by selecting oral health belief as a dependent variable. A statistical package SPSS for Windows ver. 12.0 was employed to make all the statistical analysis. As a result of making the logistic regression analysis, benefit that was one of the subfactors of oral health belief had something to do with oral health education experience, and the subfactors that exerted an influence on scaling experience were benefit, susceptibility and barrier. When the multiple regression analysis was carried out to find out influential factors for oral health belief, monthly mean income had an impact on susceptibility and barrier among the subfactors of oral health belief, and self-rated oral health status affected seriousness and barrier. There were differences among the taxi drivers in oral health belief according to their own characteristics, and oral health belief was linked to oral health behavior. Therefore oral health belief and oral health behavior should be taken into account when it's planned to promote the oral health of taxi drivers.

다문화 결혼이주여성의 구강건강 관련 특성에 관한 연구 : 경북 김천시를 중심으로

Objectives: The purpose of the study is to investigate the oral health characteristics of the multicultural international marriage women in Gimcheon, Gyeongbuk in Korea. Methods: The subjects were 73 multicultural international marriage women in Gimcheon, Gyeongbuk in Korea. The study methods consisted of direct interview with the subjects and oral examination through dental mirror and head lamp by one dentist and two dental hygienists. The questionnaire included the use of medical services, oral health education experience, subjective oral health awareness, toothbrushing, and sociodemographical characteristics of the subjects. Results: There were significant correlations between the subjective oral health awareness, oral health behavior and DMFT index. The subjective oral health awareness significantly changed after the international marriage in Korea. The recognition of subjective oral health status significantly improved after the oral health education by the dentist and the dental hygienist. Conclusions: The subjective oral health status of the international marriage women improved significantly after immigration into Korea. Therefore, Korean government should try to provide the better medical services to the international marriage women and protect their human rights as Korean immigrants on the basis of the Law.

Integrating oral health education and practical experience into the physician assistant curriculum

Cahill, Laurin; Colletti, Thomas DHSc, PA-C; Coniglio, David EdD, PA-C; Tillman, David PhD Author Information

일부 초등학교 담임교사의 구강보건교육경험유무에 따른 구강건강행태

Objectives: The purpose of this study was to investigate the oral health behavior according to oral health education experience in the elementary school teachers and to provide the basic data for the development of oral health education program. Methods: A self-reported questionnaire was filled out by 239 elementary school teachers in Busan and Ulsan from May 7 to 31, 2013. The questionnaire consisted of general characteristics of the subjects, use of oral health devices, dental clinic visit within a year, purpose of dental clinic visit, subjective oral health condition, place and contents of oral health education, future contents of oral health education, purpose of tooth brushing, recognition of sealant, recognition of dental caries prevention effect of fluoride, and method and frequency of tooth brushing. Data were analyzed by Predictive Analysis Software(PASW) Statistics 19.0R(SPSS Inc., Chicago IL, USA). Results: Of the 239 teachers, 187 teachers had oral health education experience and 52 did not. Those who had oral health education experience reported higher scores in tooth brushing than those who did not. 59.4% of the respondents answered the experience of oral health education in dental clinics. Conclusions: Oral health behavior was different from the experience of oral health education in the elementary school teachers. The teachers are the most important persons influencing on the right tooth brushing habit in the students. So the teachers must take the continuing and systematic oral health education.

일부 보육교사들의 구강건강인식, 구강건강행위, 자아존중감 및 OHIP-14와의 연관성과 영향요인

Objectives: The purpose of the study is to investigate the correlation and influencing factors of oral health awareness, oral health behaviors, self-esteem and OHIP-14. Methods: A self-reported questionnaire was filled out by 313 childcare teachers in Jeonnam from June 4 to 14, 2013. The questionnaire consisted of 3 questions of general characteristics, 4 questions of occupation, 1 question of oral health education experience, and 1 question of oral health education participation. The instrument for awareness and behavior of oral health were modified and consisted of 10 questions of awareness and 10 questions of behavior by Likert 5 scale. Cronbach's alpha was 0.718 in awareness and 0.812 in behavior. Instrument for self-esteem was modified from Rosenberg. Self-esteem questionnaire consisted fo 5 questions of positive answers and 5 questions of negative answers by Likert 5 scale. Cronbach's alpha in self esteem was 0.846 in the study. Oral Health Impact Profile-14(OHIP-14) was adapted from Slade by Likert 5 scale and consisted fo 14 questions. Cronbach’s alpha was 0.934 in the study. Data were analyzed by chi square test, t-test, one way ANOVA, Scheffe multiple range test, Pearason's correlation test, and stepwise multiple regression test. Results: There were positive correlations between oral health awareness, oral health behavior(r=0.502), and self-esteem(r=0.332), but negative correlations with OHIP-14. Oral health behavior showed positive correlations with self-esteem(r=0.230). The factors on oral health awareness were high oral health behavior and self esteem, low OHIP-14, and active participation in education. Self-esteem was closely related to high with high oral health awareness. low OHIP-14, low job satisfaction. Conclusions: Childcare teachers play the very important roles in the development of oral health education program for children and continuous education.

사회경제적 수준에 따른 치아우식증 예방과 관련 인식조사: 한국갤럽자료를 활용하여

Objectives: The purpose of the study is to investigate the cognition of dental caries prevention by the level of socioeconomic status based on Gallup survey in Korea. Methods: This study was done by Korean Gallup survey in October, 2010. A trained researcher carried out the computer aided telephone interview(CATI) using a structured questionnaire. This study was based on the latest population statistics of resident registration and whole country's phone data base. This survey included 869 selected Korean adults over 19 years old, and they were asked to answer a CATI. The questionnaire consisted of general characteristics of the subjects and socioeconomic factors including age, gender, education level, monthly income, and residential area. Cognition of dental caries prevention was measured by Likert 4 scale including ‘much’, ‘a little’, ‘rarely’, and ‘never’. The attitude toward dental caries prevention consisted of daily tooth brushing frequency, experience of oral health education, regular dental checkup, chewing gums(xylitol), regular scaling, and use of oral care devices. Data were analyzed using SPSS 20.0 for frequency analysis, t-test, chi-square test, and one way ANOVA. Cronbach’s alpha was 0.462 in oral health concern and attitude. Results: Mean of the frequencies of daily tooth brushing in men was 2.54 times and 2.78 in women. By the comparison to age group, 35-44 years old group had 2.82 times, 19-37 years old group had 2.72 times, and 45-64 years old group had 2.51 times. The level of education and monthly income was proportional to the tooth brushing frequency. Highly educated and higher monthly income group received regular dental checkup within a year and used the auxiliary oral health care devices. Conclusions: This study suggested the relationship between dental caries prevention and socioeconomic status. It is important to provide the low socioeconomic group with the better oral health promotion services in the future.

중·고생의 치아우식증과 구강건강행태와의 관련성 연구: 제9차(2013년) 청소년 건강행태 온라인 조사

Objectives: The purpose of the study is to investigate the relationship between dental caries and oral health behaviors in middle and high school students by web-based survey of the ninth(2013) Korean youth risk behavior. Methods: The subjects were 75,149 students from 400 middle schools and 400 high schools. Finally, the survey participation rate was 96.4%(72,435 students from 799 schools) by complex sample design. The questionnaire consisted of general characteristics of the subjects, oral health behaviors, and oral health status. General characteristics included gender, types of schools, economic condition, and residential types. Oral health behaviors included subjective oral health condition, frequency of tooth brushing, tooth brushing after meal within recent 7 days, sealant within 12 months, fluoride application within 12 months, scaling within 12 months, and oral health education experience within 12 months. Oral health condition included dental caries incidence within 12 months. Results: Oral health behavior influenced on dental caries in the middle and high school students in Korea. This study showed the relationship between the sociodemographic characteristics, tooth brushing frequency, sealant experience, dental caries and halitosis experience, and scaling within 12 months. Scaling is the best prevention method for dental caries and halitosis in the students. Conclusions: The study showed the necessity for practical oral health education and the effect of fluoride application for dental caries prevention.

Oral Health Behaviors and Related Factors in Myanmar Population

Oral Health Behaviors and Related Factors in Myanmar Population To evaluate the relationship of oral health behaviors with socio-demographic, self-perceived oral health, oral health knowledge and health education experience in Myanmar population.Data were collected from a convenience sample of 305 aged 16-65 years who were residents in Yangon, Myanmar. Questionnaires were used to assess socio-demographics, selfperceived oral health, oral health knowledge, health education experience and oral health behaviors. The relationship of oral health behaviors with socio-demographics, self-perceived oral health, oral health knowledge, and health education experience was examined by a logistic regression analysis.

Oral Health and Interprofessional Education Experiences in Family Medicine and Pediatric Residency

INTRODUCTION Prevention of dental diseases in children requires interprofessional education (IPE) and care coordination between oral health professionals and primary care providers; however, the extent of preparation of medical residents and its impact on their provision of preventive oral health services in clinical practice requires further investigation. METHODS A two-stage cluster sample of 470 US family medicine and 205 pediatric residency programs was used. A random sample of 30% (N=140) of family medicine and 29% (N=60) of pediatric residency programs were randomly selected. Of these, 42 programs (21%) invited residents to participate. Residents (N=95, 28%) completed an online questionnaire regarding oral health training in residency. Statistical analysis included frequencies and Spearman’s rank correlations. RESULTS Eighty-three percent of family medicine and pediatric residents combined reported receiving oral health education. Clinical experiences involving oral healthcare were frequently reported (77%, n=75); however, IPE with an oral health professional was limited. Both groups indicated they provided anticipatory guidance regarding regular dental visits and toothbrushing “very often” and avoiding bottles at bedtime “often.” Residents reported performing dental caries assessments “often” and applying fluoride varnish “occasionally.” For family medicine residents, moderate correlations (p ≤ 0.01) were found between hours of oral health education and providing anticipatory guidance. For pediatric residents, a moderate correlation (p < 0.01) was found between hours of oral health education and assessing teeth for demineralization. CONCLUSION Increased effort is needed to meet national recommendations for educating family medicine and pediatric residents regarding oral healthcare for children, including increased IPE involving oral health professionals. Received: 05/25/2015 Accepted: 08/28/2015 Published: 10/22/2015 © 2015 Bailey et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Oral Health and Interprofessional Education ORIGINAL RESEARCH 2(3):eP1081 | 2 Introduction Oral health is a vital component of overall health and, therefore, the responsibility of pediatricians. Accordingly, the American Academy of Pediatrics (AAP) recommends pediatricians play an integral role in children’s oral health by providing preventive oral health services including anticipatory guidance, oral health screenings and assessments, and fluoride varnish applications during well-child visits (AAP, 2014). This recommendation applies not only to pediatricians but to other primary care providers (PCP), such as family physicians, nurse practitioners, and physician assistants (PA) (National Interprofessional Initiative on Oral health [NIIOH], 2011). In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended PCP prescribe fluoride supplementation to children beginning at 6 months of age if they reside in areas with suboptimal fluoride concentration in the drinking water and provide fluoride varnish applications to all children beginning at eruption of the first tooth (USPSTF, 2014). In support of these recommendations, medical insurers are requir-ed to reimburse providers under the Affordable Care Act (ACA) for services assigned a grade A or B by the USPSTF. This reimbursement includes fluoride varnish applications for children ages 0-5 years (Kaiser Family Foundation [KFF], 2014). These national children’s oral health initiatives coincide with the recent emphasis on integrating interprofessional education (IPE) opportunities across the healthcare professions to improve the health of the nation and overall quality of care (Institute of Medicine [IOM], 2011). IPE opportunities involving oral health experts such as dental hygienists, dentists, and/or dental professional students are integral to effectively train PCP to de-liver preventive oral health services to children. Little is known about IPE opportunities involving dental professionals in family medicine and pediatric residencies. Patients of all ages experience needless dental diseaserelated pain and expense, in part, because their PCP has not been trained to provide preventive oral health services (NIIOH, 2009). The general health status of children and adolescents can be improved by prevention and early intervention of oral diseases, including dental caries, before they develop into more complicated Implications for Interprofessional Practice

초등학교 6학년의 구강보건인식과 실천에 영향을 미치는 요인

1 This study was conducted to provide basic data for improvement of the oral health management ability and the factors affecting oral health recognition and practice of 6th graders. The research subjects total 259 numbers of 6th grade students in two schools located in Changwon, it was investigated and analyzed with structured questionnaires. The collected data is analyzed by using IBM SPSS Statistics 19.0. The average oral health recognition score investigated were 3.19±0.41, and 2.95±0.43 for oral health practices. The oral health recognition was statistically significant differences by fatherʼs education (p<0.01), perceived oral health status (p<0.01), perceived grade (p<0.01), intention to attend oral health education (p<0.001). The oral health practices was statistically significant differences by fatherʼs education (p<0.01), perceived oral health status (p<0.001), perceived grade (p<0.05), parentʼs interest in childʼs toothbrushing (p<0.01), experience of oral health education (p<0.001), intention to attend oral health education (p<0.05). The factors that may improve the oral health recognition are in order of oral health practices, intention to attend oral health education, and parentʼs attention to child's tooth brushing. The factors that may improve the oral health practice was found to be in order of oral health recognition, parentʼs attention to child's tooth brushing, and perceived oral health status. As a result, in order to improve oral health management ability of 6th grade students, the surrounding environment, the attitude on oral care, the interest of oral, and the current disease status of oral health are required to be identified, then the oral health education program should be provided.

Study on the Oral Health Behaviors of Geriatric Care Helpers

이 연구는 충청지역의 노인요양병원과 시설 11개소에서 근무하는 요양보호사 127명을 대상으로 요양보호사의 구강보건행태를 파악하고 행태에 영향을 미치는 요인을 분석함으로써 노인건강복지정책을 위한 구강보건교육프로그램 개발과 노인을 위한 구강건강증진사업 접근방법을 모색하고자 조사가 실시되었다.<BR> 1. 구강보건지식과 구강보건행태의 상관관계를 분석한 결과로서 양(+)의 관련성이 있고, 유의한 상관관계가 나타났다(p=.001). 2. 구강보건행태에 영향을 미치는 관련요인으로는 구강보건지식 p=.029, 구강건강교육경험 p=.000로 나타나 두 변수 모두 유의한 결과가 나타났다. 수정된 결정계수(Adj.R²)는 .250으로 나타났고, 분산분석 결과(f=22.001) p-v가 .000이므로 의미가 있음을 알 수 있었다.<BR> 이상을 종합해보면, 현대사회는 생활수준과 삶의 질향상으로 건강에 대한 관심이 높아지고 있으며 구강보건관리가 중요한 부분으로 인식되어 지고 있다. 특히 요양병원과 시설에서 근무하는 요양보호사들의 노인의 구강보건관리의 역할을 담당하고 있으므로 그들을 위한 구강보건교육프로그램 개발과 구강보건전문가들의 지도 및 관리가 필요할 것으로 사료된다.

임부의 영유아 구강보건지식에 미치는 영향

The purpose of this study was to identify influencing factors associated with infantile oral health knowledge among pregnant women. The participants were 300 pregnant women who agreed to participate in this study. The data were analyzed with descriptive statistics, t-test, ANOVA, Pearson correlation, and simultaneous multiple regression using the SPSS 21.0 ver program. Findings of the study can be summarized as follows. First, the infantile oral health knowledge of primigravida total score was <TEX>$28.80{\pm}3.02$</TEX>, and multigravida total score was <TEX>$30.23{\pm}2.94$</TEX>. Second, infantile oral health knowledge different according to education, experience of delivery, experience of oral health education and need of oral health education, Third, a positive correlation existed between need of oral health education, experience of delivery, education, and experience of oral health education. Forth, the predictors that affect the infantile oral health knowledge were experience of delivery, need of oral health education, experience of oral health education, education,. Consequently, it was necessary to encourage primigravida to take part in infantile oral health education program and oral health projects.

일부 고등학생의 개인의 기질적 특성과 치과 관련 지식에 따른 치과공포감에 관한 연구

This study is to analyze the personality trait and dental fear of high school students. This study is conducted with a total of 603 first grader at high school in DaeGu city from 1st September to 30th October, 2009. In prevention and dental treatment knowledge category, the average score of female are higher than male. The concern of oral health, the experience of oral health education and the number of toothbrush are significantly different in the knowledge category. In dental fear category, the number of dental pain, the visiting is treatment, the recognize of dental state, the number of toothbrush and the change of dental visiting date are significantly different. In the prevention knowledge according to dental fear state, low fear group 7.03 is higher than high fear group. In the dental treatment knowledge according to dental fear state, high fear group 7.15 is higher than low fear group. In personal temperament, there are not significantly relationship between prevention knowledge, dental treatment knowledge and dental fear. These findings are basis to development of education programs which were included prevention and dental treatment knowledge before visiting dental clinics for reducing dental fear.

유아교육기관 교사들의 구강보건교육 실태에 관한 연구

Objectives : The purpose of this study is to improve the oral health knowledge in children education institute teacher. Methods : Data were selected by convenience sampling method. A self-administered questionnaire was filled out by the children education institute teachers. Frequency analysis and <TEX>$x^2$</TEX> test were used to analyze the actual condition of oral health education and utilizing media contents. Pearson's Results : 1. The teachers received the oral health education (94.3%) twice to five times. 2. There was a difference between position and career of teacher in implementing oral health education. 3. Most of the oral health education were done by the dentists. Tooth brushing method was the most common education contents. Skill demonstration was the most common teaching method. 4. There was a positive correlation between experience and implementation of oral health education. 5. Use of education media accounted for 74.1% in oral health education. The number of media was more than two to five. 6. Self-devised media contents were the most commonly used in oral health education. Visual materials, dentiform and tooth brush were the most common contents in oral health education. Conclusions : It is necessary to develop the systematic and repetitive oral health education curriculum for the children education institute teachers. The dissemination of media for oral care is needed for oral health care knowledge acquisition.

중학생들의 구강보건교육경험 유무에 따른 구강건강증진행위의 영향

Objectives : The aim of this study is to investigate the influencing factors of oral health behaviors according to oral health education experiences in middle school students. Methods : The subjects were 301 middle school students who lived in Gimhae and Jinhae. All statistical analyses were performed using SPSS. Results : The group with oral health education experience had higher scores in oral health knowledge(p<.01) than the group without oral health education. The group with oral health education experience has higher scores in oral health behavior (p<.01) than the group without oral health education. The group with oral health education experience has higher scores in self-efficiency (p<.01) than the group without oral health education. The experience of oral health education shows positive correlation with oral health knowledge(r=0.184), oral health behavior(r=0.199) and self-efficiency(r=0.199). There existed a positive correlation between oral health knowledge and self-efficiency(r=0.351). Conclusions : It is necessary to provide oral health promotion program in middle school students. The importance of oral health care is closely related to oral health knowledge.

Influential Factors for the Oral Health practice of Dental Hygiene Students and Non-Dental Hygiene Students

Abstract The purpose of this study was to make a comparative analysis of the oral health practice between dental hygiene students and Non-Dental Hygiene students in an effort to shed light on the importance of oral health education and its implications for personnels responsible for oral health practice. Their oral health awareness was investigated, and what factors might affect their actual oral health practice was observed. An then a comparative analysis was conducted. Followings are the main results of this study. First, when the characteristics of the self-rated oral health of the college students were analyzed, the dental hygiene students were ahead of the other students who didn't major in dental hygiene in every factor including oral health concern(p<0.001), awareness of oral health importance(p<0.01) and self-perceived oral health status(p<0.01). Second, the dental hygiene students significantly excelled the other students in both the level of oral health awareness(p<0.001) and the level of oral health practice(p<0.001). The findings of the study showed that more oral health education experiences led to better oral health awareness and better oral health practice, and that better oral health awareness led to better oral health practice.

유아기 자녀에 대한 모친의 구강건강관리행위에 영향을 미치는 요인 연구

Objectives : This study were to find out differences in mother`s oral health knowledge and oral health care behaviors and to find out factors that affected mothers` oral health care behavior for their young children. Methods : The survey was carried out with questionnaire about personal factor, cognitive factor, psychological factor and behavioral factor to 227 mothers. They had children from 3 to 5 years. The collected data was analyzed by SPSS WIN 12.0. Results : There were statistically significant differences in oral health knowledges as mother`s educational background, importance of oral health, experience of oral health education, and oral health locus of control. There were statistically significant differences in mother`s oral health care behaviors as mother`s job, interest of oral health, importance of oral health, experience of oral health education, and oral health locus of control. And mother` oral health care behavior for herself, interest of oral health, and oral health locus of control were found as important variables in mothers`s oral health care behavior for their children. Conclusions : Mother`s oral health care behavior for herself was the powerful factor that affected mother`s oral health care behavior for her children.