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FEAR, AVOIDANCE ATTITUDES AND VACCINATION TOWARDS COVID-19 AND BREASTFEEDING SELF-EFFICACY OF MOTHERS WITH 0-6 MONTHS-OLD BABIES IN RURAL AREA

Year 2023, Volume: 3 Issue: 3, 48 - 60, 27.12.2023

Abstract

Aim: Aim of study is to determine fear, avoidance attitude and vaccination towards COVID-19 and breastfeeding self-efficacy of mothers with 0-6 months old babies in rural area. Material and Method: This is a cross-sectional study. Sample consisted of 297 mothers with 0-6 month old babies. Data were collected through the Introductory Information Form, Fear of COVID-19 Scale, Avoidance Attitudes from COVID-19, and Breastfeeding Self-Efficacy Scale. Results: Breasfeeding self-efficiacy was found to be highest in those who had never been vaccinated. 19.2% of mothers received COVID-19 vaccine in this pregnancy. Breasfeeding self-efficiacy is higher in those not vaccinated against COVID-19 in this pregnancy. A positive correlation was found between fear and cognitive avoidance (r:0.45), and behavioral avoidance (r:0.48). A positive correlation (r:0.13) was found between age and fear. It was established that mothers' fear of coronavirus predicted coronavirus avoidance by 32%, cognitive avoidance by 21%, and behavioral avoidance by 23% significantly. Conclusion: It was determined that the fear of coronavirus causes avoidance in mothers, but fear and avoidance did not affect breastfeeding self-efficacy. In addition, it was determined that vaccination affected breastfeeding self-efficacy.

Supporting Institution

YOKTUR

Project Number

YOKTUR

Thanks

The authors would like to give thanks to participants to study

References

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  • Aluş-Tokat, M., Okumuş, H., & Dennis, C. L. (2010). Translation and psychometric assessment of the breastfeeding self-efficacy scale-short form among pregnant and postnatal women in Turkey. Midwifery, 26(1), 101-108. https://doi.org/10.1016/j.midw.2008.04.002
  • Asadi, L., Tabatabaei, R. S., Safinejad, H., & Mohammadi, M. (2020). New Corona Virus (COVID-19) management in pregnancy and childbirth. Archives of Clinical Infectious Diseases, 15, e102938. https://doi.org/10.5812/archcid.102938
  • Ataman-Bor, N., İpekçi, N. N., & Öztürk, M. (2021). An assessment of the relationship between coronavirus anxiety of breastfeeding mothers and their breastfeeding self-efficacy. Göbeklitepe International Journal of Health Sciences, 4(4), 70-86. http://gobeklitepejournal.com/Makaleler/829643503_8%20ID%2042.pdf
  • Bakioğlu, F., Korkmaz, O., & Ercan, H. (2021). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 19(6), 2369-2382. https://doi.org/10.1007/s11469-020-00331-y
  • Beheshti, M. A. Z., Alimoradi, Z., & Bahrami, N. (2021). Study of the predictors of breastfeeding self-efficacy in mothers during the Covid-19 pandemic. Research Square, 1-19. https://doi.org/10.21203/rs.3.rs-246918/v1
  • Bertrand, K., Honerkamp-Smith, G., & Chambers, C. D. (2021). Maternal and child outcomes reported by breastfeeding women following Messenger RNA COVID-19 Vaccination. Breastfeeding Medicine, 16(9), 697-701. https://doi.org/10.1089/bfm.2021.0169 .
  • Brockway, M., Benzies, K., & Hayden, K.A. (2017). Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: A systematic review and meta-analysis. Journal of Human Lactation, 33(3), 486-499. https://doi.org/10.1177/0890334417707957
  • Carbone, L., Mappa, I., Sirico, A., Di Girolamo, R., Saccone, G., Di Mascio, D., Donadono, V., Cuomo, L., Gabrielli, O., Migliorini, S., Luviso, M., D’antonio, F., Rizzo, G., Maruotti, G. M. (2021). Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine. American Journal of Obstetrics & Gynecology, Maternal-Fetal Medicine, 3(4), 100352. https://doi.org/10.1016/j.ajogmf.2021.100352
  • Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98-101. https://doi.org/10.1111/1467-8721.ep10768783
  • Çırakoğlu O. C. (2011). The investigation of Swine Influenza (H1N1) pandemic related perceptions in terms of anxiety and avoidance variables. Turkish Journal of Psychology, 26(67), 49-64. https://www.psikolog.org.tr/tr/yayinlar/dergiler/1031828/tpd1300443320110000m000096.pdf
  • Davanzo, R., Moro, G., Sandri, F., Agosti, M., Moretti, C., & Mosca, F. (2020). Breastfeeding and coronavirus disease‐2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Maternal &Child Nutrition, 16(3), e13010. https://doi.org/10.1111/mcn.13010
  • Dennis, C. L. (2003). Breastfeeding self efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic and Neonatal Nursing, 32, 734-743. https://doi.org/10.1177/0884217503258459
  • Faul, F., Erdfelder, E., Lang, A. G. & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191. https://doi.org/10.3758/bf03193146
  • Geniş, B., Gürhan, N., Koç, M., Geniş, Ç., Şirin, B., Çırakoğlu, O. C., & Coşar, B. (2020). Development of perception and attitude scales related with COVID-19 pandemia. Pearson Journal of Social Sciences & Humanities, 5(7), 306-28. https://doi.org/10.46872/pj.127
  • Gokceoglu, E., & Küçükoğlu, S. (2018). Validity and reliability study of Perception of Insufficient Milk Supply Questionnaire for Turkish Society. International Journal of Innovative Research and Reviews, 2(2), 15-20. https://dergipark.org.tr/tr/pub/injirr/issue/51805/801243.
  • Harper, C. A., Satchell, L. P., Fido, D., & Latzman, R. D. (2021). Functional fear predicts public health compliance in the COVID-19 pandemic. International Journal of Mental Health and Addiction, 19(5), 1875-1888. https://doi.org/10.1007/s11469-020-00281-5
  • Kurt, Ş. H. (2021). Mother-Child Communication and Mothers' Fear of Coronavirus Disease During the Pandemic. -Current Approaches in Psychiatry, 13(Suppl 1), 245-256. https://doi.org/10.18863/pgy.971643.
  • Leech, N. L., Barrett, K. C. & Morgan, G. A. (2005). SPSS for intermediate statistics: Use and interpretation. Second Edition, Taylor & Francis.
  • Liu, S., Yang, L., Zhang, C., Xiang, Y. T., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry, 7(4), e17-e18. https://doi.org/10.1016/S2215-0366(20)30077-8
  • Lum, L. H. W., & Tambyah, P. A. (2020). Outbreak of COVID-19 - An urgent need for good science to silence our fears?. Singapore Medical Association, 61(2), 55-57. https://doi.org/10.11622/smedj.2020018
  • Martínez-Lorca, M., Martínez-Lorca, A., Criado-Álvarez, J. J., Armesilla, M. D. C., & Latorre, J. M. (2020). The fear of COVID-19 scale: Validation in Spanish university students. Psychiatry Research, 293, 113350. https://doi.org/10.1016/j.psychres.2020.113350
  • McLaurin-Jiang, S., Garner, C. D., Krutsch, K., & Hale, T. W. (2021). Maternal and child symptoms following COVID-19 Vaccination Among Breastfeeding Mothers. Breastfeeding Medicine, 16(9), 702-709. https://doi.org/10.1089/bfm.2021.0079
  • Milligan-Saville, J. S., & Graham, B. M. (2016). Mothers do it differently: Reproductive experience alters fear extinction in female rats and women. Translational psychiatry, 6(10), e928. https://doi.org/10.1038/tp.2016.193
  • Nanishi, K., Green, J., Taguri, M., & Jimba, M. (2015). Determining a cut-off point for scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary data analysis of an ıntervention study in Japan. PLoS One, 10(6), e0129698. https://doi.org/10.1371/journal.pone.0129698
  • Piltch-Loeb, R., & Abramson, D. (2020). Information-accessing behavior during Zika Virus outbreak, United States, 2016. Emerging Infectious Diseases, 26(9), 2290-2292. https://doi.org/10.3201/eid2609.191519
  • Reznik, A., Gritsenko, V., Konstantinov, V., Khamenka, N., & Isralowitz, R. (2021). COVID-19 fear in Eastern Europe: Validation of the fear of COVID-19 scale. International Journal of Mental Health and Addiction, 19(5), 1903-1908. https://doi.org/10.1007/s11469-020-00283-3
  • Salehi, L., Rahimzadeh, M., Molaei, E., Zaheri, H., Esmaelzadeh-Saeieh, S. (2020). The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain and Behavior, 10(11), e01835. https://doi.org/10.1002/brb3.1835.
  • Schaal, N. K., Zöllkau, J., Hepp, P., Fehm, T., & Hagenbeck, C. (2021). Pregnant and breastfeeding women’s attitudes and fears regarding the COVID‑19 vaccination. Archives of Gynecology and Obstetrics, 1-8. https://doi.org/10.1007/s00404-021-06297-z.
  • Şahin-Uysal, N., Tuğrul-Ersak, D., Azami, A., Alıyeva, K., Duran, E., & Esin, S. (2021). Has COVID-19 pandemic period affected mothers’ breastfeeding self-efficacy perceptions?. Health and Society, 31(3), 77-84. https://ssyv.org.tr/wp-content/uploads/2022/04/8-COVID-19-Pandemi-Sureci-Annelerin-Emzirme-Oz-Yeterlilik-Algilarini-Etkiledi-mi.pdf
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  • Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., Mckay, D., & Asmundson, G. J. G. (2020). Development and initial validation of the COVID stress scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janxdis.2020.102232.
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  • World Health Organization (WHO). (2021). Update on WHO Interim recommendations on COVID-19 vaccination of pregnant and lactating women. Tracey Goodman, WHO/HQ/IVB AFRO Webinar, June 2, 2021 https://cdn.who.int/media/docs/default-source/2021-dha-docs/update-on-who-interim-recommendations-on-c-19-vaccination-for-pregnant-and-lactating-women-70-.pdf?sfvrsn=2c1d9ac8_1&download=true Date of Access: 7.7.2020.
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KIRSAL BÖLGEDE 0-6 AYLIK BEBEĞİ OLAN ANNELERİN COVİD-19’A YÖNELİK KORKU, KAÇINMA TUTUMU, AŞILANMA VE EMZİRME ÖZYETERLİLİĞİ

Year 2023, Volume: 3 Issue: 3, 48 - 60, 27.12.2023

Abstract

Amaç: Bu araştırmanın amacı kırsal bölgede 0-6 aylık bebeği olan annelerin COVID-19’a yönelik korku, kaçınma tutumu ve aşılanma durumu ile emzirme özyeterliliğinin belirlenmesidir. Gereç ve Yöntem: Kesitsel tiptedir. Örneklemini 0-6 aylık bebeği olan 297 anne oluşturmuştur. Veriler Tanıtıcı Bilgi Formu, COVID-19 Korkusu Ölçeği, COVID-19’dan Kaçınma Tutumları Ölçeği, Emzirme Özyeterliliği Ölçeği ile toplanmıştır. Bulgular: Emzirme özyeterliği hiç aşı olmayanlarda daha yüksek belirlenmiştir. Annelerin %19.2’si bu gebeliğinde COVID-19 aşısı olmuştur. Emzirme özyeterliği bu gebeliğinde COVID-19 aşısı olmayanlarda daha yüksektir. Korku ile bilişsel kaçınma (r:0.45) ve dvranışsal kaçınma (r:0.48) arasında pozitif korelasyon saptanmıştır. Yaş ile korku arasında pozitif korelasyon belirlenmiştir (r:0.13). Annelerin koronavirüs korkusunun kaçınmayı %32, bilişsel kaçınmayı %21, davranışsal kaçınmayı %23 oranla anlamlı şekilde yordadığı belirlenmiştir. It was established that mothers' fear of coronavirus predicted coronavirus avoidance by 32%, cognitive avoidance by 21%, and behavioral avoidance by 23%. Sonuç: Koronavirüs korkusunun annelerde kaçınmayı neden olduğu, fakat korku ve kaçınmanın emzirme özyeterliliğini etkilemediği belirlenmiştir. Ayrıca aşılanmanın emzirme özyeterliliğini etkilediği belirlenmiştir.

Project Number

YOKTUR

References

  • Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2022). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction, 20(3), 1537–1545 https://doi.org/10.1007/s11469-020-00270-8
  • Aluş-Tokat, M., Okumuş, H., & Dennis, C. L. (2010). Translation and psychometric assessment of the breastfeeding self-efficacy scale-short form among pregnant and postnatal women in Turkey. Midwifery, 26(1), 101-108. https://doi.org/10.1016/j.midw.2008.04.002
  • Asadi, L., Tabatabaei, R. S., Safinejad, H., & Mohammadi, M. (2020). New Corona Virus (COVID-19) management in pregnancy and childbirth. Archives of Clinical Infectious Diseases, 15, e102938. https://doi.org/10.5812/archcid.102938
  • Ataman-Bor, N., İpekçi, N. N., & Öztürk, M. (2021). An assessment of the relationship between coronavirus anxiety of breastfeeding mothers and their breastfeeding self-efficacy. Göbeklitepe International Journal of Health Sciences, 4(4), 70-86. http://gobeklitepejournal.com/Makaleler/829643503_8%20ID%2042.pdf
  • Bakioğlu, F., Korkmaz, O., & Ercan, H. (2021). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 19(6), 2369-2382. https://doi.org/10.1007/s11469-020-00331-y
  • Beheshti, M. A. Z., Alimoradi, Z., & Bahrami, N. (2021). Study of the predictors of breastfeeding self-efficacy in mothers during the Covid-19 pandemic. Research Square, 1-19. https://doi.org/10.21203/rs.3.rs-246918/v1
  • Bertrand, K., Honerkamp-Smith, G., & Chambers, C. D. (2021). Maternal and child outcomes reported by breastfeeding women following Messenger RNA COVID-19 Vaccination. Breastfeeding Medicine, 16(9), 697-701. https://doi.org/10.1089/bfm.2021.0169 .
  • Brockway, M., Benzies, K., & Hayden, K.A. (2017). Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: A systematic review and meta-analysis. Journal of Human Lactation, 33(3), 486-499. https://doi.org/10.1177/0890334417707957
  • Carbone, L., Mappa, I., Sirico, A., Di Girolamo, R., Saccone, G., Di Mascio, D., Donadono, V., Cuomo, L., Gabrielli, O., Migliorini, S., Luviso, M., D’antonio, F., Rizzo, G., Maruotti, G. M. (2021). Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine. American Journal of Obstetrics & Gynecology, Maternal-Fetal Medicine, 3(4), 100352. https://doi.org/10.1016/j.ajogmf.2021.100352
  • Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98-101. https://doi.org/10.1111/1467-8721.ep10768783
  • Çırakoğlu O. C. (2011). The investigation of Swine Influenza (H1N1) pandemic related perceptions in terms of anxiety and avoidance variables. Turkish Journal of Psychology, 26(67), 49-64. https://www.psikolog.org.tr/tr/yayinlar/dergiler/1031828/tpd1300443320110000m000096.pdf
  • Davanzo, R., Moro, G., Sandri, F., Agosti, M., Moretti, C., & Mosca, F. (2020). Breastfeeding and coronavirus disease‐2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Maternal &Child Nutrition, 16(3), e13010. https://doi.org/10.1111/mcn.13010
  • Dennis, C. L. (2003). Breastfeeding self efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic and Neonatal Nursing, 32, 734-743. https://doi.org/10.1177/0884217503258459
  • Faul, F., Erdfelder, E., Lang, A. G. & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191. https://doi.org/10.3758/bf03193146
  • Geniş, B., Gürhan, N., Koç, M., Geniş, Ç., Şirin, B., Çırakoğlu, O. C., & Coşar, B. (2020). Development of perception and attitude scales related with COVID-19 pandemia. Pearson Journal of Social Sciences & Humanities, 5(7), 306-28. https://doi.org/10.46872/pj.127
  • Gokceoglu, E., & Küçükoğlu, S. (2018). Validity and reliability study of Perception of Insufficient Milk Supply Questionnaire for Turkish Society. International Journal of Innovative Research and Reviews, 2(2), 15-20. https://dergipark.org.tr/tr/pub/injirr/issue/51805/801243.
  • Harper, C. A., Satchell, L. P., Fido, D., & Latzman, R. D. (2021). Functional fear predicts public health compliance in the COVID-19 pandemic. International Journal of Mental Health and Addiction, 19(5), 1875-1888. https://doi.org/10.1007/s11469-020-00281-5
  • Kurt, Ş. H. (2021). Mother-Child Communication and Mothers' Fear of Coronavirus Disease During the Pandemic. -Current Approaches in Psychiatry, 13(Suppl 1), 245-256. https://doi.org/10.18863/pgy.971643.
  • Leech, N. L., Barrett, K. C. & Morgan, G. A. (2005). SPSS for intermediate statistics: Use and interpretation. Second Edition, Taylor & Francis.
  • Liu, S., Yang, L., Zhang, C., Xiang, Y. T., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry, 7(4), e17-e18. https://doi.org/10.1016/S2215-0366(20)30077-8
  • Lum, L. H. W., & Tambyah, P. A. (2020). Outbreak of COVID-19 - An urgent need for good science to silence our fears?. Singapore Medical Association, 61(2), 55-57. https://doi.org/10.11622/smedj.2020018
  • Martínez-Lorca, M., Martínez-Lorca, A., Criado-Álvarez, J. J., Armesilla, M. D. C., & Latorre, J. M. (2020). The fear of COVID-19 scale: Validation in Spanish university students. Psychiatry Research, 293, 113350. https://doi.org/10.1016/j.psychres.2020.113350
  • McLaurin-Jiang, S., Garner, C. D., Krutsch, K., & Hale, T. W. (2021). Maternal and child symptoms following COVID-19 Vaccination Among Breastfeeding Mothers. Breastfeeding Medicine, 16(9), 702-709. https://doi.org/10.1089/bfm.2021.0079
  • Milligan-Saville, J. S., & Graham, B. M. (2016). Mothers do it differently: Reproductive experience alters fear extinction in female rats and women. Translational psychiatry, 6(10), e928. https://doi.org/10.1038/tp.2016.193
  • Nanishi, K., Green, J., Taguri, M., & Jimba, M. (2015). Determining a cut-off point for scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary data analysis of an ıntervention study in Japan. PLoS One, 10(6), e0129698. https://doi.org/10.1371/journal.pone.0129698
  • Piltch-Loeb, R., & Abramson, D. (2020). Information-accessing behavior during Zika Virus outbreak, United States, 2016. Emerging Infectious Diseases, 26(9), 2290-2292. https://doi.org/10.3201/eid2609.191519
  • Reznik, A., Gritsenko, V., Konstantinov, V., Khamenka, N., & Isralowitz, R. (2021). COVID-19 fear in Eastern Europe: Validation of the fear of COVID-19 scale. International Journal of Mental Health and Addiction, 19(5), 1903-1908. https://doi.org/10.1007/s11469-020-00283-3
  • Salehi, L., Rahimzadeh, M., Molaei, E., Zaheri, H., Esmaelzadeh-Saeieh, S. (2020). The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain and Behavior, 10(11), e01835. https://doi.org/10.1002/brb3.1835.
  • Schaal, N. K., Zöllkau, J., Hepp, P., Fehm, T., & Hagenbeck, C. (2021). Pregnant and breastfeeding women’s attitudes and fears regarding the COVID‑19 vaccination. Archives of Gynecology and Obstetrics, 1-8. https://doi.org/10.1007/s00404-021-06297-z.
  • Şahin-Uysal, N., Tuğrul-Ersak, D., Azami, A., Alıyeva, K., Duran, E., & Esin, S. (2021). Has COVID-19 pandemic period affected mothers’ breastfeeding self-efficacy perceptions?. Health and Society, 31(3), 77-84. https://ssyv.org.tr/wp-content/uploads/2022/04/8-COVID-19-Pandemi-Sureci-Annelerin-Emzirme-Oz-Yeterlilik-Algilarini-Etkiledi-mi.pdf
  • Tang, S., & Graham, B. M. (2020). The role of hormonal and reproductive status in the treatment of anxiety disorders in women. Advances in Experimental Medicine and Biology, 1191, 523-541. https://doi.org/10.1007/978-981-32-9705-0_26.
  • Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., Mckay, D., & Asmundson, G. J. G. (2020). Development and initial validation of the COVID stress scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janxdis.2020.102232.
  • Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal Environment Research and Public Health, 17: 1729-1754. https://doi.org/10.3390/ijerph17051729.
  • World Health Organization (WHO). (2020a). Coronavirus disease (COVID-19). https://www.who.int/health-topics/coronavirus#tab=tab_1 Date of Access: 7.7.2020.
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  • World Health Organization (WHO). (2021). Update on WHO Interim recommendations on COVID-19 vaccination of pregnant and lactating women. Tracey Goodman, WHO/HQ/IVB AFRO Webinar, June 2, 2021 https://cdn.who.int/media/docs/default-source/2021-dha-docs/update-on-who-interim-recommendations-on-c-19-vaccination-for-pregnant-and-lactating-women-70-.pdf?sfvrsn=2c1d9ac8_1&download=true Date of Access: 7.7.2020.
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There are 40 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Ayşegül Kılıçlı 0000-0003-1105-9991

Emine Beyaz 0000-0002-1122-2317

Project Number YOKTUR
Early Pub Date December 27, 2023
Publication Date December 27, 2023
Submission Date October 23, 2022
Published in Issue Year 2023 Volume: 3 Issue: 3

Cite

APA Kılıçlı, A., & Beyaz, E. (2023). FEAR, AVOIDANCE ATTITUDES AND VACCINATION TOWARDS COVID-19 AND BREASTFEEDING SELF-EFFICACY OF MOTHERS WITH 0-6 MONTHS-OLD BABIES IN RURAL AREA. Muş Alparslan Üniversitesi Sağlık Bilimleri Dergisi, 3(3), 48-60.