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Evaluation of goal attainment in geriatric settings.

Determination of the impact of programs designed to enhance the functional independence of geriatric residents requires prior specification of goals in terms that clearly indicate the desired outcomes. The Geriatric Resident Goals Scale (GRGS) is a listing of specific goals developed to provide a systematic means of assessing resident status and program effectiveness. For male residents in a VA Nursing Home Care Unit, the obtained internal consistency reliability coefficient was .97 (N = 198), and the reliability coefficient reflecting a combination of test-retest and interrater consistency was .95 (N = 22). For a group of 178 residents, the GRGS was predictive of level of independence ratings (r = .82) and mental status (r = .71). The data showed the GRGS to be a highly reliable and valid means of assessing the functioning of geriatric residents, lending support to an assessment process based on a listing of specific goals. The GRGS can be viewed as a general procedure that is adaptable to a range of geriatic settings and programs.

Activities of Daily Living↗

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults.

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.

Black or African American↗

Adolescent health insurance coverage: recent changes and access to care.

OBJECTIVE: To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care. Together, the results provide a current and comprehensive profile of adolescent health insurance coverage. METHODS: We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey. RESULTS: An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased. CONCLUSIONS: This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.adolescents, health insurance, access, Medicaid, SCHIP.

Adolescent↗

Determinants of intrapartum fetal death in a remote and indigent population in China.

OBJECTIVE: To explore the reasons for the high rate of intrapartum fetal death observed in a remote and indigent population in China. STUDY DESIGN: We conducted an epidemiologic analysis of determinants of intrapartum fetal death in a sample of 20,891 births in 18 hospitals participating in the Qingyuan Perinatal Surveillance System from January 1, 1997 to June 30, 1998. The main determinant examined was cesarean delivery; other determinants included mother's insurance status, residence, maternal age, infant's gender, parity, gestational age, birth weight, and obstetric complications. Rates of intrapartum fetal death within categories of various maternal and infant factors were first calculated and compared; adjusted odds ratios for intrapartum fetal death were then estimated by multiple logistic regression analysis. RESULTS: The intrapartum fetal death rate in this population was 5 per 1000 total births, which accounted for about one-third of all fetal deaths. Compared with vaginal delivery, elective cesarean delivery was associated with a 100% (i.e., no intrapartum fetal death among 1572 elective cesarean deliveries) and emergency cesarean delivery with a 88% reduction, in intrapartum fetal death. Other significant determinants were related to access to obstetric care (i.e., insurance status and residence). CONCLUSION: Lack of access to quality obstetric care is the major determinant of intrapartum fetal death in this population.

Adult↗

Blood recipient notification for hepatitis C in Prince Edward Island.

BACKGROUND: Two of the major risk factors for hepatitis C are injection drug use and receipt of blood or blood products. Many patients are unaware that they have received transfusions. In 1998 Prince Edward Island conducted a province-wide look-back notification program to notify patients who had received transfusions in PEI between Jan. 1, 1984, and June 1, 1990. The authors present the results of the notification program. METHODS: A registry for recipients of blood and blood products was created from the province's Red Cross blood bank records. The registry data were linked with Vital Statistics data to determine death status and with Health Registration data to determine residence status of recipients (in PEI or moved out of province). All identified recipients with a current PEI mailing address were sent a letter recommending hepatitis C virus (HCV) testing. Laboratory records were checked to determine HCV test results. RESULTS: The registry contained data for 6086 recipients of blood or blood products during the look-back period; 51.1% (3109/6086) had died by the time of notification. Of the remainder, 18.4% (549/2977) were not directly notified because they had moved out of province, had refused delivery of the notification letter or had died recently, or because identifying information was missing from the blood bank records. Of the recipients who were notified 80.4% (1953/2428) underwent testing, and 2.2% (43/1953) were found to be HCV positive. Most of these (58.1% [25/43]) had undergone testing before notification. The HCV positivity rate differed significantly between recipients tested before notification and those tested after notification (9.9% v. 1.1%, p < 0.001). HCV-positive recipients were more likely than other notified recipients to have had multiple transfusions (39.5% v. 9.5%, p < 0.001). INTERPRETATION: Before notification 4.1% of PEI recipients had undergone HCV testing. After notification 91.2% of PEI recipients were identified as tested, dead or moved out of province. The notification program resulted in the identification of the majority of PEI's transfusion-related cases of hepatitis C.

Adult↗

Patterns and predictions of resident misbehavior--a 10-year retrospective look.

BACKGROUND: Surgical educators are charged with ensuring that their trainees conduct themselves in a professional manner. The authors retrospectively reviewed a 10-year experience of incident reports on surgical housestaff to determine patterns and predictors of behavior. METHODS: A retrospective review of all letters, e-mails, and incident reports was conducted for general surgery residents from 1995 to 2005. Descriptive variables were selected for binary categorization (not mutually exclusive): poor professional conduct, protocol violation, administrative deficiency, verbal mistreatment, physical boundary issues, mistreatment of superiors, and deficient medical student interaction. Resident status was defined as current, graduate, and attrition. RESULTS: Of 110 residents [90 [82%] categorical, 23 [21%] undesignated preliminary (3 overlapped both groups); 87 [79%] male, 23 [21%] female] who trained at the University of Pennsylvania during this period, 66 complaints were generated about 29 individuals. Overall, 50 of the 66 complaints (76%) were directed toward men and the remaining 16 (24%) toward women; 24% of all men and 35% of all women received 1 or more complaints. A total of 76% of complaints concerned categorical residents and 24% undesignated preliminary residents. And 26% of all categorical residents and 26% of all preliminary residents received at least 1 complaint. The most common complaints concerned professional conduct (83%), protocol violation (33%), verbal mistreatment (23%), deficiencies of administrative duties (8%), violations of physical boundaries (5%), deficient medical student interaction (5%), and mistreatment of attendings by residents (3%). Recipients of verbal mistreatment included staff nurses (27%), radiology technicians (13%), medical students (13%), environmental services employees (7%), security guards (7%), patients (7%), surgery attendings (7%), anesthesia attendings (7%), internal medicine chief residents (7%), and pharmacists (7%). A total of 31% of the complaints were regarding residents who involuntarily departed and 7% regarding residents who left voluntarily before completion. The mean PGY level at first complaint was 2.2 years. Of the 29 residents receiving complaints, 16 had recurrent offenses (range 2 to 7 total complaints, positive predictive value [PPV] 53%). CONCLUSION: Resident misbehavior manifests early and recurs often. Furthermore, it is frequently directed toward perceived subordinates. Nondesignated preliminary status, premature departure from the program, and the eventual selection of specific subspecialty fellowships seems to increase the risk for resident misbehavior. Identified residents require close surveillance and remediation.

Adult↗

Oral health status in 65-74 years old adults in France, 1995.

BACKGROUND: A study was carried out to assess the oral health status of the non-institutionalized population aged 65-74 years and living in the Rhône-Alpes region, France, in 1995. METHODS: The representative sample was composed of 603 subjects comprised of 41.5% of men of which 24.5% lived in rural areas--i.e. less than 2,000 inhabitants--and 75.5% of urban areas. The quota sample used was stratified by socio-economic status, residence and gender. Oral health was defined by dentate status, D (Decayed), M (Missing), F (Filled) components and DMFT components. Carious lesions, fillings, missing teeth were recorded using the World Health Organization criteria. An indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth--D/D+F was used. RESULTS: The DMFT index at 65-74 years for the French population was 23.3 +/- 4.0. The dental condition of the study group in the Rhônes-Alpes region of France appears satisfactory considering the low percentage of untreated decayed teeth at 65-74 years old (17.4%) and the low rate of edentate people (16.3%). Gender, location and socio-economic variables in relation to the dental status were discussed. CONCLUSION: The relatively good oral health status of the senior citizens and the low rate of need for treatment of dental decay together with the level of oral care available provided a solid base for further development of a qualitative national dental care system.

Aged↗

Vision-specific function and quality of life after cataract extraction in south India.

PURPOSE: To assess visual and overall patient function after intracapsular (ICCE) and extracapsular (ECCE) cataract extraction in rural South India. SETTING: Aravind Eye Hospital, Tirunelveli, Tamil Nadu, South India, and the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland, USA. METHODS: This study evaluated preoperative visual acuity and demographic information and postoperative visual acuity and functional status measures in 71 patients having ECCE with posterior chamber intraocular lens (IOL) placement and 73 patients having ICCE with aphakic spectacle correction at Aravind-Tirunelveli Eye Hospital, Tamil Nadu, India. The principal outcomes assessed were visual acuity; quality-of-life score (possible range 0 to 100%); visual function measurement (possible range 0 to 100%). RESULTS: Patients in the ECCE group scored 10.17 (P = .0001) points higher than those in the ICCE group on the visual function scale after adjustment for differences in age, sex, level of education, marital status, residence, and type of employment. The ECCE group scored 7.69 points higher on visual function when adjusting for the differences in best corrected visual acuity, which was also better in the ECCE group. In the quality-of-life assessment, 77.1% in the ECCE group and 46.6% in the ICCE group scored 90% or better (OR 3.85; P = .006). CONCLUSIONS: Patients in rural south India having ECCE with posterior chamber IOL implantation obtained better postoperative visual function, quality of life, and visual acuity than those receiving ICCE with aphakic spectacle correction. These differences, which were not significantly affected by adjustment for age, sex, education, marital status, type of residence, and occupation, indicate that ECCE is clearly superior to ICCE.

Adult↗

Wartime migration and the incidence of tuberculosis in the Zagreb region, Croatia.

The objective of the present study was to investigate the rate of decline in the incidence of tuberculosis (TB) in residents (1985-1994) and in refugees and displaced persons (1992-1994) during prewar and war periods (1985-1994) in the region of Zagreb, Croatia, and to examine a possible change in the trend of decline in the resident population. Data on the incidence of TB were obtained from the Epidemiology Department, Institute for Lung Diseases, Zagreb, Croatia. The sample comprised two groups of subjects: residents (800,000-1,000,000 inhabitants) and all refugees and displaced persons temporarily residing in the Zagreb region (78,000-95,000 persons). Data were analysed by stepwise logistic regression. The most significant predictors of the TB incidence rate were the square of the year and residence status. The rate of TB incidence in nonresidents was significantly higher than in residents. The decline in incidence in residents was significantly slower than in the nonresident group. The results did not indicate a potential change in the natural decline of the incidence of tuberculosis in the resident population during the study periods. The difference between the regression trends of the incidence of tuberculosis in residents and nonresidents was the result of various concomitant factors, including artefacts of the war.

Croatia↗

Is health status related to residence in medically underserved areas? Evidence and implications for policy.

This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non-MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non-MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20-item Short-Form Health Survey's (SF-20) six subscales. After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non-MUAs for the physical functioning, role functioning, general mental health, self-perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable "education" was a consistent predictor of each of the health status subscales. Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non-MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.

Adult↗

[Effects of the Hansin-Awaji Earthquake on health-status of community residents].

OBJECTIVE: The aim of this study was to assess effects of the Hansin-Awaji Earthquake on health-status of community residents. METHOD: This study was conducted at Itami City, Hyogo prefecture, one of the affected areas of this disaster. Methods as follows: 1) We assessed health-status of 159 adult residents (36 males and 123 females) before, just after, and 1 year after this disaster using annual health check-up data. 2) We compared health check-up data of 109 adult residents (42 males and 67 females) living in temporary-housing after this disaster with the control group matched by age and sex not living in temporary-housing 6 months after the disaster. RESULT: 1) In the residents living in severe damaged area, triglyceride level significantly just after this disaster and tended to go down one year after. 2) Significantly more temporary-housing residents had greater prevalence of irregular dietary habits, more smoking habit, lower HDL-cholesterol level and higher triglyceride level, compared to the control group. CONCLUSION: We found this disaster had many negative effects on their health-status. In addition, temporary-housing residents had poorer health-status than control group. Therefore, these results suggest that we must deal with improvements to the health-status of these residents.

Adult↗

The influence of tail autotomy on agonistic behaviour in a territorial salamander.

Assessment of potentially asymmetrical characters (such as fighting ability and resident advantage) is often important in determining the outcome of agonistic interactions. Loss of body parts, a predator defence mechanism used by many animals, may lead to a reduction in fighting ability and may be easily assessed by competitors. We investigated the influence of tail loss on the expression of agonistic behaviour in the territorial red-backed salamander, Plethodon cinereus. Residents and intruders were matched for body size, and pairs were tested in all combinations of tailed or tailless residents with tailed or tailless intruders. Neither residents nor intruders altered their behaviour based on their own tail condition, but they did alter their behaviour based on the tail condition of their opponents. Intruders showed more aggression or less submission towards tailless residents than towards tailed residents. When contests were between residents and intruders of the same tail condition (both tailed or tailless), intruders were more aggressive towards residents when both were tailless than when both were tailed, indicating that tail loss does not directly hamper aggressive displays. In contests where the asymmetry between residents and intruders was small (based on tail condition and residency status), intruders showed more aggression and less submission than in contests where the asymmetry was large. Residents did not differ in their behaviour for most comparisons. Thus, for intruders, the tail condition of residents is an important determinant of agonistic behaviour displayed in territorial contests. For residents, factors other than tail condition (such as resource value) may be more likely to influence their behaviour. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

Menopause in Australia and Japan: effects of country of residence on menopausal status and menopausal symptoms.

OBJECTIVES: The aim of the study was to explore the effects of country of residence on menopausal status and menopausal symptoms in Australian and Japanese women. The study objectives included exploring the impact of country of residence (Australia and Japan) and menopausal status on menopausal symptoms, and identifying whether country of residence (Australia and Japan) moderates the relationship between menopausal status and menopausal symptoms. METHODS: Analyses are based on 1743 women aged between 40 and 60 years who participated in the multi-race, multi-site, cross-sectional study of mid-aged women called the Australian and Japanese Midlife Women's Health Study (AJMWHS) in 2001--2002. Study participants completed a mailed questionnaire that contained questions on a variety of health-related topics. RESULTS: In both cultures there was a similar increase in prevalence of depression (p < 0.001), somatic symptoms (p < 0.001) and vasomotor symptoms (p < 0.001) at perimenopause. Australian women experienced more night sweats than Japanese women but the prevalence of hot flashes was not statistically different. Postmenopausal Japanese women had more somatic, psychological and sexual symptoms. The main effect for menopausal status and the interaction effect of country of residence was significant in the somatic symptoms (p < 0.001), but not in any of the other areas. CONCLUSIONS: Vasomotor, psychological and somatic symptoms decrease after menopause in Australian women, with only sexual symptoms continuing. In Japanese women, somatic, psychological and sexual symptoms remain high after menopause. It is possible that westernization may be having a significant impact on the aging of women in Japan and it is, therefore important to capture through research just what this impact may be.

Adult↗

Descriptive epidemiological analysis of diving accidents in Hawaii from 1983 to 2001.

The Hyperbaric Treatment Center (HTC) at the University of Hawaii, has evaluated and treated over 1100 divers for dysbaric disease from 1983 to 2001. We describe some epidemiological parameters and compare trends between local residents and tourist divers in this article. Data obtained from this review were analyzed for age, gender, type of injury and resident status. While trends in Hawaii have mirrored national figures, we did determine that there were some significant differences between resident and tourist divers' patterns of injury over this period of time.

Age Distribution↗

Predictors of self-rated health status among Texas residents.

INTRODUCTION: The purpose of this study was to investigate the predictors of self-rated health status for Texas adults using the current 2003 Behavioral Risk Factor Surveillance System data. Self-rated health is generally accepted as a valid measure of health status in population studies, and understanding its correlates may help public health professionals prioritize health-promotion and disease-prevention interventions. METHODS: The two research questions addressed by this study involved the predictors of self-rated health: 1) "Do demographic characteristics, health care coverage, leisure-time physical activity, and body mass index predict self-rated health status for Texas residents aged 18 to 64 years?" and 2) "Does choice of interview language (English vs Spanish) predict self-rated health status for Texas residents of Hispanic ethnicity aged 18 to 64 years?" Key analysis variables were identified, and descriptive statistics were used to describe the major variables and determine whether the number of respondents for each variable was sufficient for analysis. Multivariate regression analysis was used to assess the variables. RESULTS: Multiple logistic regression analysis (controlling for diabetes and arthritis) of the self-rated health predictors indicated that older age, lack of health care coverage, lack of a college education, being Hispanic, having a lower income, obesity, and not exercising explained 19.4% of the variance of fair and poor self-rated health. The interview language (English or Spanish), age, sex, education, income, obesity, health insurance coverage, and physical activity (controlling for chronic illness) explained 22.8% of the variance in fair and poor self-rated health for Hispanic respondents. CONCLUSION: The results of this study suggest that a college education, a lower body mass index, non-Hispanic ethnicity, and participation in physical activity are associated with good, very good, or excellent self-rated health status. The finding that the interview language significantly predicted fair and poor self-rated health substantiates previous research and emphasizes the importance of culturally sensitive approaches to health care services.

Adolescent↗

[Studies on strategies for changing food composition of residents based on their nutritional status].

Investigations of resident food consumption and evaluations of their dietary nutrition were carried out to correctly lead to the adjustment of food composition, promotion of coordinating development of food consumption and production, and continuous improvement of people's nutritional level and health status. Results showed that residents consumed less protein of high quality, more fat in the urban area, insufficient some trace element and more salt in Hebei province. Based on these facts, it is recommended that to consume vegetable food as major dietary composition with a variety of grains and vegetables, to increase adequately animal food and legumes, to decrease salt intake, and to lower fat intake in the urban areas be the strategic goals for the food composition changes. Measures to implement these goals are discussed in the paper, also.

China↗

Self-reported symptoms of temporomandibular dysfunction in a female university student population in Saudi Arabia.

The symptoms of temporomandibular dysfunction (TMD), reported by 705 female university students of Riyadh, Saudi Arabia, are analysed. The population is representative of the educated class of Saudi Arabia. The most frequently reported symptoms were jaw feeling tired (34.5%), awareness of uncomfortable bite (31.3%), pain in front of the ear (22.4%) and discomfort upon wide opening (22.4%). The frequency of subjective reactions was, pain interferes with activity (42%), disturbed sleep (40.6%), taking of medication (27.8%) and pain being frustrating or depressing (26.8%). Some interesting relationships were found between the reported symptoms and marital status, residence and college of education. These findings are similar to those reported in a Bedouin community in Egypt, but lower than that in a Saudi Arabian population attending dental clinics, Saudi male dental students and high school students.

Adolescent↗

Patterns of avian seroprevalence to western equine encephalomyelitis and Saint Louis encephalitis viruses in California, USA.

Temporal and spatial changes in the enzootic activity of western equine encephalomyelitis (WEE) and St. Louis encephalitis (SLE) viruses were monitored at representative wetland study sites in the Coachella, San Joaquin, and Sacramento valleys of California from 1996 to 1998 using three methods: (1) virus isolation from pools of 50 host-seeking Culex tarsalis Coquillett females, (2) seroconversions in flocks of 10 sentinel chickens, and (3) seroprevalence in wild birds collected by mist nets and grain baited traps. Overall, 74 WEE and one SLE isolates were obtained from 222,455 Cx. tarsalis females tested in 4,988 pools. In addition, 133 and 40 seroconversions were detected in 28 chicken flocks, and 143 and 27 of 20,192 sera tested from 149 species of wild birds were positive for antibodies to WEE and SLE, respectively. WEE was active in all three valleys, whereas SLE only was detected in Coachella Valley. Seroconversions in sentinel chickens provided the most sensitive indication of enzootic activity and were correlated with seroprevalence rates in wild birds. Avian seroprevalence rates did not provide an early warning of pending enzootic activity in chickens, because positive sera from after hatching year birds collected during spring most probably were the result of infections acquired during the previous season. Few seroconversions were detected among banded recaptured birds collected during spring and early summer. Age and resident status, but not sex, were significant risk factors for wild bird infection, with the highest seroprevalence rates among after hatching year individuals of permanent resident species. Migrants (with the exception of mourning doves) and winter resident species rarely were positive. House finches, house sparrows, Gambel's quail, California quail, common ground doves, and mourning doves were most frequently positive for antibodies. The initial detection of enzootic activity each summer coincided closely with the appearance of hatching year birds of these species in our study areas, perhaps indicating their role in virus amplification. Bird species most frequently positive roosted or nested in elevated upland vegetation, sites where Cx. tarsalis host-seeking females hunt most frequently. These serosurveys provided important background information for planned host competence and chronic infection studies.

Animals↗