1
|
Tsheten T, Chateau D, Dorji N, Pokhrel HP, Clements AC, Gray DJ, Wangdi K. Impact of COVID-19 on mental health in Bhutan: a way forward for action. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 11:100179. [PMID: 37020787 PMCID: PMC10008798 DOI: 10.1016/j.lansea.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan's government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community.
Collapse
Affiliation(s)
- Tsheten Tsheten
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- Royal Centre for Disease Control, Ministry of Health, Bhutan
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Nima Dorji
- Punakha District Hospital, Ministry of Health, Bhutan
| | | | - Archie C.A. Clements
- Telethon Kids Institute, Nedlands, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - Darren J. Gray
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kinley Wangdi
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
2
|
Gyeltshen K, Phuntsho S, Wangdi K. Knowledge, Attitude, and Practice towards COVID-19 among Patients Attending Phuentsholing Hospital, Bhutan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2942. [PMID: 36833636 PMCID: PMC9957525 DOI: 10.3390/ijerph20042942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Bhutan is one of the few countries in the world to take unprecedented steps to control the spread of COVID-19 in the country. This study aimed to investigate knowledge, attitude, and practice (KAP) and their associated covariates among patients attending Phuentsholing Hospital, Bhutan. Therefore, a cross-sectional study was conducted among patients attending Phuentsholing Hospital in Bhutan between March 17 and April 9, 2021, using an interview-administered questionnaire. The multivariable logistic regression was used to identify statistically significant covariates of good KAP. Further, the association between levels of KAP scores was assessed using Pearson's correlation coefficient. Of the 441 participants, 54.6% (241) were female. Knowledge, attitude, and practice score were reported by 55.3%, 51.8%, and 83.7% of participants, respectively. Higher education, secondary education, monastic education, and non-formal education were 9 [adjusted odds ratio (AOR) = 9.23; 95% confidence interval (CI) 3.438, 24.797], 3.5 (AOR = 3.5; 95% CI 1.425, 8.619), and 4 (AOR = 3.8; 95% CI 1.199, 12.141) times more likely to report good knowledge than illiterates. A positive attitude was associated with higher (AOR = 2.97; 95% CI 1.154, 7.66) and secondary (AOR = 3.53; 95% CI 1.454, 8.55) education compared to illiteracy. The good practice was associated with higher (AOR = 12.31; 95% CI 2.952, 51.318) and secondary (AOR = 11.5; 95% CI 3.439, 38.476) education compared to illiteracy. Participants in the age groups 26-35 years (AOR = 0.11; 95% CI 0.026, 0.484) and >45 years (AOR = 0.12; 95% CI 0.026, 0.588) were less likely to exhibit good practice compared to those aged 18-25 years. Those working in the private or business sectors were 9 (AOR = 8.81; 95% CI 1.165, 41.455) times more likely to have good practice compared to civil servants. There was a weak but positive correlation between knowledge-attitude (r = 0.228), knowledge-practice (r = 0.220), and attitude-practice scores (r = 0.338). The need for health education on COVID-19 to increase knowledge and attitude is highly recommended, and should be focused on the less educated and other vulnerable groups such as farmers and students, as well as those older than 25 years.
Collapse
Affiliation(s)
| | | | - Kinley Wangdi
- Department of Global Health, National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Acton, Canberra, ACT 2602, Australia
| |
Collapse
|
3
|
Patil SV, Bhadake M, Acharya A. ‘Dengue-COVID-19 overlap’: Is it an ‘antigenic mimicry’ or coexistent two different viral genotypic diseases? Prospective, observational study in tertiary care setting in India. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
4
|
Chejor P, Letho Z. Role of Hospital Drivers During the COVID-19 Pandemic in National Referral Hospital, Bhutan. Asia Pac J Public Health 2022; 34:735-736. [PMID: 35730489 DOI: 10.1177/10105395221108590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, WA, Australia
| | - Zimba Letho
- Medical Education and Research Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| |
Collapse
|
5
|
Downey LE, Gadsden T, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for endemic infectious diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2022; 1:100011. [PMID: 35769109 PMCID: PMC9069250 DOI: 10.1016/j.lansea.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. Methods We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR. Findings A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries. Interpretation We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Funding This work was supported by the WHO Sri Lanka Country office.
Collapse
|
6
|
Lhendup K, Tsheten T, Rinzin T, Wangdi K. Risk Factors of Symptomatic COVID-19 in Samtse District, Bhutan. Front Public Health 2022; 10:857084. [PMID: 35586007 PMCID: PMC9108283 DOI: 10.3389/fpubh.2022.857084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/01/2022] [Indexed: 12/29/2022] Open
Abstract
IntroductionAll Coronavirus disease 2019 (COVID-19) positive cases in Samtse District, Bhutan were isolated in the isolation facilities managed by the government hospitals. This study aimed to identify the socio-demographic risk factors for developing COVID-19 symptoms amongst these patients.Methods and MaterialsA secondary data of the COVID-19 positive cases from isolation facilities of Samtse District from 5 May to 7 September 2021 was used for this study. Survival analysis was carried out to estimate the cumulative probability of symptom onset time by each risk factor. Kaplan–Meier curves were used to estimate the probabilities for the onset of symptoms at different time points and a log-rank test was employed to assess the differences between covariates.ResultsA total of 449 patients were included, of which 55.2% were males and 73.3% (328) were aged >18 years. The mean age was 42 years with a range of 3 months to 83 years. Forty-seven percent (213) reported at least one symptom. Common symptoms were fever (32.3%, 145), headache (31.6%, 142), and cough (30.1%, 135), respectively. Males were 64% less likely to be symptomatic than females [adjusted hazard ratio (aHR) = 0.36, 95% confidence interval (CI) 0.183–0.917]. Farmers (aHR = 3.17, 95% CI 1.119–8.953), and drivers and loaders (aHR = 3.18, 95% CI 1.029–9.834) were 3 times more likely to be symptomatic compared to housewives. Residents of Samtse sub-districts were 5 times more likely to be symptomatic than those living in other sub-districts (aHR = 5.16, 95% CI 2.362–11.254).ConclusionThe risk of developing COVID-19 symptoms was being fe male, farmers, drivers and loaders, and residents of the Samtse sub-district. These high-risk groups should be provided additional care when in isolation facilities.
Collapse
Affiliation(s)
- Karma Lhendup
- Samtse General Hospital, Samtse, Bhutan
- *Correspondence: Karma Lhendup
| | - Tsheten Tsheten
- Department of Global Health, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | | | - Kinley Wangdi
- Department of Global Health, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
7
|
Tsheten T, Tenzin P, Clements ACA, Gray DJ, Ugyel L, Wangdi K. The COVID-19 vaccination campaign in Bhutan: strategy and enablers. Infect Dis Poverty 2022; 11:6. [PMID: 34986883 PMCID: PMC8727980 DOI: 10.1186/s40249-021-00929-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15, 2021. With support from India, the United States, Denmark, the People's Republic of China, Croatia and other countries, Bhutan was able to conduct two rounds of nationwide vaccination campaign. While many countries struggle to overcome vaccine refusal or hesitancy due to complacency, a lack of trust, inconvenience and fear, escalated in some countries by anti-vaccine groups, Bhutan managed to inoculate more than 95% of its eligible populations in two rounds of vaccination campaign. Enabling factors of this successful vaccination campaign were strong national leadership, a well-coordinated national preparedness plan, and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures, volunteers and local leaders. In this short report, we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.
Collapse
Affiliation(s)
- Tsheten Tsheten
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia. .,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Phurpa Tenzin
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Curtin University, Perth, Australia
| | - Darren J Gray
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Lhawang Ugyel
- School of Business, University of New South Wales, Canberra, ACT, Australia
| | - Kinley Wangdi
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia
| |
Collapse
|
8
|
Sheng ZY, Li M, Yang R, Liu YH, Yin XX, Mao JR, Brown HE, Zhou HN, Wang PG, An J. COVID-19 prevention measures reduce dengue spread in Yunnan Province, China, but do not reduce established outbreak. Emerg Microbes Infect 2021; 11:240-249. [PMID: 34935597 PMCID: PMC8745368 DOI: 10.1080/22221751.2021.2022438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic and measures against it provided a unique opportunity to understand the transmission of other infectious diseases and to evaluate the efficacy of COVID-19 prevention measures on them. Here we show a dengue epidemic in Yunnan, China, during the pandemic of COVID-19 was dramatically reduced compared to non-pandemic years and, importantly, spread was confined to only one city, Ruili. Three key features characterized this dengue outbreak: (i) the urban-to-suburban spread was efficiently blocked; (ii) the scale of epidemic in urban region was less affected; (iii) co-circulation of multiple strains was attenuated. These results suggested that countermeasures taken during COVID-19 pandemic are efficient to prevent dengue transmission between cities and from urban to suburban, as well to reduce the co-circulation of multiple serotypes or genotypes. Nevertheless, as revealed by the spatial analysis, once the dengue outbreak was established, its distribution was very stable and resistant to measures against COVID-19, implying the possibility to develop a precise prediction method.
Collapse
Affiliation(s)
- Z Y Sheng
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - M Li
- Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases, Simao Pu'er, Yunnan, PR China
| | - R Yang
- Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases, Simao Pu'er, Yunnan, PR China
| | - Y H Liu
- Ruili Center of Disease Prevention and Control, Ruili, Yunnan, PR China
| | - X X Yin
- Ruili Center of Disease Prevention and Control, Ruili, Yunnan, PR China
| | - J R Mao
- Ruili People's Hospital, Ruili, Yunnan, PR China
| | - Heidi E Brown
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona
| | - H N Zhou
- Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases, Simao Pu'er, Yunnan, PR China
| | - P G Wang
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - J An
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
9
|
Dorji T, Wangmo K, Yezer, Wangchuk T, Tshokey, Wangdi K. Knowledge, Attitude, and Practice Toward COVID-19 Among Sherubtse College Students in Bhutan: A Web-Based Cross-Sectional Study. Front Public Health 2021; 9:721493. [PMID: 34869145 PMCID: PMC8637861 DOI: 10.3389/fpubh.2021.721493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
Bhutan has reopened schools and colleges after an initial closure to contain coronavirus disease 2019 (COVID-19) transmission. However, the risk of transmissions is higher in the schools and colleges due to crowding. Therefore, this study aimed to assess the level of knowledge, attitude, and practice (KAP) toward COVID-19 among the students of Sherubtse College in Bhutan. A cross-sectional study using a questionnaire was conducted in September 2020 among the students of Sherubtse College, Bhutan. The questionnaire was made in the Google Forms and administered through a social forum WeChat app. The KAP scores were calculated that include mean scores. The association between the KAP was assessed using the Pearson's correlation coefficient. A total of 613 students participated in the survey. The majority of the participants (57%) were female and 56% were from the third year. The mean knowledge score was 10.7 (SD = 1.7; range 0–14), mean attitude score of 3.67 (SD = 1.0; range: 0–5), and mean practice score of 5.19 (SD = range: 0–6). A majority of the students had good knowledge (98%) and practice (93.5%) scores, and a positive attitude (86.6%) toward COVID-19. A positive but weak correlation between good knowledge and practice (r = 0.1, p = 0.0126) was observed. Having a positive attitude led to practicing appropriately most of the time (r = 0.1866, p < 0.001). The students had good KAP scores and followed the COVID-19 prevention protocols advocated by the government. Good knowledge and a positive attitude were translated into good practice. Therefore, the education campaign of the Bhutan government seems to be effective in the students.
Collapse
Affiliation(s)
| | - Karma Wangmo
- Regional Livestock Development Centre, Kanglung, Bhutan
| | - Yezer
- Sherubtse College, Royal University of Bhutan, Trashigang, Bhutan
| | | | - Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
10
|
Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Wangdi K. Clinical features and outcomes of COVID-19 and dengue co-infection: a systematic review. BMC Infect Dis 2021; 21:729. [PMID: 34340682 PMCID: PMC8327042 DOI: 10.1186/s12879-021-06409-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dengue is the most common arboviral disease in the tropical and sub-tropical regions of the world. Like other regions, dengue-endemic areas have faced the additional public health and socio-economic impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic. COVID-19 and dengue co-infections have been reported, with complicated patient management and care requirements. This review aimed to collate and synthesise current knowledge on the clinical features and outcomes of COVID-19 and dengue virus co-infection, a potentially important new dimension to be considered in public health management of the COVID-19 pandemic. METHODS A systematic literature review was conducted using PubMed, Web of Science and Scopus databases from 1st January to 21st November 2020. The key search terms used were "dengue" and "coronavirus". Descriptive analysis with graphical illustrations were used to present the clinical and laboratory parameters of the co-infection. RESULTS Thirteen published papers and four news articles were included in the review. Most studies were case reports with a detailed description of the clinical and laboratory characteristics of the co-infection. All cases were in adults with the exception of a six-year old child. The common symptoms of co-infection were fever, dyspnea, headache, and cough. Common laboratory results included thrombocytopenia, lymphocytopenia, elevated transaminases, and leukopenia. Serious outcomes of co-infection included septic shock, acute respiratory disease syndrome and multi-organ failure, leading to death in some patients. CONCLUSIONS COVID-19 and dengue co-infection was associated with severe disease and fatal outcomes. The correct diagnosis and treatment of co-infection poses a substantial challenge due to the overlapping clinical and laboratory parameters. Therefore, confirmative diagnostic tests are necessary for accurate and timely diagnosis and patient management.
Collapse
Affiliation(s)
- Tsheten Tsheten
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | | | - Darren J. Gray
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ripon K. Adhikary
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kinley Wangdi
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Societal lockdowns in response to the COVID-19 pandemic have led to unprecedented disruption to daily life across the globe. A collateral effect of these lockdowns may be a change to transmission dynamics of a wide range of infectious diseases that are all highly dependent on rates of contact between humans. With timing, duration and intensity of lockdowns varying country-to-country, the wave of lockdowns in 2020 present a unique opportunity to observe how changes in human contact rates, disease control and surveillance affect dengue virus transmission in a global natural experiment. We explore the theoretical basis for the impact of lockdowns on dengue transmission and surveillance then summarise the current evidence base from country reports. RECENT FINDINGS We find considerable variation in the intensity of dengue epidemics reported so far in 2020 with some countries experiencing historic low levels of transmission while others are seeing record outbreaks. Despite many studies warning of the risks of lockdown for dengue transmission, few empirically quantify the impact and issues such as the specific timing of the lockdowns and multi-annual cycles of dengue are not accounted for. In the few studies where such issues have been accounted for, the impact of lockdowns on dengue appears to be limited. SUMMARY Studying the impact of lockdowns on dengue transmission is important both in how we deal with the immediate COVID-19 and dengue crisis, but also over the coming years in the post-pandemic recovery period. It is clear lockdowns have had very different impacts in different settings. Further analyses might ultimately allow this unique natural experiment to provide insights into how to better control dengue that will ultimately lead to better long-term control.
Collapse
Affiliation(s)
- Oliver Brady
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|