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Downs S, Manohar S, Staromiejska W, Keo C, Say S, Chhinh N, Fanzo J, Sok S. Centering context when characterizing food environments: the potential of participatory mapping to inform food environment research. Front Nutr 2024; 11:1324102. [PMID: 38450238 PMCID: PMC10914972 DOI: 10.3389/fnut.2024.1324102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Food environments are a critical place within the food system to implement interventions aimed at enabling sustainable diets. In this perspective article, we argue for the need for food environment research to more comprehensively examine the different types of food environments that people access within their communities to ensure that interventions and programs are better aligned with people's lived experiences. We highlight the potential ways in which participatory mapping (PM) can be leveraged to better design food environment research by: (1) identifying the different food environment types that are accessed within a given community; (2) providing insight into the timing for data collection; (3) informing the prioritization of where to conduct food environment assessments; and (4) highlighting the dynamism of food environments over time (e.g., across a given day or across seasons). We provide a case study example of the application of PM and the lessons learned from it in Cambodia. By conceptualizing food environments in a more comprehensive way, from the perspective of the people living within a given community, we will be able to measure food environments in a way that more closely aligns with people's lived experiences.
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Affiliation(s)
- Shauna Downs
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Newark, NJ, United States
| | - Swetha Manohar
- Global Food Ethics Policy Program, School of Advanced International Studies, Washington, DC, United States
- Nutrition, Diets and Health Unit, International Food Policy Research Institute, Washington, DC, United States
| | - Wiktoria Staromiejska
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Newark, NJ, United States
| | - Chanvuthy Keo
- Faculty of Social Science and Humanities, Royal University of Phnom Penh, Russian Federation Boulevard, Khan Toul Kork, Cambodia
| | - Sophea Say
- Department of Tourism, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Nyda Chhinh
- Department of Economic Development, Faculty of Development Studies, Royal University of Phnom Penh, Russian Federation Boulevard, Khan Toul Kork, Cambodia
| | - Jessica Fanzo
- Columbia’s Climate School, Columbia University, New York, NY, United States
| | - Serey Sok
- Research Office, Royal University of Phnom Penh, Russian Federation Boulevard, Khan Toul Kork, Cambodia
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Abdul M, Ingabire A, Lam CYN, Bennett B, Menzel K, MacKenzie-Shalders K, van Herwerden L. Indigenous food sovereignty assessment-A systematic literature review. Nutr Diet 2024; 81:12-27. [PMID: 37154011 DOI: 10.1111/1747-0080.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023]
Abstract
AIMS The aims of this systematic review were to (1) identify assessment approaches of Indigenous food sovereignty using the core domains of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability, (2) describe Indigenous research methodologies when assessing Indigenous food sovereignty. METHODS Guided by Indigenous members of the research team, a systematic review across four databases (Medline, Embase, CINAHL and PsycINFO) was performed. Studies in any language from 1996 to 2021, that used one or more of the core domains (identified from a recent scoping review) of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability were included. RESULTS From 20 062 records, after exclusion criteria were applied, 34 studies were included. Indigenous food sovereignty assessment approaches were mostly qualitative (n = 17) or mixed methods (n = 16), with interviews the most utilised (n = 29), followed by focus groups and meetings (n = 23) and validated frameworks (n = 7) as assessment tools. Indigenous food sovereignty assessment approaches were mostly around inclusion of traditional food knowledge (n = 21), or environmental/intervention sustainability (n = 15). Community-Based Participatory Research approaches were utilised across many studies (n = 26), with one-third utilising Indigenous methods of inquiry. Acknowledgement of data sovereignty (n = 6) or collaboration with Indigenous researchers (n = 4) was limited. CONCLUSION This review highlights Indigenous food sovereignty assessment approaches in the literature worldwide. It emphasises the importance of using Indigenous research methodologies in research conducted by or with Indigenous Peoples and acknowledges Indigenous communities should lead future research in this area.
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Affiliation(s)
- Malika Abdul
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Ale Ingabire
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Chin Yu Nicole Lam
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Bindi Bennett
- National Centre for Reconciliation, Truth and Justice, Federation University, Brisbane, Australia
| | - Kelly Menzel
- Gnibi College of Indigenous Australian Peoples, Southern Cross University, Gold Coast, Australia
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Wilcox H, Bishop S, Francis B, Lombard K, Beresford SAA, Ornelas IJ. Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children. BMC Public Health 2024; 24:232. [PMID: 38243203 PMCID: PMC10797868 DOI: 10.1186/s12889-024-17689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND American Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden. METHODS Our process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes. RESULTS We identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards. CONCLUSIONS The program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.
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Affiliation(s)
- Heather Wilcox
- University of Washington, Box 351621, Seattle, WA, 98195, USA
| | - Sonia Bishop
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | | | | | - India J Ornelas
- University of Washington, Box 351621, Seattle, WA, 98195, USA.
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Davies A, Gwynn J, Allman-Farinelli M, Flood V, Dickson M, Turner N, Porykali B, Lock Ngiyampaa M. Programs Addressing Food Security for First Nations Peoples: A Scoping Review. Nutrients 2023; 15:3127. [PMID: 37513545 PMCID: PMC10384335 DOI: 10.3390/nu15143127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Access to food is a right that every individual must have to ensure a standard of living that is sufficient for maintaining good health and wellbeing. This review, developed and implemented by a team of First Nations and non-First Nations peoples, aimed to scope the literature on programs addressing food security for First Nations peoples in Australia, Aotearoa/New Zealand, Canada, and the United States of America. Collectively, First Nations groups share continued traumas, disadvantages, and devastation brought upon them as a result of British colonisation. Despite the impacts of colonial conquest, the resilience of First Nations peoples continues through the fight for self-determination, sovereignty, equity, and equality. Three databases and grey literature were searched from 2010. Two reviewers completed screening, data extraction, and critical appraisal. Nine food security programs were included in this review. Five were from the United States of America and four from Canada, with no program from Australia or Aotearoa/New Zealand meeting the inclusion criteria. The programs that appear to be most suitable for addressing food security for First Nations peoples were participatory in design, had community governance, integrated cultural knowledge and food systems to increase the accessibility and availability of cultural foods, incorporated educational components, and utilized collaborations among various agencies. Findings showed that while it is important to address short-term emergency food relief, the aim should be sustainable food security through a longer-term system and policy change underpinned by co-designed research and evaluation.
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Affiliation(s)
- Alyse Davies
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Josephine Gwynn
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, The University of Sydney, Lismore, NSW, 2480, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Nicole Turner
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Health Program, George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Mark Lock Ngiyampaa
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC 3220, Australia
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Cerceo E, Sharma E, Boguslavsky A, Rachoin JS. Impact of Food Environments on Obesity Rates: A State-Level Analysis. J Obes 2023; 2023:5052613. [PMID: 37794996 PMCID: PMC10546892 DOI: 10.1155/2023/5052613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/04/2023] [Accepted: 06/03/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Limited access to healthy food in areas that are predominantly food deserts or food swamps may be associated with obesity. Other unhealthy behaviors may also be associated with obesity and poor food environments. Methods We calculated Modified Retail Food Environment Index (mRFEI) to assess food retailers. Using data collected from the Behavioral Risk Factor Surveillance System (BRFSS) survey, the NJ Department of Health (NJDOH), and the US Census Bureau, we conducted a cross-sectional analysis of the interaction of obesity with the food environment and assessed smoking, leisure-time physical activity (LPA), and poor sleep. Results There were 17.9% food deserts and 9.3% food swamps in NJ. There was a statistically significant negative correlation between mRFEI and obesity rate (Pearson's r -0.13, p < 0.001), suggesting that lack of access to healthy food is associated with obesity. Regression analysis was significantly and independently associated with increased obesity prevalence (adjusted R square 0.74 and p=0.008). Obesity correlated positively with unhealthy behaviors. Each unhealthy behavior was negatively correlated with mRFEI. The mean prevalence for smoking, LPA, and sleep <7 hours was 15.4 (12.5-18.6), 26.5 (22.5-32.3), and 37.3 (34.9-40.4), respectively. Conclusion Obesity tracks with food deserts and especially food swamps. It is also correlated with other unhealthy behaviors (smoking, LPA, and poor sleep).
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Affiliation(s)
- Elizabeth Cerceo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
- Division of Hospital Medicine, Cooper University Healthcare, Camden, New Jersey, USA
| | - Elena Sharma
- Department of Medicine, Providence Saint Peter Hospital, Olympia, Washington, USA
| | - Anne Boguslavsky
- Division of Hospital Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jean-Sebastien Rachoin
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
- Division of Hospital Medicine, Cooper University Healthcare, Camden, New Jersey, USA
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Seeking Sweetness: A Systematic Scoping Review of Factors Influencing Sugar-Sweetened Beverage Consumption in Remote Indigenous Communities Worldwide. BEVERAGES 2023. [DOI: 10.3390/beverages9010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is well-established that remote Indigenous communities have higher rates of sugar-sweetened beverage (SSB) consumption than non-Indigenous counterparts, which results in higher rates of chronic diseases such as type 2 diabetes mellitus (T2DM), obesity, and kidney disease. The aetiology leading to this behaviour remains understudied and overlooked. Therefore, the aim of this literature review is to understand the underpinning factors that contribute to SSB consumption in remote Indigenous communities. Studies were identified through five databases (n = 2529) and grey literature searching (n = 54). Following the PRISMA guidelines, each paper was assessed for eligibility, which left 34 studies for inclusion in the review. Within these papers, 37 different factors were found to influence SSB consumption in remote Indigenous communities. These were organised according to the Determinants of Nutrition and Eating (DONE) framework. SSB consumption was found to influence intake through each main level of the framework; individual (n = 9), interpersonal (n = 18), environmental (n = 9), and policy (n = 3). Preference was identified to be the most common factor to influence intake (n = 19), followed by health literacy (n = 15) and community availability (n = 12). Despite this, interventions to reduce SSB intake have never targeted this factor. This paper highlights the importance of a multi-level whole-of-system approach and suggests that an individual’s taste/preference should shape the direction of future research and intervention in this area.
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Eskandari F, Lake AA, Rose K, Butler M, O'Malley C. A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries. Food Sci Nutr 2022; 10:3689-3723. [PMID: 36348796 PMCID: PMC9632201 DOI: 10.1002/fsn3.2969] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.
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Affiliation(s)
- Fatemeh Eskandari
- Centre for Public Health Research, School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Fuse ‐ The Centre for Translational Research in Public HealthNewcastle upon TyneUK
| | - Amelia A. Lake
- Centre for Public Health Research, School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Fuse ‐ The Centre for Translational Research in Public HealthNewcastle upon TyneUK
| | - Kelly Rose
- Centre for Public Health Research, School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Fuse ‐ The Centre for Translational Research in Public HealthNewcastle upon TyneUK
| | - Mark Butler
- Centre for Public Health Research, School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Claire O'Malley
- Centre for Public Health Research, School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Fuse ‐ The Centre for Translational Research in Public HealthNewcastle upon TyneUK
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Haslam A, Nikolaus CJ, Sinclair KA. Association of Food Environment Characteristics with Health Outcomes in Counties with a High Proportion of Native American Residents. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Cassandra J. Nikolaus
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Ka’Imi A. Sinclair
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
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The global food environment transition based on the socio-demographic index. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2022.100632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Vázquez-Lorente H, Herrera-Quintana L, Molina-López J, Zapata-Soria M, Planells E. Need of nutritional assessment and monitoring in a population with acquired brain injury: an analytical cross-sectional study. Nutr Neurosci 2022; 26:525-534. [PMID: 35499860 DOI: 10.1080/1028415x.2022.2065815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with acquired brain injury (ABI) may be at an increased risk of malnutrition due to the pathophysiology of their condition, which can affect their anthropometrical profile and therefore their quality of life. The present study analyzes the anthropometrical profile of these individuals, describes their dietary habits and nutrients intake and identifies the related risk factors influencing health status and quality of life. METHODS Twenty-three volunteers with ABI from the province of Granada (Spain) were recruited for this cross-sectional study. Nutritional assessment was quantitatively and qualitatively performed using a 72-h dietary record and a food frequency questionnaire, respectively. Body composition parameters were evaluated by bioelectrical impedance. RESULTS Low intakes of minerals related to bone health, extra virgin olive oil (EVOO) and fruits were reported. Moreover, women presented a poorer anthropometrical profile compared to men. With reference to age, a significant inverse correlation was observed with sarcopenic obesity, appendicular muscle mass index and Vitamin B6 intake [(r = -0.617, p < 0.01), (r = -0.475, p < 0.05) and (r = -0.498, p < 0.05), respectively]. Intake of EVOO was inversely correlated to body mass index (r = -0.767, p < 0.001). Lastly, a direct correlation was observed between the consumption of alcohol and sweets and snacks (r = 0.608, p < 0.01). CONCLUSION The main findings support the existence of poor dietary quality and anthropometrical profile. Interdisciplinary team assessment would be beneficial to enhance the quality of life and attenuate the development of comorbidities in subjects with ABI.
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Affiliation(s)
- H. Vázquez-Lorente
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
| | - L. Herrera-Quintana
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
| | - J. Molina-López
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, Huelva, Spain
| | - M. Zapata-Soria
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
- Brain Damage Association (AGREDACE), Granada, Spain
| | - E. Planells
- Department of Physiology, School of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
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Ahmed S, Warne T, Stewart A, Byker Shanks C, Dupuis V. Role of Wild Food Environments for Cultural Identity, Food Security, and Dietary Quality in a Rural American State. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.774701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wild foods are primary components of traditional and Indigenous food systems that are valued for food security while being vulnerable to global change. This case study examines practices, experiences, and perceptions associated with wild food environments through a household survey in the rural American state of Montana. Findings highlight that wild food environments contribute to cultural identity, sense of place, food security, and dietary quality of surveyed households while being vulnerable to loss of traditional ecological knowledge as well as climate and land-use change. Of the 182 informants, 80% hunt, 83% fish, and 68% forage wild botanicals. More than half of the informants agreed that wild food procurement is part of their cultural identity (66%). Collectively, informants procure more than 172 wild food species with the most prevalent being deer, waterfowl, elk, trout, bass, a range of berries, mushrooms, and botanicals used medicinally. Participants have a multidimensional value system where wild food procurement is valued for diets, recreation, family time, spirituality, and connection to the environment. The majority of participants agreed that the consumption of wild foods contributes to the nutritional quality (87%) and diversity (82%) of their diets while lowering food costs (59%). At least half of the informants reported observing changes in climate patterns over the past decade including increased temperature (50%) and more extreme and variable weather patterns (38%) that they perceive are impacting wild food environments including shifts in wild game, fish, and edible plant populations. Based on findings, we support that wild food environments and associated bio-cultural resources are a critical place to understand, conserve, and promote for nutrition. We thus advance the concept of “conservation for nutrition”. Community engagement, education, and policy plans are called for to promote wild food environments toward supporting sustainable diets and planetary health.
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