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Abstract
BACKGROUND Aim of this study was to evaluate the perioperative level of pain and anxiety for endoscopic sinus surgery, and to compare 3 different types of nasal packing. MATERIAL AND METHODS Prospective, controlled, randomized study comparing different types of nasal packing in regard to perioperative anxiety and pain. Patients suffered from chronic rhinosinusitis with nasal polyps involving all paranasal sinuses. Patients daily evaluated by standardized questionnaires (FPI-R, KASA, STAI) and also visual analog scale for pain on 5 consecutive days before and after endoscopic sinus surgery of all paranasal sinuses. Nasal packings were removed on 2(nd) postoperative day. RESULTS A total of 73 patients (polyvinyl acetate packing N = 14, glove packing N = 37, glove packing with breathing tubes N = 22) completed the study. Female gender, bad preoperative mood and absence of pain were associated with increased preoperative state anxiety based on regression analysis. Also, preoperative gathering of additional information from relatives and friends was correlated with increased preoperative anxiety. Patients had significantly minor preoperative anxiety if they could expect use of nasal packings with breathing tubes. CONCLUSION Female patients, who gathered information about the operation from friends or relatives or patient in worse preoperative mood are at risk for increased state anxiety and should be identified prior to rhinosurgical procedures. Use of nasal packing with at least partially preserved nasal breathing is recommended in clinically anxious patients.
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Affiliation(s)
- W Hosemann
- Klinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Universitätsklinikum Greifswald, D-17475 Greifswald, Germany.
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Abstract
OBJECTIVE Apart from increased somatic morbidity, extreme obesity causes grave psychosocial and psychopathological problems. We examined a sample of 50 extremely adipose women (BMI < 40 kg/m2) from 2000 to 2003 to find out whether surgical reduction of stomach volume leads to lasting change in Body Mass Index (BMI), psychosocial symptoms, and health related quality of life. We found that positive changes in BMI reduction, psychosocial symptoms, and health related quality of life could be expected three years after gastric banding (Int. J Psychiatry Med 2005; 35:109-122). During the following three years, we continued to observe these patients to determine long-term effects. METHOD Fifty adipose women who had taken part in the first study from 2004 to 2006 were surveyed. Annual primary outcome measures were BMI, self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), Hospital Anxiety and Depression Scale (HADS-D), and Health Survey (SF-36). RESULTS At the 6-year mark, significant changes in BMI (p < 0.01), significantly increased employment (0.012) and the existence of a partnership (p < 0.01), plus significant changes on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression: p < 0.011), and all scales of the SF-36 Health Survey (all p < 0.01) were observed. CONCLUSIONS The positive changes in BMI reduction, i.e., increased employment and subjects living in a partnership, improvement in eating behavior, reduction in anxiety and depressive symptoms, and improvement in health related quality of life were also confirmed as remaining stable over a 3-year observation period, i.e., for a total of six years.
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Affiliation(s)
- M K Nickel
- Clinic for Psychosomatic Medicine and Psychotherapy, Medical University of Graz, Austria.
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Nickel C, Tanca S, Kolowos S, Pedrosa-Gil F, Bachler E, Loew TH, Gross M, Rother WK, Nickel MK. Men with chronic occupational stress benefit from behavioural/psycho-educational group training: a randomized, prospective, controlled trial. Psychol Med 2007; 37:1141-1149. [PMID: 17147835 DOI: 10.1017/s0033291706009445] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Overworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking. METHOD Of 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36). RESULTS A significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales. CONCLUSIONS Behavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.
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Affiliation(s)
- C Nickel
- Clinic for Psychosomatic Medicine, Inntalklinik, Simbach/Inn, Germany
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Nickel C, Lojewski N, Muehlbacher M, Cangoez B, Müller-Rabe T, Buschmann W, Mitterlehner FO, Lahmann C, Egger C, Kettler C, Rother N, Tritt K, Bachler E, Fartacek R, Leiberich P, Pedrosa Gil F, Rother WK, Loew TH, Nickel M. [Treatment results from inpatient psychosomatic rehabilitation of Turkish migrants: a prospective study]. Gesundheitswesen 2006; 68:147-53. [PMID: 16575693 DOI: 10.1055/s-2006-926548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.
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Affiliation(s)
- C Nickel
- Klinik für Psychosomatische Medizin, Inntalklinik, Simbach/Inn
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Tritt K, Stadtmüller G, von Heymann F, Molfenter S, Loew TH. Multizentrische Prüfung der Wirksamkeit stationärer Behandlungen bei depressiven Patienten in der Psychosomatik und Psychotherapeutischen Medizin. Psychother Psychosom Med Psychol 2006. [DOI: 10.1055/s-2006-934319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nickel C, Widermann C, Harms D, Leiberich PL, Tritt K, Kettler C, Lahmann C, Rother WK, Loew TH, Nickel MK. Patients with extreme obesity: change in mental symptoms three years after gastric banding. Int J Psychiatry Med 2006; 35:109-22. [PMID: 16240969 DOI: 10.2190/anyr-we1m-39g5-k92d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. METHOD We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). RESULTS In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery. CONCLUSIONS Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).
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Affiliation(s)
- C Nickel
- Clinic for Psychosomatic Medicine, Germany
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Tritt K, von Heymann F, Loew TH, Joraschky P. Patienten in stationärer psychosomatischer Reha-Behandlung - Patientencharakterisierung und Behandlungsergebnisse anhand der Psy-BaDo-PTM. Psychother Psych Med 2005. [DOI: 10.1055/s-2005-863429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Loew TH, Tritt K, Siegfried W, Bohmann H, Martus P, Hahn EG. Efficacy of 'functional relaxation' in comparison to terbutaline and a 'placebo relaxation' method in patients with acute asthma. A randomized, prospective, placebo-controlled, crossover experimental investigation. Psychother Psychosom 2001; 70:151-7. [PMID: 11340417 DOI: 10.1159/000056241] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND 'Functional relaxation' (FR) according to Marianne Fuchs is a body-oriented psychotherapy that involves teaching the patient a type of relaxation techniques aimed at maintaining equilibrium of the nervous system. METHODS In order to determine whether the practice of elementary parts of this therapy has an immediate beneficial effect on pulmonary function, a randomized, single-blind, prospective crossover study was done with 21 asthmatics with acute bronchoconstriction. On 3 consecutive days they were given either (1) a 5-min verbal standard instruction in elementary exercises of FR (eFR), which they were to practice during subsequent bodyplethysmographic measurement or (2) inhalative terbutaline (IT), a beta(2)-sympathomimetic drug, or (3) an unspecific 'placebo relaxation' technique (PRT), so that all subjects tried all 3 treatments in random order. Spirometric variables were assessed. RESULTS There was a significant decrease in specific airway resistance with eFR, which, though not as pronounced as with IT, was significantly greater than with PRT. This study shows that clinically relevant effects can be achieved for patients with asthma through mind-body interaction, which can be triggered by reproducible procedures. CONCLUSION Further development of the FR approach could lead to a nonpharmacological and effective supplementary treatment for asthma, which is in high demand by many patients.
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Affiliation(s)
- T H Loew
- Department of Psychosomatic Medicine and Psychotherapy, Biometry and Epidemiology, University of Erlangen, Germany.
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Loew TH, Sohn R, Martus P, Tritt K, Rechlin T. Functional relaxation as a somatopsychotherapeutic intervention: a prospective controlled study. Altern Ther Health Med 2000; 6:70-5. [PMID: 11076449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
CONTEXT Functional relaxation is based on concentration on body perception while moving the joints of the skeleton smoothly and simultaneously breathing out. Case reports have shown that patients with headaches can profit from functional relaxation. OBJECTIVE To examine whether patients with chronic tension headaches (International Headache Society diagnosis) who use functional relaxation as a complementary treatment will report less pain than before they learned this technique. DESIGN Randomized, prospective, single-blind, controlled trial. Standardized elements of functional relaxation were compared to a placebo-relaxation technique, a simple isotomic exercise of the hand. SETTING Primary care, ambulatory private practice. PARTICIPANTS Twelve matched pairs were chosen according to age, sex, and initial pain intensity. This poststratification was performed on patients, who kept a complete pain diary covering 60 days before and 60 days after the introduction to the therapy. After a 45-minute introduction in small groups, the patients were told to do the exercises as often as possible for the following 2 months. MAIN OUTCOME MEASURES Pain diary. RESULTS In the functional-relaxation group, a significant reduction was found in the sum of total pain hours and in high- and medium-intensive pain (Wilcoxon signed rank test). CONCLUSIONS This study supports the concept that this psychosomatic therapy can bring relief from tension headaches. This procedure can be viewed as an easy-to-learn relaxation technique to be used either prophylactic or complementary to pharmaceutical treatment.
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Affiliation(s)
- T H Loew
- Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen, Germany
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Mahler V, Schmidt A, Fartasch M, Loew TH, Diepgen TL. [Value of psychotherapy in expert assessment of skin diseases. Recommendations and indications for additional psychotherapy evaluation in expert assessment from the viewpoint of dermatology]. Hautarzt 1998; 49:626-33. [PMID: 9759563 DOI: 10.1007/s001050050799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Skin diseases, the psyche and psychological changes are often intertwined, especially in patients presenting for expert dermatologic opinion. In many cases an additional evaluation provided by psychotherapeutic medicine may be necessary. This resource may help with the diagnosis, explanation of the problem and estimation of the degree of disability. The different legal guidelines of the various evaluation boards must be considered. The role of psychotherapeutic evaluation is demonstrated through case examples. The evaluation of new possibly occupationally-related disorders such as multiple chemical sensitivity and mobbing is considered.
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Affiliation(s)
- V Mahler
- Dermatologische Universitätsklinik Erlangen
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Abstract
Psychogenic pain, disturbances of gait and stance, sensory symptoms, dizziness, and psychogenic seizures have been found to be the most common conversion symptoms in neurology clinics. A retrospective analysis of 18 patients suffering from pseudoseizure "status" is presented in this study. All of the patients fulfilled the DSM-III-R criteria of conversion disorder. However, 5 of them had concomitant major depression, 6 suffered from bulimia nervosa, and 7 met the criteria for substance abuse. On Axis II, 10 cases of borderline personality disorder, 2 cases of antisocial personality disorder, and 3 cases of histrionic personality disorder were diagnosed. The majority of the patients had attempted suicide and other forms of self-destructive behavior. The findings suggest that patients with pseudoseizure "status" suffer from severe affective imbalances and disturbed impulse control.
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Affiliation(s)
- T Rechlin
- Department of Psychosomatics and Psychiatry, University of Erlangen-Nürnberg, Germany
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Loew TH, Heerwagen E. [Attitude of established physicians to treating HIV-infected patients and to "acquired immunodeficiency syndrome". An empirical study]. Med Klin (Munich) 1996; 91:272-6. [PMID: 8709904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no empirical data available on attitudes concerning AIDS and habits towards HIV infected patients of physicians in general or private practice. In this study results of a self-evaluation are presented. METHODS 178 physicians working with out-patients in different medical fields were randomly selected for a cross sectional study and interviewed using a standardised questionnaire. RESULTS 89% think that they are sufficiently informed about AIDS (in the USA 20%). They regarded the risk of infection to be lower than the Anglo-American physicians. They believed there is a lack of interchange of information between colleagues regarding the degree of infectiousness of referred patients. A third of the physicians fear that other patients will go elsewhere if they find out that their physician is treating AIDS patients. 54% would hold special clinic sessions for HIV-patients outside the normal schedule for practice times. 89% believed that HIV patients were partly to blame for their illness. CONCLUSIONS Although the physicians recognise the problem of HIV-infection, they partly deny the real necessities and facts. A reason for this could be the emotions underlying the general attitude to everything pertaining to HIV-disease. Attitudes to HIV-disease and the dealing with it in daily practice must be considered on the basis of individual emotional motives.
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Affiliation(s)
- T H Loew
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universität Erlangen-Nürnberg
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Loew TH, Siegfried W, Martus P, Tritt K, Hahn EG. 'Functional relaxation' reduces acute airway obstruction in asthmatics as effectively as inhaled terbutaline. Psychother Psychosom 1996; 65:124-8. [PMID: 8784942 DOI: 10.1159/000289063] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND 'Functional relaxation' (German: 'Funktionelle Entspannung') has been developed since 1944 by the German physiotherapist M. Fuchs. It is based on concentrating on body perception while moving the joints of the skeleton smoothly and at the same time breathing out. This procedure induces a physical and emotional relaxation in many cases. The aim of the study was to compare the efficiency of standardized elements of a somatopsychotherapy (eFE) and a standardized bronchodilatative test using terbutaline (IT). METHODS Seventeen asthmatic patients with acute airway obstruction had either IT or eFE on 2 consecutive days. Airway resistance (R(aw)) was measured before and after IT and eFE. It was used for statistical evaluation as it is independent of the patient's will. RESULTS Although both therapies lead to a significant mean decrease in R(aw) (p < 0.01), the comparison revealed no superiority of one over the other (ANOVA on repeated measurements, p > 0.78). CONCLUSIONS This study supports the benefit of psychosomatic therapy in the relief of asthma and the procedure can be used as an easy-to-learn relaxation technique to be used during acute asthmatic airway obstruction.
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Affiliation(s)
- T H Loew
- Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen, Germany
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Loew TH, Goeta-Kreisler K. ["Med.-Psych.": combined internal medicine-psychiatric graduate education in the USA versus "specialist in psychotherapeutic medicine". Differences and common ground]. Med Klin (Munich) 1995; 90:716-719. [PMID: 8583990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- T H Loew
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universität Erlangen-Nürnberg
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Loew TH, Rieger C, Joraschky P, Ebert D, Lungershausen E. [Assessment of curriculum by medical students: comparison of participants and non-participants in voluntary anamnesis groups. An empirical study]. Nervenarzt 1995; 66:845-50. [PMID: 8532101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A representative sample of medical students (n = 121) was given a questionnaire to assess parts of their medical education (lectures, seminars, clerkships) and to design a subjectively ideal timetable, which was compared with the real faculty program. Overall traditional lectures received a low rating (n = 0.17) and individual studies with the textbooks a high rating (n = 0.53). The information given in programs in psychiatry and psychosomatics in significantly less motivating than information to be learned in other medical subjects. This is surprising because the ground work for training in the doctor-patient relationship should be in these fields. Students with former group experience (participation in peer groups on history taking (wish to have more practically oriented education compared with the students without group experience. It is not clear whether the important factor is participation in group experience before starting medical school. (64% of the participants had group experience in the first group as opposed to only 45% of the other group). This information should be taken into consideration when reforming medical school programs.
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Affiliation(s)
- T H Loew
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universität Erlangen-Nürnberg
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