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At least 1,243 records · Page 69Linked to original sources
PubMed2005

[Development and validation of a health related quality of life questionnaire for Brazilian children with epilepsy: preliminary findings].

PURPOSE: To construct a multidimensional questionnaire that analyses the epileptic child quality of life from the parental point of view. METHOD: The pilot questionnaire was composed of 157 questions distributed in several dimensions. Fifty-one epileptic children's parents answered the questionnaire. The instrument was tested in its diverse properties: frequency of endorsement, homogeneity (Cronbach alpha), criterion and face validity, and later it was reduced. RESULTS: Endorsement frequency excluded 65 questions that did not attain a minimum of 5% response per item. Cronbach alpha was as follows: physical (0.93), psychological (0.91), social (0.91), familiar (0.70), cognitive (0.92), medical (0.30) and economical (0.37). Patient groups, in relation to seizure control, significantly differed only in physical domain and total score, although there was a trend to differences in other domains. The final questionnaire (QVCE50) has 50 items, with good homogeneity in the physical, psychological and cognitive domains. CONCLUSION: QVCE-50 is a promissing Brazilian HRQL questionnaire for children with epilepsy. It needs to be applied in a larger population to confirm its psychometric properties.

Adolescent↗
PubMed1994

[The factor structure of the adult psychiatry morbidity questionnaire in a community sample of Brazilian cities].

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptoms and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue = 3.81, 10.9%); Irritability/Depression (eigenvalue = 2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue = 1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

Adolescent↗
PubMed2004

[Validation of the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF) for Portuguese].

OBJECTIVE: To translate into and validate for Portuguese the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF), a condition-specific quality-of-life questionnaire for patients with urinary incontinence. METHODS: Two Brazilians independently translated the original ICIQ-SF into Portuguese. These two translations were harmonized, and then checked by independent back-translation by two native English speakers. The harmonized translation was pre-tested in a pilot study on 20 patients. The final version of the ICIQ-SF in Portuguese was applied to 123 consecutive patients aged 16 or over (29 males and 94 females) with a complaint of urinary incontinence, who had sought the Department of Urogynecology and Uroneurology of the School of Medical Sciences of Unicamp. The Portuguese version of the King's Health Questionnaire (KHQ) was also applied to the same group. The psychometric properties of the questionnaire, such as reliability and construct validity were assessed. RESULTS: The median age was 53 years (range: 16 to 86). The mean retest interval for the ICIQ-SF was 14.37 days (range: 6 to 41). No changes from the original format of the ICIQ-SF were observed at the end of the process of translation and cultural adaptation. The internal consistency was high (0.88), as measured by the Cronbach alpha coefficient. The test-retest value was considered moderate to strong, as measured by the weighted Kappa index (range: 0.72 to 0.75) and Pearson correlation coefficient (0.89). The correlation between the ICIQ-SF and KHQ was considered to be moderate to good for most items (range: 0.44 to 0.77). The evaluation of the construct and concurrent validity was also satisfactory and statistically significant. CONCLUSIONS: The "International Consultation on Incontinence Questionnaire" (ICIQ-SF) was successfully translated into Portuguese and validated for application to Brazilian female and male patients complaining of urinary incontinence, with satisfactory reliability and construct validity.

Adolescent↗
PubMedDate not supplied

[Validation of a brief questionnaire to measure the risk of abnormal eating behaviors].

OBJECTIVE: To assess the validity and reliability of a questionnaire for the screening of risk eating behaviors. MATERIAL AND METHODS: The questionnaire was applied to female high school students in Mexico City in October 2002, as well as to a sample of eating disorder patients seen at the Eating Disorders Unit of the National Institute of Psychiatry between September and December 2002. Statistical methods included internal consistency analysis (Cronbach's alpha) and factor and principal component analysis with oblique rotation. The cutoff point, sensitivity, specificity, and predictive values of the questionnaire were determined using 2 x 2 tables. RESULTS: The questionnaire showed a high reliability (alpha=0.83) and a three-factor structure with 64.7% of the total explained variance. A discriminant analysis showed that almost 90% of cases were correctly classified. CONCLUSIONS: This questionnaire is reliable and valid for assessing risk eating behaviors in the study population.

Adult↗
PubMed2001

Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris.

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.

Brazil↗
PubMed2005

Validation of the Portuguese version of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) for the screening of binge eating disorder.

OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

Adolescent↗
PubMed2002

Comparison of patient and doctor responses to a total hip arthroplasty clinical evaluation questionnaire.

BACKGROUND: Surgeons traditionally undertake a prospective evaluation of patients undergoing total hip arthroplasty in order to determine outcomes. The validity of doctor-derived data is questionable because of the potential for interobserver error, reporting bias, and differences between the perceptions of doctors and patients. Also, the use of doctor-derived data necessitates the use of costly outpatient services. Consequently, there are likely to be benefits associated with the use of patient-derived clinical evaluation data. However, few studies have focused on whether data obtained from the patient and doctor differ. METHODS: The agreement between patient and doctor responses on a sixteen-item total hip arthroplasty clinical evaluation questionnaire completed at more than 2900 clinical assessments was determined. Data from repeated assessments performed preoperatively and postoperatively enabled stratified analyses that were used to examine reasons for disagreement and factors influencing agreement. Agreement was measured with use of the kappa coefficient. RESULTS: For twelve of the sixteen items, the patient responses had acceptable agreement with the doctor responses. Some important differences between patient-derived and doctor-derived data were found. If the patient had other joint or health problems, had a revision total hip arthroplasty, or reported mild or moderate pain, there was a greater chance of reduced agreement on the pain items. Younger patients demonstrated better agreement with doctors than older patients did. CONCLUSIONS: Patients' perceptions of symptoms and outcomes after total hip arthroplasty are relatively similar to those of their doctor. There is minimum risk of misinterpreting outcomes data by replacing doctor-completed questionnaires with patient-completed questionnaires in uncomplicated total hip arthroplasty cases. For patients with comorbid joint problems or other health problems, and for those reporting substantial pain, direct physician involvement in the evaluation of pain is recommended. The selective use of patient-completed questionnaires has the potential to substantially reduce the costs of outcomes evaluation programs by minimizing doctor input. Pending revision of some of the items, the use of this patient-completed questionnaire is advocated.

Age Distribution↗
PubMed2006

Screening for suspected chronic obstructive pulmonary disease with an eleven-item pre-interview questionnaire (11-Q).

OBJECTIVE: Early diagnosis is central to the management of chronic obstructive pulmonary disease (COPD). In time-constrained clinical situations, a pre-interview questionnaire can be a useful method for alerting both clinicians and patients with COPD, particularly for elderly patients. To screen subjects who might have COPD, we have developed an efficient pre-interview questionnaire. METHODS: In study I, we developed an 11-item questionnaire (11-Q) to alert primary care providers to the possibility of COPD, and the validity of this questionnaire was investigated. In study II, a randomized and prospective cross-sectional study was performed on a total of 245 subjects with or without respiratory symptoms. RESULTS: Good test-retest reliability and validity were shown in study I; the internal consistency of 11-Q was highly preserved (Cronbach alpha value of 0.867), with a high reproducibility of responses by inter- and intra examinees. Study II showed that the 11-Q in COPD patients with more than moderate severity was significantly higher than that in bronchial asthma or non-cardiopulmonary subjects (both, p<0.0001). Among the COPD patients, the total score significantly distinguished the severity of COPD as mild or more than moderate. CONCLUSION: The pre-interview questionnaire, 11-Q, was found to be a useful tool to alert primary care providers to subjects with COPD and could also be used to distinguish COPD with a more than moderate severity from bronchial asthma. The 11-Q can be used as a simple and inexpensive method of predicting COPD, thus being a useful tool to alert primary care providers to patients with suspected COPD, particularly among the elderly.

Aged↗
PubMed2003

Validity and reproducibility of a self-administered food frequency questionnaire used in the baseline survey of the JPHC Study Cohort I.

We examined the validity and reproducibility of a 44-item food frequency questionnaire used in a baseline survey of the Japan Public Health Center-Based Prospective Study Cohort I conducted in February 1990. Subjects were 94 men and 107 women selected on a voluntary basis among respondents to the baseline survey. Four or five years after the baseline survey, they provided four 7-day diet records during a 1-year period, and then responded to the same questionnaire a second time. The median (range) for energy-adjusted correlation coefficients between 30 nutrients measured by the questionnaire and the diet records was 0.36 (0.06-0.81) for men and 0.37 (0.11-0.52) for women. The median correlation (range) for 17 food groups was 0.30 (0.08-0.75) for men and 0.28 (0.08-0.46) for women. The median correlation (range) for energy-adjusted correlation coefficients between the two questionnaires was 0.24 (0.04-0.69) for men and 0.50 (0.27-0.60) for women for the nutrients, and 0.34 (0.15-0.63) for men and 0.48 (0.18-0.55) for women for the food groups, respectively. The results indicate that this brief food frequency questionnaire provides reasonably valid and reproducible measures of consumption for many nutrients and food groups, and is useful for examining the association between diet and health in the Japanese population.

Diet Records↗
PubMed1989

[Research into actual conditions and preventive care in periodontal disease. Relationship between questionnaire results and periodontal disease in youth].

The purpose of this study was to determine the prevalence of periodontal disease and the relationship between the results of questionnaire concerning periodontal disease and the actual periodontal condition in youth. The examination was carried out in three parts. In the first part, a questionnaire was conducted on 3,886 junior and senior high school students (12 to 18 years of age) living in Kawagoe, Japan. The questionnaire was composed by of items concerning habits of oral hygiene, periodontal symptoms, understanding of periodontal disease and history of diagnosis by dentist of periodontal disease. Secondary, mass intraoral examination was carried out on all objects. The examination covered gingival inflammation, periodontal probing depth, calculus, dental plaque, dental caries and malalignment. Lastly, we examined the relationship between the results of periodontal examination and questionnaire with the original periodontal classification. The following results were obtained: 1. As an example of items in questionnaire, 83.1% brushed their teeth more than two times daily. The understanding of oral hygiene concerning dental caries was improved, but concerning periodontal disease was still poor. 2. The symptom most frequently reported was gingival bleeding during tooth brushing (18.4%). 3. The percentage of persons with periodontal disease (moderate gingival inflammation and periodontal pocket 4 mm or deeper) was of the highest frequency at 13 years old. The proportion of males increased with the advanced state of periodontal disease. 4. A significant correlation was found (chi 2-test: alpha less than 0.001) between advanced state of periodontal disease and a decrease in tooth brushing time per day. 5. A significant correlation was found between the advance of periodontal disease and gingival bleeding on tooth brushing (chi 2-test: alpha less than 0.001). Similarly, a correlation was found between the advance of periodontal disease and gingival swelling (chi 2-test: alpha less than 0.001). 6. A significant correlation was found (chi 2-test: alpha less than 0.001) between the advance of periodontal disease and aggravation of condition of dental plaque, calculus, dental caries and malalignment.

Adolescent↗
PubMed2006

Patient Interpretation of Neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care.

OBJECTIVE: Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients' cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care. RESEARCH DESIGN AND METHODS: The Patient Interpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n = 325) and U.S. (n = 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy. RESULTS: Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients' common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach's alpha = 0.62-0.90) and test-retest reliability (Pearson's r = 0.51-0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (rp = 0.15-0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity. CONCLUSIONS: The 39-item PIN questionnaire is a reliable and valid measure of patients' cognitive and emotional representations of neuropathy affecting foot self-care.

Aged↗
PubMed1990

Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians.

There was a need to design a questionnaire that could accurately assess the activity patterns of Native Americans to evaluate the relationship between physical activity and diabetes. Such a questionnaire was developed and implemented into the data collection scheme of the prospective Pima Indian Study of Arizona. The questionnaire, which assesses historical, past-year, and past-week leisure and occupational activity, was examined in 29 Pima individuals aged 21-36 yr and was shown to be reliable with test-retest correlations (rank-order correlations ranged from 0.62 to 0.96 for leisure and occupational activity). Reproducibility of the past-year leisure physical-activity estimate was determined in 69 participants aged 10-59 yr and was found to be reliable in all age-groups with the exception of the 10- to 14-yr-old age-group (rank-order correlations were 0.31 in the 10- to 14-yr-old age-group compared to 0.88 to 0.92 in those greater than 20 yr of age). Validity of the current-activity section of the questionnaire was demonstrated indirectly through comparisons with activity monitors. The past-week leisure-activity estimate was related to the Caltrac activity monitor counts per hour (rho = 0.62, P less than 0.05, n = 17). In summary, a physical-activity questionnaire has been developed that is both reliable and feasible to use in the Pima Indian population to evaluate the relationship of physical activity to non-insulin-dependent diabetes mellitus.

Adolescent↗
PubMed2000

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management.

OBJECTIVE: To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs. RESEARCH DESIGN AND METHODS: Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further assess reliability and validity; Cronbach's alpha and product-moment correlations were calculated for components having > or =3 items with loadings >0.50. RESULTS: The validated 73-item mailed satisfaction survey had a 34.1% response rate. Principal components analysis yielded 13 components with eigenvalues > 1.0. The Scree test proposed a 6-component solution (39 items), which explained 59% of the total variation. Internal consistency reliabilities computed for the first 6 components (alpha = 0.79-0.95) were acceptable. CONCLUSIONS: The final questionnaire, the Diabetes Management Evaluation Tool (DMET), was designed to assess patient satisfaction with diabetes disease management programs. Although more extensive testing of the questionnaire is appropriate, preliminary reliability and validity of the DMET has been demonstrated.

Adolescent↗
PubMed2005

Development of a discriminative questionnaire to assess nonphysical aspects of quality of life of dogs.

OBJECTIVE: To develop a preliminary discriminative questionnaire for assessment of nonphysical aspects of the quality of life (QOL) of pet dogs and evaluate the questionnaire's content validity, test-retest reliability, and internal consistency. STUDY POPULATION: Owners of 120 dogs. PROCEDURE: Each QOL question had 4 response options, representing descending levels of QOL that were equally weighted. A maximum of 38 items contributed to the QOL score. The questionnaire was administered by telephone to owners of dogs with appointments at a veterinary teaching hospital before the appointment. After the appointment, each dog was classified as sick or healthy by use of defined criteria; owners of healthy dogs had a second interview 3 to 4 weeks later. Test-retest reliability (kappa), internal consistency (Cronbach alpha), and respondents' comprehension were used as criteria for excluding an item. RESULTS: There were 77 sick and 43 healthy dogs. Twenty-two QOL questions had significant kappa values (0.11 to 0.91). The Cronbach alpha values for 5 domains of QOL ranged from 0.45 to 0.61, indicating that the domains had moderate internal consistency (homogeneity). The initial pool of 38 items was reduced to 27. CONCLUSIONS AND CLINICAL RELEVANCE: The questionnaire was designed to complement veterinary assessment of dogs' physical health. The questionnaire may be a useful tool in making decisions regarding dogs' QOL.

Animals↗
PubMed2005

Evaluation of a behavioral assessment questionnaire for use in the characterization of behavioral problems of dogs relinquished to animal shelters.

OBJECTIVE: To evaluate a behavioral intake questionnaire in animal shelters for the presence of biased results and assess its use in the characterization of behavioral problems of dogs relinquished to shelters. DESIGN: Cross-sectional study. Animals-54 dogs being relinquished to a shelter and 784 dogs belonging to veterinary clients. Procedure-Owners who were relinquishing their dogs and agreed to complete the behavioral questionnaire were alternately assigned to 1 of 2 groups; participants were aware that information provided would be confidential or nonconfidential (i.e., likely used for adoption purposes). Data from confidential and nonconfidential information groups were compared, and the former were compared with data (collected via the questionnaire) regarding a population of client-owned dogs. RESULTS: Analyses revealed significant differences in 2 areas of reported problem behavior between the confidential and nonconfidential information groups: owner-directed aggression and stranger-directed fear. Compared with client-owned-group data, significantly more relinquished shelter dogs in the confidential information group were reported to have owner-directed aggression, stranger-directed aggression, dog-directed aggression or fear, stranger-directed fear, nonsocial fear, and separation-related behaviors. CONCLUSIONS AND CLINICAL RELEVANCE: Among persons relinquishing dogs to a shelter, those who believed questionnaire responses were confidential reported owner-directed aggression and fear of strangers in their pets more frequently than relinquishers who believed responses were nonconfidential. Confidentiality had no apparent effect on the reporting of other assessed behavioral problems. Results suggest that behavioral questionnaires may sometimes provide inaccurate information in a shelter setting, but the information may still be useful when evaluating behavior of relinquished dogs.

Aggression↗
PubMed1998

The Verbalizer-Visualizer Questionnaire: a review.

The psychometric properties of Richardson's 1977 Verbalizer-Visualizer Questionnaire have been studied by analyzing papers in which this questionnaire was employed. Such review showed that the Verbalizer-Visualizer Questionnaire does not measure a unidimensional construct and does not predict the actual use of mental imagery in thinking. Further, a lack of long-term reliability of the questionnaire emerged. In conclusion, use of the questionnaire to assess the verbal-visual cognitive style appears questionable.

Eye Movements↗
PubMed2000

The Groningen Enjoyment Questionnaire: a measure of enjoyment in leisure-time physical activity.

The purpose of this study was to develop a short and easily used questionnaire to measure enjoyment in leisure-time physical activity. The first part of the study involved the questionnaire's composition. A set of 30 positively formulated potential items was generated and subsequently completed by 59 subjects. We used these results to trim the questionnaire to 10 items. In the second part of the study, the questionnaire was administered to 82 subjects and research was done into reliability and validity. The results indicate that the Groningen Enjoyment Questionnaire can be considered reliable and valid.

Aged↗
PubMed2004

Development of the sport achievement orientation questionnaire for Japanese athletes by exploratory factor analysis.

In this study, a questionnaire to assess achievement orientation in sport for Japanese athletes was developed. We created the questionnaire by picking items from free descriptions of Japanese athletes and using factor analysis of the responses in a Japanese sport setting. The subjects were 2,415 athletes (M=16.7 yr., SD=2.7) in Japan. Factor analyses in this study identified three factors. Top Level Orientation, Demonstrating Ability Orientation, and Win Orientation, respectively. An examination of the intercorrelations among the three scores showed the subscales were related. There were no correlations between the new measure and the Japanese versions of the Sport Orientation Questionnaire and the Task and Ego Orientation in Sport Questionnaire except that the correlation of Win Orientation and the SOQ Athletic Success Orientation was low and negative. These results suggested that the three subscales appeared to be separate but related factors, and that it is an original measurement for only Japanese athletes. The overall factor reliability and validity based on the sample suggested that the Sport Achievement Orientation Questionnaire for Japanese Athletes can be valuable means for the investigation of achievement orientation in Japanese sport and exercise settings.

Achievement↗