Skip header and navigation

Refine By

13 records – page 1 of 2.

Adhesive capsulitis of the shoulder (frozen shoulder) produces bone loss in the affected humerus, but long-term bony recovery is good.

https://arctichealth.org/en/permalink/ahliterature205412
Source
Bone. 1998 Jun;22(6):691-4
Publication Type
Article
Date
Jun-1998
Author
J. Leppälä
P. Kannus
H. Sievänen
M. Järvinen
I. Vuori
Author Affiliation
Accident and Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
Source
Bone. 1998 Jun;22(6):691-4
Date
Jun-1998
Language
English
Publication Type
Article
Keywords
Aged
Bone Density - physiology
Bone Remodeling - physiology
Bursitis - complications - physiopathology - radiography
Female
Finland
Forearm - radiography
Humans
Humerus - physiopathology - radiography
Male
Middle Aged
Osteoporosis - etiology
Questionnaires
Radius - radiography
Shoulder Joint
Ulna - radiography
Abstract
The objective of the study was to assess the short- and long-term effects of adhesive capsulitis (frozen shoulder) on the bone mineral density (BMD) of the affected extremity. BMD and clinical status of 22 patients (group A) with active-phase unilateral adhesive capsulitis and 31 patients (group B) with a previous adhesive capsulitis (average 9 years before the examination) were determined. BMD was measured from the proximal humerus, humeral shaft, radial shaft, ulnar shaft, and distal forearm of both upper extremities using dual-energy X-ray absorptiometry (DXA). In group A, the mean BMD of the affected extremity, as compared with that of the unaffected side, was significantly lower in the proximal humerus (-5.6%; p = 0.001) and humeral shaft (-3.0%; p = 0.008). The radial shaft, ulnar shaft, and distal forearm showed no significant side-to-side differences. In contrast, in group B, the affected-to-unaffected side BMD differences were small and statistically insignificant. Compared with the 31 patients in group B, the relative side-to-side BMD difference of the 22 patients with active-phase disease (group A) was significantly lower in the proximal humerus (-5.6% vs. -1.5%, p = 0.009). In the other sites, groups A and B showed no significant differences. In conclusion, this study indicates that adhesive capsulitis of the shoulder results in significant bone loss in the humerus of the affected extremity, but in the long term, capsulitis-induced bone loss shows good recovery.
PubMed ID
9626410 View in PubMed
Less detail

Adolescence physical activity is associated with higher tibial pQCT bone values in adulthood after 28-years of follow-up--the Cardiovascular Risk in Young Finns Study.

https://arctichealth.org/en/permalink/ahliterature269110
Source
Bone. 2015 Jun;75:77-83
Publication Type
Article
Date
Jun-2015
Author
S. Tolonen
H. Sievänen
V. Mikkilä
R. Telama
M. Oikonen
M. Laaksonen
J. Viikari
M. Kähönen
O T Raitakari
Source
Bone. 2015 Jun;75:77-83
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Bone Density - physiology
Child
Child, Preschool
Cohort Studies
Female
Finland
Follow-Up Studies
Fractures, Bone - epidemiology
Humans
Life Style
Male
Middle Aged
Motor Activity - physiology
Odds Ratio
Prevalence
Tibia - growth & development - radiography
Tomography, X-Ray Computed
Young Adult
Abstract
High peak bone mass and strong bone phenotype are known to be partly explained by physical activity during growth but there are few prospective studies on this topic. In this 28-year follow-up of Cardiovascular Risk in Young Finns Study cohort, we assessed whether habitual childhood and adolescence physical activity or inactivity at the age of 3-18 years were associated with adult phenotype of weight-bearing tibia and the risk of low-energy fractures. Baseline physical activity and data on clinical, nutritional and lifestyle factors were assessed separately for females and males aged 3-6-years (N=395-421) and 9-18-years (N=923-965). At the age of 31-46-years, the prevalence of low-energy fractures was assessed with a questionnaire and several tibial traits were measured with pQCT (bone mineral content (BMC; mg), total and cortical cross-sectional areas (mm(2)), trabecular (for the distal site only) and cortical (for the shaft only) bone densities (mg/cm(3)), stress-strain index (SSI; mm(3), for the shaft only), bone strength index (BSI; mg(2)/cm(4), for the distal site only) and the cortical strength index (CSI, for the shaft only)). For the statistical analysis, each bone trait was categorized as below the cohort median or the median and above and the adjusted odds ratios (OR) were determined. In females, frequent physical activity at the age of 9-18-years was associated with higher adulthood values of BSI, total and cortical areas, BMC, CSI and SSI at the tibia independently of many health and lifestyle factors (ORs 0.33-0.53, P=0.05; P-values for trend 0.002-0.05). Cortical density at the tibial shaft showed the opposite trend (P-value for trend 0.03). Similarly in males, frequent physical activity was associated with higher values of adult total and cortical areas and CSI at the tibia (ORs 0.48-0.53, P=0.05; P-values for trend 0.01-0.02). However, there was no evidence that childhood or adolescence physical activity was associated with lower risk of low energy fractures during the follow-up. In conclusion, frequent habitual physical activity in adolescence seems to confer benefits on tibial bone size and geometry in adulthood.
PubMed ID
25697084 View in PubMed
Less detail

Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010.

https://arctichealth.org/en/permalink/ahliterature119371
Source
Osteoporos Int. 2013 May;24(5):1599-603
Publication Type
Article
Date
May-2013
Author
N. Korhonen
S. Niemi
J. Parkkari
H. Sievänen
M. Palvanen
P. Kannus
Author Affiliation
Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, P.O. Box 30, 33501 Tampere, Finland. njkorhon@student.uef.fi
Source
Osteoporos Int. 2013 May;24(5):1599-603
Date
May-2013
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Female
Finland - epidemiology
Hip Fractures - epidemiology
Humans
Incidence
Male
Middle Aged
Osteoporotic Fractures - epidemiology
Registries
Sex Distribution
Abstract
We determined the current trend in the number and incidence of hip fracture among persons 50 years of age or older in Finland between 1970 and 2010. After a clear rise until the late 1990s, the incidence of hip fracture has continuously declined.
Hip fractures are a major public health issue associated with excess morbidity and mortality. We determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined Caucasian population of 5.4 million people.
We took into account all persons 50 years of age or older who were admitted to hospitals for primary treatment of hip fracture between 1970 and 2010.
The number of hip fractures rose sharply till the end of 1990s (from 1,857 in 1970 to 7,122 in 1997), but since then, the rise has leveled off (7,594 fractures in 2010). Similarly, the age-adjusted incidence of hip fracture increased until 1997 but declined thereafter. The decline was especially clear in women whose age-adjusted incidence was 515.7 (per 100,000 persons) in 1997 but only 382.6 in 2010. In men, the corresponding incidence was 245.3 in 1997 and 210.7 in 2010. The number of hip fractures will increase 1.8-fold by 2030 even with the current 2010 incidence rates because the size of the 50-year-old or older population is likely to increase sharply in the near future.
The declining trend in the incidence of hip fracture in Finland has continued through the entire first decade of the new millennium. Reasons for this development are uncertain, but possible explanations include increased average body weight, improved functional ability among elderly Finns, and specific measures to prevent bone loss and reduce the risk of falling.
PubMed ID
23108781 View in PubMed
Less detail

Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006.

https://arctichealth.org/en/permalink/ahliterature157192
Source
Osteoporos Int. 2009 Jan;20(1):43-6
Publication Type
Article
Date
Jan-2009
Author
P. Kannus
S. Niemi
J. Parkkari
H. Sievänen
M. Palvanen
Author Affiliation
Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland. Pekka.Kannus@uta.fi
Source
Osteoporos Int. 2009 Jan;20(1):43-6
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Aged
Female
Finland - epidemiology
Fractures, Bone - epidemiology - etiology
Humans
Incidence
Knee Injuries - epidemiology - etiology
Middle Aged
Osteoporosis, Postmenopausal - complications - epidemiology
Abstract
The study assessed the recent secular trend in the incidence of low-trauma knee fractures among older Finns in the years 1970-2006. The clear rise in women's fracture incidence from early 1970s until the late 1990s was followed by a declining fracture rate. Exact reasons for the decline are unknown, but a cohort effect toward a healthier female population with improved functionality and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.
Although low-trauma fractures of elderly adults have been recognized as a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is sparse.
We determined the current trend in the number and incidence (per 100,000 persons) of low-trauma knee fractures among elderly people in Finland, an EU country with a well-defined white population of 5.3 million, by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fractures from 1970 to 2006.
The number and incidence of low-trauma knee fractures among 60-year-old or older Finnish women sharply rose between 1970 and 1997, from 218 (number) and 55 (incidence) in 1970 to 733 and 124 in 1997. However, thereafter both the number and incidence of fractures have continuously declined so that there were only 626 fractures in these women in 2006 (incidence 94). In the age-adjusted fracture incidence, the findings were similar. During 1970-1997, the age-adjusted incidence of low-trauma knee fractures in our elderly women clearly rose (from 60 to 118), but thereafter, this incidence declined to 85 in 2006. In men, the fracture incidence did not show consistent trend changes over time (30 in 1970 and 36 in 2006).
The sharp rise in the incidence of low-trauma knee fractures in Finnish elderly women from early 1970s until late 1990s has been followed by a declining fracture rate. Exact reasons for this are unknown, but a cohort effect toward a healthier aging female population with improved functional ability and reduced risk of injurious slips, trips and falls cannot be excluded.
PubMed ID
18478311 View in PubMed
Less detail

Determinants of bone mineralization in 8 to 20 year old Finnish females.

https://arctichealth.org/en/permalink/ahliterature210272
Source
Eur J Clin Nutr. 1997 Jan;51(1):54-9
Publication Type
Article
Date
Jan-1997
Author
K. Uusi-Rasi
H. Haapasalo
P. Kannus
M. Pasanen
H. Sievänen
P. Oja
I. Vuori
Author Affiliation
UKK Institute for Health Promotion Research, Tampere, Finland.
Source
Eur J Clin Nutr. 1997 Jan;51(1):54-9
Date
Jan-1997
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Adolescent
Adult
Aging
Anthropometry
Body Weight
Calcification, Physiologic
Calcium - administration & dosage
Child
Cross-Sectional Studies
Exercise
Female
Finland
Humans
Menstruation
Muscles - physiology
Puberty
Abstract
To study the determinants of bone mass and density in Finnish girls and young women.
A cross-sectional study.
One hundred and seventy six 8 to 20 year old female volunteers living in the city of Tampere, Finland.
Calcium intake was estimated from a 7 d calcium intake diary (CaD). Bone mineral content (BMC) and areal density (BMD) were measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, femoral neck and distal radius. Volumetric bone mineral apparent density (BMAD) was estimated from these DXA data. In addition, anthropometric characteristics, isometric muscle strength, and the Tanner stage were determined. Menstrual status and physical activity level were assessed by a questionnaire and personal interview.
Body weight and Tanner stage were the most important determinants of BMC and BMD. Physical activity was the only not growth-related factor associated with BMC, BMD and BMAD. Therefore, it was examined in detail between the PA and NA groups. Site-specific benefits varied from 5-7% for the BMC (lumbar spine and radius) and BMD (lumbar spine and femoral neck) and was about 5% for the BMAD (femoral neck).
Body weight seems to be the most important determinant of the BMC and BMD of growing Finnish girls, but during puberty exercise may beneficially affect BMD at the loaded skeletal sites. Exercise may increase femoral BMAD during peripubertal years. There was no association between calcium intake and the bone variables, but the high level so calcium intake in all age groups of the study was likely to explain the lack of association.
PubMed ID
9023468 View in PubMed
Less detail

Effect of long-term unilateral activity on bone mineral density of female junior tennis players.

https://arctichealth.org/en/permalink/ahliterature206338
Source
J Bone Miner Res. 1998 Feb;13(2):310-9
Publication Type
Article
Date
Feb-1998
Author
H. Haapasalo
P. Kannus
H. Sievänen
M. Pasanen
K. Uusi-Rasi
A. Heinonen
P. Oja
I. Vuori
Author Affiliation
Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland.
Source
J Bone Miner Res. 1998 Feb;13(2):310-9
Date
Feb-1998
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Adolescent
Anthropometry
Biomechanical Phenomena
Bone Density - physiology
Bone Development - physiology
Child
Cross-Sectional Studies
Female
Finland
Hand Strength
Humans
Humerus - physiology
Lumbar Vertebrae - physiology
Physical Endurance
Radius - physiology
Regression Analysis
Tennis
Abstract
High peak bone mass in early adulthood is an important protective factor against osteoporotic fractures in later life, but little is known about the effects of exercise on growing bone. The purpose of this cross-sectional study was to determine at which state of maturity (Tanner stage), the areal bone mineral density (BMD) differences between the playing and nonplaying arms of junior tennis players become obvious, and to clarify in each developmental stage which training and background variables, if any, could explain the interindividual differences in bones' response to mechanical loading. Ninety-one 7- to 17-year-old female tennis players and 58 healthy female controls were measured. In each Tanner stage, differences in BMD in playing and nonplaying (dominant and nondominant) arms (proximal humerus, humeral shaft, and distal radius) and BMD of the lumbar spine and nondominant distal radius were compared between the controls and players. Within each Tanner stage of players, the associations between training and background variables and BMD differences were analyzed with Spearman rank correlation coefficients. In players, BMD differences between the playing and nonplaying arms were significant (P
PubMed ID
9495526 View in PubMed
Less detail

Effect of two training regimens on bone mineral density in healthy perimenopausal women: a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature206155
Source
J Bone Miner Res. 1998 Mar;13(3):483-90
Publication Type
Article
Date
Mar-1998
Author
A. Heinonen
P. Oja
H. Sievänen
M. Pasanen
I. Vuori
Author Affiliation
UKK Institute for Health Promotion Research, Tampere, Finland.
Source
J Bone Miner Res. 1998 Mar;13(3):483-90
Date
Mar-1998
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Bone Density - physiology
Calcaneus - radiography
Calcium, Dietary - administration & dosage
Female
Femur Neck - radiography
Finland
Gymnastics
Humans
Longitudinal Studies
Lumbar vertebrae - radiography
Middle Aged
Patient compliance
Physical Endurance
Premenopause - physiology
Questionnaires
Radius - radiography
Abstract
The aim of this randomized controlled trial was to evaluate the effects of 18 months of calisthenics and endurance training regimens on bone mineral density (BMD) in perimenopausal women. Clinically healthy sedentary female volunteers (n = 105) aged 52-53 years were randomly assigned to a calisthenics (n = 36), endurance (n = 34), or control (n = 35) group. The calisthenics training (2.6 times per week on average, 50 minutes per session) consisted of rhythmic strength-endurance exercises by large muscle groups, and the endurance training (3.2 times per week, 50 minutes) consisted of walking, stair climbing, ergometer cycling, and jogging at a controlled heart rate zone corresponding to 55-75% of the individual maximal oxygen uptake (VO2max) of the subjects. The control subjects performed a light stretching program once a week The BMD of the lumbar spine (L2-L4), right femoral neck, calcaneus, and distal radius was measured by dual-energy X-ray absorptiometry at 0, 4, 8, 10, 14, and 18 months, and the maximal isometric strength during trunk extension and flexion, leg extension, and arm flexion and the VO2max by ergospirometry were evaluated at 0, 8, 10, and 18 months of intervention. The VO2max improved significantly (p = 0.021) in the endurance group. The linear trend of the femoral neck BMD in the endurance group, as determined by generalized linear models, was significantly different (p = 0.043) from that of the control group, the trend indicating a maintenance of the prestudy BMD. In the calisthenics group, the training effect was not significant. However, the distal radius BMD of the endurance group showed a significant negative trend (p = 0.006). These results suggest that multiexercise endurance training maintains the BMD the clinically important femoral neck of perimenopausal women. This form of endurance training proved also to be feasible for healthy perimenopausal women.
PubMed ID
9525349 View in PubMed
Less detail

Evaluation of a model for prediction of lumbar bone mineral density.

https://arctichealth.org/en/permalink/ahliterature223320
Source
Bone Miner. 1992 Aug;18(2):153-8
Publication Type
Article
Date
Aug-1992
Author
H. Sievänen
P. Kannus
P. Oja
I. Vuori
Author Affiliation
UKK Institute for Health Promotion Research, Tampere, Finland.
Source
Bone Miner. 1992 Aug;18(2):153-8
Date
Aug-1992
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Adult
Analysis of Variance
Bone Density
Female
Finland
Humans
Lumbar Vertebrae
Menopause
Middle Aged
Models, Biological
Abstract
A mathematical model with adequate clinical accuracy would be useful for predicting life-long bone mass behaviour in various skeletal sites. We have tested the performance of a multivariate nonlinear model, recently developed by an Italian research group for predicting lumbar bone mass and density, in a sample of 239 pre- or post-menopausal healthy Finnish women whose lumbar bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry. The model, which was based on height, weight, body mass index, age and years since menopause, predicted poorly (R-squared = 0.14) the measured BMD. Furthermore, it compressed strongly the actual variation of the BMD values resulting in a considerable overestimation or underestimation (about 30%) of low or high BMD values, respectively. Our results indicated that the predictive value of a simple model is not clinically acceptable and therefore the usefulness of this kind of model remains questionable.
PubMed ID
1525596 View in PubMed
Less detail

Factors predicting dynamic balance and quality of life in home-dwelling elderly women.

https://arctichealth.org/en/permalink/ahliterature49630
Source
Gerontology. 2005 Mar-Apr;51(2):116-21
Publication Type
Article
Author
S. Karinkanta
A. Heinonen
H. Sievanen
K. Uusi-Rasi
P. Kannus
Author Affiliation
UKK Institute for Health Promotion Research, Tampere, Finland. saija.karinkanta@uta.fi
Source
Gerontology. 2005 Mar-Apr;51(2):116-21
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Aged
Cohort Studies
Cross-Sectional Studies
Female
Humans
Muscle, Skeletal - physiology
Musculoskeletal Equilibrium
Quality of Life
Questionnaires
Research Support, Non-U.S. Gov't
Risk factors
Abstract
BACKGROUND: Proper balance seems to be a critical factor in terms of fall prevention among the elderly. OBJECTIVE: The purpose of this cross-sectional study was to examine factors that are associated with dynamic balance and health-related quality of life in home-dwelling elderly women. METHODS: One hundred and fifty-three healthy postmenopausal women (mean age: 72 years, height: 159 cm, weight: 72 kg) were examined. General health and physical activity were assessed by a questionnaire. Quality of life was measured using a health-related quality of life questionnaire (Rand 36-Item Health Survey 1.0). Dynamic balance (agility) was tested by a figure-of-eight running test. Static balance (postural sway) was tested on an unstable platform. Maximal isometric strength of the leg extensors was measured with a leg press dynamometer. Dynamic muscle strength of lower limbs was tested by measuring ground reaction forces with a force platform during common daily activities (sit-to-stand and step-on-a-stair tests). RESULTS: Concerning physical activity, 33% of the subjects reported brisk exercise (walking, Nordic walking, cross-country skiing, swimming and aquatic exercises) at least twice a week, and 22% some kind of brisk activity once a week in addition to lighter physical exercise. The remaining 45% did not exercise regularly and were classified as sedentary. The correlations of step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength to dynamic balance were from -0.32 to -0.43 (the better the strength, the better the balance). In the regression analysis with backward elimination, step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength, age, brisk physical activity, number of diseases and dynamic postural stability explained 42% of the variance in the dynamic balance. Similarly, dynamic balance (figure-of-eight running time), number of diseases and walking more than 3 km per day explained 14% of the variance in the quality of life score. Of these, figure-of-eight running time was the strongest predictor of the quality of life score, explaining 9% of its variance. CONCLUSION: This study emphasizes the concept that in home-dwelling elderly women good muscle strength in lower limbs is crucial for proper body balance and that dynamic balance is an independent predictor of a standardized quality of life estimate. The results provide important and useful information when planning meaningful contents for studies related to fall prevention and quality of life and interventions in elderly women.
PubMed ID
15711078 View in PubMed
Less detail

Kids Out; evaluation of a brief multimodal cluster randomized intervention integrated in health education lessons to increase physical activity and reduce sedentary behavior among eighth graders.

https://arctichealth.org/en/permalink/ahliterature300892
Source
BMC Public Health. 2019 Apr 17; 19(1):415
Publication Type
Journal Article
Randomized Controlled Trial
Date
Apr-17-2019
Author
M Aittasalo
A-M Jussila
K Tokola
H Sievänen
H Vähä-Ypyä
T Vasankari
Author Affiliation
UKK Institute for Health Promotion Research, PO Box 30, 33501, Tampere, Finland. minna.aittasalo@ukkinstituutti.fi.
Source
BMC Public Health. 2019 Apr 17; 19(1):415
Date
Apr-17-2019
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adolescent
Adolescent Behavior
Exercise
Female
Finland
Health Education - methods
Health Promotion - methods
Humans
Male
Motor Activity
Pediatric Obesity - prevention & control
School Health Services - organization & administration
Sedentary Behavior
Students - psychology
Surveys and Questionnaires
Abstract
Most Finnish adolescents are not sufficiently physically active. Health education (HE) provides beneficial starting point for physical activity (PA) promotion in schools. This study evaluates an intervention integrated into three HE lessons to increase PA and reduce sedentary behavior (SB) among eighth graders.
All public secondary schools in Tampere, Finland participated and were randomized to intervention (INT, n?=?7) and comparison group (COM, n?=?7). In INT (690 students, 36 classes) the teachers (n?=?14) implemented behavioral theory-driven content during three HE lessons. In COM (860 students, 41 classes) the teachers (n?=?14) carried out standard lessons. The evaluation was based on RE-AIM: Effectiveness was assessed from baseline to 4?weeks (Follow-up 1) and Maintenance from 4?weeks to 7?months (Follow-up 2) with change in students' PA and SB and related psychosocial and parental factors. Methods included questionnaire, accelerometer and activity diary. Linear mixed models with baseline adjustments and random effect correction were used to compare the difference in change between INT and COM. Data on Reach, Adoption and Implementation were collected during the process.
Intervention effects were only seen in the self-reported data favoring INT in the weekly number of days with at least 1?h of brisk leisure PA (0.3 [95%CI 0.1 to 0.6]), proportion of students meeting PA recommendations (4.1 [95%CI 2.5 to 5.7]), proportion of students reporting that their family sets limitations for screen time (5.4 [95%CI 3.3 to 7.4]) and in the number of days on which the students intended to do leisure PA in the following week (0.3 [95%CI 0.1 to 0.6]). The effects on PA were still beneficial for INT at Follow-up 2. The intervention reached 96% of the students, was adopted in all 7 schools and was implemented by 13/14 teachers in 35/36 classes.
The intervention was feasible and had small favorable effects on students' self-reported PA, intention to do PA and family norm in screen time. The effects on PA persisted until Follow-up 2. It is likely that for greater impacts the HE lessons should have been supported with other actions without compromising feasibility.
NCT01633918 (June 27th, 2012).
PubMed ID
30995905 View in PubMed
Less detail

13 records – page 1 of 2.