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PubMed2003

Trend of measles morbidity in Thailand.

RATIONALE: Measles is still an important public health problem in Thailand despite the high coverage of measles vaccination since 1984, and the second dose of measles vaccination in primary school children in 1991. OBJECTIVE: To study the trend of measles morbidity in Thai children. MATERIAL AND METHOD: Review of the Annual Epidemiological Surveillance Report of the Epidemiology Section, Department of Communicable Disease Control, Ministry of Public Health (MOPH), and hospital records of measle cases at the Queen Sirikit National Institute of Child Health (QSNICH) (Bangkok Children's Hospital). Paired t-test and analysis of variance (ANOVA) were used for data analysis in the present study. RESULTS: Before 1984, measles morbidity was very high, at the level of 52.3 to 93.67 per 100,000 population. After measles vaccine was included in the EPI (Expanded Program on Immunization), the morbidity fluctuated for some years, and the group of children infected with measles changed from under 5 years to the age group of 5-9 years old. So a second dose of measles vaccine was added to the EPI given to children in Prathom 1 (first year in primary school, 6 years old and over). After 4 years of adding the second dose of measles in the EPI, measles cases was still present in a significant number in both the under 5 and 5-9 age groups. From the statistics of measles cases at the QSNICH, with an average of 736 measles cases per year, the number of measles cases is now decreasing, but the incidence of measles is still high in both the under 5 and 5-9 age groups. CONCLUSION: According to the EPI in Thailand, children were given measles vaccine at the age of 9 months which is when seroconversion was significantly lower than immunization after one year of age. The trend of measles morbidity is decreasing, but is still high in children in the under 5 and 5-9 age groups. Vaccine failure may be one of the contributing factors of measles cases in children in these age groups. A booster dose of measles vaccine at 15-18 months old is suggested in order to increase the seroprotection in children in the under 5 and 5-9 age groups.

Analysis of Variance↗
PubMed2003

Vertical banded gastroplasty: a simple, effective and safe surgery for morbid obesity.

BACKGROUND: The purpose of this study was to analyze the data of 92 patients who were treated with vertical banded gastroplasty (VBGP) for morbid obesity. We wanted to show that VBGP is a simple, effective and safe surgery for an experienced gastrointestinal surgeon. METHODS: From January 1994 through June 2000, 92 patients with morbid obesity who were treated with VBGP were enrolled into this study. All associated data were corrected and analyzed. The gastric pouch was created with end-to-end anastomosis instrument (EEA-31) and two applications of thoracic anastomosis instrument (TA)90-4.8 or TA90-B. The outlet of the gastric pouch was 10 to 12 mm in diameter. The results were classified as excellent, good, fair, poor, and bad. RESULTS: Staple disruption occurred in four patients with two applications of TA90-4.8 at the beginning of the series. No surgical deaths occurred. Fifteen patients had excellent results. Thirty-eight patients had good results. Twenty-three patients had fair results. Only 16 patients had poor or bad results. CONCLUSION: VBGP is a simple, effective and safe surgery for an experienced gastrointestinal surgeon in management of morbid obesity. The associated morbidity and mortality rates are low and the results are good.

Adolescent↗
PubMed2003

Diabetes mellitus related morbidity, risk of hospitalization and disability.

OBJECTIVE: To investigate the rates of complications, hospitalizations and disabilities attributable to type 1 and type 2 diabetes mellitus (DM) combined, unless otherwise noted. METHODOLOGY: Risk assessment of DM-related morbidity, hospitalizations and disabilities using data from the medical literature and health statistics on the population. Calculation of morbidity, hospitalization, and disability ratios (MbR, HR, DR) will allow comparison of observed rates in people with DM to those reported in the nondiabetic population. RESULTS: MbRs vary according to the morbid condition studied: approximately 300% at age 45-64 years for ischemic heart disease, 533% for coronary heart disease or stroke, 226% to 388% for chronic heart failure, 560% for peripheral vascular disease, 380% for neuropathy at age 35-74 years, 890% to 2225% for lower limb amputations, 1458% to 3287% for end-stage renal disease. For ocular complications: cataracts, 165% to 232%; glaucoma 140% to 330%; trouble seeing, 180% to 231%; blindness at age > or = 65 years, 517%. Higher values are noted at younger ages. HR: 200% to 409%. DR: 217% to 328%. CONCLUSION: Among diseases, DM is one of the leading and growing causes of hospital admission and disability. Precise risk assessment of morbidity is essential for realistic underwriting of health and disability insurance.

Adult↗
PubMed2004

Effectiveness and infectious morbidity of outpatient cervical ripening with a Foley catheter.

OBJECTIVE: To assess the effectiveness and infectious morbidity of outpatient cervical ripening with a Foley catheter. STUDY DESIGN: Labor inductions utilizing a Foley catheter for cervical ripening from January 1994 to October 1999 were retrospectively reviewed. The inductions were divided into inpatient and outpatient groups. Vaginal delivery rates and infectious morbidity were compared between the 2 groups. RESULTS: There were 315 inpatient and 300 outpatient cases. The observed differences in vaginal delivery rates and infectious morbidity were not clinically or statistically significant. However, there was insufficient power to exclude a type II error. The cost savings was $165,000, and there is the potential to save $750 per patient with this method. CONCLUSION: Outpatient cervical ripening with a Foley catheter is clinically effective, does not result in excess infectious morbidity and is more cost effective as compared to inpatient cervical ripening.

Adult↗
PubMed2002

[Morbidity among the ceramic factory employees in relation to the environmental exposure].

1192 employees of the ceramic factory were included in the study. They were divided into six groups according to the environmental exposure: 1--dustiness exceeding the allowable values, 2--noise exceeding the allowable values, 3--ceramic paints and organic solvents, 4--shift and night work, 5 and 6 non-occupational factors. After through medical examinations the morbidity rates were estimated (general and specific) for each population group. The morbidity rates were standardised for age. Besides, the odds ratio (OR) and the population attribute risk (PAR%) were calculated for each group. Differences in general morbidity and the incidence of particular diseases were observed between the groups. Analysis of the results with the help of OR and PAR% showed that non-occupational factors played a more important role in general morbidity than occupational ones.

Adult↗
PubMed2004

[Long-term impact of a mass treatment by praziquantel on morbidity due to Schistosoma haematobium in two hyperendemic villages of Niger].

Although it is established that the treatment by praziquantel reduces the urinary lesions due to Schistosoma haematobium, the frequency of mass treatment necessary to maintain a low morbidity level remains poorly known. The objective of this work was to study the impact over three years of a single praziquantel mass treatment on schistosomiasis morbidity in two different systems of disease transmission in Niger. The study was performed in 2 villages hyperendemic for schistosomiasis in the South-West of Niger presenting respectively 2 different systems of schistosomiasis transmission: Koutoukalé-Zéno (K Zéno), located close to an irrigated area of the Niger River Valley where the transmission is permanent, and Téguey located along a temporary pond where the transmission is seasonal. After the initial evaluation (1994), we carried out a survey 3 years later (1997) except in K. Zéno where an intermediate evaluation was performed 10 months after the initial survey (1995). Approximately 300 randomised people have been examined as follows: macroscopic examination of urine and reagent sticks for macro- and micro-haematuria, filtration and microscopic examination of urine for Schistosoma eggs, and ultrasound scan of the urinary tract for morbidity. The therapeutic coverage has reached 69.9% in K. Zéno and 78.2% in Téguey. The prevalence of infestation decreased from 74.1% to 56.4 % in K. Zéno (p < 0.001) and from 65.3% to 30.4% in Téguey (p < 0.001) at the end of the 3 years. The prevalence of heavy infestation (eggs > or = 50) went in the same time from 9.9% to 12.8% (p = 0.3) in K. Zéno and from 9.1% to 3.3% in Téguey (p = 0.01). Using ultrasound scan, the prevalence of the bladder lesions reached its previous level in both villages. However the prevalence of hydronephrosis decreased from 21.1% to 3.9% in K. éno (p < 0.001) and from 12.6% to 4.2% in Téguey (p < 0.001). Three years after the single mass treatment, the morbidity did not reach the initial level. The effectiveness of the treatment is better in the pond system where the transmission is seasonal. The lesions of the upper tract decreased more slowly than the bladder lesions, but a long time after the treatment. The re-infestation induced the re-appearance of the bladder lesions sooner than the lesions of the upper tract. The periodicity of the treatment should be variable according to the transmission system. It should occur every 2 years in irrigated areas and could be delayed (3 years) in temporary ponds. The control was beneficial in the pond system and induced a significant reduction of the severe lesions.

Adolescent↗
PubMed2003

Alcohol-related morbidity and mortality.

Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone.

Alcohol Drinking↗
PubMed2001

[Maternal morbidity and mortality in HELLP Syndrome].

OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

Adult↗
PubMed2004

A modern analysis of morbidity after pancreatic resection.

Complications after pancreatic resection remain prevalent. Procedure-related morbidity has previously focused on prevention of pancreatic and biliary fistulas (PFs and BFs) with other complications receiving less attention. We examined morbidity and its impact on reoperation, length of stay (LOS), and mortality following pancreatic resection. We retrospectively reviewed patients having elective pancreatectomy at the University of Tennessee affiliated hospitals during a recent 5-year time period. Factors examined included morbidity, mortality, and the need for reoperation. Patient deaths were analyzed with a focus on antecedent complications. Comparisons were made using Student's t test and chi2 analysis where appropriated. From 1997 to 2003, 125 patients had pancreatic resections: 93 Whipple procedures, 27 distal, and 5 total pancreatectomies. Twenty-nine patients (23%) did not have intraperitoneal drainage (IPD). Resections were performed for cancer in 75 per cent. Seventy complications occurred in 55 patients (44%). Morbidity related to an intra-abdominal process resulted in 16 reoperations and 4/6 deaths in this series (overall mortality, 4.8%). There were no BFs. Of 10 patients with PFs (8%), none required reoperation, and there was no PF-related mortality. No patient without IPD developed a PF. The presence of a PF significantly increased LOS when compared to those without (30.9 +/- 13.1 vs 17.4 +/- 12.2 days, P < 0.01). Forty-four per cent of all complications were related to either intra-abdominal abscess (IAA), hemorrhage, or feeding tube placement (18, 8, and 5, respectively). Management of IAA included percutaneous drainage in 16 and reoperation in 2 with 1 associated death. Hemorrhage necessitated reoperation in 6, resulted in 1 patient death, and was followed by IAA in 2. Of 5 jejunostomy tube complications, 4 required reoperation and 2 patients died. LOS was significantly greater in these 28 patients when compared to all others (28.1 +/- 16.9 vs 15.8 +/- 9.9 days, P < 0.001). Following pancreatectomy, 1) BFs should be a rare event; 2) PFs remain important but are most often managed nonoperatively with few sequelae; 3) in this series, IAA and hemorrhage were more common than PF, frequently mandated reoperation, prolonged hospitalization, and were associated with procedure related mortality; 4) feeding tube complications, though rare, are often catastrophic; 5) future efforts should focus on factors that could reduce abscess formation and a reduction in overall complications--many of which are potentially preventable.

Adult↗
PubMedDate not supplied

[Morbidity following cardiac surgery. A proposal for qualification].

The authors propose a new scoring table to quantify morbidity events related to cardiac surgery. They intend to quantify the relative impact of each occurred event and also to calculate and score the sum of all morbidity events occurring in a given patient. The table was constructed based on the opinion of a panel of international experts that were asked to quantify the morbidity events on the proposed list. Their answers were integrated and analyzed according to the inferring Delphi's method, in order to establish the relative weight of each event, scoring events for each system. The methodology that was adopted is throughly discussed and speculation is made over the use of the table score for related morbidity in cardiac surgery, namely as a tool to compare both the surgical performance and for quality ranking. The scoring table is now being tested clinically.

Cardiac Surgical Procedures↗
PubMed1992

[Comparison of anesthetic morbidity and mortality before and after the implementation of quality assurance in Tri-Service General Hospital].

The desire to improve anesthetic outcome is a cornerstone in modern anesthesia. There are many means to reach this goal, such as enforcement in personal training, elevation of monitoring standards, constant vigilance and stern quality assurance (QA). The department of Anesthesiology, Tri-Service General Hospital, has adopted the QA program and implemented it since March 1, 1990. Because there were no significant differences in terms of personnel training, monitoring standards and types of anesthesia and surgery before and after the application of QA program, we investigated the effects of QA on anesthetic major morbidity and coma/mortality. We analyzed the anesthetic results obtained in two separate periods respectively spanning from Jan. 1, 1989 to Dec. 31, 1989 and from Mar. 1, 1990 to Feb. 28, 1991. During the first two months of 1990, the department's personnel were trained to be familiar with the QA program. We compared the anesthetic major morbidity and coma/mortality of one year before the implementation of QA with those in a one-year period after its implementation. Before and after enforcement of QA, there were no significant differences (p greater than 0.05) regarding major morbidity and coma/mortality, but the rates of anesthetic complications were lower after the practice of QA program. Since the functions of QA was aimed at alerting the anesthetic personnel to keep constant vigilance over the act of anesthesia, QA in theory could reduce anesthetic accidents and mishaps related jointly to surgery and anesthesia. The reason why QA did not decrease anesthetic major morbidity and coma/mortality in this study may be due to limited number of anesthesia in relatively short period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Coexistent morbidity in chronic and hypertrophic adenotonsillitis: a case study in 3600 subjects].

OBJECTIVE: To know the frequency of chronic and hypertrophic adenotonsillitis, affected population, coexisting morbidity and surgical procedures in a population of Zone 89, IMSS at Guadalajara, Jalisco. MATERIALS AND METHODS: Descriptive, transversal and prospective study of patients with diagnosis of chronic and hypertrophic adenotonsillitis treated between January 2000 and October 2001 were studied. Through age groups were analyzed coexisting morbidity and surgical procedures. RESULTS: Of the 3600 patients with chronic and hypertrophic adenotonsillitis evaluated, they were distinguished 3 age groups that are characterized by coexisting morbidity, the average age group (45%) was between 6 to 10 years and characterized by the presence of chronic sinusitis, otitis media with effusion and recurrent otitis media; while the children younger than 5 years (30.3%) prevailed the obstruction of the upper respiratory tract, chronic sinusitis, bronchitis and otitis media with effusion; however, all individuals aged from 16 to 49 years (9.4%) was notary the presence of chronic otitis media and peritonsillar abscess. CONCLUSIONS: The present study represented the first step for future studies and permitted us to understand the frequency and coexisting morbidity of this pathology in our medium. The usefulness of this study will contribute to the promotion of prevention measures, opportune detection of complications, acquire new methods of bacteriologies diagnostics and therapeutic strategies. It is possible that new prevention measures will chain react a new series of events that will translate into a reduction of this pathology, surgeries and complications.

Adenoids↗
PubMed2005

Exchange transfusion and its morbidity in ten-year period at King Chulalongkorn Hospital.

The objectives of this study were to consider the rate of exchange transfusion (ET) in the newborns at King Chulalongkorn Hospital, Bangkok, from 1994 to 2003, and to evaluate its morbidity and mortality. One hundred and sixty five neonates underwent 183 episodes of ET: In-housed fullterm had ET performed at a younger age than the readmitted/referred infants (72.2 +/- 30.9 vs 150.2 +/- 90.7 hours, p < 0.001), and the in-housed preterm neonates (85.4 +/- 36.7 hours, p < 0. 05). They also had lower mean TsB than those of the readmitted/referred infants when ET was initiated (21.8 +/- 2.1 vs.26. 0 +/- 5.1 mg/dL, p < 0.001). Preterm needed phototherapy after ET longer than fullterm neonates (5.3 +/- 3.2 vs 3.3 +/- 1.7 days, p < 0.001). ABO incompatibility (21.3%), G6PD deficiency (13.4%), both conditions (6.7%), and others (22.2%) were identified as causes of hyperbilirubinemia. Unknown causes accounted for 36.4%. There was no mortality in the present study. Overall rate of morbidity was 15.3% of which 67 percent was infection associated conditions. Preterm suffered additional complications of anemia, apnea and cardiac arrest. Sick infants (31.3%) were more likely to develop complications than healthy ones (6.8%). In the healthy group, preterm were more likely to develop morbidity than fullterm neonates (p = 0.0016), while no significant difference was identified between them in the sick group (p = 0.8). ET causes high morbidity, therefore, it should be initiated only when the benefit of preventing kernicterus outweighs the complications associated with the procedure.

Exchange Transfusion, Whole Blood↗
PubMed2005

Post-treatment plasma transforming growth factor beta 1 (TGF-beta1) level predicts for late morbidity in patients with advanced head and neck cancer.

Between 2001 and 2002, 29 patients with advanced inoperable squamous head and neck cancer treated with radiotherapy with or without simultaneous chemotherapy were evaluated for their plasma TGF-beta1 levels prior to the treatment, in the middle of the radiotherapy course and at the end of the treatment. Patients were assessed for treatment response and late morbidity. Predictive value of TGF-beta1 level on either of the assessed parameters was tested. From 29 eligible patients (pts), 18 achieved complete response, 8 partial response and three pts progressed primarily. After a median follow-up of 16 months we recorded 16 cases of grade >1 late morbidity. We found that post-treatment elevated plasma TGF-beta1 level predicts late morbidity grade >1 (p=0.05) rather than pre-treatment level (p=0.062). Neither pre-treatment nor post-treatment plasma TGF-beta1 level has a predictive value to the treatment response (CR vs. no CR, p=0.125 and 0.252, respectively). The post-treatment plasma TGF-beta 1 level can predict late morbidity grade >1 in advanced head and neck cancer treated with radio(chemo)therapy. This could make a basis for dose escalation in selected patients.

Adult↗
PubMed2005

Regional differences in cardiovascular risk factor profile cannot fully explain differences in cardiovascular morbidity in the Netherlands: a comparison of two urban areas.

BACKGROUND: Our objective was to investigate whether a region in the south of the Netherlands (Heerlen/Kerkrade) had a high burden of cardiovascular disease in comparison with a nearby region (Maastricht) and the average Dutch population, respectively. We also wanted to determine if there are interregional differences in cardiovascular risk factor profile. DESIGN: Cross-sectional study. METHODS: Data from a nationwide registry (CBS) were used to analyse cardiovascular mortality in the two regions and the average in the Netherlands. Data from a primary care morbidity registration network (RNH) were used to compare cardiovascular morbidity and cardiovascular risk factors in both regions. A standardisation procedure was carried out for age and sex. Data were analysed using logistic regression analyses. RESULTS: The overall cardiovascular mortality rate was higher in the Heerlen/Kerkrade region (7.8 per thousand) compared with Maastricht (6.1 per thousand, OR=1.3, 95% CI 1.2-1.5) and the average in the Netherlands (5.7 per thousand). Similarly, most cardiovascular morbidity rates for Heerlen/Kerkrade were more elevated compared with the RNH overall and with Maastricht. Prevalence rates of risk factors such as diabetes mellitus (7.2%, OR=1.5, 95% CI 1.3-1.7) and overweight (10.8%, OR= 2.0, 95% CI 1.8-2.2) were significantly higher in the Heerlen/Kerkrade region compared with Maastricht. There were no differences with regard to hypertension (15.2%, OR=1.0, 95% CI 0.9-1.1). CONCLUSION: Heerlen/Kerkrade is indeed a region with a high burden of cardiovascular disease. Differences in morbidity between Heerlen/Kerkrade and Maastricht cannot be fully explained by differences in cardiovascular risk factor profile.

Adult↗
PubMed2005

[Consistency analysis in the use of abdominal ultrasonography for diagnosing schistosomiasis japonica-related morbidity].

OBJECTIVE: To explore the consistency among different indices of abdominal ultrasonography for the diagnosis of schistosomiasis japonica related morbidity and the best combination of the indices. METHODS: Six indices of abdominal ultrasonography were selected to investigate schistosomiasis related morbidity in residents in a village of Hunan Province, and the Kappa coefficients of diagnostic consistency among different indices and Cronbach's alpha coefficients of different combinations of indices were computed. RESULTS: The Kappa coefficients of 'liver parenchyma > or = grade II' with 'right midclavicular subcostal' and with 'portal vein diameter' were 0.4131 and 0.4655 respectively, higher than normal level. The degree of their consistency was fair, and others showed poor or almost no consistency. Among the combinations made up of different indices, the Cronbach's alpha coefficient of the combination made up of 'liver parenchyma > or = grade II', 'right midclavicular subcostal' and 'portal vein diameter' was 0.6566 which was the highest, showing the strongest internal consistency. CONCLUSION: The six indices can not be replaced with each other in assessing schistosomiasis related morbidity. Before abdominal ultrasonography is used extensively to assess the morbidity, it is necessary to study the diagnostic consistency of these indices and the best combination of the indices.

Abdomen↗
PubMed2005

Co-morbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction.

OBJECTIVES: To determine the prevalence of psychiatric morbidity among Nigerian patients with temporomandibular joint pain and dysfunction (facial arthromyalgia). to delineate the specific types of comorbid psychiatric disorders and identify the socio-demographic characteristics of the patients with psychiatric disorders. DESIGN: A two-stage design was adopted to study the prevalence and types of co-morbid psychiatric disorders of identified 24 patients with temporomandibular joint pain and dysfunction over a period of 5 years. SETTING: Pain and Psychiatric clinics of the University of Benin Teaching Hospital, Benini City, Nigeria. METHODS: The patients were controlled for age gender, and marital status. The State-Trait Anxiety Inventory. 28-item General Health Questionnaires and the Hospital Anxiety and Depression Scales were used for first stage screening while the second stage interview utilised the Psychiatric Assessment Schedule. RESULTS: The prevalence of psychiatric morbidity was 37.5% and 12.5% in the study and control groups respectively. Generalised anxiety disorder and dysthmia were the main forms of psychiatric disorders identified. Temporomandibular joint pain and dysfunction patients with co-morbid psychiatric disorders were significantly older (P<0.0001), had the illness for shorter periods before presentation (p<0.001) and were non-professionals. CONCLUSION: The findings highlight the need for multi-disciplinary approach to the assessment and management of patients with temporomandibular joint pain and dysfunction.

Adult↗
PubMed1992

Psychiatric morbidity among Dunedin Chinese women.

A community postal survey of minor psychiatric morbidity among Chinese women living in Dunedin was conducted. The 28-item version of the General Health Questionnaire (GHQ-28) was used as the case identification instrument. The overall rate of psychiatric morbidity of Dunedin Chinese women did not differ from their European counterparts. The sociodemographic factors found to be associated with minor psychiatric morbidity included having no children, and being either very well or very poorly educated. Among (foreign born) migrants, those who were born in China, whose reason for migration was "follow the lead of their family" or "family reunion", had resided in New Zealand for ten years or more and spoke English infrequently tended to have higher psychiatric morbidity.

Adolescent↗