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In this study, we aimed to examine the effectiveness of relaxation training in women with PMDD through a randomized controlled design. Sixty-three women were recruited and randomized to relaxation training or control groups. The outcome measurements, administered at baseline and post-training, included the Premenstrual Symptoms Screening Tool (PSST), Hospital Anxiety and Depression Scale (HADS), Nottingham Health Profile (NHP), and Sheehan Disability Scale (SDS). The intervention group received 12 sessions of relaxation training, including progressive muscle relaxation and guided imagination. While there were significant differences within the group in the relaxation training group, no significant differences were found in the control group. Relaxation training had a positive effect on reducing premenstrual symptoms, anxiety, depression and disability and improving quality of life in women with PMDD. More research is necessary to recommend relaxation training as a primary and long-term treatment and to understand how it should be included in a comprehensive treatment plan.
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Background/aim: The Canadian Occupational Performance Measure (COPM) is a person-centered assessment tool frequently used to identify occupational problems in older individuals and establish goals for geriatric rehabilitation. This study aims to assess the validity and reliability of the Turkish version of COPM (COPM-TR) in older people. Materials and methods: One hundred older people completed the COPM-TR, and 25 of them participated in a retest within two weeks. The convergent construct validity analyses of the COPM-TR included conducting correlation analyses between the COPM-TR and the Functional Independence Measure (FIM) and Lawton Brody Instrumental Activities of Daily Living (Lawton-IADL) scales. The Performance and Satisfaction subscales were subjected to an item analysis for the internal consistency of the COPM-TR. A test-retest analysis was conducted to investigate the reliability. Results: According to convergent construct validity analysis, it was found that there is a moderate correlation between COPM-TR performance and FIM (r = 0.51), and a strong correlation between Lawton IADL (r = 0.62). Similarly, there was a strong correlation between COPM-TR satisfaction and FIM (r = 0.61) and Lawton IADL (r = 0.61). Test-retest reliability was excellent for performance score and good for satisfaction score (ICC values 0.92; 0.78, respectively). COPM-TR showed excellent-high internal consistency (Cronbach's alpha 0.92 for performance and 0.88 for satisfaction). Conclusion: COPM-TR is a valid and reliable tool that can be used to assess occupational performance in older people.
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Atividades Cotidianas , Avaliação Geriátrica , Psicometria , Humanos , Masculino , Idoso , Feminino , Reprodutibilidade dos Testes , Avaliação Geriátrica/métodos , Turquia , Idoso de 80 Anos ou mais , Canadá , Avaliação da DeficiênciaRESUMO
Occupational balance is a crucial concept in occupational therapy, accepted as a key component of health and well-being. The Occupational Balance-Questionnaire (OB-Quest) is designed as a standardized instrument to assess occupational balance. This study investigated the validity and reliability of the OB-Quest Turkish, which consisted of translation, cross-cultural adaptation, and analysis psychometric properties phases. The factor structure of the OB-Quest indicated a good model fit. The criterion-related validity showed a positive correlation with Beck Depression Inventory and a negative correlation with the 12-item Short Form Survey. The OB-Quest-Turkish showed questionable internal consistency and an excellent correlation between test-retest.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.2010160 .
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Terapia Ocupacional , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Traduções , Comparação TransculturalRESUMO
In this study, the authors examined the effects of the "Workplace Health Promotion Program" (WHPP) on pain, fatigue, stress, professional quality of life (Pro-QoL), and coping skills for nurses. The authors conducted a randomized control trial in 30 nurses who agreed to participate in this study. Progressive relaxation training, posture and breath exercises, and ergonomic suggestions as a WHPP were applied to the intervention group (n = 15) during the five weeks. The intervention group showed decrease in pain (p = .001), fatigue (p = .001), and stress levels (p = .003) and increase in coping skills and Pro-QoL (p < .05). In contrast, the authors observed no improvement in the control group. The authors concluded at the end of the study that WHPP remains effective in nurses.
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Qualidade de Vida , Local de Trabalho , Fadiga , Seguimentos , Promoção da Saúde , Humanos , DorRESUMO
In this study, the authors aimed to investigate the effects of a client-centered lifestyle intervention for women with fibromyalgia syndrome on the levels of disease severity, occupational participation, anxiety, depression, and life satisfaction. The quasi-experimental controlled study was conducted at Occupational Therapy Department of Hacettepe University in Turkey between January 2018 and May 2018. Based on the literature review and basic assessments, a lifestyle intervention program was designed focusing both on the participants' occupational goals and the effects of fibromyalgia symptoms. The results were measured using the Revised Fibromyalgia Impact Questionnaire (FIQR), The Canadian Occupational Performance Measure (COPM), Hospital Anxiety and Depression Scale (HADS), and Satisfaction with Life Scale (SWLS). Significant differences were found in intervention group compared to control in terms of COPM-Performance (p = .001), COPM-Satisfaction (p = .001), HADS-Anxiety (p = .009), and HADS-Depression (p = .001). Although FIQR and SWLS levels improved positively in the intervention group (respectively; p = .001 and p =.012), there was no difference between the groups. According to these results, the client-centered and occupation-based lifestyle intervention applied to individuals with fibromyalgia could be effective on occupational participation and psychological symptoms.
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Fibromialgia , Ansiedade/diagnóstico , Ansiedade/terapia , Canadá , Feminino , Fibromialgia/psicologia , Fibromialgia/terapia , Humanos , Estilo de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Individuals with diabetes mellitus have difficulty solving problems in meaningful occupations and have similar difficulties with self-care regimens. We examined the effects of an occupation-based intervention supported with problem-solving therapy in individuals with type 2 diabetes mellitus on participation in and satisfaction with meaningful occupations, diabetes-related psychosocial self-efficacy, preferred coping strategies and individual well-being. METHODS: This study was planned as a single-blind, randomised controlled study with a 3-month follow-up involving 67 adults with type 2 diabetes. The Canadian Occupational Performance Measure, Diabetes Empowerment Scale, Brief COPE and five-item World Health Organisation Well-Being Index were used. This programme included evaluations, diabetes education, and problem-solving therapy. The intervention was conducted for 6 weeks, and each weekly session lasted approximately 60 min. Differences between groups were analysed using the Mann-Whitney U test, and the Friedman test was used to calculate group-time interaction differences (i.e., baseline, after 6 weeks and after 3 months). RESULTS: All participants identified the most significant occupational performance problems in self-care as personal care. Significant improvement was reported in the intervention group compared to the control group regarding participation in meaningful occupation, satisfaction with performance, psychosocial self-efficacy, and well-being results (p < 0.001) after the programme and 3 months of follow-up. Participant use of effective coping strategies, active coping and acceptance strategies, and self-efficacy, as revealed by the results, suggested improvement in favour of the intervention group (p < 0.05). CONCLUSIONS: Occupation-based problem-solving therapy encourages participation in meaningful occupations and improves psychosocial self-efficacy, effective coping styles, and well-being in patients with type 2 diabetes mellitus. Problem-solving therapies that incorporate individuals' priorities via meaningful occupation can be used to lead to a meaningful and quality life for individuals with type 2 diabetes mellitus. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03783598 . Retrospectively Registered. First Posted-December 21, 2018, Last Update Posted-February 18, 2020.
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Adaptação Psicológica , Diabetes Mellitus Tipo 2/psicologia , Terapia Ocupacional/métodos , Qualidade de Vida , Autocuidado/psicologia , Adulto , Canadá , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Método Simples-CegoRESUMO
The authors of this study compared the effects of pilates exercises and connective tissue massage (CTM) on pain intensity; pain-pressure threshold; and tolerance, anxiety, progress, and health-related quality of life in females with fibromyalgia. It was a pilot, assessor masked, randomized controlled trial conducted between January and August of 2013. Twenty-one women with fibromyalgia were randomly assigned to the pilates exercise program (six of whom did not complete the program), and 22 were randomly assigned to CTM (one of whom did not complete this program). Each group received the assigned intervention three times per week during a 4-week period. The Visual Analogue Scale, algometry, State-Trait Anxiety Inventory, Fibromyalgia Impact Questionnaire, and Nottingham Health Profile were used at baseline and at the end of treatments. Significant improvements were found in both groups for all parameters. However, the scores for pain-pressure threshold were significantly elevated and the symptoms of anxiety were significantly diminished in the exercise group compared to the massage group. Thus, exercise and massage might be used to provide improvements in women with fibromyalgia. The exercise group showed more advantages than the massage group and thus might be preferred for patients with fibromyalgia. However, an adequately powered trial is required to determine this with certainty.
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Técnicas de Exercício e de Movimento/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Massagem/métodos , Medição da Dor , Qualidade de Vida , Ansiedade/etiologia , Ansiedade/terapia , Feminino , Fibromialgia/psicologia , Humanos , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Projetos Piloto , Resultado do TratamentoRESUMO
INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the King's Health Questionnaire (KHQ) into Turkish and to test its reliability and validity among Turkish women with urinary incontinence (UI). METHODS: Three hundred and thirty-five women with symptoms of UI completed the Turkish versions of the KHQ, short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and the Incontinence Severity Index (ISI). Psychometric analysis of the KHQ included assessments of test-retest reliability, internal consistency, construct, and criterion validity. Factor analysis was used to explore the underlying structure of the KHQ. RESULTS: The internal consistency (Cronbach's alpha ≥0.68) and test-retest reliability of the KHQ were found to be high (p < 0.001). Interdomain correlation analysis showed good convergent validity among Role, Physical, and Social Limitations, with relatively higher correlations and divergent validity between Personal Relationships and other domains, with relatively lower correlations. Exploratory factor analysis identified three factors, namely, Daily Life and Emotions, Personal Relationship, and General Health Perception. The KHQ was also significantly correlated with IIQ-7, UDI-6, and ISI (p < 0.01). CONCLUSIONS: The results suggest that the Turkish KHQ is a valid and reliable condition-specific quality of life instrument for Turkish women with UI.
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Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Turquia , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Adulto JovemRESUMO
AIM: The aim of this study was to make the Turkish cultural adaptation of the the Stroke Activity Scale (SAS). METHOD: This study was designed as a methodological research. The psychometric properties of the SAS scale were evaluated by validity and reliability analyses. RESULTS: The average age of 84 stroke patients (mean ± SD) was 59.52 ± 14.03 years. Kaiser-Meyer-Olkin (0.816) and Bartlett's Test of Sphericity (χ2 = 288.968, df = 10, p < 0.001) showed that the data set can be factored. A one-factor structure was obtained with Principal Component Analysis (PCA). The factor loads of the items obtained with PCA and Confirmatory Factor Analysis (CFA) were found to be statistically significant. The obtained chi-square statistics (χ2 = 2.227, p = 0.694), normalized chi-square/freedom (χ2/sd) value (0 ≤ 0.557 ≤ 2) and other goodness of fit indices showed good compliance. The positive highly significant correlation (r = 0.846, p < 0.001) between the SAS and Rivermead Mobility Index (RMI) scales confirmed the Concurrent validity. Cronbach's alpha (0.864) value showed high reliability and Intraclass Correlation Coefficient (ICC) value (0.983, p < 0.001) showed excellent agreement. CONCLUSIONS: In this study, which was conducted for the Turkish adaptation of the SAS scale, the 5-item and 1-factor structure was evaluated as a valid and reliable scale for evaluating the balance abilities of stroke patients living in Turkey.
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BACKGROUND: Line dancing is a popular form of exercise shown to affect balance and mood positively. However, few studies examine its effectiveness in multiple sclerosis (MS). The study aims to investigate the effects of line dancing on balance, mood, and health-related quality of life in MS. METHODS: Participants were randomized into the line dance (n =15) and the control groups (n =16). Outcomes were measured using the Berg Balance Scale, Hospital Anxiety and Depression Scale, and Multiple Sclerosis Quality of Life-54 (MSQoL-54) at baseline and post intervention. RESULTS: Post-intervention in the line dancing group, significant improvements were observed in balance, anxiety status, and health-related quality of life. When the groups were compared, significant differences were found in balance, anxiety, and the mental health composite of the MSQoL-54. CONCLUSION: This study recommends the use of line dancing as a therapeutic intervention in MS. Nevertheless, comparisons with different intervention approaches and follow-up studies are needed.
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PURPOSE: The study aimed to examine the effects of "Cognitive Orientation to daily Occupational Performance" (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents' satisfaction level. METHODS: Thirty-two children with CP were randomized to experimental (nâ=â16) or control (nâ=â16) groups, with nâ=â2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT. RESULTS: No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (pâ<â0.05). CONCLUSION: CO-OP is expected to be beneficial if incorporated into CP rehabilitation.
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Paralisia Cerebral , Terapia Ocupacional , Humanos , Criança , Pais , Modalidades de Fisioterapia , OrientaçãoRESUMO
AIM: Fibromyalgia syndrome (FMS) has a significant impact on daily life, but the fact that most diagnosed individuals are women makes it difficult to understand the occupational needs and lifestyle choices of male patients. The purpose of this study was to examine the effectiveness of a client-centered lifestyle intervention program in men with fibromyalgia and compare it with women. METHODS: The client-centered lifestyle intervention program was applied to 15 men with fibromyalgia in two sessions per week for 4 weeks in individual sessions and compared with data from 15 women who had previously participated in the same program. The Revised Fibromyalgia Questionnaire, the Canadian Occupational Performance Measure, the Hospital Anxiety and Depression Scale, and the Satisfaction with Life Scale were used as outcome measures. RESULTS: When comparing results between baseline and 4 weeks later, statistically significant differences were found in the male group in the areas of fibromyalgia severity (p = .001), occupational performance (p = .001), occupational satisfaction (p = .001), anxiety (p = .002), depression (p = .005), and life satisfaction (p = .002). It was found that occupational performance and occupational satisfaction increased significantly more in women than in men (p = .004 and p = .001, respectively). CONCLUSION: The client-centered lifestyle intervention was shown to be effective in fibromyalgia severity, occupational performance, occupational satisfaction, anxiety, depression, and life satisfaction of both men and women with FMS. Levels of progress in occupational participation could show gender-based differences. The study suggests that more attention should be paid to psychosocial factors when assessing men's occupational participation and planning appropriate interventions.
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OBJECTIVE: "Fear-avoidance behavior" means that the individual avoids a specific activity or movement due to the perception that it may cause injury. Fear of movement associated with pain can reduce individuals' adaptation to exercise programs. This situation may cause individuals to refrain from taking action and increase the existing limitation. Our aim is investigating of Fear-Avoidance Beliefs Questionnaire (FABQ) in patients with neck pain and creating a questionnaire option for clinicians and researchers to evaluate the fear-avoidance behavior in neck pain in Turkish. METHODS: The sample of the research was comprised 175 patients between the ages of 18-65, who have a complaint of neck pain that lasted for at least 3 months. The test was applied on patients with neck pain and no treatment, with an interval of 2-7 days. The Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP) were applied on the participants to evaluate the validity of the FABQ. RESULTS: Accordingly, between FABQ and NHP (r=0.227), pain (NHPP) (r=0.214), emotional reactions (r=0.220), and physical activity (NHPPA) (r=0.243), a weak relationship was observed. A weak correlation was observed between physical activity (FABQ-PA) which are subscales of the FABQ questionnaire and NDI (r=0.210), NHPP (r=0.205), and NHPPA (r=0.267). CONCLUSION: FABQ is a valid and reliable tool for patients with neck pain. In our study, a weak relationship was detected between FABQ, NDI, and NHP, as like VAS.
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The caregiving burden experienced by informal caregivers of individuals with schizophrenia (ICIWS) can affect their perceived occupational balance (OB). This study examines the differences in OB among ICIWS with different caregiving burden levels. This cross-sectional study was conducted with a sample of 149 ICIWS. The Occupational Balance Questionnaire 11-Turkish Version (OBQ11-T) was used to assess the participants' OB. The Zarit Caregiver Burden Scale was employed to evaluate caregiving burden levels. Statistically significant differences were found in the total score of OBQ11-T, Item 3 (time for doing things wanted), Item 5 (having sufficient time for doing obligatory occupations), and Item 9 (balance between obligatory/voluntary occupations) between the severe and little caregiving burden groups (p < .05). Caregiving for individuals with schizophrenia can lead to varying levels of caregiving burden, which negatively affects OB. Occupational therapists working with ICIWS should assess OB and address OB-related challenges to alleviate caregiver burden.
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Fossil mollusc shells are used for dating geological materials because they are well preserved throughout geological time. In this study, the radicals in the structure of fossil mollusc shells (Dreissena iconica, Valvata piscinalis, Bithynia tentaculate, Unio pictorum) collected from the Eastern Part of Old Konya Lake in Türkiye were investigated by EPR technique. For all fossil shells, microwave and temperature dependence of the signals were examined, and the signals suitable for dating are discussed. Characteristic features of intrinsic and impurity-related radicals were identified and the importance of paleontological evaluation of molluscs to get a reliable equivalent dose in EPR dating studies was emphasised.
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Fósseis , Lagos , Animais , Moluscos , Paleontologia , GeologiaRESUMO
INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the reliability and validity of the Turkish version of the Pelvic Floor Distress Inventory-20 (PFDI-20). METHODS: One hundred and twenty-eight women with pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, and anal incontinence were enrolled in the study. The Turkish version was developed using forward back translation. Construct validity was examined by correlation of clinical methods. Interclass correlation coefficients (ICC) compared the PFDI-20 and subscale scores. Cronbach's alpha assessed the internal consistency of the Turkish version. RESULTS: The PFDI-20 has three subscales. The test-retest reliability of the PFDI-20 and subscale was excellent (ICC 0.96 to 0.98, p < 0.001). Cronbach's alpha value (0.79) was moderate for the PFDI-20. Construct validity demonstrated that the PFDI-20 and each subscale displayed significant correlation with other clinical methods used (p < 0.05). CONCLUSIONS: The PFDI-20 is a valid and reliable condition-specific questionnaire for Turkish women with pelvic floor disorders.
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Idioma , Distúrbios do Assoalho Pélvico/diagnóstico , Índice de Gravidade de Doença , Inquéritos e Questionários , Traduções , Adulto , Incontinência Fecal/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/diagnóstico , Reprodutibilidade dos Testes , Turquia , Incontinência Urinária/diagnósticoRESUMO
OBJECTIVE: This study analyzed and compared the effects of manual lymph drainage therapy (MLDT) and connective tissue massage (CTM) in women with primary fibromyalgia (PFM). METHODS: The study design was a randomized controlled trial. Fifty women with PFM completed the study. The patients were divided randomly into 2 groups. Whereas 25 of them received MLDT, the other 25 underwent CTM. The treatment program was carried out 5 times a week for 3 weeks in each group. Pain was evaluated by a visual analogue scale and algometry. The Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile were used to describe health status and health-related quality of life (HRQoL). Wilcoxon signed rank test and Mann-Whitney U test were used to analyze the data. RESULTS: In both groups, significant improvements were found regarding pain intensity, pain pressure threshold, and HRQoL (P < .05). However, the scores of FIQ-7 (P = .006), FIQ-9 (P = .006), and FIQ-total (P = .010) were significantly lower in the MLDT group than they were in the CTM group at the end of treatment. CONCLUSIONS: For this particular group of patients, both MLDT and CTM appear to yield improvements in terms of pain, health status, and HRQoL. The results indicate that these manual therapy techniques might be used in the treatment of PFM. However, MLDT was found to be more effective than CTM according to some subitems of FIQ (morning tiredness and anxiety) and FIQ total score. Manual lymph drainage therapy might be preferred; however, further long-term follow-up studies are needed.
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Tecido Conjuntivo , Drenagem/métodos , Fibromialgia/terapia , Vasos Linfáticos , Massagem/métodos , Qualidade de Vida , Adulto , Feminino , Fibromialgia/diagnóstico , Humanos , Pessoa de Meia-Idade , Medição da Dor , Limiar da Dor/fisiologia , Satisfação do Paciente , Probabilidade , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of the study was to evaluate the short-term and 1-year follow-up results of connective tissue manipulation and combined ultrasound (US) therapy (US and high-voltage pulsed galvanic stimulation) in terms of pain, complaint of nonrestorative sleep, and impact on the functional activities in patients with fibromyalgia (FM). METHODS: This is an observational prospective cohort study of 20 female patients with FM. Intensity of pain, complaint of nonrestorative sleep, and impact of FM on functional activities were evaluated by visual analogue scales. All evaluations were performed before and after 20 sessions of treatment, which included connective tissue manipulation of the back daily, for a total of 20 sessions, and combined US therapy of the upper back region every other session. One-year follow-up evaluations were performed on 14 subjects. Friedman test was used to analyze time-dependent changes. RESULTS: Statistical analyses revealed that pain intensity, impact of FM on functional activities, and complaints of nonrestorative sleep improved after the treatment program (P < .05). CONCLUSION: Methods used in this study seemed to be helpful in improving pain intensity, complaints of nonrestorative sleep, and impact on functional activities in patients with FM.
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Fibromialgia/terapia , Manipulação Quiroprática , Manejo da Dor , Terapia por Ultrassom , Atividades Cotidianas , Adulto , Estudos de Coortes , Terapia Combinada , Tecido Conjuntivo , Feminino , Fibromialgia/complicações , Seguimentos , Humanos , Dor/etiologia , Satisfação do Paciente , Estudos Prospectivos , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapiaRESUMO
OBJECTIVE: This study aimed to estimate the influence of the duration of mobile phone use on heart rate variability (HRV) in healthy individuals. METHODS: One hundred forty-eight individuals without any established systemic disease and who had undergone 24-h ambulatory ECG monitoring were included in the case-control study. All the individuals had been using mobile phones for more than 10 years. Three-channel 24-h Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-min (m) mean NN intervals (SDANN), the proportion of NN50 divided by the total number of NNs (pNN50), the root mean square differences of successive NN intervals (RMSSD), high (HF)-, low (LF)-, very low (VLF)-frequency power, total power components, and the LF/HF ratio. Individuals were divided into four groups according to their duration of mobile phone use [no mobile phone use (Control group), <30 min/day (Group 1), 30-60 min/day (Group 2), and >60 min/day (Group 3)]. RESULTS: All the groups had similar features with regard to demographic and clinical characteristics. No significant arrhythmias were observed in any of the groups. The LF/HF ratio was higher, whereas the SDNN, SDANN, RMSSD, and pNN50 values were lower in the study groups than in the control group (p<0.05). No significant differences were identified among groups with respect to heart rate, VLF, and total power values (p>0.05). CONCLUSION: In this study, it was shown that the duration of mobile phone use may affect the autonomic balance in healthy subjects. The electromagnetic field created by mobile phone use may induce HRV changes in the long term.