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Conley S, Al-Saleh S, Chlan LL. Disability research must be a priority for nurses to advance health equity. Nurs Outlook 2023:101986. [PMID: 37173158 DOI: 10.1016/j.outlook.2023.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
Disability results from an interplay between health conditions and environmental and personal factors. People with disabilities face substantial and ongoing health inequities; however, research to mitigate these inequalities is lacking. There is an urgent need for a better understanding of the multilevel factors that influence health outcomes in people with visible and invisible disabilities across all the lenses of the National Institute of Nursing Research strategic plan. Disability research must be a priority of nurses and the National Institute of Nursing Research to advance health equity for all.
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Chen X, Lu E, Stone SL, Thu Bui OT, Warsett K, Diop H. Stressful Life Events, Postpartum Depressive Symptoms, and Partner and Social Support Among Pregnant People with Disabilities. Womens Health Issues 2023; 33:167-174. [PMID: 36463011 DOI: 10.1016/j.whi.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION As an increasing number of people with disabilities become pregnant and give birth, understanding their vulnerabilities for poor mental health and life stress can help to improve their health and well-being. We examined whether people with disabilities are more likely to experience stressful life events 12 months before childbirth, postpartum depressive symptoms (PDS), and lack of postpartum partner and social support, and compared these associations by race/ethnicity. METHODS Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016-2020 data (n = 6,483), we used univariate and multivariable logistic regression models to estimate the associations of disability with stressful life events, PDS, and postpartum partner and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence interval (CI). We also conducted stratified analyses by race/ethnicity. RESULTS The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3% among Asian non-Hispanic people. Compared with people without disabilities, those with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36-1.74), partner-related stress (RR, 2.55; 95% CI, 2.23-2.91), financial stress (RR, 1.55; 95% CI, 1.44-1.68), traumatic stress (RR, 2.27; 95% CI, 1.85-2.79), and PDS (RR, 3.77; 95% CI, 3.13-4.53). People with disabilities were also more likely to lack a partner's emotional support (RR, 2.57; 95% CI, 2.21-2.97), financial support from the newborn's father (RR, 2.89; 95% CI, 2.39-3.51), and social support while feeling tired or frustrated (RR, 2.05; 95% CI, 1.68-2.52). These associations remained statistically significant after adjustment for maternal factors and newborn's birth year. Strong associations of disability with stressful life events (including emotional stress and partner-related stress), PDS, lacking partner's emotional support, and social support existed across racial/ethnic groups. CONCLUSIONS Pregnant people with disabilities may benefit from additional screening for stressful life events and depression during pregnancy and postpartum. Multidisciplinary efforts that combine mental health screening and treatment, peer support groups, increased health care provider training about caring for people with disabilities during pregnancy, and better access to care for pregnant people with disabilities are needed to improve their health and support their desire to become parents.
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Affiliation(s)
- Xiaoli Chen
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Division of Maternal and Child Health Research and Analysis, Boston, Massachusetts.
| | - Emily Lu
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Division of Maternal and Child Health Research and Analysis, Boston, Massachusetts
| | - Sarah L Stone
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Division of Maternal and Child Health Research and Analysis, Boston, Massachusetts
| | - Oanh Thi Thu Bui
- Massachusetts Department of Public Health, Office of Health Equity, CLAS Program, Boston, Massachusetts
| | - Kimberley Warsett
- Massachusetts Department of Public Health, Office of Health Equity, Health and Disability Program, Boston, Massachusetts
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Division of Maternal and Child Health Research and Analysis, Boston, Massachusetts
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Closing the nursing leadership gap: Leveraging partnerships with people with intellectual disabilities and developmental disabilities. Nurs Outlook 2022; 70:783-785. [PMID: 36085060 DOI: 10.1016/j.outlook.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
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Comparative effects of disability education on attitudes, knowledge and skills of baccalaureate nursing students. Nurse Educ Pract 2022; 61:103330. [DOI: 10.1016/j.nepr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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Mohamed Rohani M, Mohd Nor NA. Dental students' perception on Disability Equality Training as part of the special care dentistry curriculum. J Dent Educ 2021; 85:690-698. [PMID: 33476414 DOI: 10.1002/jdd.12528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/26/2020] [Accepted: 12/12/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Special Care Dentistry (SCD) undergraduate program increasingly aims to address student attitudes toward people with disabilities (PWD). One of the efforts made by the Faculty of Dentistry, University of Malaya (FODUM), is to introduce Disability Equality Training (DET) as part of the learning activity in the SCD curriculum. This study aimed to explore students' perception about the DET program. METHODS This was a qualitative research project exploring students' perception toward DET in 2 cohorts of third-year dental students from FODUM (n = 100). The reflection notes were analyzed using Luborsky's method of thematic analysis. Identification of themes was based on statements that were most frequently reported by students. RESULTS The majority of the students gave positive feedback for the training, which includes enhanced knowledge, attitudes, and skills about treating PWD. They also reflected that the DET improved their understanding of social and professional responsibility. In terms of learning experience, many reported that the training was useful and enjoyable. Students' suggestions for improvement included learning "sign language", visiting special needs centers, and providing simulation exercises involving real PWD. CONCLUSION Students' comments on the DET were positive and they enjoyed the learning experience. The findings support the continuation of DET as part of the undergraduate dental curriculum. Dental institutions seeking to implement or refine the SCD curriculum are encouraged to include DET based on its potential benefits for undergraduate students.
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Affiliation(s)
- Maryani Mohamed Rohani
- Special Care Dentistry, Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Azlida Mohd Nor
- Dental Public Health, Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol 2020; 65:101-112. [PMID: 32105109 PMCID: PMC9534792 DOI: 10.1037/rep0000317] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE/OBJECTIVE Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes. RESULTS While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability). CONCLUSIONS/IMPLICATIONS This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Smeltzer SC, Ross JG, Mariani B, Meakim CH, Bruderle E, Petit de Mange E, Nthenge S. Innovative Approach to Address Disability Concepts and Standardized Patients With Disability in an Undergraduate Curriculum. J Nurs Educ 2019; 57:760-764. [PMID: 30512115 DOI: 10.3928/01484834-20181119-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 09/06/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite a growing population of people with disabilities (PWD), health care professionals, including nurses, receive little educational preparation to provide health care to them. To address this issue in nursing education, the faculty of a school of nursing designed and implemented an innovative teaching strategy that can be adopted by other nursing programs and faculty. METHOD A systematic plan was developed and implemented to integrate standardized patients with disabilities (SPWD) into an existing undergraduate nursing program. Steps included careful planning, review, and modification of existing simulation-based scenarios, obtaining buy-in of faculty across the curriculum, recruitment and training of PWD to be SPWD, and implementation of the project. RESULTS The program in which all undergraduate nursing students have repeated contact with SPWD has been successfully implemented throughout the curriculum. CONCLUSION The project addressed the multiple calls to improve the preparation of health care professionals to provide quality care to PWD. [J Nurs Educ. 2018;57(12):760-764.].
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Obstetric clinicians' experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study. Disabil Health J 2017; 11:8-13. [PMID: 28784583 DOI: 10.1016/j.dhjo.2017.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/15/2017] [Accepted: 07/24/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Women with physical disabilities (WPD) experience major barriers to care during pregnancy. Lack of education about disability in health professionals' education is a pervasive barrier to quality care. In an effort to explore this issue, this study examined the issue from the perspective of obstetric clinicians who provide care to WPD. OBJECTIVE This qualitative descriptive study explored perspectives of obstetric clinicians who provide perinatal care for WPD to inform the educational preparation of clinicians to care for women with disabilities. METHOD We contacted 33 obstetric clinicians who care for pregnant WPD. Thirteen obstetricians and one nurse midwife participated in semi-structured telephone interviews. Interview transcriptions were content analyzed to identify initial themes. Investigators discussed and revised the themes as additional transcripts were reviewed and new themes were identified. RESULTS Themes identified from transcript analyses included: lack of education at any level including during postgraduate residency and fellowship on care of pregnant WPD, unplanned career pathway, educating other clinicians, and positive and negative experiences providing obstetrical care to women with physical disability. Several clinicians provided this care because of requests from other clinicians and did not begin their careers with the goal of providing obstetric care to women with physical disabilities. None had received formal education or training including during their residencies or fellowships. The clinicians described very rewarding experiences caring for WPD. CONCLUSIONS The experiences reported by this study's participants suggest the need to include disability in undergraduate and postgraduate education and training to improve obstetric care to WPD.
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Bloom TL, Mosher W, Alhusen J, Lantos H, Hughes RB. Fertility Desires and Intentions Among U.S. Women by Disability Status: Findings from the 2011-2013 National Survey of Family Growth. Matern Child Health J 2017; 21:1606-1615. [PMID: 28197818 PMCID: PMC5517347 DOI: 10.1007/s10995-016-2250-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives We compared fertility desires and intentions among women with disabilities and women without disabilities in the United States, using a new evidence-based measure of disability. Methods We analyzed data from a sample of 5601 US women 15-44 years of age in the 2011-2013 National Survey of Family Growth. The data were analyzed via cross-tabulation and logistic regression. We classified women into those with a disability and those without a disability. Results Women with disabilities were about as likely to want a baby (61%) as women without disabilities (60%). But only 43% of women with disabilities intended to have a baby in the future, compared with 50% of women without disabilities. Thus, the difference between the percent who want a baby and the percent who intend to have one was larger for disabled women. Women with disabilities were also less certain of their fertility intentions. Multivariate analysis shows that having a disability lowers the odds of intending another birth, after controlling for several other determinants of fertility intentions. Conclusions for Practice All women, regardless of disability status, desired more children than they actually planned to have, but the gap was larger for most groups of women with disabilities than for non-disabled women. Given the sample sizes available in this analysis, future research should use more detailed classifications of disability, however, we have shown that women living with disabilities constitute large populations with unexplored family planning needs.
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Affiliation(s)
- Tina L Bloom
- Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA.
| | - William Mosher
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanne Alhusen
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | | | - Rosemary B Hughes
- University of Montana Rural Institute for Inclusive Communities, Missoula, MT, USA
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Smeltzer SC, Mitra M, Iezzoni LI, Long-Bellil L, Smith LD. Perinatal Experiences of Women With Physical Disabilities and Their Recommendations for Clinicians. J Obstet Gynecol Neonatal Nurs 2016; 45:781-789. [PMID: 27619410 DOI: 10.1016/j.jogn.2016.07.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the perinatal experiences of women with physical disabilities (WWPD) and their associated recommendations for maternity care clinicians to improve care. DESIGN A mixed-methods study was conducted with a semistructured interview guide to identify the experiences of WWPD. This qualitative descriptive study was part of a larger study of the unmet needs and barriers to perinatal care experienced by WWPD SETTING: Telephone interview. PARTICIPANTS Twenty-five women with physical disabilities who gave birth within the last 10 years and were 21 to 55 years of age were recruited and agreed to participate in the study. METHODS Participants were asked about their interactions with clinicians during pregnancy and their recommendations for clinicians to improve perinatal care for women with physical disabilities. Content analysis was used to analyze transcribed interviews. Themes that emerged from analysis of the interviews were identified and coded. Kurasaski's coding was used to establish the reliability of the coding. RESULTS Three themes emerged from analysis of the interview data: Clinicians' lack of knowledge about pregnancy-related needs of WWPD; Clinicians' failure to consider women's knowledge, experience, and expertise about their own disabilities; and Clinicians' lack of awareness of the reproductive concerns of WWPD. Women provided recommendations that warrant attention from clinicians who provide perinatal care for women who live with physical disabilities. CONCLUSION Participants experienced problematic interactions with clinicians related to pregnancy and identified recommendations for maternity care clinicians to address those problems with the goal of improving perinatal health care for WWPD.
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Shpigelman CN, Zlotnick C, Brand R. Attitudes Toward Nursing Students With Disabilities: Promoting Social Inclusion. J Nurs Educ 2016; 55:441-9. [DOI: 10.3928/01484834-20160715-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/01/2016] [Indexed: 11/20/2022]
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Willis DS, Thurston M. Working with the disabled patient: exploring student nurses views for curriculum development using a SWOT analysis. NURSE EDUCATION TODAY 2015; 35:383-387. [PMID: 25467717 DOI: 10.1016/j.nedt.2014.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/03/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Increased longevity will mean an increase in people presenting with cognitive and physical disabilities, such as sight loss or dementia. The Patient Rights (Scotland) Act 2011 states that health care should be patient-focussed, taking into account patient needs. This will necessitate nursing curricula to reflect the needs of people who have disabilities and equip the future workforce with knowledge and skills to provide appropriate care. This study explores student nurses' strengths and weakness when working with people with disabilities and identifies opportunities and threats to developing their knowledge and skills to meet the needs of this population. METHODS As part of a study day, students from the year one Nursing programme were asked to take part in a SWOT analysis and post comments under the categories: strengths, weakness, opportunity and threats on a central wall about working with people with disabilities. RESULTS Students acknowledged some of the challenges of being disabled especially in a health setting but also believed they were developing their skills to provide holistic care that ensured autonomy. Communication was viewed as both a strength and weakness and was identified as an essential skill to working effectively with people who had a disability. Students acknowledged that clinical staff were not always experts in working with people who were disabled and welcomed the opportunity to work with experts and clients as well as being directed to resources to increase their knowledge. CONCLUSIONS Integration of disability into the nursing curriculum is needed to ensure students have awareness of and the confidence to work effectively with people who have a range of cognitive and physical disabilities alongside other medical problems.
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Affiliation(s)
- Diane S Willis
- Nursing Health Care, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, United Kingdom.
| | - Mhairi Thurston
- Nursing and Counselling, Abertay University, Kydd Building, 1-3 Bell Street, Dundee, DD1 1HD, United Kingdom.
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Abstract
The biomedicalist conceptualization of disablement as a personal medical tragedy has been criticized by disability studies scholars for discounting the difference between disability and impairment and the ways disability is produced by socio-environmental factors. This paper discusses prospects for partnerships between disability studies teaching/research and medical education; addresses some of the themes around the necessity of critical disability studies training for medical students; and examines a selection of issues and themes that have arisen from disability education courses within medical schools globally. The paper concludes that providing there is a commitment from senior management, universities are well positioned to apply both vertical and horizontal approaches to teaching disability studies to medical students.
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Affiliation(s)
- Fiona Kumari Campbell
- School of Human Services & Social Work, Logan Campus University Drive, Griffith University, Meadowbrook, Qld 4131, Australia.
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