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Hastanede Yatan Çocuklarda Görülen Psikososyal Semptomlar, Ebeveynlerin Sağlık Hizmet Sunumu Memnuniyet Durumları ve İlişkili Faktörler

Year 2022, Volume: 11 Issue: 1, 34 - 41, 28.02.2022
https://doi.org/10.53424/balikesirsbd.949338

Abstract

Amaç: Çalışmanın amacı, hastanede yatan çocuklarda görülen psikososyal semptomlar ile ebeveynlerin sağlık hizmet sunumu memnuniyet durumlarını ve bazı sosyo-demografik özellikler ile olan ilişkisini incelemektir.
Gereç ve Yöntem: Araştırma kesitsel tiptedir. Çalışmada amaçlı örneklem yöntemiyle çocuk servisinde en az 3 gün yatan 6-12 yaş çocuklar ve ebeveynleri örneklemi oluşturmuştur. Veriler; tanımlayıcı istatistikler, Student-t Testi, tek yönlü varyans analizi (ANOVA) ve Pearson korelasyon analizi ile değerlendirilmiştir.
Bulgular: Çocukların yaş ortalaması 8.13 ± 2.12’yıldır. Erkek çocukların iletişim güçlüğü, anne-babaları lise ve üzeri eğitime sahip olan çocukların anksiyete, anneleri ortaokul ve altı düzeyde olan ve hastalık süresi beş gün ve daha uzun süren çocukların ise öfke ve saldırganlık sorunlarını daha fazla yaşadıkları belirlenmiştir. İlk sırada doğan çocuklara sahip ebeveynlerde ailenin katılımının, erkek cinsiyette çocuğu olan, kırsal bölgede yaşayan ve çocuğu ilk sırada doğan ebeveynlerin ise genel memnuniyet puanının düşük olduğu saptanmıştır. Hastanede yatan çocukların psikososyal semptom puanları ile ebeveynlerin sağlık bakımı memnuniyet puanları arasında negatif yönde anlamlı olduğu belirlenmiştir (r=-0.286; p<0.05).
Sonuç: Hastanede yatan çocuklarda psikososyal semptomlar yaygın olarak görülmekte olup, çocuğun cinsiyeti, anne ve babanın eğitimi, hastalık süresi önemli belirleyicilerdir. Ebeveynlerin sağlık bakım memnuniyetini ise çocuğun doğum sırası, hastalık tanısı, çocuğun cinsiyeti ve yaşanılan yerden etkilemektedir. Ebeveyn memnuniyeti çocukların psikososyal semptomlarını etkilemektedir.

References

  • Atay, G., Eras, Z., & Ertem, İ. (2011). Çocuk hastaların hastane yatışları sırasında gelişimlerinin desteklenmesi. Çocuk Dergisi, 2011;11,1-4. doi:10.5222/j.child.2011.001
  • Başbakkal, Z., Sönmez, S., Celasin, N.Ş., & Esenay, F. (2010). 3-6 yaş grubu çocuğun akut bir hastalık nedeniyle hastaneye yatışa karşı davranışsal tepkilerinin belirlenmesi. Uluslararası İnsan Bilimleri Dergisi, 7(1),456-468. http://www.acarindex.com/dosyalar/makale/acarindex-1423936647.pdf
  • Burns-Nader, S., Hernandez-Reif, M., & Porter, M. (2014). The relationship between mothers’ coping patterns and children’s anxiety about their hospitalization as reflected in drawings. J Child Health Care, 18(1),6-18. doi: 10.1177/1367493512468361.
  • Burns-Nader, S., &Hernandez-Reif, M. (2016). Facilitating play for hospitalized children through child life services. Children’s Health Care, 45,1-21. doi: 10.1080/02739615.2014.94 8161.
  • Commodari, E. (2010). Children staying in hospital; a research on psychological stress of caregivers. Italian Journal of Pediatrics, 36,40. https://doi.org/10.1186/1824-7288-36-40
  • Coyne, I. (2006). Children’s Experiences of Hospitalization. Journal of Child Health Care, 10(4),326–336. doi: 10.1177/1367493506067884.
  • Curley, M.A.Q., Hunsberger, M., & Sion, K.H. (2013). Psychometric evaluation of the Family-Centered Care Scale (FCCS) for pediatric acute care nursing. Nursing Research, 62(3), 160-68. doi: 10.1097/NNR.0b013e318286d64b
  • Çavuşoğlu, H. (2019). Çocuk Sağlığı Hemşireliği. 13. Baskı, Cilt 1. Sistem Ofset Basımevi. Ankara, 113-132.
  • Dalgas-Pelish, P. (2006). Effect of a self-esteem intervention, Program on school-age children. Pediatric Nursing, July-August 32, 341-8. PMID: 16927727
  • Delvecchio, E., Salcuni, S., Lis, A., Germani, A., & Di Riso, D. (2019). Hospitalized children: anxiety, coping strategies, and pretend play. Front. Public Health, 7,250. doi: 10.3389/fpubh.2019.0025.
  • Doupnik, S.K., Henry, M.K., Bae, H., Litman, J., Turner, S., Scharko, A.M., Feudtner, C. (2017). Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study. Acad Pediatr., 17,184–90. doi: 10.1016/j.acap.2016.08.009.
  • Doupnik, S.K., Hill, D., Palakshappa, D., Worsley, D., Bae, H., Shaik, A., … & Feudtner, C. (2017). Parent coping support interventions during acute pediatric hospitalizations: A Meta-Analysis. Pediatrics, 140(3):e20164171. doi: 10.1542/peds.2016-4171.
  • Kabukçu Başay, B., Başay, Ö., Ürüt, A., Hasmercan, B., Uysal, M., & Eren Usul, B. (2020). Hospitalized children: A study on the factors affecting psychosocial adjustment. J Clin Psy., 23,402-413. doi: 10.5505/kpd.2020.80958.
  • Kim SJ, Kim HY, Park YA, Kim SH, Yoo SY, Lee JE, & Moon, S.Y. (2017). Factors influencing fatigue among mothers with hospitalized children: A structural equation model. J Spec Pediatr Nurs., 22(1). doi: 10.1111/jspn.12171.
  • Kibret, G.T., & Radie, Y.T. (2019). Parental satisfaction and involvement concerning care of their hospitalized child. Global Scientific Journals, 7(3) Online: ISSN 2320-9186
  • Koukourikos, K., Tzeha, L., Pantelidou, P., & Tsaloglidou, A. (2015). The importance of play during hospitalization of children. Mater Sociomed, 27,438–41. doi: 10.5455/msm.2015.27.438-441 2.
  • Legg, M.J. (2011). What is psychosocial care and how can nurses better provide it to adult oncology patients. Australian Journal of Advanced Nursing, 28,61-7. https://www.ajan.com.au/archive/Vol28/28-3_Legg.pdf
  • Li, W.H.C., Chung, J.O.K., Ho, K.Y., & Kwok, B.M.C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatr, 11,16–36.doi: 10.1186/s12887-016-0570-5.
  • Matziou, V., Boutopoulou, B., Chrysostomou, A., Vlachioti, E., Mantziou, T., & Petsios, K. (2011). Parents’satisfaction concerning their child’s hospital care. Japan Journal of Nursing Scienc., 8(2),163-73. doi: 10.1111/j.1742-7924.2010.00171.x.
  • Melo, E.M.O.P., Ferreira, P.L., Lima, R.A.G., & Mello, D.F. (2014). The involvement of parents in the health care provided to hospitalized children. Rev. Latino-Am. Enfermagem, 22(3),432-9. doi: 10.1590/0104-1169.3308.2434.
  • Moumtzoglou, A. (2000). Development and application of a questionnaire for assessing parent satisfaction with care. International Journal for Quality in Health Care, 12(4),331–337. https://doi.org/10.1093/intqhc/12.4.331
  • Pantell, M.S., De Marchis, E., Bueno, A., & Gottlieb, L.M. (2019). Practice capacity to address patients’ social needs and physician satisfaction and perceived quality of care. Ann Fam Med., 17(1),42–45. doi: 10.1370/afm.2334
  • Potasz, C., De Varela, M.J.V., De Carvalho, L.C., Do Prado, L.F., & Do Prado, G.F. (2013). Effect of play activities on hospitalized children’s stress: a randomized clinical trial. Scandinavian Journal of Occupational Therapy, 20(1),1-79. doi: 10.3109/11038128.2012.729087.
  • Power, N., & Franck, L. (2008). Parent participation in the care of hospitalized children: a systematic rewiev. Journal of Advanced Nursing, 62(6),622-64. doi: 10.1111/j.1365-2648.2008.04643.x.
  • Priest, H. (2010). Effective psychological care for physically ill patients in hospital. Nursing Standard, 24(44),48-56. doi: 10.7748/ns2010.07.24.44.48.c7886.
  • Romaniuk, D., O’Mara, L., &Danesh, A.N. (2014). Are parents doing what they want to do? Congruency between parents’ actual and desired participation in the care of their hospitalized child. Issues in Comprehensive Pediatric Nursing, 37(2),103-121. doi: 10.3109/01460862.2014.880532.
  • Rushton, J., Bruckman, D., & Kelleher, K. (2010). Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med., 156:592-8. doi: 10.1001/archpedi.156.6.592.
  • Schonfeld, J.D., & Perrin, E.C. (2013). Adaptation to disease. In: Rudolph CD, Rudolph AM, Lister GE, First LR, Gerdhon AA (eds). Rudolp’s Pediatrics. McGraw-Hill.. p.368-374.
  • Small, L., Mazurek Melnyk, B., & Sidora-Arcoleo, K. (2009). The effects of gender on the coping outcomes of young children following an unanticipated critical care hospitalization. J Spec Pediatr Nurs, 14,112–22. doi: 10.1111/j.1744-6155.2009.00184.x.
  • Toledano-Toledano, F., & Luna, D. (2020). The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study. BioPsychoSocial Med., (14)29. https://doi.org/10.1186/s13030-020-00201-y
  • Ulus, B., & Kublay, G. (2012). PedsQL sağlık bakımı ebeveyn memnuniyet ölçeğinin Türkçe’ye uyarlanması. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 3(1),44-50. https://toad.halileksi.net/olcek/pedsql-saglik-bakimi-ebeveyn-memnuniyet-olcegi
  • Üstün, G., & Kelleci, M. (2013). Assessment scale for psychosocial symptoms in hospitalized children scale development, reliability and validity study. HealthMED, 7(7),2219-28. http://pdf.healthmed.ba/healthmed_7_7_web.pdf
  • Üstün, G., Erşan, E.E., Kelleci, M., & Turgut, H. (2014). Hastanede Yatan Çocuklarda Psikososyal Semptomların Bazı Değişkenler Açısından İncelenmesi. Cumhuriyet Tıp Dergisi, 36,25-33. https://doi.org/10.7197/cmj.v36i1.1008002456
  • Varni, J.W, Burwinkle, T.M, & Seid, M. (2005). The PedsQLTM as a Pediatric Patient- reported outcome: Reliability and validity of the PedsQLTM measurement model in 25.000 children. Expert Rev Pharmacoecon Outcomes Res. 5(6),705-19.doi: 10.1586/14737167.5.6.705.
  • Vaz, L.E., Wagner, D.V., Ramsey, K.L., Jenisch, C., Austin, J.P., Jungbauer RM, … & Zuckerman K.E. (2020). Identification of caregiver-reported social risk factors in hospitalized children. Hosp Pediatr., 10,20–8. doi: 10.1542/hpeds.2019-0206.
  • Weissenstein, A., Straeter, A., Villalon, G., Luchter, E., & Bittmann, S. (2011). Parent satisfaction with a paediatric practice in Germany: A questionnairebased study. Italian Journal of Pediatrics, 37(31). https://doi.org/10.1186/1824-7288-37-31
  • Wissow, L.S., Larson, S., Anderson, J., & Hadjiisky, E. (2005). Pediatric residents’ responses that discourage discussion of psychosocial problems in primary care. Pediatrics, 115(6),1569-78. doi: 10.1542/peds.2004-1535.
  • Zengerle-Levy, K. (2006). Nursing the child who is alone in the hospital. Pediatric Nursing, 32, 226-37. PMID: 1680268

Psychosocial Symptoms in Hospitalized Children, Health Service Delivery Satisfaction of Parents and Related Factors

Year 2022, Volume: 11 Issue: 1, 34 - 41, 28.02.2022
https://doi.org/10.53424/balikesirsbd.949338

Abstract

Aim: The aim of the study was to determine the psychosocial symptoms in hospitalized children and their parents’ satisfaction with health service delivery and to examine their relationship with some socio-demographic characteristics.
Material and Methods: The research is of cross-sectional type. The sample of the study consisted of children aged 6-12 and their parents, who were hospitalized for at least 3 days in the pediatric ward in a 6-month period using purposeful sampling method. Data; descriptive statistics were evaluated by Independent Samples T Test, One Way Analysis of Variance (ANOVA) and Pearson Correlation Analysis.
Results: The average age of the children is 8.13±2.12. It was determined that boys with communication difficulties, children with high school and above parents' education had anxiety, and children with a middle school and below education level and whose illness lasted 5 days or longer had more anger and aggression problems. It was determined that the participation of the family was low in the parents who had children born in the first row, and the general satisfaction level of the parents who had a male child and lived in the rural area and whose children were born first. The correlation between the score obtained from the Psychosocial Symptoms Diagnostic Scale of Hospitalized Children and the PedsQL Health Care Parental Satisfaction Scale score was found to be negatively significant (r=-0.286; p=0.00).
Conclusion: Psychosocial symptoms are commonly seen in hospitalized children, the child’s sex, mother’s and father’s education, disease duration are important determinants. Parents’ satisfaction with health care affects the birth order of the child, the diagnosis of the disease, the gender of the child, and the place of residence. Parental satisfaction affects the psychosocial symptoms of children.

References

  • Atay, G., Eras, Z., & Ertem, İ. (2011). Çocuk hastaların hastane yatışları sırasında gelişimlerinin desteklenmesi. Çocuk Dergisi, 2011;11,1-4. doi:10.5222/j.child.2011.001
  • Başbakkal, Z., Sönmez, S., Celasin, N.Ş., & Esenay, F. (2010). 3-6 yaş grubu çocuğun akut bir hastalık nedeniyle hastaneye yatışa karşı davranışsal tepkilerinin belirlenmesi. Uluslararası İnsan Bilimleri Dergisi, 7(1),456-468. http://www.acarindex.com/dosyalar/makale/acarindex-1423936647.pdf
  • Burns-Nader, S., Hernandez-Reif, M., & Porter, M. (2014). The relationship between mothers’ coping patterns and children’s anxiety about their hospitalization as reflected in drawings. J Child Health Care, 18(1),6-18. doi: 10.1177/1367493512468361.
  • Burns-Nader, S., &Hernandez-Reif, M. (2016). Facilitating play for hospitalized children through child life services. Children’s Health Care, 45,1-21. doi: 10.1080/02739615.2014.94 8161.
  • Commodari, E. (2010). Children staying in hospital; a research on psychological stress of caregivers. Italian Journal of Pediatrics, 36,40. https://doi.org/10.1186/1824-7288-36-40
  • Coyne, I. (2006). Children’s Experiences of Hospitalization. Journal of Child Health Care, 10(4),326–336. doi: 10.1177/1367493506067884.
  • Curley, M.A.Q., Hunsberger, M., & Sion, K.H. (2013). Psychometric evaluation of the Family-Centered Care Scale (FCCS) for pediatric acute care nursing. Nursing Research, 62(3), 160-68. doi: 10.1097/NNR.0b013e318286d64b
  • Çavuşoğlu, H. (2019). Çocuk Sağlığı Hemşireliği. 13. Baskı, Cilt 1. Sistem Ofset Basımevi. Ankara, 113-132.
  • Dalgas-Pelish, P. (2006). Effect of a self-esteem intervention, Program on school-age children. Pediatric Nursing, July-August 32, 341-8. PMID: 16927727
  • Delvecchio, E., Salcuni, S., Lis, A., Germani, A., & Di Riso, D. (2019). Hospitalized children: anxiety, coping strategies, and pretend play. Front. Public Health, 7,250. doi: 10.3389/fpubh.2019.0025.
  • Doupnik, S.K., Henry, M.K., Bae, H., Litman, J., Turner, S., Scharko, A.M., Feudtner, C. (2017). Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study. Acad Pediatr., 17,184–90. doi: 10.1016/j.acap.2016.08.009.
  • Doupnik, S.K., Hill, D., Palakshappa, D., Worsley, D., Bae, H., Shaik, A., … & Feudtner, C. (2017). Parent coping support interventions during acute pediatric hospitalizations: A Meta-Analysis. Pediatrics, 140(3):e20164171. doi: 10.1542/peds.2016-4171.
  • Kabukçu Başay, B., Başay, Ö., Ürüt, A., Hasmercan, B., Uysal, M., & Eren Usul, B. (2020). Hospitalized children: A study on the factors affecting psychosocial adjustment. J Clin Psy., 23,402-413. doi: 10.5505/kpd.2020.80958.
  • Kim SJ, Kim HY, Park YA, Kim SH, Yoo SY, Lee JE, & Moon, S.Y. (2017). Factors influencing fatigue among mothers with hospitalized children: A structural equation model. J Spec Pediatr Nurs., 22(1). doi: 10.1111/jspn.12171.
  • Kibret, G.T., & Radie, Y.T. (2019). Parental satisfaction and involvement concerning care of their hospitalized child. Global Scientific Journals, 7(3) Online: ISSN 2320-9186
  • Koukourikos, K., Tzeha, L., Pantelidou, P., & Tsaloglidou, A. (2015). The importance of play during hospitalization of children. Mater Sociomed, 27,438–41. doi: 10.5455/msm.2015.27.438-441 2.
  • Legg, M.J. (2011). What is psychosocial care and how can nurses better provide it to adult oncology patients. Australian Journal of Advanced Nursing, 28,61-7. https://www.ajan.com.au/archive/Vol28/28-3_Legg.pdf
  • Li, W.H.C., Chung, J.O.K., Ho, K.Y., & Kwok, B.M.C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatr, 11,16–36.doi: 10.1186/s12887-016-0570-5.
  • Matziou, V., Boutopoulou, B., Chrysostomou, A., Vlachioti, E., Mantziou, T., & Petsios, K. (2011). Parents’satisfaction concerning their child’s hospital care. Japan Journal of Nursing Scienc., 8(2),163-73. doi: 10.1111/j.1742-7924.2010.00171.x.
  • Melo, E.M.O.P., Ferreira, P.L., Lima, R.A.G., & Mello, D.F. (2014). The involvement of parents in the health care provided to hospitalized children. Rev. Latino-Am. Enfermagem, 22(3),432-9. doi: 10.1590/0104-1169.3308.2434.
  • Moumtzoglou, A. (2000). Development and application of a questionnaire for assessing parent satisfaction with care. International Journal for Quality in Health Care, 12(4),331–337. https://doi.org/10.1093/intqhc/12.4.331
  • Pantell, M.S., De Marchis, E., Bueno, A., & Gottlieb, L.M. (2019). Practice capacity to address patients’ social needs and physician satisfaction and perceived quality of care. Ann Fam Med., 17(1),42–45. doi: 10.1370/afm.2334
  • Potasz, C., De Varela, M.J.V., De Carvalho, L.C., Do Prado, L.F., & Do Prado, G.F. (2013). Effect of play activities on hospitalized children’s stress: a randomized clinical trial. Scandinavian Journal of Occupational Therapy, 20(1),1-79. doi: 10.3109/11038128.2012.729087.
  • Power, N., & Franck, L. (2008). Parent participation in the care of hospitalized children: a systematic rewiev. Journal of Advanced Nursing, 62(6),622-64. doi: 10.1111/j.1365-2648.2008.04643.x.
  • Priest, H. (2010). Effective psychological care for physically ill patients in hospital. Nursing Standard, 24(44),48-56. doi: 10.7748/ns2010.07.24.44.48.c7886.
  • Romaniuk, D., O’Mara, L., &Danesh, A.N. (2014). Are parents doing what they want to do? Congruency between parents’ actual and desired participation in the care of their hospitalized child. Issues in Comprehensive Pediatric Nursing, 37(2),103-121. doi: 10.3109/01460862.2014.880532.
  • Rushton, J., Bruckman, D., & Kelleher, K. (2010). Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med., 156:592-8. doi: 10.1001/archpedi.156.6.592.
  • Schonfeld, J.D., & Perrin, E.C. (2013). Adaptation to disease. In: Rudolph CD, Rudolph AM, Lister GE, First LR, Gerdhon AA (eds). Rudolp’s Pediatrics. McGraw-Hill.. p.368-374.
  • Small, L., Mazurek Melnyk, B., & Sidora-Arcoleo, K. (2009). The effects of gender on the coping outcomes of young children following an unanticipated critical care hospitalization. J Spec Pediatr Nurs, 14,112–22. doi: 10.1111/j.1744-6155.2009.00184.x.
  • Toledano-Toledano, F., & Luna, D. (2020). The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study. BioPsychoSocial Med., (14)29. https://doi.org/10.1186/s13030-020-00201-y
  • Ulus, B., & Kublay, G. (2012). PedsQL sağlık bakımı ebeveyn memnuniyet ölçeğinin Türkçe’ye uyarlanması. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 3(1),44-50. https://toad.halileksi.net/olcek/pedsql-saglik-bakimi-ebeveyn-memnuniyet-olcegi
  • Üstün, G., & Kelleci, M. (2013). Assessment scale for psychosocial symptoms in hospitalized children scale development, reliability and validity study. HealthMED, 7(7),2219-28. http://pdf.healthmed.ba/healthmed_7_7_web.pdf
  • Üstün, G., Erşan, E.E., Kelleci, M., & Turgut, H. (2014). Hastanede Yatan Çocuklarda Psikososyal Semptomların Bazı Değişkenler Açısından İncelenmesi. Cumhuriyet Tıp Dergisi, 36,25-33. https://doi.org/10.7197/cmj.v36i1.1008002456
  • Varni, J.W, Burwinkle, T.M, & Seid, M. (2005). The PedsQLTM as a Pediatric Patient- reported outcome: Reliability and validity of the PedsQLTM measurement model in 25.000 children. Expert Rev Pharmacoecon Outcomes Res. 5(6),705-19.doi: 10.1586/14737167.5.6.705.
  • Vaz, L.E., Wagner, D.V., Ramsey, K.L., Jenisch, C., Austin, J.P., Jungbauer RM, … & Zuckerman K.E. (2020). Identification of caregiver-reported social risk factors in hospitalized children. Hosp Pediatr., 10,20–8. doi: 10.1542/hpeds.2019-0206.
  • Weissenstein, A., Straeter, A., Villalon, G., Luchter, E., & Bittmann, S. (2011). Parent satisfaction with a paediatric practice in Germany: A questionnairebased study. Italian Journal of Pediatrics, 37(31). https://doi.org/10.1186/1824-7288-37-31
  • Wissow, L.S., Larson, S., Anderson, J., & Hadjiisky, E. (2005). Pediatric residents’ responses that discourage discussion of psychosocial problems in primary care. Pediatrics, 115(6),1569-78. doi: 10.1542/peds.2004-1535.
  • Zengerle-Levy, K. (2006). Nursing the child who is alone in the hospital. Pediatric Nursing, 32, 226-37. PMID: 1680268
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Fadime Üstüner Top 0000-0002-7341-5704

Hasan Hüseyin Çam 0000-0002-1722-4727

Nilüfer İlyas This is me 0000-0003-2928-7685

Publication Date February 28, 2022
Submission Date June 8, 2021
Published in Issue Year 2022 Volume: 11 Issue: 1

Cite

APA Üstüner Top, F., Çam, H. H., & İlyas, N. (2022). Hastanede Yatan Çocuklarda Görülen Psikososyal Semptomlar, Ebeveynlerin Sağlık Hizmet Sunumu Memnuniyet Durumları ve İlişkili Faktörler. Balıkesir Sağlık Bilimleri Dergisi, 11(1), 34-41. https://doi.org/10.53424/balikesirsbd.949338

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