International Journal of Psychiatry in Medicine最新文献

{"title":"Adverse childhood experiences and early initiation of substance use: A survival analysis.","authors":"Amy L Meadows, Justin C Strickland, S Maela Hyder, Rita C Basconi, Margaret E Stull, Frances P Wagner, Mai N Nguyen, Abner O Rayapati, Craig R Rush","doi":"10.1177/00912174231195751","DOIUrl":"10.1177/00912174231195751","url":null,"abstract":"<p><strong>Objective: </strong>Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examined the relationship between ACEs and age of initiation of substance use using survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation.</p><p><strong>Method: </strong>Participants were recruited from the University of Kentucky's Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English speaking, and actively engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation.</p><p><strong>Results: </strong>A total of 107 participants completed the study. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset ( hazard ratio (HR) = 1.14, 95% CI=1.02-1.28, <i>p</i> = 0.02, and HR=1.19, 95% CI = 1.04-1.37, <i>p</i> = 0.01, respectively.</p><p><strong>Conclusions: </strong>A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10303715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of exercise interventions on quality of life and depression in lung cancer patients: A systematic review and meta-analysis.","authors":"Ying Lu, Xuelian Bai, Chengwen Pan","doi":"10.1177/00912174231190451","DOIUrl":"10.1177/00912174231190451","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer is a leading cause of cancer-related mortality worldwide. Depression is also a common concern for lung cancer patients and is of concern because it negatively impacts overall well-being. This study summarizes the existing literature on the impact of exercise interventions on quality of life and depression in patients diagnosed with lung cancer.</p><p><strong>Methods: </strong>A systematic search of electronic databases was performed to identify relevant randomized controlled trials (RCTs) investigating the effects of exercise interventions on depression and quality of life in patients with lung cancer. Two evaluators collected information from the chosen studies utilizing a standardized data extraction form. The quality of the studies was evaluated using the Cochrane risk of bias tool.</p><p><strong>Results: </strong>Nine RCTs were included in the meta-analysis, with 798 participants. The pooled standardized mean difference (SMD) for the effect of exercise interventions on depression was -0.60, representing a statistically significant reduction in depression levels following exercise interventions (<i>p</i> < 0.001). The pooled SMD for the effect of exercise interventions on quality of life was 0.61, indicating a statistically significant association between quality of life and exercise interventions (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>There is evidence that exercise may benefit the mental health of individuals with lung cancer, including improvements in depression symptoms and quality of life, based on the intervention studies reviewed here. Given the heterogeneity in findings, however, additional randomized controlled trials are needed to augment the existing findings. Nevertheless, there appears to be sufficient evidence for now to encourage primary care physicians to recommend exercise for patients with lung cancer, while offering guidelines on how to gradually and safely increase physical activity depending on the patient's health status.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10051697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personality traits and attitude towards euthanasia among medical students in Serbia.","authors":"Ivan Ristic, Dragana Ignjatovic-Ristic, Tatjana Gazibara","doi":"10.1177/00912174231191963","DOIUrl":"10.1177/00912174231191963","url":null,"abstract":"<p><strong>Objective: </strong>Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2^nd and 5^th year medical students about euthanasia and the relationship between these attitudes and students' personality traits.</p><p><strong>Methods: </strong>Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60).</p><p><strong>Results: </strong>More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5^th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized.</p><p><strong>Conclusion: </strong>Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9874265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of vortioxetine on anhedonia in patients with schizophrenia.","authors":"Alen Greš, Marina Šagud, Aleksandra Dickov","doi":"10.1177/00912174231199925","DOIUrl":"10.1177/00912174231199925","url":null,"abstract":"<p><strong>Objective: </strong>Anhedonia is a common symptom of depression, but is also a negative symptom of schizophrenia. The purpose of this study was to examine the effects of vortioxetine on anhedonia in patients with schizophrenia.</p><p><strong>Methods: </strong>A total of 120 patients with schizophrenia in remission who met inclusion criteria were randomized 1:1 by the envelope method into intervention and control groups. All participants in both groups were divided into three subgroups based on the antipsychotic therapy they were receiving (olanzapine, risperidone, or aripiprazole). Vortioxetine was administered to those in the intervention group at a fixed dose of 10 mg per day. The Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Chapman Scale for Social and Physical Anhedonia (CSPA) were administered. The study lasted 12 weeks. Participants were assessed twice: At baseline and at the end of the study. Six participants dropped out, with 114 completing the trial.</p><p><strong>Findings: </strong>Vortioxetine treatment had a significant effect on level of physical anhedonia. The treatment interaction was also statistically significant, but with a relatively small effect (F = 3.17, <i>P</i> < .05; η2 = .061). Vortioxetine treatment had a particularly strong effect on the level of social anhedonia. The interaction between the treatment and the type of antipsychotics was also statistically significant with a small effect (F = 5.04, <i>P</i> < 0. 01; η2 = .091).</p><p><strong>Conclusion: </strong>The combination of olanzapine and vortioxetine was found to be the best option to reduce symptoms of social and physical anhedonia in these patients with remitted schizophrenia.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical health consequences of psychological conditions.","authors":"Harold G Koenig","doi":"10.1177/00912174241227019","DOIUrl":"10.1177/00912174241227019","url":null,"abstract":"","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic frontal QRS-T angle is independently associated with panic disorder.","authors":"Mücahid Yılmaz, Seda Yılmaz","doi":"10.1177/00912174231184759","DOIUrl":"10.1177/00912174231184759","url":null,"abstract":"<p><strong>Objective: </strong>Panic disorder (PD) may cause serious cardiac arrhythmias by causing electrical abnormalities. Abnormal P-wave axis (aPwa), presence of fragmented QRS (fQRS), wide frontal QRS-T angle (fQRSTa), QRS duration corrected (QRSdc) and log/ logQRS duration/RR interval (log/logQRS/RR) have been correlated with increased risk of serious supraventricular and ventricular cardiac arrhythmias in a general population. The purpose of this study was to compare these newly explored atrial and ventricular arrhythmia indicators in patients with PD and in healthy subjects.</p><p><strong>Method: </strong>A total of 169 newly diagnosed PD patients and 128 healthy subjects were included in the study. The Panic and Agoraphobia Scale (PAS) was administered, and 12-lead electrocardiography (ECG) measurements were obtained. Electrocardiographic parameters including aPwa, fQRSTa, presence of fQRS, QRS duration corrected (QRSdc), and log/logQRS duration/RR distance (log/logQRS/RR) were compared between the two groups.</p><p><strong>Results: </strong>aPwa and fQRS, in addition to fQRSTa, QRSdc, and log/ logQRS/RR ratio values, were significantly increased in the PD group compared to healthy controls. Correlation analyses revealed that wider fQRSTa, number of fQRS derivation, number of total fQRS, wider QRSdc, and log/logQRS/RR ratio significantly correlated with PAS score. Logistic regression analysis demonstrated that fQRSTa and the number of total fQRS were independently associated with PD.</p><p><strong>Conclusion: </strong>PD is associated with wider fQRSTa, QRSdc, and log/logQRS/RR in addition to the increased abnormal aPwa and presence of fQRS. These findings suggest that untreated PD patients may be susceptible to supraventricular and ventricular arrhythmia, indicating that ECG should be routinely obtained in the management of PD patients.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9798826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe depressive symptoms in patients with hypertension: Are antihypertensive medications implicated?","authors":"Omar Salem Gammoh, Abdelrahim Alqudah, Hanan Abu Shaikh, Abdel-Ellah Al-Shudifat","doi":"10.1177/00912174231173339","DOIUrl":"10.1177/00912174231173339","url":null,"abstract":"<p><strong>Objective: </strong>This study examined whether antihypertensive medications and other patient characteristics are associated with severe depressive symptoms in patients with hypertension.</p><p><strong>Methods: </strong>Patients with a diagnosis of hypertension were recruited from the internal medicine outpatient clinics of a hospital in Amman, Jordan, into this cross-sectional study. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9); anxiety by the General Anxiety Disorder-7; sleep quality by the Insomnia Severity Index; and psychological stress by the Perceived Stress Scale. Multivariable binary logistic regression was used to examine the association between the different classes of antihypertensive medication and depressive symptoms.</p><p><strong>Results: </strong>Of the 431 participants, 282 (65.4%) were men; 240 (55.7%) reported having type 2 diabetes; 359 (83.3%) had dyslipidemia; 142 (32.9%) were on beta-blockers; 197 (45.2%) were on ACE inhibitors or angiotensin receptor blockers; 203 (47.1%) were on metformin; and 133 (30.9%) were taking sulfonylurea. Severe depressive symptoms, indicated by scoring above the cut-off of 14 on the PHQ-9, were present in 165 (38.3%) patients. Severe depression was associated with younger age (<55 years) (OR = 3.15, 95% CI = 1.83-5.41, <i>P</i> < 0.001), unemployment (OR = 2.15, 95% CI = 1.15-4.00, <i>P</i> = 0.01), diabetes (OR = 1.81, 95% CI = 1.09-3.02, <i>P</i> = 0.02), severe anxiety (OR = 6.40, 95% CI = 3.64-11.28, <i>P</i> < 0.001), and severe insomnia (OR = 4.73, 95% CI = 2.85-7.82, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Severe depressive symptoms were not associated with antihypertensive medications or other drugs used by hypertensive patients. Younger age, diabetes, anxiety, and insomnia were the primary correlates of depression.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy orthorexia, orthorexia nervosa, and personality traits in a community sample in Turkey.","authors":"Kübra Sezer Katar, Başak Şahin, Mustafa Batuhan Kurtoğlu","doi":"10.1177/00912174231194745","DOIUrl":"10.1177/00912174231194745","url":null,"abstract":"<p><strong>Objective: </strong>Orthorexia nervosa is an eating disorder characterized by a rigid preoccupation with a perceived healthy diet. However, little is known about healthy orthorexia compared to orthorexia nervosa. The current study examined the relationship between healthy orthorexia and orthorexia nervosa and personality traits in a Turkish sample.</p><p><strong>Methods: </strong>Three hundred fifty participants from a community sample aged 18-65 were included in the study. Participants completed a sociodemographic data collection form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Teruel Orthorexia Scale (TOS), and the 10-Item Personality Inventory (TIPI).</p><p><strong>Results: </strong>The frequency of healthy orthorexia was 32.3% and orthorexia nervosa was 10.2%. There were no differences between genders regarding healthy orthorexia and orthorexia nervosa scores. Healthy orthorexia symptoms were negatively correlated with depression and anxiety (r = -0.11 and r = -0.20, respectively, <i>P</i> < .05), while they were positively correlated with agreeableness (r = 0.17), conscientiousness (r = 0.14), and extraversion (r = 0.15). Orthorexia nervosa symptoms were positively associated with anxiety (r = 0.12), depression (r = 0.10), and healthy orthorexia (r = 0.55). Hierarchical regression analyses demonstrated that depression was negatively associated with healthy orthorexia symptoms, explaining 4% of the variance. The agreeableness trait was positively associated with healthy orthorexia symptoms, explaining 4% of the variance. However, no specific personality trait was associated with orthorexia nervosa symptoms.</p><p><strong>Conclusion: </strong>To our knowledge, the present study is the first to examine the relationships between personality traits, healthy orthorexia, and orthorexia nervosa symptoms in a Turkish sample. Sociocultural factors may be important for understanding orthorexia nervosa and healthy eating behaviors in this population.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and anxiety in patients with hemophilia A and B.","authors":"Fatos D Koseoglu, Demirci Zuhal, Ozen Onen-Sertoz, Sahin Fahri","doi":"10.1177/00912174231196343","DOIUrl":"10.1177/00912174231196343","url":null,"abstract":"<p><strong>Objective: </strong>This study described the prevalence of and correlates of depression and anxiety in adult patients with hemophilia A and B.</p><p><strong>Methods: </strong>In this cross-sectional study, we investigated patients with hemophilia who were being seen at an adult hemophilia center in Turkey. Participants were screened for depression and anxiety during their annual clinic visit, which included administration of the Beck Depression Inventory and State-Trait Anxiety Scale.</p><p><strong>Results: </strong>Of the 90 patients, 22 (24.4%) met criteria for significant depressive symptoms and 67 (74.4%) met criteria for significant anxiety symptoms. There were no significant associations between depression and any psychosocial or clinical characteristics or adherence to hemophilia prophylaxis, except for educational status. No association was found between state and trait anxiety scores and psychosocial and clinical characteristics other than hemophilia type. After adjusting for confounding factors, multivariable analysis showed that high school education level was associated with depression (OR: 1.87, CI: 1.31-2.36, <i>P</i> = .010) and type B hemophilia was associated with anxiety (OR: 1.32, CI: 1.09-1.75, <i>P</i> = .042).</p><p><strong>Conclusion: </strong>Depression and anxiety are major psychiatric comorbidities in patients with hemophilia in Turkey. Routine evaluation for mood and anxiety disorders are important in the routine care of patients with haemophilia.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9965243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of post-traumatic stress disorder in patients with schizophrenia 2 years after an earthquake in Turkey.","authors":"Ali Baran Tanrıkulu, Hilal Kaya, Mehmet Hamdi Örüm, Sümeyya Akyıldırım","doi":"10.1177/00912174231180467","DOIUrl":"10.1177/00912174231180467","url":null,"abstract":"<p><strong>Objectives: </strong>High rates of post-traumatic stress disorder (PTSD) have been observed in earthquake survivors many years after the event. However, its prevalence among patients with schizophrenia is largely unknown. This study, which was conducted two years after the 2020 Elazığ earthquake, sought to identify risk factors for earthquake-related PTSD among patients with schizophrenia and healthy subjects.</p><p><strong>Methods: </strong>Adult patients with schizophrenia (<i>N</i> = 103) and healthy subjects (<i>N</i> = 103) who had survived the earthquake were recruited from affected areas in the Eastern Anatolian Region of Turkey, Elazığ. A detailed questionnaire of earthquake-related risk factors, the Brief Coping Orientation to Problems Experienced (Brief COPE), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Clinician-Administered PTSD scale for DSM-V (CAPS-5) scale were administered to participants.</p><p><strong>Results: </strong>Twelve percent of the patients with schizophrenia and 25% of the healthy subjects had earthquake-related PTSD diagnoses two years after the 2020 Elazığ earthquake. Healthy subjects had a significantly higher rate of earthquake-related PTSD when compared to patients with schizophrenia. Religious coping, self-blaming, less emotional support seeking, and going to a safer place on the night of the earthquake were found to be associated with PTSD in patients with schizophrenia. History of traumatic events, self-blaming, and less social support from family were found to be associated with a PTSD diagnosis in healthy subjects.</p><p><strong>Conclusions: </strong>The earthquake in Turkey created a situation such that significant symptoms of PTSD remained present at two years following the event in both patients diagnosed with schizophrenia and healthy subjects. Patients with schizophrenia have different risk factors for the development of PTSD when compared with healthy subjects. Clinical interventions should consider risk factors, coping strategies, and perceived social support when seeking to prevent earthquake-related PTSD.</p>","PeriodicalId":50294,"journal":{"name":"International Journal of Psychiatry in Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}