Repositório RCAAP

ABSTRACT Objective To estimate the prevalence of overweight/obesity and its associated factors among basic education teachers. Methods This is a cross-sectional study with probabilistic sampling by clustering. A questionnaire with socio-demographic, occupational, and psychosocial variables, as well as lifestyle, and health profiles was used. Results 707 teachers participated in the study. Associations with overweight / obesity were found for the variables: the male gender, age >40 years, three or more children, workload, contracted/designated employment relationship, fat intake through meat, abusive consumption of alcoholic beverages, presence of depressive episodes, endocrine problems, arterial hypertension, and negative self-perception of health with the prevalence ratio ranging from 1.16 to 1.52 in the associated variables. Conclusion Overweight / obesity affected approximately half of those surveyed. There is a relationship between sociodemographic, occupational, and psychosocial variables and lifestyles, on the one hand, and health factors and the presence of overweight / obesity in teachers, on the other. Measures must be implemented on modifiable factors, aiming to promote their quality of life.

ABSTRACT Objective Describe the dietary intake of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation. Methods Data from 0 to 19-year-old patients’ medical records who were submitted to the procedure from January 2012 to September 2017 were used. These medical records provided anthropometric, food intake control and symptoms data for three moments: three days before infusion (M1), the infusion day (M2), and 25 days after the cell infusion (M3). This study was approved by the Ethics in Research Committee (17-0267). Results The patients presented weight loss (p>0.001) and a decrease in body mass index (p>0.001) in M1 versus M2 and M3. The means of calorie intake (p=0.031), protein (p=0.006), lipid (p=0.017), dietary fiber (p=0.035), calcium (p=0.005), iron (p=0.012), and sodium (p=0.022) had a reduction from M1 to M2 and an increase from M2 to M3. There was a decrease in mean intake of carbohydrates and calories per kilo from M1 to M2 and an increase from M2 to M3. The nutritional status was related to temperature above 37ºC (p<0.001) and to mucositis (p=0.001), in M1 and M2. There was a correlation of dietary intake with the presence of temperature above 37ºC (p=0.019) in M2 and M3. Conclusion Reduced intake and worsening of the patients’ previous nutritional status appear to interfere with allogeneic hematopoietic stem cell transplantation and its complications, such as the presence of temperature above 37ºC and mucositis.

RESUMO Objetivo O objetivo deste estudo foi avaliar o efeito da educação visual no conforto dos pacientes que recebem terapia de hemodiálise. Métodos Foi utilizado um projeto de estudo aleatório em um ambiente controlado. Este estudo foi realizado com 90 pacientes hemodialisados crônicos em dois centros de diálise, sendo que 45 pacientes pertenciam ao grupo de intervenção e os outros 45 pacientes perterciam ao grupo de controle. Formulário de dados do paciente, escala de conforto de hemodiálise - Versão II, escala de controle de fluidos do paciente de hemodiálise, escala de conhecimento dietético e escala de comportamentos dietéticos foram os documentos usados. No grupo de intervenção, foram conduzidas três entrevistas. Na primeira entrevista, a educação visual foi aplicada e reaplicada após 15 dias. No grupo de controle, duas entrevistas foram realizadas e nenhuma intervenção foi feita. Resultados Descobriu-se que o programa de treinamento tem um amplo efeito sobre o conforto e relaxamento físico do paciente, assim como relaxamento psicoespiritual, transcendência psicoespiritual, transcendência ambiental e relaxamento sociocultural. Além disso, foi notado um efeito moderado sobre o alívio físico no grupo de intervenção no terceiro mês. Dessa maneira, foi determinado que o programa de educação visual aplicado teve um amplo efeito no controle de fluidos, conhecimento de dieta e comportamento do grupo de intervenção. Conclusão Verificou-se que a educação visual tem um efeito positivo no estado de conforto, no conhecimento dietético e no comportamento dietético dos pacientes submetidos à terapia de hemodiálise

ABSTRACT Objective To analyze the factors that are associated with the nutritional risk and appetite loss of long-aged older people with two assessment instruments. Methods A cross-sectional and quantitative study was developed in Três Lagoas, a city in the Brazilian state of Mato Grosso do Sul. The household data collection was conducted with 87 long-aged older adults (≥90 years) living in the community. The risk of malnutrition, malnutrition, and the risk of weight loss were the dependent variables, assessed by the Simplified Nutritional Appetite Questionnaire and by the Mini-Nutritional Assessment - Short Form. The association with independent sociodemographic, general health, psychological, cognitive, and physical variables was analyzed using logistic regressions. Results Most of the older adults were female (55.2%), with an average age of 93.3 years, and 1.4 years of schooling. According to the Simplified Nutritional Appetite Questionnaire, 34.5% of the older individuals were at risk of losing weight. As for the results of the Mini-Nutritional Assessment, 19.5% were classified as malnourished, and 39.1% at risk of malnutrition. A greater nutritional risk in both instruments was associated with the individual's poorer self-perceived health, lower calf circumference, and presence of depressive symptoms. The greater the number of medications used, the lower the chance of weight loss. The agreement between the two instruments was low. Conclusion There was an association connecting malnutrition and appetite/weight loss with lower calf circumference, worse self-perceived health status, and presence of depressive symptoms. These results can assist in interventions planning to reduce the nutritional risk and improve the life quality of older adults.

ABSTRACT Objective To verify the association between cooking habits, socioeconomic data, and food choices of individuals with Type 1 Diabetes Mellitus during the pandemic of COVID-19. Methods Transversal study with individuals with Type 1 Diabetes Mellitus carried out in July 2020. Socioeconomic data and information about social distancing and food practices were collected with an online form. The research was approved by the university’s Ethics and Research Committee (Process number 4.147.663). Results Out of the 472 participants, 50.9% reported that they have been cooking more during the pandemic. An association between cooking more and having a university degree (p<0.000) was observed. Not being able to comply with social distancing rules because of work necessities was associated with not cooking (p=0.006). Cooking more during the quarantine was associated with eating less than five meals per day (p=0.04), having an appropriate consumption of fruits (p=0.02) and vegetables (p=0.04), and increased water intake (p=0.01). Conclusion In Brazil, the habit of cooking during the pandemic may represent an increase in domestic work, reinforced by social inequalities. Therefore, comprehending the cooking habits and food choices of people with diabetes may widen the perspectives of health professionals involved in the treatment of the disease and contribute to the elaboration of public policies that take the country's inequalities into account. We emphasize the importance of investing in policies that encourage the development of culinary skills, as well as the habit of cooking as part of the actions of Food and Nutrition Education.

ABSTRACT Objective To investigate the association of dietary total antioxidant capacity with anthropometric, functional, and biochemical parameters in chronic kidney disease patients on hemodialysis. Methods This is a cross-sectional study of hemodialysis patients in Western Bahia. A structured questionnaire, three 24-hour dietary recalls, anthropometric measurements and clinical and biochemical records were used for data collection. Dietary total antioxidant capacity was estimated using 24-hour dietary recalls data. A database of ferric reducing antioxidant power values for foods was used to evaluate the dietary total antioxidant capacity. Multiple linear regression was applied to assess the relationship between dietary total antioxidant capacity and anthropometric, functional, and biochemical parameters. Results A total of 97 patients were evaluated, of which 57.7% were men and 57.7% were aged between 36 and 59 years. After adjusting for gender, education level, and socioeconomic level, inverse associations were found between dietary total antioxidant capacity and body mass index (p=0.008). Handgrip strength (p=0.037) and serum albumin concentration (p=0.047) were positively associated with dietary total antioxidant capacity. Conclusion High dietary total antioxidant capacity is associated with low body mass index, high handgrip strength, and high serum albumin concentration in chronic kidney disease patients undergoing hemodialysis.

ABSTRACT Objective his study analyzed collective activities, involving eating with autistic children and adolescents, their families and professionals and included walks to street-food markets, picnics and participating in Festa Junina, aiming at investigating feeding in the perspective of commensality. Methods Ethnographic research carried out, based on participant observation during a walk to the street-food market, picnic and Festa Junina, conducted with 19 children and 13 adolescents of an Institution for autistic people. The data recorded were analyzed within the phenomenology framework. Results The activities showed the interaction of autistic children/adolescents with space, people and food, revealing the way autistic people relate, belong and position themselves. The investigators highlighted commensality, emphasizing food as a mediator of relationships, considering a scenario that may present contradictions and power relationships, and allows new possibilities of being together with this audience, outside home and beyond therapeutic care. Conclusion Staying and eating in a group influences the autistic child/adolescent and the activities were configured as an invitation to shared meals, with unexpected behaviors that went beyond institutional therapeutic purposes.

ABSTRACT Objective To investigate factors associated with skipping breakfast in preschoolers and test a dose-dependent relationship between the frequency of breakfast consumption and the prevalence of overweight/obesity. Methods This is a cross-sectional study, carried out with 463 children (24 to 59 months of age) who live in the urban location of Goiânia, Goiás, Brazil. Sociodemographic data, maternal and child nutritional status, lifestyle, and dietary practices were collected using a standardized questionnaire and Habitual Food Recall during a home-based interview. Skipping breakfast was defined as a frequency of consumption “less than seven days a week”. Based on body mass index by age, children were classified as overweight/obese if Z-score ≥2. Multiple logistic regression was used to assess the association between the variables surveyed and skipping breakfast. The dose-dependent relationship between breakfast frequency and overweight/obesity was determined by the trend test. Results The prevalence of skipping breakfast was 8.42% (95%IC: 6.1-11.3). There was an association between the habit of substituting dinner for a sandwich/snack (adjusted OR: 2.61, 95%IC: 1.25-5.46; p=0.010) and the mother’s overweight (adjusted OR: 2.63; 95%CI: 1.29-5.37; p=0.008) with the habit of skipping breakfast. The trend test shows that the prevalence of overweight/obesity decreases as the frequency of breakfast consumption increases (p=0.035). Additionally, when assessing the quality of breakfast, frequent consumption of foods considered unhealthy was observed. Conclusion There is a dose-response association between overweight/obesity and skipping breakfast. Children who substitute traditional dinner for a sandwich/snack and whose mothers are overweight are more likely to skip breakfast.

ABSTRACT Objective The aim of this research was to produce new formulations of peanut “paçoca” candy, replacing peanut flour with Kinako flour, and check if the addition of this ingredient bears a negative impact on acceptance. Methods Eight formulations of peanut “paçoca” candy, sweetened with sucrose and sucralose, were prepared with partial and total replacement of peanut flour by Kinako flour. The assessment of the acceptance was carried out by 121 tasters, using the 9cm unstructured hedonic scale. Willingness to purchase the different samples was evaluated by a 5-point scale. In addition, a sociodemographic questionnaire was applied. The results were submitted to ANOVA and Tukey’s test. Results Most of the survey participants stated that they rarely consume soybeans and/or soy derivatives. Regarding acceptance, among the eight formulations analyzed, samples sweetened with sucrose, containing either 100% peanut flour and 50% peanut flour replaced by Kinako flour, did not differ significantly between them (p<0.05) and were the most appreciated by consumers considering the flavor and overall impression attributes. Conclusion The results showed that replacing peanut flour with Kinako flour in peanut “paçoca” candy is feasible and that more sensory studies are needed to add this flour to other foods, to provide the nutritional benefits present in soybean.

ABSTRACT Objective Between 2010 and 2017, it was registered one of the most intense droughts in the Brazilian Northeastern Semiarid region, when the rainfall was below the historical level for the region. This context was related to water scarcity for human consumption and productive activities in this territory, where the semiarid backlands of the state of Pernambuco are located. The objective of this study was to assess the condition of food security and its associated factors in areas affected by drought in the semiarid zone of Pernambuco, Brazil. Methods It was a cross-sectional study on a populational base. Data were collected by socioeconomic and demographic surveys, and the Brazilian Food Insecurity Scale, which were applied to 252 households, from September to October 2015. The data was analyzed by socioeconomic and demographic characterization of the households, and the identification of the food insecurity prevalence and its associated factors, by Poisson regression. Results The prevalence of food insecurity was high (74.6%). Among those, 9,1% were on starvation, which means severe insecurity. Food insecurity was statistically associated to sanitation, per capita income, and the number of household residents. Lack of money was the main self-reported cause to food insecurity. Conclusion The high prevalence of food insecurity being associated to indicators of great social vulnerability shows the role of social and economic inequities on the inadequate access to food amongst families in the semiarid zone on a nearly generalized low-income context. These findings corroborate to the evident need of expanding and reinforcing public policies, as well sustainable development models to prioritize and promote social inclusion of communities at greater vulnerabilities in the Brazilian semiarid area. Thus, the need of these economic and social public strategies is highlighted by the worsening of historical vulnerable conditions due to the cycles of droughts on this region.

ABSTRACT Objective To identify interaction patterns on body size and health on Instagram and associated factors in nutrition students. Methods A total of 406 students (78% female) were included in this cross-sectional study. Instagram sociodemographic, academic and interaction data (Instagram time of use, exposure frequency to contents on body size and health, Instagram as a source of information and number of followers) were collected using a self-administered virtual questionnaire. A factor analysis by main component was used to derive the interaction patterns of Instagram as well as regression analyses to test the association of the patterns with the sociodemographic and academic factors. Results Three interaction patterns were observed on body size and health, named: “Fitness Pattern”; “Body Positivity Pattern” and “High Engagement Pattern”. Private Institutions’ Students who are on or have been on a diet and studying in the first semesters were associated with the “Fitness Pattern” (p<0.05). Female students, from public institutions, who changed their weight during the course and whose family’s head had higher education, were associated with the “Body Positivity Pattern” (p<0.05). Female students, younger and on a diet, were associated with the “High engagement Pattern” (p<0.05). Conclusion Gender, type of educational institution and diet practice of nutrition students are the factors that are most associated with different patterns of interaction on body size and health on Instagram.

ABSTRACT Objective Food addiction, an increasingly prevalent disorder, involves multiple physiological and psychological factors. It is often associated with obesity and psychiatric disorders. This study aimed to determine the main factors affecting food addiction in women. Methods In total, 383 adult women were evaluated using an anamnesis form to record participant demographic information and anthropometric measurements, along with the Yale Food Addiction Scale, Beck Depression Inventory, and body perception scale. We created a model according to Beck Depression Inventory, body mass index, age, body perception scale, and marital status, which were thought to influence Yale Food Addiction Scale. Results Mean participant age was 30.13±10.84 years. Food addiction scores of the participants showed significant positive correlations with body weight, body mass index, and depression scores, and significant negative correlations with the body perception scale scores (p<0.05). The results revealed that the Yale Food Addiction Scale score is affected by the Beck Depression Inventory and body mass index. Increase in Beck Depression Inventory and body mass index increased the Yale Food Addiction Scale score by 0.054 and 0.076 units, respectively. Conclusion The main factors affecting emotional eating in women are coexistence of high scores of depression and high body mass index. It is determined that people can have depression, food addiction and obesity at the same time.

ABSTRACT Objective To investigate the associations between sociodemographic population conditions and adolescents’ body image Methods This is a cross-sectional study using data from the Pesquisa Nacional de Saúde do Escolar (PeNSE, National School Health Survey), conducted in 2015. The objective was to analyze the relationship between students’ sociodemographic conditions and body image attending public and private schools in Brazil capitals and the Federal District. For the statistical analysis, we conducted the Poisson regression models, generating adjusted prevalence ratios and their respective 95% CI. In the multiple models, sociodemographic variables were included, which were significantly associated with body image variables (p<0.05) or which altered the prevalence ratios by at least 10%. Results The research involved 10,926 adolescentes The analyses showed that the older the adolescents, the greater their dissatisfaction with their body. As for the school administrative status, students from private schools were more unhappy with their image (Girls: 33% and Boys: 17.6%) and, they tend to have more attitudes to lose weight (Girls: 42.8% and Boys: 28%). The mother’s level of education causes daughters to be more dissatisfied with their bodies (33.3%) and sons showing more attitudes of wanting to lose weight (26.6%). Conclusion Sociodemographic conditions are directly and indirectly associated with the adolescents’ body image. Negative deviations in body image can result in binge eating and social disorders hindering the development of these pubescent children. The consequences of these actions become a risk to health and psychological well-being, strongly supporting the initiative of programs aimed at issues related to body image in the school setting.

ABSTRACT Objective This study evaluated reproducibility, relative validity, using a 24-hour recall questionnaire as a reference standard, and estimated calibration factors for a food frequency questionnaire adapted for use with German descendants living in Brazil. Methods The target population consisted of 50 volunteers, of both genders, aged over 20 years, living in a German colonization city in southern Brazil. The food frequency questionnaire was applied twice, in the first and third months of the investigation. During this period, three 24-hour recalls were applied, with an interval of one month between them. Reproducibility was estimated by the intraclass correlation coefficient. Validity was tested by the intraclass correlation coefficient, weighted kappa test and Bland-Altman method. Calibration factors were estimated using linear regression. Results Among the food frequency questionnaires, there was a strong correlation for energy and most of the nutrients corrected for energy. There was a weak correlation between a food frequency questionnaire and a 24-hour dietary recall. However, the exact concordance in the categorization in tertiles among the instruments ranged from 28% (vitamin A) to 52% (fiber and potassium). Gross values of the food frequency questionnaire were reduced with the calibration and approached the consumption data estimated by the 24-hour dietary recall. Conclusions The food frequency questionnaire showed good reproducibility, however, weak correlation with the 24-hour dietary recall. The calibration of the data obtained by the food frequency questionnaire brought them closer to the reference method.

ABSTRACT Objective The aim of the study was to evaluate the agreement between the weight of older adults measured on a chair scale and a platform scale. Methods This is a cross-sectional study. We evaluated 131 older adults (?60 years old), walk-in patients, admitted to a university hospital. Weight was measured on a digital chair scale model MS5811 (Charder® brand) and after on a mechanical platform scale (Filizola® brand). For the agreement analysis, the intraclass correlation coefficient and the Bland-Altman plot were used. Results Most of the sample consisted of males individuals (57.3%; n= 75). The average age was 70.47±7.59 years (60-96 years old). Measured by both methods, weight showed normal distribution. The average weight measured was 67.99±14.03 kg on the chair scale and 68.04±14.02 kg on the platform scale. The intraclass correlation coefficient of weight measured by the two methods was 1.00 (IC95%=1.00-1.00; p<0.001). In the Bland-Altman plot, the mean bias for the weight measured on the chair scale and the platform scale was 0.049 (IC95%=-0.011 to 0.110; p=0.1084). Conclusions The agreement between the weight measured on a chair scale and on a platform scale was almost excellent. Thus, the chair scale can be used as an alternative method of measuring weight, especially in the older adults with postural instability, mobility restrictions or immobility syndrome.

ABSTRACT Objective To estimate the prevalence of hypertension in participants of the Study of Cardiovascular Risks in Adolescents in Federal District, Brazil, and to investigate the factors related to lifestyle and nutritional status. Methods Lifestyle, economic, and demographic variables were obtained using a self-administered questionnaire. Anthropometric data and blood pressure measurements were collected according to a standardized protocol. Descriptive statistics was used to know the distribution of the investigated parameters in relation to the outcome. The association between hypertension and the variables of interest was investigated by hierarchical multivariate analysis using Poisson regression, considering p<0.05. Results We evaluated 2,646 adolescents with a mean age of 14.9 years. The prevalence of hypertension was 8.0% (95%CI 6.8-9.3). Studying in schools in the rural region (PR=2.1; 95%CI 1.4-3.3), having obesity (PR=4.0; 95%CI 2.5-6.3), male sex (PR=2.2; 95%CI 1.6-3.0) and age over 15 years (PR=1.4; 95% CI 1.0-1.9) were factors associated with a higher prevalence of hypertension. School feeding consumption was a protective factor (PR=0.7; 95%CI 0.6-0.9). Conclusions The prevalence of arterial hypertension was 8% and was associated with male sex, age at least 15 years, attendance in rural schools, and obesity. The consumption of school feeding was a protective factor.

ABSTRACT Studies have shown that changes in mastication are related to overweight in children and adolescents as these changes influence the increase in food consumption. The objective of this article was to characterize, through a systematic review, the mastication in children and adolescents with overweight or obesity. For this, two independent authors performed a systematic review of the electronic databases: Medical Literature Analysis and Retrieval System Online, Scopus, Cumulative Index to Nursing and Allied Health, Web of Science and Latin American and Caribbean Literature in Health Sciences. Masticatory characteristics were considered as primary outcomes; the methods of analyzing mastication, the physical characteristics of the foods/materials used in the analyses and the fasting time were considered as secondary outcomes. This review was prepared in accordance with the items of the preferential reports for systematic analysis and meta-analysis. The systematic review protocol was submitted to the International Prospective Registry of Systematic Reviews. Nine articles were included in this review. The reviewed articles suggest that children and/or adolescents with overweight or obese present masticatory damages because they have worse masticatory performance and altered orofacial myofunctional characteristics.

ABSTRACT This article aimed to carry out a historical analysis of the dissemination of the scientific concepts on obesity, overweight and excess weight in the field of nutritional epidemiology in the world. The methodological procedures comprised: (1) Systematic search in the PubMed® database using single keywords and without date filter; (2) Documentary analysis of normative instruments on the websites of the World Health Organization, the Centers for Disease Control and Prevention and the World Obesity Federation; and (3) Analysis of the scientific production of scientists participating in the obesity classification of the International Obesity Task Force. The historical analysis showed that, considering the volume of publications on obesity, it appears that in the 1940-1949 decade the problem of obesity emerged on the world scenario. From the number of publications issued in the last 20 years, which corresponds to 85% of the investigated period, we can deduct that scientists’ concern to investigate the subject as a phenomenon coincides with the World Health Organization declaration of obesity as a global epidemic issued in the year 2000. In accordance with normative procedures established by international organizations, there has been a hegemonic use of the concepts of obesity and overweight, in this order of priority, by scientists worldwide. The concept of excess weight has experienced a relative rise since the year 2000, but its use has been very restricted, expressing dissonance in face of the recommendations of international standardization organizations, a fact that suggests discussion and review of its use by the world scientific community.

ABSTRACT Although hospital malnutrition is highly prevalent worldwide, it is difficult to compare the data due to the different nutritional assessment tools used. The Global Leadership Initiative on Malnutrition, which aims to operationalize malnutrition diagnosis, consists of five criteria: three phenotypic and two etiological criteria. Many researchers have studied the applicability and clinical relevance of Global Leadership Initiative on Malnutrition, and methodological standards have been established by the Global Leadership Initiative on Malnutrition commission for the application and possible validation of the tool. This study aimed to analyze the methodological processes of the studies that compared the Global Leadership Initiative on Malnutrition with a test tool. A literature review was conducted by the Portal Periódicos from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior between November 2020 and January 2021. This review included articles published in English between 2016 and 2021 that compared the Global Leadership Initiative on Malnutrition with another tool used for diagnosing malnutrition. The sample had 13 articles, of which 11 did not adequately describe how the Global Leadership Initiative on Malnutrition criteria were applied. Only two studies utilized a combination of the phenotypic and etiological criteria. Some studies differed from the methodological recommendations of the Global Leadership Initiative on Malnutrition commission. Thus, it seems that applying the Global Leadership Initiative on Malnutrition in a manner different from the original framework elicited limited results regarding the applicability and reliability of the tool. Therefore, more studies should be conducted on the application of the GLIM Global Leadership Initiative on Malnutrition in different populations and contexts as per the patterns suggested to determine its actual applicability and reliability.

ABSTRACT Objective Dietary supplements use is increasing. Dietary supplements may contain high doses of substances or dangerous ingredient combinations. This article aims to investigate, by analyzing dietary supplements labels, if there are any doping substances or dangerous amounts of any other component in the reviewed dietary supplements. Methods Several brands which possessed their supplements sorted in pre-workout and post-workout were analyzed. 40 dietary supplements with all ingredients described were included. The minimum and maximum dosages of dietary supplements were statistically described as Mean±SD. Results Citrus aurantium extract, Yohimbe extract, Garcinia cambogia extract and Maca root extract were reported in some of the analyzed dietary supplements. Regarding caffeine, the pre-workout group displayed higher mean caffeine (241±86mg) than the post-workout group (183±68mg), and the minimal mean dose was 226±84mg; meanwhile, the maximal mean dose was 242±88mg. Concerning creatine, the pre-workout group displayed lower mean creatine (3106±1079mg) than the post-workout group (4137±4177mg), and the minimal mean dose was 3167±1728mg; meanwhile, the maximal mean dose was 3917±3643mg. The salt content in the post-workout group displayed a much higher mean (2155±4486mg) than the pre-workout group (464±605mg), and the minimal mean dose was 1635±3930mg; meanwhile, the maximal mean dose was 1708±3926g. Conclusions No doping substances were reported in the dietary supplements, but consumption recommendations on the label could lead to excessive consumption of some not yet fully tested ingredients.