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Introduction@#In 2018, a total of 901 new cases of gastric cancer were recorded, of which 64.8% in males and 34.2% in females. The incidence rate of gastric cancer was 28.5 per 100 000 population, which 38.2 for males and 19.2 for females.@*Goal@#We aimed to investigate the associations between some risk factors and gastric cancer among the Mongolian population. @*Materials and Methods@#A case-control study was conducted between November 2017 and September 2019. We selected 120 cases from National cancer center of Mongolia who newly diagnosed gastric cancer. And 120 controls were selected by matching by sex, age and the place of residence. Informed consents were obtained from all subjects. All subjects were personally interviewed with researchers used by a structured questionnaire consisting of 86 questions. The SPSS 21 (version 16.0, SPSS Inc., Chicago, IL, USA) software was used for all analyses.@*Results@#The mean age was 59.2±11.4 (26-85) years. Habits of having dinner after 6.00 pm (OR 1.42, 95%CI 1.11-1.83, p=0.008), having leftover meals (OR 2.22, 95%CI 1.27-3.86, p=0.008), daily consumption of tea with salt (OR 1.97, 95%CI 1.18-3.30, p=0.01), smoking on an empty stomach (OR 2.44, 95%CI 1.11-5.37, p=0.033), weekly consumption of ham and smoked meat (OR 1.5, 95%CI 1.17- 2.13, p=0.02), and consumption of fat grease (OR 2.09, 95%CI .03-4.24, p=0.038) were significantly increased gastric cancer risk. In contrast, habit of eating at regular times (OR 0.43, 95%CI 0.25-0.73, p=0.002), chewing thoroughly (OR 0.39, 95%CI 0.23-0.67, p=0.001), cooking meat thoroughly until it’s tender (OR 0.48, 95%CI 0.25-0.97, p=0.047), daily consumption of vegetables (OR 0.45, 95%CI 0.27-0.76, p=0.003), and daily consumption of fruit juice (OR 0.36, 95%CI 0.15-0.85, p=0.026) were significantly reduced gastric cancer risk. Furthermore, having first-degree relatives diagnosed with gastric cancer had 2-3 fold higher increased risk of gastric cancer (parents OR 2.88, 95%CI 1.07- 7.78, p=0.038, sibling (OR 3.09, 95%CI 1.09-8.81, p=0.036). Also, previous records of the digestive disease increased risk of gastric cancer (OR 3.65, 95%CI 2.10-6.35, p<0.0001).@*Conclusion@#Dietary habits, family history of gastric cancer and previous records of digestive disease were associated with risk of gastric cancer. Thus, prevention effort could be focused on the population with a family history of gastric cancer, changing bad dietary habit and screening precancerous disease of gastric cancer.
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Background@#Iron is an essential mineral needed for physical and cognitive development with iron needs greatest during pregnancy, infancy, childhood, and adolescence. Iron is vital throughout the lifespan as it is a component of haemoglobin, the protein responsible for transporting oxygen from the lungs to body cells for energy production. Iron deficiency results from a depletion of body iron stores due to increased iron needs, inadequate dietary iron intake, reduced iron absorption, or loss of iron from infections caused by malaria, hookworms, and other intestinal parasites. In advanced stages, iron deficiency leads to iron deficiency anaemia, a condition of low red blood cells and reduced oxygen-carrying capacity.@*Goal@#This study aimed to determine body iron stores in Mongolian children aged 6-59 months, and estimate prevalence of iron deficiency among of studied children. @*Materials and Methods@#In this study were used materials that collected during the fifth national nutrition survey conducted in 21 provinces of 4 economic regions and 8 districts of Ulaanbaatar city of Mongolia. The fifth national nutrition survey was household based survey; therefore sampling unit was household with 5 year-old child. We had used demographic information collected by interview methods and laboratory examination results on ferritin, soluble transferrin (sTfR), C reactive protein (CRP) and α1-acid glycoprotein (AFP) in serum samples collected from 6 to 59 months old children, pregnant women and 15–49 year-old men living in child’s households. Serum Ferritin and soluble transferrin (sTfR) were used as a biomarker for iron store and iron deficiency and C reactive protein (CRP) and AFG were used as indicators for acute and chronic infection. The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. Effects of C reactive protein (CRP) and AGP concentrations on estimates of ID according to serum ferritin (SF) and soluble transferrin receptor (sTfR) were considered in the study. @*Ethical considerations @#The survey protocol was discussed at the scientific committee of the Public health institute and approved by director of scientific committee of PHI on June 28, 2016. Ethical approval for conducting the survey, including obtaining biological samples was obtained from the Medical ethics committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent was obtained from each participants and adult caregivers of under 5 year-old children. @*Results@#Biomarkers of iron status were adjusted with inflammation indicators and estimated iron deficiency (ID) and total body iron store in 1732 children 6-59 month-olds. The study findings showed that adjusted mean concentration of serum ferritin and soluble transferrin receptor was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. The calculated total body iron store by using adjusted SF and soluble transferrin receptor was 2.8 mg/kg among surveyed children. Iron deficiency was estimated by using 2 different biomarkers among selected population group. The prevalence of iron deficiency estimated by using SF was 20.7% in children 6-59 months. Iron deficiency in children defined by using serum soluble transferrin receptor was 27.7%.@*Conclusions@#</br> 1. The average serum ferritin and soluble transferrin receptor concentrations was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. Total body iron store estimated by using SF and soluble transferrin was 2.8 mg/kg among surveyed children. </br>2. The prevalence of iron deficiency estimated by using SF and sTfR was 20.7% and 27.7% in children 6-59 months, respectively. According to the WHO recommendation, prevalence of iron deficiency among Mongolian children aged 6-59 months is classified as “prevalent”. </br>3. Overall proportion of children with low body iron store was 22.4%. The prevalence of iron depletion is relatively common in boys, young children aged 6–23 months, and rural children aged 6-59 months.
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@#Gastric and esophageal cancer is a significant global health issue. The epidemiology of these tumors has significantly increased over the past several years especially in developing and developed countries. Many dietary exposures have been proposed to protect against or increase risk for esophageal and gastrointestinal (GI) cancers, including poor diets, foods, individual nutrients, methods of food preparation, and habits of consumption. Overweight/obese status is associated with an increased risk for many cancer types such as esophageal, gallbladder, kidney, pancreatic and gastric cancer. The association between obesity and cancer is strong. Nowadays there is a recognized decrease in incidence and mortality of distal gastric cancer and an increase in incidence and mortality of proximal esophageal cancer. In Mongolia, gastric cancer is the second most common cancer in males and the third most common in females. It is very important to understand how diet and nutrition affect to gastric and esophageal cancers. In this review we will discuss the effect of diet in locally advanced gastro-esophageal cancer. Although we tried to conclude all published articles about gastric and esophageal cancers in Mongolia. </br> In this survey, is considered dietary risks into 5 groups as following; </br> • Insufficient nutrition education(don’t know food and nutrients significance and food hygiene, don’t know right consumption of food) </br> • Bad habits (hot tea and meals, salty tea and food, low consumption of fruits and vegetables, sometimes eating breakfast, most of daily energy of food in the night, high amount of sugar, a drink of caffeine, overweight and etc.) </br> • Food processing technology (such as overcooking, pickling, preserving, frying, excessive salt in tea fried and etc). </br> • Chemical contaminants in food products (various inorganic fertilizers, heavy metals and etc.) </br> • Household economic capacity is influencing</br> Diet can be used as a tool to evoke the positive/desirable biological responses of an organism aiming to maximize health and protection against diseases (chronic/non-communicable diseasesparticularly cancer) by mostly means of prevention.
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Background@#Overweight and obesity are conditions of over nutrition resulting from consumption of more calories than the body requires leading to excess body fat accumulation. The prevalence of both overweight and obesity is increasing globally in all age groups in high, middle, and low-income countries and is largely attributed to the “nutrition transition” with a shift from traditional diets to readily available and inexpensive high-energy and low-nutrient foods [1]. </br> The move away from traditional to “Junk” foods often occurs at the same time as the move of populations away from daily physical activity and increase in sedentary activities such as time spent in front of a phone, computer, or television, furthering increasing the risk of becoming overweight. People who are overweight or obese are at higher risk for serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis. The increase in overweight and obesity is accompanied by a dramatic increase in prevalence of these chronic diseases at the global level. While the long-term repercussions of overweight and obesity are severe, they are largely preventable and treatable through healthy diets and healthy lifestyle behaviors [2].@*Materials and Methods@#The NNS V was implemented in 21 provinces (aimags) in 4 economic regions (Central, Eastern, Khangai, and Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [3]. Total participated 1944 mothers’ years of age who had a child aged 0-59 months. @*Ethical considerations @#The survey methodology was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted the PHI Directors Order on 28th June, 2016. Ethics approval for conducting the NNS V, including obtaining biological (blood and urine) samples, was obtained from the Medical Ethics Committee under Ministry of Health, Mongolia on 7th July, 2016 with granted approval to conduct the survey and send blood serum samples to the VitMin laboratory in Germany. Participation in the survey was voluntary and oral and written informed consent was obtained from all individuals selected for the survey. Participant confidentiality was maintained during data collection, data entry, data analysis, and in the dissemination of survey findings. @*Results@#Nearly half of mothers (46.2%) were overweight with 16.5% of mothers obese and 4.1% underweight. The prevalence of overweight in mothers was highest in rural areas (50.1%), married status (49.3%), and lowest in Ulaanbaatar (42.3%) compared to other regions (48.6% to 52.6%). The overall prevalence of anaemia among mothers was 16.2% with highest prevalence amongst Kazakh (31.9%) and other ethnic minority mothers (25.1%), mothers with secondary education (20.3%) and unemployed mothers (19.9%). Minimum dietary diversity is a proxy indicator for the nutrient content of a diet based on consumption of at least 5 of 10 food groups.<sup>1</sup> People who consume food items from at least 5 food groups are likely to consume at least 1 animal-source food and items from 2 or more of the fruit and vegetable food groups. In the NNS V, 70.2% of mothers met the minimum dietary diversity requirement with a higher prevalence in urban areas (74.8%) and Ulaanbaatar (77.5%).@*Conclusion@#The prevalence of overweight and obesity in mothers of reproductive age is 46.2%, with the highest percentage of mothers with overweight and obesity being in rural areas (50.1%), which is 5.8 percentage points higher than that of urban mothers. 16.2% of mothers are anemic. Prevalence of Minimum dietary diversity among mothers is 70.2%. Food consumption is inadequate in mothers with the primary and secondary education, and in mothers in rural areas, and in poorest mothers or in mothers with the second and third wealth index. @*@#<sup>1</sup><i>FAO and FHI 360. 2016. Minimum Dietary Diversity for Women: A Guide for Measurement. Rome: FAO.</i>
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BackgroundSchoolchildren spent most of time in school and the school environment is one of several settings thatcan influence children’s food choices and eating habits. Schools can ensure that the available food andbeverage options are healthy and help young people eat food that meets dietary recommendations forfruits, vegetables, whole grains, and nonfat or low-fat dairy products.GoalTo assess quality of common foods and diet in school environmentsObjectives:1. Define food items and groups in school environment;2. laboratory analysis in sample foods on “School lunch” and around school environmentMaterial and MethodsThirty public and private schools from six districts of city of UB were randomly selected from a list of allschools. Laboratory tests were analyzed total 250 samples from school canteens and within 250 metersdistances around sampled schools.ResultSchoolchildren are exposed to a wide range of unhealthy food and beverages in the school environmentand healthier food and drink’s choices are very limited in these settings. The high availability of differentvarieties of unhealthy food and drinks at affordable prices makes these products the most preferablechoices for children. Overall, 46.5 percent of schoolchildren were served in school canteen and 33.9percent of schoolchildren were served outside of schools including shops and buffet. Main factors of foodchoice were first, like eating (30.2%), food price (27.8%), hungry (16.7%) and food advertisement was6.3% among schoolchildren. Most of common foods (92.5%) were analyzed with high in salt, sugar andlow content of vitamins and minerals around school environment. There was very high sugar content per100 gram products for instance, “Batos” ice-cream 22.75 gr, “Iberry” ice cream 14.05 gr and, “Granat”juice 1364 gr. In addition, fat content is also high in schoolchildren’s common food consumption. Fatcontent tested 31.4gr in chips and 30.6 gr in pie, cake and 26.9 gr in biscuits per 100 gr products.
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Introduction. Population life expectancy and health status are directly related to adolescent health,as many chronic disease conditions are affi liated with adolescence. The Mongolia GSHS, 2010 wasstudied dietary behavior and some risk factors belong to non communicable diseases of secondaryschoolchildren among surveyed children. Overall, 5.5% of students have eating habits that are healthybased on the WHO recommendations developed form the Mongolian Ministry of Health. One in sixstudents (15.9%) ate fruits and vegetable fi ve or more times per day. 27.3% of students consumeddairy products valuable for childhood growth two or more times per day. More than one in four students(27.6%) drank carbonated beverages and soft drinks one or more times per day.Findings of this survey show that attention is needed into adolescence and period of young children toprevent and decrease NCD and thus this was a background of our study.Goal. Determine schoolchildren’s food consumption and dietary behavior.Material and Methods. The 2013 Mongolia GSHS employed a two-stage cluster sample designto produce is preventative sample of students in grades 7-12. In total, 60 schools (25 schools fromUlaanbaatar city and 35 rural, respectively) and 203 classes were selected to participate in the MongolianGSHS.School level: The fi rst-stage sampling frame consisted of all schools (urban, rural, public, or private)containing any grades 7-12. Schools were selected systematically with probability proportional to schoolenrollment size.Class level: The second-stage sampling frame consisted of randomly selecting intact classrooms(using a random start) from each school to participate. All relevant classes in each selected school wereincluded in the sampling frame. All students in the sampled classrooms were eligible to participate in theGSHS (2013).“Nationwide health survey based on schools in Mongolia 2013” covered 5393 schoolchildren (age 12-18) from 59 public and private schools. Coverage rate was 89% and total response rate was 88%.Result. According to the WHO recommendations, 18.6 percent (95%CI 17.2-20.1) of students consumedfruits and vegetables fi ve or more times per day. Additionally, consumption of fruits and vegetablesdecreases as age and grade increase.Totally, 31.3 percent (95%CI 29.3-33.3) of students consumed dairy products such as milk, yogurt andcheese two or more times per day in the past month. In addition, 33.0% (95%CI 30.5-35.5) of malestudents eat dairy products compared to 29.5% of female students; that is males consume 3.5% morefruits and vegetables; however there is no statistical difference. On the other hand, 43.4 percent ofchildren aged 12 years or younger consumed dairy products, 32.9 percent of children aged 13 to 15years old and 24.8 percent of children aged 16 years old or older consume dairy products; thus, showinga decreasing trend with age.One of three (33.6%) of students drank carbonated beverages one or more times per day during the pastmonth. Consumption of carbonated beverages differed between males and females (37.6% vs. 29.7%)and increased by age. By age group, high consumption of carbonated and soft drinks was observedamong students aged 16 years old or older (34.4-35.2 percent), while 33.8 percent of children aged13-15 years old, and 29.4 percent of students 12 years old or younger consumed carbonated and softdrinks.Amongst all students, 55.3 percent (95%CI 52.0-69.3) ate breakfast “usually or always”, 26.1 percentate breakfast “sometimes”, and 13.7 percent ate breakfast “rarely or never”. About 1.9% of studentswent hungry to school “usually or always” during the past one month because of insuffi cient food in theirhome.Among participated school children, 26.4 percent (95%CI 21.5-31.9) of students ate fast food three ormore times within the last seven days at restaurants such as Max Burger, Mondonald and their schoolcafeteria. Percentage of students that ate regularly at fast food restaurants or school canteens wasincreased by 8% than the indicator of the previous survey result.Conclusion1. Fruits and Vegetables: One in fi ve students consumed fruits and vegetables in accordance withthe dietary guidelines for healthy eating and this indicator are increased by 2.7% compared to theprevious study.2. Dairy products: Consumption of dairy products is increased by 4% compared to the previous study;however, it is decreased with age.3. Carbonated Beverages: Consumption of carbonated beverages by students was at similar level inboth, urban and rural areas, and it is increased by 6 points from the previous study level, especiallyhigher consumption was observed among male students.4. Fast Food: Percentage of students that ate regularly at fast food restaurants or school canteens wasincreased by 8% than the indicator of the previous survey result.
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Introduction In recent years it has been observed epidemiological transition in the world population’s morbidity and mortality causes, indicating a shift from communicable diseases to non-communicable diseases. In 2012, cardiovascular diseases alone accounts for 30 per cent of all deaths in the world. In Mongolia, non-communicable diseases are growing steadily and becoming the leading causes of morbidity and mortality of population. According to the Global School-based Student Health Survey-Mongolia 2010, overall, 19.3 per cent of school children had 4 or more nutritional risk factors of NCD and 8,3 per cent of students were overweight and 0,8 per cent were obese. Above mentioned study shows that, the prevention of NCD should be started from childhood, improving the consumption of fruits and vegetables for school snack and lunch is important in the prevention of NCD among school children. The study is aimed at determination of types, consumption and chemical composition of food products and meals provided in school snack program. Scope and methods of investigation The investigation was performed in Ulaanbaatar and Tuv aimag. Under the our investigation included a totally 14 school canteens of Ulaanbaatar and Tuv aimag. Consumption of Food products was investigated using the Food Consumption Questionnaire method. All managers of school canteens interviewed by well-trained researchers using the time from 20 to 30 min for each of them. Food samples were obtained, keeping in cool boxes, transported to the Public Health Central Laboratory of National Center of Public Health, Mongolia. Chemical composition of food and snack samples were investigated according to the related standard methods for determination of protein, fat, carbohydrates, Vitamin C, Calcium. Results Consumption of vegetables and local fruits for school snack and meal was not enough for prevention of NCD among school children. Use of milk and milk products for school snacks and lunch were obtained only 1-3 times during the 10 days, which is too poor consumption. According to the results of chemical analysis, 83.4 per cent of all food samples had calories less than 340 kcal, which is the required value of calories of school snack per one student. With regard to protein level 50 per cent of samples had 2.57-7.7grams of protein, which is lower than the recommended level of 10-12 gr. Fat level of samples were ranged between 7.2-1.97 grams and 95.5 per cent of samples had lower fat content compared to the recommended value of 9.0 grams. When 68.7 per cent of samples had 4.5-38.03 grams of carbohydrates, which is lower than the recommended amount, some 4.5 per cent of samples had higher carbohydrates compared to the recommendation. Amount of vitamin C in school snack was extremely lower than the recommended amount that vitamin C was found between 0.02-2.31mg, satisfying only 10 per cent of the national recommendation of vitamin C amount for school snack. Amount of Calcium in milk products of school snack and meals was also low than recommended level.
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BackgroundAn estimated 522 066 students are studying in secondary school of Mongolia and it was 19% of total population. Population life expectancy and health status is directly related to adolescents’ health, as many chronic disease conditions are affiliated with adolescence. Many premature deaths among adults result from behavior initiated during adolescence. According to the NRC survey, one in thirteen schoolchildren (7.3%) was underweight, 16.3% was stunting, and 13.8% were iodine deficiency. It has taken 52.8% of total daily energy among 11-14 years schoolchildren and 50.5% were between 15 and 17 ages. In addition, research in Mongolia in 2005 indicate serious problems in healthy eating behavior; 8% of adolescents consumed milk products on daily basis, 71.7% had breakfast only sometimes, and 83.2% had a meal one time per day. Micronutrient deficiency such as anemia, A, D vitamins among them is cause of low consumption of vegetable and fruits. There is a need to study schoolchildren’s dietary recall.ObjectiveTo study and evaluate schoolchildren’s nutritional statusMaterials and MethodsThe descriptive and cross sectional study was carried out in 4 districts of Ulaanbaatar city (750 schoolchildren from each district) and 2 aimags (889 schoolchildren from Uvurkhangai and 925 from Dornod) of Mongolia. Also determined current nutrition situation of surveyed schoolchildren by using 24 hours recall method and assessed.ResultA total of 4760 (46.6% boys and 53.4% girls) school children surveyed and 46.6% were boys and 53.4% were girls. 71.7 percent of total respondents have breakfast sometimes, 83.2 of them have a lunch only one time per day, and 38.3 percent of total daily energy takes from dinner and have not any difference between age groups. Adolescent aged 7-10 years takes 92.7 percent of total calorie, 90.1 percent of protein, 93.9 percent of carbohydrate and 92.3 percent of fat compared to RDI of Mongolia and thus animale fat is the 1.6 times more than the norm. Consumption of vitamins and minerials such as vitamin A, and iron8 calcium were insufficient among schoolchildren. Specially, it was lower among male student than female. For instance vitamin C intake was 48.0- 58.6 percent among female students aged above 11 years and it was 47.3- 51.8 percent for male students. About 30 percent of total calcium is consumed per day among overal respondents. Conclusions:1. Daily intake of basic nutrients and energy is lower by 10-30 percent than RDI of Mongolia among schoolchildren.2. High consumption of in diet among male adolescents of age 15 years and above causes disbalance of adequate ratio of main nutrients as protein8 fat and carbohydrates.3. There is not enough suffecient consumption of vitamins and minerials specially calcium.
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Goal: To determine schoolchildren’s growth and nutrition situationMaterials and MethodsThe descriptive and cross sectional study was carried out in 4 districts of Ulaanbaatar city (750 schoolchildren from each district) and 2 aimags (889 schoolchildren from Uvurkhangai and 925 from Dornod) of Mongolia. The study was conducted in two steps, Step 1 or beginning of school year covered totally 4760 schoolchildren and in end of school year totally 4108 schoolchildren. Data for the survey was collected by using questionnaire and clinical examintions and antropometric measurements. Weight of schoolchildren was used UNISCALE electrical scales with precision to 100g and height was used standard measurement with precision to 1mm. Schoolchildren’s growth was assessed by method “Sigma” and compared to the survey “Growth means of schoolchildren up to 16 years of Mongolia” (PHI, 2006). The nutritional status of schoolchildren were taken in accordance with the Z score calculated with relation to WHO average population anthropometric reference (WHO, 1995). Also determined current nutrition situation of surveyed schoolchildren by using 24 hours recall method and assessed. Nutrition assessment was used the standard indicators of Technical Committee, WHO [3, 7, 8].ResultsA total of 4760 (46.6% boys and 53.4% girls) school children were present beginning of the school year and 4108 (46.0% boys and 54% girls) of their were end of school year during the visit. Almost 60 of the total school children were from districts of UB beginning and end of school year. Beginning of the school year, 5.1 percent of total surveyed schoolchildren were assessed underweight and 14.1 percent is stunting, 1.7 percent is wasting and end of school year it was 4.7 percent underweight, 13.9 percent stunting and 1.2 percent wasting.71.7 percent of total respondents have breakfast sometimes, 83.2 of them have a lunch only one time per day, and 38.3 percent of total daily energy takes from dinner and have not any difference between age groups. Consumption of food products such as green vegetables, beef liver which are rich with vitamin A is inadequate. Example; among 7-10 years old 184.9 mcg, 11-14 years 247.2 mcg, above 15 years old was 241.6 mcg. Amount minerals such as calcium and phosphorium per day was among 7-10 years old 398.2mg and 756.1мг, 11-14 насанд кальци 277.8-301.5мг, фосфор 688.6-899.5мг, above 15 years old was calcium 366.4-378.3mg, phosphorium 875.3-978.8mg. Dairy consumption was analyzed by urban and rural areas among schoolchildren and it was among urban schoolchildren is more by 16.6-21.4 percent from rural areas.Conclusion:1. The progress made improving gradually the nutritional status of schoolchildren from previous study. The prevalence of underweight, stunting and wasting is “low” level among schoolchildren by WHO. There is statistically significant lower nutritional status among schoolchildren in rural area than in urban.2. Micronutrient deficiency is main reason of undernutrition among schoolchildren. In other words, the vitamins (C, A, D), and minerals (Ca, Fe) which are essential for schoolchildren growth and fiber is insufficient in their food. The consumption of diary is inadequate among schoolchildren of rural area compared to urban.3. Consumption of fruits and vegetables and diary products is inadeguate among total surveyed schoolchildren especially in rural area.