Work-related Strain Research Articles

Work-Related Strain, Sense of Coherence and Intercultural Sensitivity Among Mental Health Nurses in Qatar: ACross-Sectional Study.

Migrant nurses face many challenges as they adapt and assimilate into their new working environments. The aim of this cross-sectional study was to investigate the perceptions of work-related strain, sense of coherenceand intercultural sensitivity among nurses who were employed at a public mental health facility in Qatar. We used three self-report questionnaires: the work-related strain inventory, sense of coherence scale and an intercultural sensitivity scale. A cohort of 136 nurses voluntarily engaged in the study. The majority of participants were male, migrated from South Asia and were in their mid-30s. The study found that both sense of coherence and intercultural sensitivity were inversely proportional to work-related strain. Work-related strain was found to be lower than expected; the factors that appear to protect against work-related strain include longer clinical experience, a high sense of coherence, and intercultural sensitivity. Additionally, greater age and extended clinical experience, combined with a history of work in three or more countries, associated with higher scores on the sense of coherence scale. Lastly, being female, having a postgraduate degree and holding a senior-level position were associated with increased intercultural sensitivity. As nurses' migration across national and international borders increases in response to global demand, this study has important implications for nursing administrators, educators and policymakers in relation to the development and implementation of strategies to enhance nurses' sense of coherence and intercultural sensitivity and prevent work-related strain. Trial Registration number: NCT04196751.

Characteristics of nurses with musculoskeletal disorders from Dr Soedarso Regional Hospital, Pontianak, Indonesia

Musculoskeletal disorders (MSDs) can have a significant negative impact on quality of life, resulting in reduced ability to work, absenteeism, and possibly switching occupations. The purpose of this study was to investigate the relationship between the prevalence and severity of MSDs and the nurse characteristics (NCs) of nurses working in the Dr Soedarso Regional Hospital (DSRH) inpatient department. An analytical and descriptive cross-sectional methodology was used to examine 134 nurses from Inpatient Wards A and B. Total sampling was used to select the respondents. The level of exposure to the conditions investigated by the quick exposure check (QEC), namely, static and dynamic movements in the back, shoulders/arms, neck, and work-related stress, was significantly correlated with gender and neck (0.050), a history of education-related physical strain, such as back mobility (0.021), years of work-related strain on the neck (0.040), and work-related stress (0.033). There were no significant correlations found between age and static and dynamic movements of the back, shoulders/arms, and neck. Gender, education level, and employment duration all have a strong correlation with MSDs among DSRH inpatient nurses.

Perceived job insecurity climate in uncertain times: implications for work-related health among leaders versus non-leaders

PurposePrevious studies have demonstrated that perceived job insecurity climate denotes an individual-level stressor. The present study reiterated this notion and investigated whether leadership responsibility moderated the association between perceived job insecurity climate and work-related strain about one year into the coronavirus disease (COVID-19) pandemic.Design/methodology/approachA sample of full-time workers (N = 1,399) in the USA was recruited, comprising 663 leaders and 763 non-leaders. Employing a cross-sectional design, the authors hypothesized that perceived job insecurity climate would be associated with work-related strain (i.e. burnout, absenteeism and presenteeism) and that these associations were stronger for employees with leadership responsibilities compared to non-leaders.FindingsFindings revealed main effects of perceived job insecurity climate on burnout but not on absenteeism or presenteeism. Furthermore, leadership responsibility moderated the associations between perceived job insecurity climate and two out of three burnout measures in the hypothesized direction. The findings also revealed interaction effects regarding absenteeism and presenteeism, indicating that these associations are only positive and significant for employees with leadership responsibilities.Practical implicationsPerceptions of widespread job insecurity engender strain among leaders while simultaneously implying a heightened need for effective leadership. Organizations and practitioners should take the present findings into consideration when implementing preventive and restorative measures to address leaders' health and organizational competitiveness when job insecurity increases.Originality/valueThis study found that, as an individual stressor, perceived job insecurity climate is more detrimental to employees with leadership responsibility than to non-leaders.

The relationship between the work-related strain, psychological flexibility and psychological resilience levels of nurses in the COVID-19 pandemic process

Purpose:This research was conducted to define relationship between the work-related strain, psychological flexibility, psychological resilience levels of nurses in COVID-19 pandemic.
 Material and Methods: This cross-sectional, correlational research was carried out with 359 nurses. The data were collected using a Personal Information Form, the Work-Related Strain Inventory, Acceptance and Action Questionnaire II and Brief Resilience Scale. 
 Results: The mean work-related strain score of the participants was 41.45±6.51 (min:18, max: 72), while their mean psychological resilience score was 18.57±4.72. 
 Conclusion: As a result of this study, it was determined that, as psychological resilience levels of nurses increased, their psychological flexibility levels also increased.

The power of music.

How music can so powerfully impact our bodies and minds defies rational explanation. Through our senses, music can mysteriously reach our deepest emotions without using language or images. Even if we do not understand it intellectually, music speaks to us, and can transform our experience. Music is often a communal experience. Anthony Storr, psychoanalyst and musician, writes that when a group of people sing together, ‘a culturally agreed upon pattern of rhythm and melody, i.e. a song, that is sung together, provides a shared form of emotion that, at least during the course of the song, carries along the participants so that they experience their bodies responding emotionally in very similar ways, sharing the emotions of the music’ (Music and the Mind, HarperCollins Publishers, 1992). But why are we talking about music here? Music is integral to healing practices in many indigenous cultures. In Western medicine, the impact of music on wellbeing is increasingly explored. The beneficial impact of music on reducing anxiety and stress responses, with possible resulting immune system modulation, has been observed in individuals with a range of nervous system conditions, from autism, depression, Parkinson's and schizophrenia. In patients with dementia, music and singing can reduce hallucinations and depression, increase social interactions and may even be associated with slower cognitive impairment. During the early phases of the COVID-19 outbreak, when most of the world was in lockdown and clinical staff were under severe psychological distress, an Italian hospital piloted a music therapy programme for healthcare staff assisting COVID-19 patients (https://doi.org/10.1016/j.aip.2020.101688). After listening to playlists prepared by trained music therapists and customized to individual preferences, clinical staff reported significantly reduced tiredness, sadness, fear and worry. Similarly, in a randomized controlled trial investigating mindfulness and music therapy in nurses caring for COVID-19 patients in Turkey, work-related strain was reduced in the intervention compared to control group. (https://doi.org/10.1097/hnp.0000000000000511). British Lung Foundation (BLF) commissioned Phoene to deliver a training programme for singing leaders entitled ‘Singing for Lung Health (SLH)’, with more than 100 groups established across the UK. Service evaluation has shown that SLH is associated with improved respiratory related quality of life and reduced health care utilization (https://journals.sagepub.com/doi/10.1177/1757913918774079). In the words of a SLH participant: ‘I feel as though my airways have really opened up and my natural breathing is more fluid. Singing has so many benefits: physical, emotional and pure enjoyment’. Group singing as a treatment for patients with chronic lung diseases is increasingly explored in Europe, North America, Australia and Africa, with research ongoing to study the physiological and psychosocial benefits for participants and how this intervention could best be implemented more widely (https://www.mdpi.com/2227-9059/10/9/2086#B14-biomedicines-10-02086). None declared.

Effects of emotional labor on musculoskeletal disorders among physical therapists in Seoul

Introduction: Health care workers, including physical therapists, have some of the most important roles in the health care system as shown during the COVID-19 pandemic. Physical therapists encounter emotionally and physically vulnerable patients, experience emotional labor, and are exposed to conditions that can lead to job stress and musculoskeletal disorders. We aimed to examine the relationship between physical therapists’ emotional labor and its effect on perceived job stress and risk of musculoskeletal disorders. Methods: We conducted a 30-day survey among 230 physical therapists working in various settings from October 2 to November 1, 2019. Questionnaires, including questions on musculoskeletal symptoms, perceived job stress, and emotional labor, were administered to the participants. Results: The physical therapist's surface behavior affected the body burden. Job burnout experienced by physical therapists had an effect on their interpersonal relationships. The physical therapist's emotional law affects the degree of compensation. Conclusion: To prevent the long-term consequences of work-related strain, physical therapists should receive support in terms of maintaining a healthy lifestyle and developing effective methods of communication with patients. Encouragement of activities for psychological rejuvenation with colleagues with whom they can share emotional difficulties is also desirable. It is also necessary to establish a communication channel that can directly convey the grievances of physical therapists to hospitals.

Mediating Role of Entrepreneurial Work-Related Strains and Work Engagement among Job Demand–Resource Model and Success

Post-COVID-19 working conditions have been the primary reason behind increased stress among business owners. There is an ever-rising need for entrepreneurial work engagement in their jobs to mitigate the increased entrepreneurial work pressures caused by uncontrolled digitization, enhanced consumer power, and brutal competition. Therefore, this study intends to respond to the existing practical and empirical gaps by investigating the relationships between entrepreneurial job demands (EJD), work-related stress, entrepreneurial job resources (EJR), and entrepreneurial work engagement (WE) for their role in generating entrepreneurial success (ES), especially in the Chinese context. It also tested the mediating role of work-related stress and entrepreneurial work engagement on the relationship between job demands, job resources, and entrepreneurial success. Structured questionnaires were circulated among the targeted respondents (i.e., business owners across China) using quantitative techniques, followed by PLS-SEM for data analysis, as these are the best-suited techniques, considering the context and time constraints. The results verified the impact of job demands on work-related strain, followed by the inverse direct impact of work-related strain on entrepreneurial success. This study found the significant impact of entrepreneurial job resources on entrepreneurial work engagement, followed by the positive impact of WE on entrepreneurial success. Likewise, work engagement’s mediating role was validated, while work-related strain could only negatively mediate the relationship between EJD and ES. Likewise, this study has practical and empirical implications for practitioners and researchers to be mindful of their employees’ emotional states by providing sufficient resources and psychological interventions to ensure business success.

Rank, strain, and corruption among Chinese public officials: A general strain theory perspective.

The problem of corruption has long been a societal focus in China. Agnew's general strain theory (GST) offers a good explanation of the drive to engage in corruption; that is, offenders are likely to be driven by various types of strains and engage in corrupt behavior as a coping mechanism. However, whether and how an official's rank moderates the effect of strain on corrupt behavior has yet to be explored. The current study surveyed 687 inmates from 60 prisons in China who had been convicted of corrupt behaviors. The results show that although different levels of officials experience different types of strain, nearly all types of strains are significantly and positively associated with the frequency of corrupt behavior. As for the conditional effect, officials' ranks significantly moderate the relationship between work-related strain and the frequency of corrupt behavior; that is, work-related strain is shown to have a more significant effect on officials at the clerk level (a higher rank) than on officials at non-clerk level (a lower rank). This research is believed to further expand on the applicability of GST to corruption in non-Western societies.

Daily moods, health routines and recovery among employees working in the retail and services sector: A diary study

AbstractThis study examined the quality and fluctuation of daily moods as well as health routines and means of recovery from work strain among employees (n = 38) working nonstandard, often unpredictable schedules in the retail and services sector in Finland. Data were collected via a background questionnaire and a one‐week mobile diary. The results indicated that the daily moods of employees were relatively positive but varied greatly from day to day. Hectic working days, unpredictable changes in work schedules, and compounded responsibilities at home and work were reported as causes of daily strain stemming from work. In contrast, more sleep and exercise were positively associated with daily mood and, therefore, are likely to enhance recovery from work related strain. Additional activities employees reported as useful in recovering from work strain included low‐effort leisure activities along with social activities with family and friends, as well as mastery experiences stemming from successful work experiences.

EFFECT OF NURSES’ WORK-RELATED STRAIN LEVELS ON EMOTIONAL EXHAUSTION LEVELS DURING THE COVID-19 PANDEMIC

Bu çalışmanın amacı pandemi sürecinde, hemşirelerde görülebilecek işe bağlı gerginlik ve duygusal tükenme düzeylerini belirlemek ve işe bağlı gerginlik ve duygusal tükenme belirtilerini yordamada çeşitli demografik ve Covid-19 pandemisine ilişkin değişkenlerin rolünü incelemektir. Tanımlayıcı tasarımda olan bu araştırma, bir üniversite hastanesinde fiili olarak çalışmakta olan ve araştırmaya katılım göstermeyi kabul eden 171 hemşire ile yapılmıştır. Veriler, araştırmacılar tarafından oluşturulan demografik sorular, Maslach Tükenmişlik Ölçeğinin Duygusal Tükenme alt ölçeği ve İşe Bağlı Gerginlik Ölçeği ile toplanmıştır. Verilerin analizi varyans testi, t-testi ve basit doğrusal regresyon analizi ile değerlendirilmiştir. Hemşirelerin pandemi döneminde haftalık ortalama çalışma saati 46.36 ve günlük bakım verdikleri ortalama hasta sayısı ise 29,79’dur. Hemşirelerin %29,8’i Covid servisinde çalışmaktadır. Hemşirelerin işe bağlı gerginlik düzeylerinin ortalamanın altında, duygusal tükenme düzeylerinin ise ortalamanın üstünde olduğu görülmüştür. Ayrıca çalışmada hemşirelerin işe bağlı gerginliklerinin duygusal tükenmeleri üzerindeki etkisinin pozitif yönde ve düşük seviyede olduğu saptanmıştır (R2=0,188; p

The Effects of the COVID-19 Pandemic on Perceived Stress, State and Trait Anxiety and Work-Related Strain in Healthcare Professionals

The Effects of the COVID-19 Pandemic on Perceived Stress, State and Trait Anxiety and Work-Related Strain in Healthcare Professionals

Professional values and ethical sensitivities of nurses in COVID-19 pandemic.

BackgroundNurses are facing several ethical problems like the safety of the nurses, patients, co‐workers, and families, allocation of scarce resources, and the changing nature of the relationships of nurses with patients and families during the COVID‐19 pandemic. These have caused nurses to have feelings such as stigmatization, fear, anger, anxiety, uncertainty, work‐related strain, and burnout. Identifying nurses' ethical sensitivities and professional values are highly important to ensure that nurses are placed in the right decision‐making position. This descriptive correlational study was carried out to evaluate the professional values and ethical sensitivities of nurses during the COVID‐19 pandemic.MethodsA quantitative descriptive and correlational study was performed with 245 nurses in Turkey. The “personal information form,” the “nurses professional values scale‐revised (NPVS‐R),” and the “moral sensitivity questionnaire (MSQ)” were employed for data collection.ResultsThe nurses' 52.7% reported facing an ethical dilemma. Also, 40.3% of the nurses who had an ethical dilemma during the pandemic failed to solve it. The mean NPVS‐R scores of the nurses had statistically significant negative correlations with mean scores of the overall MSQ and its autonomy, benefit, integrative approach, and orientation subscales (p < .05). The nursing staff had high levels of professional values and moral sensitivities.ConclusionProfessional value perceptions were enhanced, and moral sensitivities were improved. Age and professional experience were identified as factors that affected the professional value perceptions and moral sensitivities of the nurses. The results will form the basis for future studies and contribute to the resolution of ethical dilemmas experienced by nurses.

Evaluation of Anxiety, Depression, and Work-Related Strain Inventory of Code Blue Teams in Turkey During the COVID-19 Pandemic: A Cross-Sectional Survey Study.

Objective:This study aimed to evaluate the anxiety, depression, and work-related strain inventory with a cross-sectional electronic questionnaire in code blue teams during the coronavirus disease-2019 pandemic in Turkey.Methods:A web-based electronic questionnaire was sent to healthcare workers registered in the database of the Turkish Society of Anaesthesiology and Reanimation and the Turkish Resuscitation Council who are in the code blue teams of the hospital where they work. An electronic questionnaire including the hospital anxiety-depression scale and the work-related strain inventory was sent to healthcare professionals. A total of 259 participants who answered the questionnaire were included in the study.Results:It was determined that 41.3% (n = 107) of all participants were at risk in terms of anxiety and 64.1% (n = 166) were at risk in terms of depression by taking above the threshold value. The mean work-related strain inventory score of the participants was found to be 41.19 ± 6.31. The mean work-related strain inventory values of the participants who received above-threshold values from both the anxiety and depression subscales were also found to be statistically significantly higher than the participants who received below-threshold values (P < .001).Conclusion:It was determined that approximately half of the code blue teams were at risk for anxiety and two-thirds of them for depression.

Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic: a cross-sectional study with quantitative and qualitative data

BackgroundThe Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic.MethodsWe conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch’s t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke).ResultsOur survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales ‘quantitative demands’, ‘hiding emotions’, ‘work-privacy conflicts’, ‘role conflicts’, ‘quality of leadership’, ‘support at work’, ‘recognition’, ‘physical demands’, ‘intention to leave profession’, ‘burnout’, ‘presenteeism’ and ‘inability to relax’. The interviews (n = 15) revealed six main themes related to nurses’ psychosocial stress: ‘overall working conditions’, ‘concern for residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ (interviews), ‘meaning of work’ and ‘quantity of social relations’ (COPSOQ III) were identified as positive effects of the pandemic.ConclusionsResults clearly illustrate an aggravation of geriatric nurses’ situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses’ strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses.

Assessment of Anxiety, Depression and Work-Related Strain Levels of Healthcare Professionals Working in Operating Rooms and Intensive Care Units During the COVID-19 Outbreak.

The purpose of the study was to determine the levels of work-related strain, anxiety, and depression in health professionals working in operating rooms and intensive care units who deal with the diagnosis, treatment, and care of coronavirus disease 19 patients. The population of the study consisted of 320 healthcare professionals working in the operating room and intensive care units. After providing detailed information about the study to the participants, a questionnaire consisting of 21 questions including sociodemographic infor- mation and working life characteristics, 14 questions from the Hospital Anxiety and Depression Scale, and 18 questions from the Work-Related Strain Inventory (WRSI) were administered under supervision. In total, 58.8% of the participants were working in intensive care units, and 41.2% of the participants were in the operating room. The scores obtained from Work-Related Strain Inventory were found to be statistically significantly high in those who wanted to choose a differ- ent profession, those who were on duty during the coronavirus disease 19 pandemic process, those whose spouses followed coronavirus disease 19 patients during the pandemic, those who encountered a suspicious situation and had a coronavirus disease 19 test, those who had difficulty in accessing personal protective equipment, and those who thought that their lives were in danger during the pandemic process. Participants with anxiety risk according to Hospital Anxiety and Depression Scale-Anxiety subscale and depression risk according to Hospital Anxiety and Depression Scale-Depression subscale were found to be 153 (47.8%) and 300 (93.8%), respectively. It was found that Work-Related Strain Inventory and anxiety-depression rates were significantly high in both the operating room and intensive care unit workers who actively provided healthcare services to patients diagnosed with coronavirus disease 19.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial.

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.

Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital: the results of a mixed-method phase-II study

ObjectivesHospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility...

Relationship between Work-Related Strain Level in Nurses and Their Medical Error Tendency

Aim: The aim of this study is to determine the relationship between work-related strain level and medical error tendency of the nurses.&#x0D; Material and Methods: The present study was carried out in relational screening model. The data was obtained from 260 nurses. The study data were collected from four state hospitals in a province located in the Western Black Sea region in Turkey between January and March 2017. Approval from the Ethical Committee and institution and verbal consent from the nurses were obtained prior to conducting the study. A descriptive characteristics form, the Work-Related Strain Inventory (WRSI) and the Medical Error Trend Scale in Nursing (MTSN) were used to collect data. The evaluation of the data was done by descriptive statistics and correlation analysis. &#x0D; Results: Nurses' work-related strain was found moderate, and their tendency to make medical error was low. A negative, significant, and very weak relationship was found between work-related strain in nurses and medical error tendency related to communication, prevention of falling, patient monitoring and equipment safety, prevention of infections, and medicine and transfusion practices.&#x0D; Conclusion: As a result of the study, it is seen that work-related strain in nurses affected the medical error tendency significantly and negatively.

The Effect of Emotional Intelligence and Work-related Strain on the Employee’s Organizational Behavior Factors

The aim of this study was to determine the effects of employee’s emotional intelligence and work-related strain on anxiety and depression. In order to collect data, face-to-face questionnaires were administered to 210 healthcare workers who agreed to fill in the information required.The survey was conducted with the use of an easy sampling method. According to the findings: (1) the anxiety / depression (HAD) variable was positively affected by the work-related strain variable; (2) the HAD variable was negatively affected by emotional intelligence; (3)when HAD (a dependent variable) and two other variables (independent ones) were subjected to a stepwise multiple regression analysis, 45 % of the variance in the HAD variable was explained by the emotional intelligence and work-relatedstrain variables. The research was limited to 210 people working in health institutions operating in Istanbul region.

Family Caregivers and Support: Implications for Work Strain and Formal Service Use

In the US, many employed caregivers make professional adjustments, exacerbating already tenuous balances between work and life. Using the framework of the Stress Process Model (SPM), current research examines the sources of support (both formal and informal) and the contextual factors that facilitate or impede caregiver support. In this research, we examine whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. This study utilizes data provided by the National Study of Caregiving (NSOC) data. Using panel methods for the pooled waves, we analyze the associations between work-strain and the number of additional caregivers with utilization of formal support (such as paid service support). Preliminary analyses align with the Stress Process Model as additional caregivers for each respective care-recipient is associated with lower levels of work strain. On the other hand, utilization of formal services (paid help and Medicaid funding) is positively associated with work strain. These findings suggest that the number of additional caregivers can reduce the negative impact of caregiving on work related strain among employed caregivers. That is, multiple caregivers may be more reflective of cooperative arrangements which offset work disruptions that occur with the onset of caregiving. In addition, formal sources may more frequently be used as a last resort to address caregiver burnout. Ongoing analyses are examining changes in the number of caregivers and its impact on disruptive work event, which could lead to financial outcomes for caregivers.