Araştırma Makalesi
BibTex RIS Kaynak Göster

-

Yıl 2015, , 361 - 369, 19.08.2015
https://doi.org/10.3944/AOTT.2015.14.0255

Öz

Amaç: Bu çalışmanın amacı cama vurmayla ve kazayla yaralanan hastaları demografik, klinik ve psikolojik parametreler açısından karşılaştırmaktır.Çalışma planı: Yaralanma ciddiyetini değerlendirmek için El Yaralanması Ciddiyet Skoru (EYCS), fonksiyon değerlendirmesi için Duruöz El İndeksi (DEİ), Hızlı Kol Omuz El Disabilite indeksi (H-KOES), yaralanmanın etkisini değerlendirmek için Revize Olayların Etkisi Ölçeği (R-OEÖ), dikkat eksikliğini değerlendirmek için Erişkin Dikkat Eksikliği ve Hiperaktivite Ölçeği (E-DEHÖ), kişilik bozukluğu semptomlarını değerlendirmek için Sınırda Kişilik Envanteri (SKE), depresyon düzeyini belirlemek için Beck Depresyon Ölçeği (BDÖ) kullanıldı.Bulgular: Cama vurarak yaralanan hastalar anlamlım olarak daha gençti ve ağırlıklı olarak dominant ellerinden yaralanmışlardı.

Kaynakça

  • Koestler AJ. Psychological perspective on hand injury and pain. J Hand Ther 2010;23:199–211.
  • Kessler RC, Lane M, Stang PE, Van Brunt DL. The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm. Psy- chol Med 2009;39:137–47.
  • Kaya A, Taner Y, Guclu B, Taner E, Kaya Y, Bahcivan HG, et al. Trauma and adult attention deficit hyperactiv- ity disorder. J Int Med Res 2008;36:9–16.
  • Jeanmonod RK, Jeanmonod D, Damewood S, Perry C, Powers M, Lazansky V. Punch injuries: insights into intentional closed fist injuries. West J Emerg Med 2011;12:6–10.
  • Kural C, Alkaş L, Tüzün S, Cetinus E, Ugras AA, Alkaş M. Anger scale and anger types of patients with fifth metacarpal neck fracture. Acta Orthop Traumatol Turc 2011;45:312–5.
  • Sarandöl A, Özbek S, Eker S, Özcan M, Kırlı S. Psychi- atric evaluation of patients with punching glass injuries admitted to the emergency room. Türkiye’de Psikiyatri 2006;8:88–92.
  • Özen Ş, Subaşı M, Yıldırım A, Baştürk M, Bez Y. Prob- lem solving skills and childhood traumas in patients who self-injured by punching glass during an anger outburst. J Clin Exp Invest 2010;1:25–30.
  • Whetsell LA, Patterson CM, Young DH, Schiller WR. Preinjury psychopathology in trauma patients. J Trauma 1989;29:1158–62.
  • Poole GV, Lewis JL, Devidas M, Hauser CJ, Martin RW, Thomae KR. Psychopathologic risk factors for intention- al and nonintentional injury. J Trauma 1997;42:711–5.
  • Trybus M, Lorkowski J, Brongel L, Hladki W. Causes and consequences of hand injuries. Am J Surg 2006;192:52– 7.
  • Mendelson RL, Burech JG, Polack EP, Kappel DA. The psychological impact of traumatic amputations. A team approach: physician, therapist, and psychologist. Hand Clin 1986;2:577–83.
  • Johnson RK. Psychologic assessment of patients with in- dustrial hand injuries. Hand Clin 1993;9:221–9.
  • Cohen RI. Post-traumatic stress disorder: does it clear up when the litigation is settled? Br J Hosp Med 1987;37:485.
  • Grunert BK, Devine CA, Matloub HS, Sanger JR, Yousif NJ, Anderson RC, et al. Psychological adjustment follow- ing work-related hand injury: 18-month follow-up. Ann Plast Surg 1992;29:537–42.
  • Grunert BK, Smith CJ, Devine CA, Fehring BA, Mat- loub HS, Sanger JR, et al. Early psychological aspects of severe hand injury. J Hand Surg Br 1988;13:177–80.
  • Dilek B, Yemez B, Kizil R, Kartal E, Gulbahar S, Sari O, et al. Anxious personality is a risk factor for developing complex regional pain syndrome type I. Rheumatol Int 2012;32:915–20.
  • Hardy M, Merritt W. Psychological evaluation and pain assessment in patients with reflex sympathetic dystrophy. J Hand Ther 1988;1:155–64.
  • Beerthuizen A, Stronks DL, Huygen FJ, Passchier J, Klein J, Spijker AV. The association between psychologi- cal factors and the development of complex regional pain syndrome type 1 (CRPS1)-a prospective multicenter study. Eur J Pain 2011;15:971–5.
  • Campbell DA, Kay SP. The Hand Injury Severity Scor- ing System. J Hand Surg Br 1996;21:295–8.
  • Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that as- sesses functional handicap. J Rheumatol 1996;23:1167– 72.
  • Erçalik T, Şahin F, Erçalik C, Doğu B, Dalgiç S, Kuran B. Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries. Dis- abil Rehabil 2011;33:1521–7.
  • Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on respons- es within the full-length DASH. BMC Musculoskelet Disord 2006;7:44.
  • Düger T, Yakut E, Öksüz C, Yörükan S, Bilgütay BS, Ayhan Ç, et al. Reliability and validity of the Turkish ver- sion of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Fizyoterapi Rehabilitasyon 2006;17:99–107.
  • Çorapçıoğlu A, Yargıç İ, Geyran P, Kocabaşoğlu N. “Olayların Etkisi Ölçeği” (IES-R) Türkçe versiyonunun geçerlilik ve güvenilirliği. New/Yeni Symmposium 2006;44:14–22.
  • Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale - Revised. Behav Res Ther 2003;41:1489–96.
  • Günay Ş, Savran C, Aksoy UM, Maner F, Turgay A, Yargıç İ. Erişkin Dikkat Eksikliği Hiperaktivite Ölçeğinin (Adult ADD/ADHD DSM-IV-Based Diagnostic Screening and Rating Scale) dilsel eşdeğerlilik, geçer- lik güvenirlik ve norm çalışması. Türkiye’de Psikiyatri 2006;8:98–107.
  • Aydemir Ö, Demet MM, Danacı AE, Deveci A, Oryal Taşkın E, Mızrak S, et al. Adaptation Into Turkish, Reli- ability and Validity of Borderline Personality Inventory. Türkiye’de Psikiyatri 2006;8:6–10.
  • Beck At, Ward Ch, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.
  • Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği ve güvenirliği. Psikoloji Dergisi 1989;7:3–13.
  • Bokhari AA, Stirrat AN. The consequences of punching glass. J Hand Surg Br 1997;22:202–3.
  • Meyer TM. Psychological aspects of mutilating hand in- juries. Hand Clin 2003;19:41–9.
  • Lohman H, Royeen C. Posttraumatic stress disorder and traumatic hand injuries: a neuro-occupational view. Am J Occup Ther 2002;56:527–37.
  • Richards T, Garvert DW, McDade E, Carlson E, Curtin C. Chronic psychological and functional sequelae after emergent hand surgery. J Hand Surg Am 2011;36:1663– 8.
  • Grunert BK, Devine CA, Matloub HS, Sanger JR, Yousif NJ. Flashbacks after traumatic hand injuries: prognostic indicators. J Hand Surg Am 1988;13:125–7.
  • Grunert BK, Matloub HS, Sanger JR, Yousif NJ, Hetter- mann S. Effects of litigation on maintenance of psycho- logical symptoms after severe hand injury. J Hand Surg Am 1991;16:1031–4.
  • Jaquet JB, van der Jagt I, Kuypers PD, Schreuders TA, Kalmijn AR, Hovius SE. Spaghetti wrist trauma: func- tional recovery, return to work, and psychological effects. Plast Reconstr Surg 2005;115:1609–17.
  • Grunert BK, Matloub HS, Sanger JR, Yousif NJ. Treat- ment of posttraumatic stress disorder after work-related hand trauma. J Hand Surg Am 1990;15:511–5.
  • Hennigar C, Saunders D, Efendov A. The Injured Work- ers Survey: development and clinical use of a psychoso- cial screening tool for patients with hand injuries. J Hand Ther 2001;14:122–7.
  • Opsteegh L, Reinders-Messelink HA, Groothoff JW, Postema K, Dijkstra PU, van der Sluis CK. Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries. J Hand Surg Am 2010;35:961–7.
  • Gustafsson M, Amilon A, Ahlström G. Trauma-related distress and mood disorders in the early stage of an acute traumatic hand injury. J Hand Surg Br 2003;28:332–8.
  • Dell’Osso B, Berlin HA, Serati M, Altamura AC. Neu- ropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology 2010;61:169–79.
  • Golier JA, Yehuda R, Bierer LM, Mitropoulou V, New AS, Schmeidler J, et al. The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry 2003;160:2018–24.
  • Harned MS, Rizvi SL, Linehan MM. Impact of co-oc- curring posttraumatic stress disorder on suicidal women with borderline personality disorder. Am J Psychiatry 2010;167:1210–7.
  • Pagura J, Stein MB, Bolton JM, Cox BJ, Grant B, Sareen J. Comorbidity of borderline personality disorder and post- traumatic stress disorder in the U.S. population. J Psychi- atr Res 2010;44:1190–8.
  • Rösler M, Retz W, Yaqoobi K, Burg E, Retz-Junginger P. Attention deficit/hyperactivity disorder in female of- fenders: prevalence, psychiatric comorbidity and psycho- social implications. Eur Arch Psychiatry Clin Neurosci 2009;259:98–105.
  • Ward RK. Assessment and management of personality disorders. Am Fam Physician 2004;70:1505–12.

Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass

Yıl 2015, , 361 - 369, 19.08.2015
https://doi.org/10.3944/AOTT.2015.14.0255

Öz

Objective: The aim of this study was to compare patients who were injured by punching glass with patients who were injured accidentally, according to demographical, clinical, and psychological parameters.
Methods: The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory (BPI), and the Beck Depression Inventory (BDI) were used for evaluating severity of the injury, functionality, impact of the injury on the patient, attention deficiency, patterns of borderline personality symptoms, and level of depression, respectively.
Results: Patients who were injured by punching glass were significantly younger and more likely to injure their dominant hand. The severity of injury and all psychological scales were significantly higher in patients who were injured by punching glass.
Conclusion: Hand therapy specialists should be aware of potential problems in patients who were injured by punching glass.

Kaynakça

  • Koestler AJ. Psychological perspective on hand injury and pain. J Hand Ther 2010;23:199–211.
  • Kessler RC, Lane M, Stang PE, Van Brunt DL. The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm. Psy- chol Med 2009;39:137–47.
  • Kaya A, Taner Y, Guclu B, Taner E, Kaya Y, Bahcivan HG, et al. Trauma and adult attention deficit hyperactiv- ity disorder. J Int Med Res 2008;36:9–16.
  • Jeanmonod RK, Jeanmonod D, Damewood S, Perry C, Powers M, Lazansky V. Punch injuries: insights into intentional closed fist injuries. West J Emerg Med 2011;12:6–10.
  • Kural C, Alkaş L, Tüzün S, Cetinus E, Ugras AA, Alkaş M. Anger scale and anger types of patients with fifth metacarpal neck fracture. Acta Orthop Traumatol Turc 2011;45:312–5.
  • Sarandöl A, Özbek S, Eker S, Özcan M, Kırlı S. Psychi- atric evaluation of patients with punching glass injuries admitted to the emergency room. Türkiye’de Psikiyatri 2006;8:88–92.
  • Özen Ş, Subaşı M, Yıldırım A, Baştürk M, Bez Y. Prob- lem solving skills and childhood traumas in patients who self-injured by punching glass during an anger outburst. J Clin Exp Invest 2010;1:25–30.
  • Whetsell LA, Patterson CM, Young DH, Schiller WR. Preinjury psychopathology in trauma patients. J Trauma 1989;29:1158–62.
  • Poole GV, Lewis JL, Devidas M, Hauser CJ, Martin RW, Thomae KR. Psychopathologic risk factors for intention- al and nonintentional injury. J Trauma 1997;42:711–5.
  • Trybus M, Lorkowski J, Brongel L, Hladki W. Causes and consequences of hand injuries. Am J Surg 2006;192:52– 7.
  • Mendelson RL, Burech JG, Polack EP, Kappel DA. The psychological impact of traumatic amputations. A team approach: physician, therapist, and psychologist. Hand Clin 1986;2:577–83.
  • Johnson RK. Psychologic assessment of patients with in- dustrial hand injuries. Hand Clin 1993;9:221–9.
  • Cohen RI. Post-traumatic stress disorder: does it clear up when the litigation is settled? Br J Hosp Med 1987;37:485.
  • Grunert BK, Devine CA, Matloub HS, Sanger JR, Yousif NJ, Anderson RC, et al. Psychological adjustment follow- ing work-related hand injury: 18-month follow-up. Ann Plast Surg 1992;29:537–42.
  • Grunert BK, Smith CJ, Devine CA, Fehring BA, Mat- loub HS, Sanger JR, et al. Early psychological aspects of severe hand injury. J Hand Surg Br 1988;13:177–80.
  • Dilek B, Yemez B, Kizil R, Kartal E, Gulbahar S, Sari O, et al. Anxious personality is a risk factor for developing complex regional pain syndrome type I. Rheumatol Int 2012;32:915–20.
  • Hardy M, Merritt W. Psychological evaluation and pain assessment in patients with reflex sympathetic dystrophy. J Hand Ther 1988;1:155–64.
  • Beerthuizen A, Stronks DL, Huygen FJ, Passchier J, Klein J, Spijker AV. The association between psychologi- cal factors and the development of complex regional pain syndrome type 1 (CRPS1)-a prospective multicenter study. Eur J Pain 2011;15:971–5.
  • Campbell DA, Kay SP. The Hand Injury Severity Scor- ing System. J Hand Surg Br 1996;21:295–8.
  • Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that as- sesses functional handicap. J Rheumatol 1996;23:1167– 72.
  • Erçalik T, Şahin F, Erçalik C, Doğu B, Dalgiç S, Kuran B. Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries. Dis- abil Rehabil 2011;33:1521–7.
  • Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on respons- es within the full-length DASH. BMC Musculoskelet Disord 2006;7:44.
  • Düger T, Yakut E, Öksüz C, Yörükan S, Bilgütay BS, Ayhan Ç, et al. Reliability and validity of the Turkish ver- sion of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Fizyoterapi Rehabilitasyon 2006;17:99–107.
  • Çorapçıoğlu A, Yargıç İ, Geyran P, Kocabaşoğlu N. “Olayların Etkisi Ölçeği” (IES-R) Türkçe versiyonunun geçerlilik ve güvenilirliği. New/Yeni Symmposium 2006;44:14–22.
  • Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale - Revised. Behav Res Ther 2003;41:1489–96.
  • Günay Ş, Savran C, Aksoy UM, Maner F, Turgay A, Yargıç İ. Erişkin Dikkat Eksikliği Hiperaktivite Ölçeğinin (Adult ADD/ADHD DSM-IV-Based Diagnostic Screening and Rating Scale) dilsel eşdeğerlilik, geçer- lik güvenirlik ve norm çalışması. Türkiye’de Psikiyatri 2006;8:98–107.
  • Aydemir Ö, Demet MM, Danacı AE, Deveci A, Oryal Taşkın E, Mızrak S, et al. Adaptation Into Turkish, Reli- ability and Validity of Borderline Personality Inventory. Türkiye’de Psikiyatri 2006;8:6–10.
  • Beck At, Ward Ch, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.
  • Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği ve güvenirliği. Psikoloji Dergisi 1989;7:3–13.
  • Bokhari AA, Stirrat AN. The consequences of punching glass. J Hand Surg Br 1997;22:202–3.
  • Meyer TM. Psychological aspects of mutilating hand in- juries. Hand Clin 2003;19:41–9.
  • Lohman H, Royeen C. Posttraumatic stress disorder and traumatic hand injuries: a neuro-occupational view. Am J Occup Ther 2002;56:527–37.
  • Richards T, Garvert DW, McDade E, Carlson E, Curtin C. Chronic psychological and functional sequelae after emergent hand surgery. J Hand Surg Am 2011;36:1663– 8.
  • Grunert BK, Devine CA, Matloub HS, Sanger JR, Yousif NJ. Flashbacks after traumatic hand injuries: prognostic indicators. J Hand Surg Am 1988;13:125–7.
  • Grunert BK, Matloub HS, Sanger JR, Yousif NJ, Hetter- mann S. Effects of litigation on maintenance of psycho- logical symptoms after severe hand injury. J Hand Surg Am 1991;16:1031–4.
  • Jaquet JB, van der Jagt I, Kuypers PD, Schreuders TA, Kalmijn AR, Hovius SE. Spaghetti wrist trauma: func- tional recovery, return to work, and psychological effects. Plast Reconstr Surg 2005;115:1609–17.
  • Grunert BK, Matloub HS, Sanger JR, Yousif NJ. Treat- ment of posttraumatic stress disorder after work-related hand trauma. J Hand Surg Am 1990;15:511–5.
  • Hennigar C, Saunders D, Efendov A. The Injured Work- ers Survey: development and clinical use of a psychoso- cial screening tool for patients with hand injuries. J Hand Ther 2001;14:122–7.
  • Opsteegh L, Reinders-Messelink HA, Groothoff JW, Postema K, Dijkstra PU, van der Sluis CK. Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries. J Hand Surg Am 2010;35:961–7.
  • Gustafsson M, Amilon A, Ahlström G. Trauma-related distress and mood disorders in the early stage of an acute traumatic hand injury. J Hand Surg Br 2003;28:332–8.
  • Dell’Osso B, Berlin HA, Serati M, Altamura AC. Neu- ropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology 2010;61:169–79.
  • Golier JA, Yehuda R, Bierer LM, Mitropoulou V, New AS, Schmeidler J, et al. The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry 2003;160:2018–24.
  • Harned MS, Rizvi SL, Linehan MM. Impact of co-oc- curring posttraumatic stress disorder on suicidal women with borderline personality disorder. Am J Psychiatry 2010;167:1210–7.
  • Pagura J, Stein MB, Bolton JM, Cox BJ, Grant B, Sareen J. Comorbidity of borderline personality disorder and post- traumatic stress disorder in the U.S. population. J Psychi- atr Res 2010;44:1190–8.
  • Rösler M, Retz W, Yaqoobi K, Burg E, Retz-Junginger P. Attention deficit/hyperactivity disorder in female of- fenders: prevalence, psychiatric comorbidity and psycho- social implications. Eur Arch Psychiatry Clin Neurosci 2009;259:98–105.
  • Ward RK. Assessment and management of personality disorders. Am Fam Physician 2004;70:1505–12.
Toplam 46 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Fusun Sahin Bu kişi benim

Nuray Akkaya

Banu Kuran Bu kişi benim

Beril Dogu

Nilgun Simsir Atalay

Nalan Oguzhanoglu Bu kişi benim

Yayımlanma Tarihi 19 Ağustos 2015
Yayımlandığı Sayı Yıl 2015

Kaynak Göster

APA Sahin, F., Akkaya, N., Kuran, B., Dogu, B., vd. (2015). Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthopaedica Et Traumatologica Turcica, 49(4), 361-369. https://doi.org/10.3944/AOTT.2015.14.0255
AMA Sahin F, Akkaya N, Kuran B, Dogu B, Simsir Atalay N, Oguzhanoglu N. Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthopaedica et Traumatologica Turcica. Ağustos 2015;49(4):361-369. doi:10.3944/AOTT.2015.14.0255
Chicago Sahin, Fusun, Nuray Akkaya, Banu Kuran, Beril Dogu, Nilgun Simsir Atalay, ve Nalan Oguzhanoglu. “Demographical, Clinical, and Psychological Differences of Patients Who Suffered Hand Injury Accidentally and by Punching Glass”. Acta Orthopaedica Et Traumatologica Turcica 49, sy. 4 (Ağustos 2015): 361-69. https://doi.org/10.3944/AOTT.2015.14.0255.
EndNote Sahin F, Akkaya N, Kuran B, Dogu B, Simsir Atalay N, Oguzhanoglu N (01 Ağustos 2015) Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthopaedica et Traumatologica Turcica 49 4 361–369.
IEEE F. Sahin, N. Akkaya, B. Kuran, B. Dogu, N. Simsir Atalay, ve N. Oguzhanoglu, “Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass”, Acta Orthopaedica et Traumatologica Turcica, c. 49, sy. 4, ss. 361–369, 2015, doi: 10.3944/AOTT.2015.14.0255.
ISNAD Sahin, Fusun vd. “Demographical, Clinical, and Psychological Differences of Patients Who Suffered Hand Injury Accidentally and by Punching Glass”. Acta Orthopaedica et Traumatologica Turcica 49/4 (Ağustos 2015), 361-369. https://doi.org/10.3944/AOTT.2015.14.0255.
JAMA Sahin F, Akkaya N, Kuran B, Dogu B, Simsir Atalay N, Oguzhanoglu N. Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthopaedica et Traumatologica Turcica. 2015;49:361–369.
MLA Sahin, Fusun vd. “Demographical, Clinical, and Psychological Differences of Patients Who Suffered Hand Injury Accidentally and by Punching Glass”. Acta Orthopaedica Et Traumatologica Turcica, c. 49, sy. 4, 2015, ss. 361-9, doi:10.3944/AOTT.2015.14.0255.
Vancouver Sahin F, Akkaya N, Kuran B, Dogu B, Simsir Atalay N, Oguzhanoglu N. Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass. Acta Orthopaedica et Traumatologica Turcica. 2015;49(4):361-9.