Open Access. Powered by Scholars. Published by Universities.®

Social and Behavioral Sciences Commons

Open Access. Powered by Scholars. Published by Universities.®

Community Health and Preventive Medicine

2014

Institution
Keyword
Publication
Publication Type
File Type

Articles 1 - 30 of 76

Full-Text Articles in Social and Behavioral Sciences

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern Dec 2014

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …


Create Workshop 2014: Leveraging Mobile Technology And Social Media In Behavioral Research, Andre M. Müller Dec 2014

Create Workshop 2014: Leveraging Mobile Technology And Social Media In Behavioral Research, Andre M. Müller

Andre M Müller

The 2014 CREATE workshop brought together some forty young health behavior researchers from thirteen different countries, all sharing an interest in mobile technology and social media research. The three- day workshop was held in Innsbruck, Austria,...


Evaluating The Effectivesness Of Information Sources Regarding Hiv Among Gold Miners In Quảng Nam, Noah Landesberg Dec 2014

Evaluating The Effectivesness Of Information Sources Regarding Hiv Among Gold Miners In Quảng Nam, Noah Landesberg

Independent Study Project (ISP) Collection

Young migrant males in strenuous manual labor environments represent a high-­‐risk population for the transmission of HIV/AIDS. In Vietnam, gold miners are representative of this high-­‐risk population. Phước Sơn district, Quảng Nam province is home to much of Vietnam’s mining activity and has a comparatively high rate of HIV. Previous studies have been done on HIV/AIDS prevalence in Quảng Nam as well as related knowledge and practices. This analysis of a 2014 questionnaire examines the effects of varying information sources on HIV/AIDS knowledge. The sample of workers was mostly male and between 25 and 49 years old. Migrants made up …


Community Health Worker Interventions For Latinos With Type 2 Diabetes: A Systematic Review Of Randomized Controlled Trials, Tariana V. Little, Monica L. Wang, Eida M. Castro, Julio Jiménez, Milagros C. Rosal Dec 2014

Community Health Worker Interventions For Latinos With Type 2 Diabetes: A Systematic Review Of Randomized Controlled Trials, Tariana V. Little, Monica L. Wang, Eida M. Castro, Julio Jiménez, Milagros C. Rosal

Tariana V. Little

This systematic review aimed to synthesize glucose (HbA1c) outcomes of community health worker (CHW)-delivered interventions for Latinos with type 2 diabetes that were tested in randomized controlled trials and to summarize characteristics of the targeted populations and interventions, including the background, training, and supervision of the CHWs. Searches of PubMed and Google Scholar databases and references from selected articles identified 12 studies that met the inclusion criteria. Of these, seven reported statistically significant improvements in HbA1c. Study participants were largely low-income, female, and Spanish-speaking and had uncontrolled diabetes. The CHWs led the interventions alone, in pairs, or as part of …


Generational Inversions: 'Working' For Social Reproduction Amid Hiv In Swaziland, Casey Golomski Dec 2014

Generational Inversions: 'Working' For Social Reproduction Amid Hiv In Swaziland, Casey Golomski

Anthropology

How do people envision social reproduction when regular modes of generational succession and continuity are disrupted in the context of HIV/AIDS? How and where can scholars identify local ideas for restoring intergenerational practices of obligation and dependency that produce mutuality rather than conflict across age groups? Expanding from studies of HIV/AIDS and religion in Africa, this article pushes for an analytic engagement with ritual as a space and mode of action to both situate local concerns about and practices for restoring dynamics of social reproduction. It describes how the enduring HIV/AIDS epidemic in Swaziland contoured age patterns of mortality where …


A Wellness Profile Of Student-Veterans At 4-Year Higher Education Institutions: The Role Of Gender, Combat Tours, And Deployment, William Monroe Heath Dec 2014

A Wellness Profile Of Student-Veterans At 4-Year Higher Education Institutions: The Role Of Gender, Combat Tours, And Deployment, William Monroe Heath

Graduate Theses and Dissertations

Afghanistan and Iraq war student-veterans have increased in population on college campuses in the United States (U.S.) as a result of using the Post 9/11 GI Bill. Healthy Campus 2020 (American College Health Association, 2012) highlighted the importance of college student wellbeing, health promotion and disease prevention, while the U.S. Department of Veteran Affairs has called for an approach to services that is strength based (United States Department of Veteran Affairs, 2008). To date, however, wellness studies conducted on Iraq and Afghanistan student-veterans using an evidenced-based model of holistic wellness have not been conducted. This study was designed to address …


Formulating Effective And Accessible Population-Based Colorectal Cancer Screening Programs, Danielle Luffman Dec 2014

Formulating Effective And Accessible Population-Based Colorectal Cancer Screening Programs, Danielle Luffman

Independent Study Project (ISP) Collection

Colorectal cancer, a type of carcinoma originating in cells of the colon or rectum, continues to rank as the third most prevalent cancer worldwide with 1.36 million cases and the fourth most fatal with 693,881 deaths during 2012. In an attempt to alleviate the burden of colorectal cancer throughout society, governments and non-governmental organizations continue to implement population-based cancer screening programs. These programs, typically designed by a federal authority, offer free screening tests to a given population for a certain type of cancer on a routine basis. National systematic screening programs have effectively reduced the incidence of and mortality from …


Hiv Drug Resistance Among Infants And Children In South Africa: How Efficient Is Genotypic Testing?, Ellen Hendrix Dec 2014

Hiv Drug Resistance Among Infants And Children In South Africa: How Efficient Is Genotypic Testing?, Ellen Hendrix

Independent Study Project (ISP) Collection

Background: South Africa has the largest prevalence of HIV infection. This epidemic impacts adults as well as the pediatric population. The presence of drug-resistant mutations to antiretroviral therapies among infants and children is on the rise. Few studies have been conducted on this topic. Objective: The study aims to determine whether drug resistance testing in the form of genotypic testing is cost-effective when deciding whether to switch to a new HIV antiretroviral therapy following drug failure. Method: An interactive research approach is taken by collecting primary data from experts in this field. Secondary sources including guidelines from the World Health …


The End Of An Era: The Cancer Stem Cell Hypothesis And Its Therapeutic Implications, Emily Paton Dec 2014

The End Of An Era: The Cancer Stem Cell Hypothesis And Its Therapeutic Implications, Emily Paton

Independent Study Project (ISP) Collection

Cancer, a leading cause of death in many developed countries, has become a global health burden. Much of the drain on healthcare systems has resulted from the high cost and ineffectiveness of conventional cancer treatments, which often lead to cancer relapse or metastasis. The failures of chemotherapy, radiation, and surgery have been elucidated by the cancer stem cell (CSC) hypothesis, which postulates that a small percentage of tumor cells drive tumorigenesis. These cells can sustain cancer through their capacity to self-renew and differentiate into specialized tumor cell types, similar to how healthy stem cells maintain healthy tissues. Conventional cancer treatments …


Collaborative Models Of Care In The Appalachian Region Of Tennessee: Examining Relationships Between Level Of Collaboration, Clinic Characteristics, And Barriers To Collaboration, Jeffrey Ellison Dec 2014

Collaborative Models Of Care In The Appalachian Region Of Tennessee: Examining Relationships Between Level Of Collaboration, Clinic Characteristics, And Barriers To Collaboration, Jeffrey Ellison

Electronic Theses and Dissertations

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic.

For the present study 136 surveys were completed by providers working in primary care …


Home And Workplace Built Environment Supports For Physical Activity, Deepti Adlakha, J. Aaron Hipp, Christine M. Marx, Yang Lin, Rachel Tabak, Elizabeth A. Dodson, Ross C. Brownson Nov 2014

Home And Workplace Built Environment Supports For Physical Activity, Deepti Adlakha, J. Aaron Hipp, Christine M. Marx, Yang Lin, Rachel Tabak, Elizabeth A. Dodson, Ross C. Brownson

Brown School Faculty Publications

Background: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health efforts and interventions to increase population PA. Purpose: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel). Methods: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was …


Assessing Technologies For Information-Seeking On Prostate Cancer Screening By Low-Income Men, Susan W. Mcroy, Emily M. Cramer, Hayeon Song Nov 2014

Assessing Technologies For Information-Seeking On Prostate Cancer Screening By Low-Income Men, Susan W. Mcroy, Emily M. Cramer, Hayeon Song

Journal of Patient-Centered Research and Reviews

Purpose: This paper presents a multipart investigation of the benefits and challenges in deploying automated question-answering as an alternative to web-based searching to provide information about prostate cancer screening for low-income men age 40 years and older.

Methods: The study comprised: 1) a survey assessing current use of the Internet, mobile phones and texting; 2) a controlled observational study of both web-based searching and automated question-answering for information about prostate cancer; and 3) a formative field study in which subjects interacted with a health department nurse using text messages.

Results: Survey results suggest the target population has greater access to, …


The Politics Of Hpv Vaccination Advocacy: Effects Of Source Expertise On Effectiveness Of A Pro-Vaccine Message, Roger Gans Oct 2014

The Politics Of Hpv Vaccination Advocacy: Effects Of Source Expertise On Effectiveness Of A Pro-Vaccine Message, Roger Gans

Proceedings of the New York State Communication Association

The Politics of HPV Vaccination Advocacy:

Effects of Source Expertise on Effectiveness of a Pro-Vaccine Message

Persistent public resistance to an apparently safe, effective and life-saving public health practice such as HPV vaccination illustrates a significant issue in the communication of behavioral recommendations based on evidence-based scientific data and consensus views of scientific and medical experts. This study examines the influence of source expertise on pro-HPV-vaccine advocacy messaging effectiveness among audiences of differing political ideologies. The findings support prior research indicating greater resistance to HPV vaccination among political conservatives. Subjects who self-identified politically as Centrists and Conservatives were significantly less …


Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams Oct 2014

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …


A Community Conversation On Adolescent Pregnancy And Parenting Services: Networks Of Support, Gatekeepers To Care, And Non-Compulsory Fathering In A Black Urban Community, Tamara Leech, Elizabeth A. Adams, Marci Littlefield Oct 2014

A Community Conversation On Adolescent Pregnancy And Parenting Services: Networks Of Support, Gatekeepers To Care, And Non-Compulsory Fathering In A Black Urban Community, Tamara Leech, Elizabeth A. Adams, Marci Littlefield

Department of Public Health Scholarship and Creative Works

This study employed Community-Based Participatory Research (CBPR) methods to document needs and capacity around adolescent pregnancy and parenting in one predominately Black, low-income urban community. Using an iterative focus group method, we engaged 60 participants in a two-day community conversation. Quantitative data from an enrollment questionnaire and qualitative transcripts of the discussions are analyzed. Our results indicate that the community’s greatest capacity lies in a network of women. Men tend to participate in parenting more holistically once formal paternity is established. Neighborhood women typically introduce adolescents to prenatal care, so delays in revealing the pregnancy to them serve as a …


Conceptualization Of Autism In The Latino Community And Its Relationship With Early Diagnosis, Katharine E. Zuckerman, Brianna Sinche, Martiza Cobian, Marlene Cervantes, Angie Mejia, Thomas Becker, Christina Nicolaidis Oct 2014

Conceptualization Of Autism In The Latino Community And Its Relationship With Early Diagnosis, Katharine E. Zuckerman, Brianna Sinche, Martiza Cobian, Marlene Cervantes, Angie Mejia, Thomas Becker, Christina Nicolaidis

School of Social Work Faculty Publications and Presentations

Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis.

Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an …


Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar Oct 2014

Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Abstract

OBJECTIVES:

Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh.

MATERIAL AND METHODS:

Three hundred eighty-five barbers from …


Meaning Of The Family-Cap Policy For Poor Women: Contraceptive And Fertility Decision-Making, Diana Romero, Hannah Fortune-Greely, Jorge Verea, Debbie Salas-Lopez Sep 2014

Meaning Of The Family-Cap Policy For Poor Women: Contraceptive And Fertility Decision-Making, Diana Romero, Hannah Fortune-Greely, Jorge Verea, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

In 1996 the US Congress enacted welfare reform legislation. In addition to new lifetime time limits and work requirements for those receiving cash and other forms of social assistance, the states could impose policies pertaining to reproductive-related behaviors of poor women. One such policy is the so-called “family-cap,” which denies additional income support to poor women who have a baby while receiving cash assistance; 24 states have implemented such policies. The ostensible goal of the policy is to limit fertility among current cash assistance recipients. This pilot study sought to explore whether poor women in a family-cap state (NJ) base …


Striving For Cultural Competence In An Hiv Program: The Transformative Impact Of A Microsystem In A Larger Health Network, Judith N Sabino, Timothy Friel, Lynn Deitrick, Debbie Salas-Lopez Sep 2014

Striving For Cultural Competence In An Hiv Program: The Transformative Impact Of A Microsystem In A Larger Health Network, Judith N Sabino, Timothy Friel, Lynn Deitrick, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.


Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum Sep 2014

Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2012 nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA’s large investment in the health center program provides new resources to help meet growing needs.

This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health …


A Qualitative Examination About Providers’ Perceptions And Recommendations Regarding The Role Of Public Librarians In Addressing Communities’ Health Literacy., Van Ta Park, Lili Luo, Denise Rosidi Sep 2014

A Qualitative Examination About Providers’ Perceptions And Recommendations Regarding The Role Of Public Librarians In Addressing Communities’ Health Literacy., Van Ta Park, Lili Luo, Denise Rosidi

Faculty Publications

We assessed health care providers’ perspectives on libraries as a source of health information and elicited input on how to adequately prepare public librarians to provide health information services. Sample text-based reference transactions were shown to determine whether they think the health inquiries were adequately answered. Results showed that participants had favorable perspectives about public libraries, and thought that the public librarians’ role includes addressing the health literacy community needs. Participants provided recommendations for public librarians to improve health literacy. To enhance the ability of public librarians to meet the health literacy needs of their communities, diverse perspectives such as …


Cancer Prevention And Control: A Multidisciplinary Approach, Michael Preston Aug 2014

Cancer Prevention And Control: A Multidisciplinary Approach, Michael Preston

Michael Preston

The Delta Leadership Institute Executive Academy is a year-long training program in leadership development and advocacy. Over 52 leaders from across the 8 state Delta Regional Authority service area (Illinois, Missouri, Kentucky, Arkansas, Tennessee, Louisiana, Mississippi, and Alabama) who work in the public, private and nonprofit sectors attended this session. At each session, the leaders study best practices in community and economic development, and learn from experts who share resources that these leaders can apply in their communities. This session provided findings on the economic burden of health disparities and interventions being used to address health disparities related to cancer.


Conversations With The Community: An Ethnography Of Two Case Studies Highlighting Community-Research Partnerships In Springfield, Ma, Vanessa Martinez Aug 2014

Conversations With The Community: An Ethnography Of Two Case Studies Highlighting Community-Research Partnerships In Springfield, Ma, Vanessa Martinez

Doctoral Dissertations

This dissertation is both qualitative and collaborative. It emphasizes the participant observation and ethnographic documentation of two community-researcher partnerships on community-level health interventions in Springfield, MA. Drawing upon critical theories and reflexive methods, I explore and analyze the process of building and sustaining researcher-community partnerships in an era of limited funding. Two Springfield, MA-based projects – one on healthy cooking/eating, and the other on contingency management – serve as case studies to provide a concrete picture of the complex relationships of researcher-community collaborations. I use ethnographic storytelling to provide a multi-dimensional look at two different community-research partnerships on health disparities …


At Risk For Ptsd: The Public Health Implications Of Trauma, Madeline Peyton Aug 2014

At Risk For Ptsd: The Public Health Implications Of Trauma, Madeline Peyton

Master's Projects and Capstones

The fieldwork experience is the summation of six semesters of graduate level public health training. At commencement, students are to be proficient in basic data analysis and epidemiological principles, in how environmental risks impact health, and demonstrate strong program planning, evaluation and leadership skills. Throughout, students are encouraged to focus their academic work on an area of public health that interest them and on a problem that they hope to impact in their professional work. I continued in an area I began as an undergraduate student of medical anthropology and explored the systems that interact to influence mental health of …


Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker Aug 2014

Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker

Frontiers in Public Health Services and Systems Research

Anecdotal evidence suggests that historically African American communities on the fringes of cities and towns in North Carolina have been systematically denied access to municipal drinking water service. This paper presents the first statistical analysis of the role of race in determining water access in these fringe areas, known as extraterritorial jurisdictions. Using publicly available property tax data, we quantified the percentage of residences with municipal water service in each census block in Wake County (the second-largest by population in North Carolina). Using the resulting water service maps plus 2010 U.S. Census data, we employed a logistic regression to assess …


Philadelphia Healthier Generation Summit, Lauren Puzen Msw,Mph Aug 2014

Philadelphia Healthier Generation Summit, Lauren Puzen Msw,Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.


The Medical Reserve Corps: Volunteers Making A Difference, Mary Lou Manning Phd, Crnp, Cic, Faan, Neale Batra Ba Aug 2014

The Medical Reserve Corps: Volunteers Making A Difference, Mary Lou Manning Phd, Crnp, Cic, Faan, Neale Batra Ba

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.


Communication, Control, And Time: The Lived Experience Of Uncertainty In Adolescent Pregnancy, Elizabeth Dortch Dalton Aug 2014

Communication, Control, And Time: The Lived Experience Of Uncertainty In Adolescent Pregnancy, Elizabeth Dortch Dalton

Doctoral Dissertations

This study qualitatively examined the lived experience of uncertainty among pregnant adolescents. Utilizing a phenomenological approach, long interviews were conducted with 10 pregnant adolescent women between the ages of 15-18 years. Interviews were transcribed and analyzed using the process of phenomenological explication. Data, emergent themes, memos, and a detailed audit trail were maintained using the qualitative data analysis package Nvivo 10 for Mac (beta version). Findings can be summarized with eight themes that underlie the essence of uncertainty in adolescent pregnancy: suspicion and denial, disclosure and reactions, controlling the flow of information, relational renegotiation, the emerging reality of pregnancy, information …


Intimacy Uncertainty And Identity In Gay Male Couples Dealing With A Serodiscordant Hiv Status, Scott Allen Eldredge Aug 2014

Intimacy Uncertainty And Identity In Gay Male Couples Dealing With A Serodiscordant Hiv Status, Scott Allen Eldredge

Doctoral Dissertations

When individuals are diagnosed with a chronic illness, their lives instantly change. Daily routines are interrupted and attendance to the symptoms and side effects of illness and medication becomes a daily chore. However, the patient is not the only one that feels the disruptive effects of illness and the partner of the chronically ill patient must also contend with the daily effects of an illness that they themselves do not have. In the case of HIV, the infectious nature of the disease, along with the stigma associated with the disease, serve to be additional sources of stress in an already-stressful …


The Environmental And Health Costs Of Alternative Diets: A Comparative Study Of The U.S. Diet Relative To The French, Japanese, Mediterranean, And Nordic Diets, Sarah Rehkamp Aug 2014

The Environmental And Health Costs Of Alternative Diets: A Comparative Study Of The U.S. Diet Relative To The French, Japanese, Mediterranean, And Nordic Diets, Sarah Rehkamp

Department of Agricultural Economics: Dissertations, Theses, and Student Research

This thesis contributes to the literature on sustainable consumption by using scenario analysis to evaluate the environmental and health costs of the U.S. diet relative to the French, Japanese, Mediterranean, and Nordic diets, identified in the literature as healthier diets. As a first step in estimating environmental costs, the energy efficiencies of each diet are calculated by decomposing each of the diets into their respective components. Then, the dietary efficiencies are translated into CO2 emissions. As a first step in estimating health costs, a pooled cross-section time-series dataset is used to find the association between BMI and five countries, …