Risk and protective factors for resilience among adolescents and young adults with beta-thalassemia major.

BACKGROUND: Resilience is the ability to overcome adversity in response to a potentially traumatic event. It can relieve people's discomfort and build personal capacity when facing a stressful situation such as beta thalassemia major. Resilience is a complex and multidimensional concept and is influenced by protective and risk factors. Therefore, the aims of the present study were to (1) investigate the relationship between protective (social support and hope) and risk (uncertainty and defensive coping) factors with resilience and (2) examine the mediating role of courageous coping between these protective and risk factors in resilience. METHODS: This descriptive-analytical study was performed on 312 adolescents and young adults with beta-thalassemia major aged 12-24 years; they were selected using purposeful sampling from two different outpatient thalassemia clinics in the south of Iran. Data were collected in a face-to-face survey using Zimmet Multidimensional Scale of Perceived Social Support, Herth Hope, Stewart Uncertainty in Illness scale, Jalowiec Coping, and Connor-Davidson resilience Scale from April 2022 to November 2022. The collected data were analyzed using descriptive tests, Pearson correlation, and a structural equation model. RESULTS: According to the main findings of mediation analysis, courageous coping partially mediated the relationship between social support and resilience [(ß = 0.042; 95% BC CI (0.003, 0.131)] and fully mediated the relationship between hope and resilience [(ß = 0.166; 95% BC CI (0.031, 0.348)]. In other cases, uncertainty and defensive coping had a direct and indirect effect on resilience, respectively. CONCLUSION: Based on these results, health professionals and healthcare policymakers should consider this mediator in developing programs to improve resilience. Also, the use of courageous coping could modulate the effect of defensive coping on resilience. Therefore, teaching the use of courageous coping can play an important role in improving resilience.

The effect of Crocus sativus L. (saffron) herbal tea on happiness in postmenopausal women: a randomized controlled trial.

BACKGROUND: Evidence suggests that menopause can be associated with a variety of negative psychological changes such as depression and anxiety, and improving the mental health status of women during menopause is one of the important priorities and challenges of the health system. The aim of this study was to determine the effect of saffron (Crocus sativus L., Iridaceae) herbal tea on happiness in postmenopausal women. METHODS: In this randomized clinical trial which was conducted in 2021, 72 postmenopausal women were enrolled and divided into intervention and control groups. The randomization blocks method was used for random allocation, and the Oxford Happiness Questionnaire was utilized to measure the scores. The intervention included the use of 30 mg of dried stigmas of the saffron plant, which was boiled once (in the morning, in 300 ml of boiling water for 10-15 min) and consumed with white rock candy as one cup of saffron tea daily. To compare the trend of changes and after removing the effect of other variables, generalized estimating equation (GEE) was used. RESULTS: There was no significant difference between the intervention and control groups in any of the quantitative and qualitative characteristics (p > 0.05). The results of paired samples t-test showed that the happiness mean score in the intervention group increased significantly (p < 0.001) from 42.93 ± 8.54 to 61.58 ± 8.24, while in the control group, there was no significant difference between the happiness mean score at the beginning and end of the study (p = 0.861). Also, after applying the treatment program in the intervention group, there was a significant difference between the two groups in terms of the happiness mean scores (p < 0.001). CONCLUSION: Saffron herbal tea had a positive effect on reducing depression and increasing the happiness score; thus, it is recommended that it should be used as a complementary treatment in consultation with the treating physician. TRIAL REGISTRATION: The present study was registered with the code of IRCT20210403050818N1 (Registration date: 09/04/2021) in the Iranian Registry of Clinical Trials. It was also approved by the Ethics Committee of Larestan University of Medical Sciences (Approval ID: IR.LARUMS.REC.1399.017).

The effect of group reminiscence therapy on death anxiety and adaptation of the elderly to old age.

AIM: In the present study, we aimed to evaluate the effectiveness of group reminiscence on death anxiety and adaptation of the elderly to old age. METHODS: This is a clinical trial study. Using simple random sampling method, we divided 32 elderly people into the intervention (n = 16) and control (n = 16) groups. Reminiscence therapy was held in 12 sessions. The study instruments including demographic characteristics questionnaire, Mini Mental Status Examination, Templer Death Anxiety, and aging adjustment questionnaires were filled out by the samples in 3 steps before the intervention, after the last day of the intervention, and 30 days after the end of the interventional sessions. RESULTS: In the intervention group, the mean score of death anxiety and adjustment to old age before the intervention showed a statistically significant difference with the post-intervention stages (P < 0.05); however, in the control group, the mean scores of death anxiety and adjustment to old age in the 3 steps were not statistically significant (P > 0.05). Also, no statistically significant difference was found between the intervention and control groups before the intervention (P > 0.05), but there was a statistically significant relationship in the steps immediately after the last day of the intervention and 30 days after the end of the interventional sessions (P < 0.05). CONCLUSION: The findings of the present study indicate that reminiscence therapy is able to effectively reduce the anxiety of death in the elderly; also, reminiscence therapy can be used to improve the adaptation ability of the elderly to old age.

The severity of moral distress in nurses: a systematic review and meta-analysis.

BACKGROUND: Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to determine the frequency and severity of moral distress in nurses through a systematic review and meta-analysis. METHODS: In this review study, searching national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Embase, ScienceDirect, Scopus, CINHAL, PubMed, and Web of Science (WoS) between 2005 and February 2020 were extracted. The random-effects model was used for analysis, and the heterogeneity of studies with the I2 index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2). RESULTS: The frequency of moral distress in 9 articles with a sample size of 1576 persons was 1.7 ± 0.5 from (0-4), in 13 articles with a sample size of 1870 persons, 3.07 ± 0.1 from (0-5), in 6 articles with a sample size of 1316 persons, 3.2 ± 0.29 from (0-6), in 18 articles with a sample size of 1959 persons, 4.6 ± 0.518 from (1-7) and in 35 articles with a sample size of 3718 persons, 81.1 ± 4.6 from (216-30), and the severity of moral distress in 4 articles with a sample size of 1116 persons, 1.7 ± 0.37 from (0-4), in 5 articles with a sample size of 1282 persons, 2.6 ± 0.28 from (0-5), in 5 articles with a sample size of 944 persons, 3.9 ± 0.63 from (0-6) and in 8 articles with a sample size of 901 persons was 82.3 ± 5.4 (0-216). CONCLUSION: The results of this study showed that the frequency and severity of moral distress in nurses are high and are a serious problem in nurses. Therefore, policymakers in this field should consider its role in the health of nurses and patients.

Assessing the effects of exercise on post-partum fatigue symptoms: A systematic review and meta-analysis.

Background: The level of activity in women who have given birth is very low despite the great benefits of exercise on their physical and mental health. There are some contradictories between the results of several preliminary studies on the effects of exercise on post-partum fatigue reduction. Therefore, the aim of this study was to assess the effects of exercise on decreasing postpartum fatigue in general and, specifically, in Iran using meta-analysis. Methods: In this study, the articles printed in international and national centres of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (WoS), were used to find the studies electronically published up to 2021. The studies' heterogeneity was examined using the I2 index, and subsequently, a random-effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Results: Finally, nine articles met the inclusion criteria in this systematic and meta-analysis review. The included samples were 456 patients in the intervention group and 446 in the control group. The mean score of fatigue after the intervention was 8.1 ± 1.1 lower than before intervention in the experimental group, and this difference was statistically significant (p ≤ 0.001). Conclusion: The results of this study indicate that exercise reduces postpartum fatigue, which can be used for counseling and treatment by gynecologists. Reduce postpartum problems in women and increase the quality of life after childbirth.

Changing Patterns in Epidemiology of Brucellosis in the South of Iran (2015-2020): Based on Cochrane-Armitage Trend Test.

BACKGROUND: Brucellosis is known in Iran as an endemic disease; however, its incidence is not the same in all provinces and is higher in some areas. OBJECTIVE: The present study was designed to determine the epidemiological status and trend of brucellosis in the period from 2015 to 2020 in the south of Fars province, Southern Iran. METHODS: This is a cross-sectional analytical study. This study included all patients with brucellosis in the period from 2015 to 2020 whose information had been registered in the Infectious Diseases Center of Larestan city. To collect the data, we used a checklist that included information such as age, gender, number of cases by year and month, occupation, and nationality of the patients with brucellosis. The rate of brucellosis incidence during these years was analyzed using the Cochran-Armitage trend test. P-value less than 0.05 was considered significant. RESULTS: The average annual incidence of the disease was 8.94 per 100 000 population. It has decreased from 26.83 (per 100 000 people) in 2015 to 1.83 (per 100 000 people) in 2020. The results of Cochrane-Armitage process test showed that the reduction in the incidence of the disease from 2015 to 2020 was significant (PTrend = 0.001). The trend of the disease by month also showed that the majority of cases occurred between December and February, with the highest incidence of the disease in February (9.93 per 100 000 people) and the lowest in May (1.1 per 100 000 people) (P = 0.001). CONCLUSION: Although the results of the present study indicated a decrease in the incidence of the disease in the southern region of Fars province, due to the fact that the disease is common between humans and livestock, there is the possibility of scattered and irregular epidemics in each period.

Global prevalence of hepatitis C in prisoners: a comprehensive systematic review and meta-analysis.

Hepatitis C virus (HCV), one of the most significant causes of liver inflammation, has a high annual mortality rate. The unfavorable hygiene conditions and inadequate health monitoring in many prisons increase the risk of blood-borne infections such as hepatitis C. The growing incidence of this disease among prisoners results in overspill transmission to the general population from undiagnosed prisoners that have been released. Therefore, the aim of this study was to investigate the prevalence of hepatitis C among the world's prison population. A systematic review and meta-analysis of studies on the prevalence of hepatitis C was carried out using the keywords "Prevalence", "Hepatitis C", and "Prisoner" in the Iranian and international databases SID, MagIran, Iran Doc, Science Direct, Scopus, PubMed, and Web of Science (WoS) from January 1990 to September 2020. After transferring the articles to the information management software EndNote and eliminating duplicate studies, the remaining studies were reviewed based on inclusion and exclusion criteria, three stages of primary and secondary evaluation, and qualitative evaluation. Comprehensive meta-analysis software and Begg and Mazumdar and I2 tests were used for data analysis and assessment of dissemination bias, and heterogeneity, respectively. Out of 93 studies (22 from Asia, 26 from Europe, seven from Africa, 29 from America, and nine from Australia) with a total sample size of 145,823 subjects, the prevalence of hepatitis C in prisoners worldwide was estimated to be 17.7% (95% confidence interval, 15-20.7%). The highest prevalence of hepatitis C on the continents included in this study was reported in prisoners incarcerated in Australia and Oceania, with 28.4% (95% CI: 21.6-36.4) in nine studies, and Europe, with 25.1% (95% CI: 19.4-31.8) in 26 studies. All studies used an ELISA test for the detection of HCV antibodies. The results showed a prevalence of HCV of 17.7% in prisoners worldwide, ranging between 10 and 30% over five continents (Asia, Europe, America, Africa, and Australia and Oceania). The highest prevalence was reported in Australia and Oceania (28.4%), indicating the need to pay more attention to this issue on the continent. It is necessary to reduce the incidence of the disease in prisons by appropriate policy-making and the development of accurate and practical programs, including the distribution of free syringes and examination, testing, and screening of prisoners.

Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching.

BACKGROUND: Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM). METHODS: Data for these analyses were derived from a cross-sectional study conducted between June and July 2016. We assessed three outcomes of interest-all treated as binary variables, including distributive and receptive needle and syringe (NS) sharing and condomless sex during the month before interview. Our primary exposure of interest was whether study participants reported any MA use in the month prior to the interview. Firstly, we report the descriptive statistics for the pooled samples and matched sub-samples using CEM. The pooled and matched estimates of the associations and their 95% CI were estimated using a logistic regression model. RESULTS: Overall, 500 MWID aged between 18 and 63 years (mean = 28.44, SD = 7.22) were recruited. Imbalances in the measured demographic characteristics and risk behaviors between MA users and non-users were attenuated using matching. In the matched samples, the regression models showed participants who reported MA use were 1.82 times more likely to report condomless sex (OR = 1.82 95% CI 1.51, 4.10; P = 0.031), and 1.35 times more likely to report distributive NS sharing in the past 30 days, as compared to MA non-users (OR = 1.35 95% CI 1.15-1.81). Finally, there was a statistically significant relationship between MA use and receptive NS sharing in the past month. People who use MA in the last month had higher odds of receptive NS sharing when compared to MA non-users (OR = 4.2 95% CI 2.7, 7.5; P = 0.013). CONCLUSIONS: Our results show a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased NS sharing, which is associated with higher risk for HIV exposure and transmission.

Changing Patterns in Epidemiology of Malaria Between 2006 and 2018 in the South of Fars Province, Southern Iran: The Fall and Rise of Malaria.

Background: Malaria is one of the major human health problems that have become increasingly important in recent decades. Objective: The present study aimed to identify the epidemiological status of malaria in the years 2006-2018 in the southern region of Fars province in southern Iran. Methods: This is a cross-sectional descriptive-analytical study. The study population consisted of all persons with malaria referred to the Center for Disease Control in the four cities of Larestan, Gerash, Evaz and Khonj in the south of Fars province, Southern Iran, between 2006 and 2018. Frequency (%) was used to report descriptive statistics and mean and standard deviation for quantitative variables. The trend of malaria incidence during these years was analyzed using the Cochran Armitage Test. The significance level was considered 5%. Findings: A total of 190 cases of malaria in the period of 2006 to 2018 occurred in the southern region of Fars province; 77.9% were men, more than 95% were Afghans, and most of them were workers. The incidence of malaria in one hundred thousand people per month showed that most of the new malaria cases were in the months of July to October. The peak incidence was in August, with 19.88 cases per 100,000 people. Cochran-Armitage test results showed that this trend was not statistically significant (P = 0.399), despite an almost upward trend in malaria incidence in the south of Fars province. Conclusion: The results of this study showed that the trend of malaria in the south of Fars province was ascending; therefore, increasing surveillance activities to prevent and control malaria in such area is of utmost importance.

The effect of lavender herbal tea on the anxiety and depression of the elderly: A randomized clinical trial.

BACKGROUND: The prevalence of depression and anxiety is increasing among the elderly around the world. It is believed that lavender can stabilize the people's mood, so this study was designed to evaluate the effect of lavender on anxiety and depression of the elderly. METHODS: This study was a single blind clinical trial with a control group. The participants in the study consisted of 60 elderly subjects (30 in each group) who referred to the Health Center of Larestan city in the south of Iran in 2019. The intervention consisted of using 2 g of lavender teabag, which was prescribed to be used 2 times as decoction in the morning and night. The duration of the intervention was 2 weeks. The eligible participants were randomly assigned to the intervention and control groups using balanced block randomization with a block size of ten. The control group did not receive any placebo. Data collection tools in this study included demographic information questionnaire, Beck Depression and Spiel Berger Anxiety Inventory. Chi-square test and independent t-test were used to analyze the data. The significance level was considered 5 %. RESULTS: The two groups were similar in terms of age, gender, educational level and marital status and there was no significant difference. The mean score of depression in the intervention group before and after drinking lavender herbal tea was 17.80 ±â€¯1.49 and 16.33 ±â€¯1.49, respectively. The mean score of depression between intervention and control groups after drinking herbal tea were 16.33 ±â€¯1.49 and 18.33 ±â€¯1.84, respectively. This indicated the effect of herbal tea on reducing depression (P < 0.001). Also, mean difference of intervention and control groups after drinking herbal tea in terms of depression and anxiety (state and trait) were (-2.00, 95 % CI (-2.86, -1.13)), (-6.40, 95 % CI (-9.43, -3.36)) and (-4.13, 95 % CI (-7.66, -0.60)), respectively. CONCLUSION: The results of the present study showed that consumption of lavender herbal tea can reduce depression and anxiety scores and since it is inexpensive and accessible, it is suggested to be used as a complementary treatment in reducing anxiety and depression.

A Comparative Study of Perceived Social Support and Depression among Elderly Members of Senior Day Centers, Elderly Residents in Nursing Homes, and Elderly Living at Home.

BACKGROUND: Social support perceived by the elderly can reduce mental health problems including depression. In Iranian society, some elderly people spend their elderly years in senior day care centers established to promote social protection for the elderly. Therefore, the purpose of this study was to assess perceived social support and depression in the elderly members of senior day care centers and compare the results with that of elderly individuals living at nursing homes and at home. MATERIALS AND METHODS: This descriptive, cross-sectional study was conducted on 315 elderly people. The participants were selected using stratified random sampling method and a random number table. The data collection tools used consisted of a demographic characteristics questionnaire, the Barthel index for assessing Activities of Daily Living (ADL), Social Support Appraisals (SSS-As) scale, and Geriatric Depression Scale short form (GDS-15). ANOVA, Chi-square, the Pearson correlation coefficient, and linear regression analysis were used to examine the hypotheses. RESULTS: The results showed that with increasing social support, depression decreased in all three groups, which was statistically significant in the two elderly groups living in nursing homes (r = -0.19, p = 0.044) and elderly members of senior day centers (r = -0.18, p = 0.049). CONCLUSIONS: According to the results, it can be concluded that senior day care centers have been able to promote perceived social support in the elderly through their participation in daily activities and social activities, and thus were able to reduce depression significantly compared to the other two groups.

The Effect of Educational Program Based on PRECEDE Model in Promoting Prostate Cancer Screening in a Sample of Iranian Men.

Prostate cancer is one of the most prevalent diseases among men. This study aimed to assess the effect of educational program based on Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) model in promoting prostate cancer screening in a sample of Iranian men. This is a quasi-experimental study carried out on 300 men aged 40 to 70 (the subjects 150 experimental and 150 control groups) in Shiraz City, Fars Province, Iran, in 2016. The participants of the intervention group attended training based on the PRECEDE model. The study compared mean scores of knowledge, attitude, enabling factors, perceived social support, quality of life, general health, self-efficacy, and screening behaviors of the subjects before and 6 months after intervention in experimental and control groups. The mean age of experimental group was 56.45 ± 8.65, and the mean age of the control group was 55.64 ± 8.71 years (P = 0.521). The study showed that there was a significant increase in the mean score of knowledge, attitudes, perceived self-efficacy, enabling factors, perceived social support, quality of life, public health and screening behaviors of the experimental group; however, no significant change was observed in the mean score of knowledge, attitudes, self-efficacy, quality of life, general health, perceived social support, enabling factors, and screening behaviors of the control group. Our findings showed that the health education programs designed based on PRECEDE could positively affect prostate cancer screening behaviors of individuals by improving their knowledge level and attitude, enabling factors, perceived social support, quality of life, general health, and self-efficacy.

Prevalence and risk factors for injection site skin infections among people who inject drugs (PWID) in Tehran.

BACKGROUND/OBJECTIVES: Injection drug use is one of the major public health problems in Iran. Injection drug use is associated with numerous negative health outcomes, such as blood-borne infections (HIV, HCV) and injection site skin infections (abscesses, cellulitis). The aim of this study was to determine prevalence of injection site skin infections and its associated risk factors among people who inject drugs (PWID) in Tehran, Iran. METHODS: The cross-sectional study was conducted from March to August 2016 in Tehran province. A total of 500 PWID were recruited by convenience and snowball sampling from Drop-in Centers (DIC) in the South of Tehran. Our primary outcomes were self-report of ever having injection sites skin infections and receiving treatment for them. We first examined associations between individual variables and lifetime history of having injection site infections in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Variables with P-value <.2 were included in a multiple logistic regression model. RESULTS: Overall, 40% (CI95%: 30.3%, 52.2%) of participants reported ever having an injection site infection. In the multivariable model, those with low socioeconomic status (AOR = 2.4, P = .03), self-reported as HIV positive (AOR =1.6, P = .01), reporting more than 3 injections per day (AOR = 4.1, P = .03) and reuse of their own syringes (AOR = 8.5, P = .03) were more likely to have injection sites skin infections. PWID who used needle and syringe program (NSP) services were less likely to report injection site infections (AOR = 0.5, P = .04). CONCLUSION: We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services.

The Effectiveness of Group Spiritual Intervention on Self-esteem and Happiness Among Men Undergoing Methadone Maintenance Treatment.

BACKGROUND: Drug dependence or substance use disorder not only affects a person's life but also brings a lot of challenges for families and communities and imposes heavy burdens on them. There are various therapies in the domain of addiction whose main purposes are to reduce or to cut down substance abuse. OBJECTIVE: This study aimed to determine the effectiveness of group spiritual intervention on selfesteem and happiness among male clients undergoing methadone maintenance treatment. METHODS: This study was an intervention study in which 60 clients affected with substance abuse and undergoing methadone maintenance treatment were recruited. The study samples were selected through convenience sampling method and then divided randomly into two groups of 30 individuals: intervention and control. The intervention group attended group spiritual interventions for 10 sessions. Self-esteem and happiness among the study participants were also measured through Coopersmith Self-Esteem Inventory and Oxford Happiness Questionnaire before and after the intervention. RESULTS: The results showed a significant difference between both intervention and control groups in terms of self-esteem and happiness (P < 0.05); so that the participants in the intervention group demonstrated a significant improvement in their self-esteem and happiness. CONCLUSION: It was concluded that group spiritual intervention as a useful method could be effective in enhancing self-esteem and happiness among addicted individuals undergoing methadone maintenance treatment. The given treatment could be also used as a complementary therapy beside methadone maintenance treatment to reduce the likelihood of people returning to substance abuse.

Comparing Injecting Risk Behaviors of Long-Term Injectors with New Injectors in Tehran, Iran.

BACKGROUND: Global estimates suggest there are 15.6 million people who inject drugs (PWID) of whom 17.8% are living with HIV.Few studies have characterized newly-onset injectors with long-term injectors and its association with injecting risk behaviors. OBJECTIVES: We examined the relationship between length of injection and risk behaviors among people who inject drugs (PWID) in Tehran, Iran. METHODS: A cross-sectional study was conducted among PWID, from March to August 2016 in Tehran, Iran. PWID were recruited by convenience and snowball sampling from five Drop-in Centers (DIC) located in the south of Tehran. Our primary independent variable was length of injecting career, defined as the number of months since injecting initiation. Those defined as new injectors (were injecting for less than 18 months), and long-term injectors (as injecting drugs for more than 18 months). We reported the adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI95%) as the effect measure. The level of significance used in multiple logistic regression model was 0.05. We used STATA v. 11 for all analyzes. RESULTS: The analytical sample comprised of 500 participants (100% male). Mean (±SD) age of PWID with a length of injection history was 31.2 ± 7.2 years. Overall, 270 (54%) (CI95%: 49.6%, 58.4%) of participants were long-term injectors. The average age of drug use initiation among long-term injectors group was lower as compared to new injectors group (31.2 vs. 29.4, p < 0.001). The odds of distributive syringe sharing among new injectors were two times higher than long-term injectors (AOR = 2.1, 95% CI 1.4-4.7). The odds of receptive syringe sharing were lower among new injectors group (AOR = 0.7, CI95% 0.2-0.87), compared to long-term injectors. New injectors had higher odds of reusing their own syringes (OR = 2.8, 95% CI: 1.4-5.7; p = 0.01). CONCLUSIONS: Improvements in harm reduction service provision can occur through taregted risk reduction education for new injectors focusing on reducing distributive syringe sharing among them.