Objectives. The first aim was to examine the effects of secondary prevention with a focus on determinants in the risk of recurrent coronary heart disease (CHD). The second aim was to analyse the effects of a cognitive behavioural therapy (CBT) intervention on the risk of recurrent cardiovascular disease (CVD) and to investigate the psychosocial situation of CHD patients. Material and methods. Papers I and II were based on the Swedish Acute Myocardial Infarction Statistics Register, 1969 to 2001: 775,901 events in 589,341 subjects. Papers III and IV were based on The Secondary Prevention in Uppsala Primary Care project (SUPRIM), a randomized controlled clinical trial in 362 CHD patients. Results. The risk of a recurrent acute myocardial infarction (AMI) event was highly dependent on time from the previous event, with the greatest risk immediately after an AMI event. In addition, sex, age, and AMI number influenced the general risk level. Furthermore, there has been a major decline in recurrence risk over 30 years, and there were considerable geographical differences in risk, best explained by residential area population density, with a high recurrent AMI risk in areas with the lowest and the highest population densities, and the lowest risk in areas with moderate population density. Disease status and sex were determinants of psychological well-being the first year after a CHD event. Sex seemed to be the stronger determinant. The CBT intervention focused on stress management during one year in patients with CHD.  There was significantly improved outcome in the intervention group on recurrent CVD and recurrent AMI during a 9 year follow up. A dose-response relationship was demonstrated between attendance rate at intervention group meetings and outcome, the higher the attendance rate the better the outcome. Conclusions. The risk of a recurrent AMI event was dependent on time from the previous event, with major improvement seen in recent decades. Regional differences were best explained by population density. Female CHD patients were at high risk concerning well-being after a coronary event, which deserves special attention. The CBT intervention for CHD patients improved outcomes concerning the risk of recurrent CVD and AMI events.

Bakgrunden till studien bygger på ett samarbete mellan sjukgymnastprogrammet på Mälardalens högskola och ett sjukhus i Sörmlands läns landsting. Syftet var att utvärdera om behandling bestående av fyra veckors KOL-skola haft effekt på patienternas hälsa, välbefinnande och fysiska kapacitet. KOL-skolan bestod utav fyra tillfällen under vilka olika vårdprofessioner gav patienterna information om bl.a. symptompåverkan, känslomässiga upplevelser och vikten av fysisk aktivitet. Det var tio patienter med kronisk obstruktiv lungsjukdom (KOL) i stadium två till fyra som deltog i interventionen. Utvärderingsinstrument som användes var The St George’s Respiratory Questionnaire och sex minuters gångtest. Resultaten visade att ingen signifikant skillnad i enkäten eller sex minuters gångtest förelåg efter intervention för gruppen. Tidigare forskning har visat att de psykosociala faktorerna har en stor inverkan på patienter med KOL och deras välbefinnande. Författarna anser därför att framtida forskning och verksamhetsutveckling bör utforma behandlingsstrategier för patienter med KOL utifrån den biopsykosociala modellen. / The background of this study is based on a cooperation between the physiotherapy program at Mälardalen University and a hospital in the county of Södermanland. The aim of the study was to evaluate whether a four week treatment of COPD-school have had an impact on patient health, well being and physical capacity. The COPD-school consisted of four occasions in which different health care professionals gave patients information on subjects including; symptom impact, emotional experiences and the importance of physical activity. There were ten patients with chronic obstructive pulmonary disease (COPD) in stage two to four who participated in the intervention. The instruments for evaluation that were used were The St. George's Respiratory Questionnaire and six minute walk test. The results showed no significant difference in the survey or six minute walk test for the group after the intervention. Previous research has shown that psychosocial factors have a profound effect on patients with COPD and their wellbeing. The authors therefore believe that future research should focus on designing treatment for patients with COPD based on the biopsychosocial model.

Darbo tikslas: įvertinti psichologinių ir socialinių darbo sąlygų ir jūrininkų fizines ir psichologine sveikatos sutrikimu sąsajas . Tyrimo metodai: duomenys buvo surinkti vienmomentinės anketinės apklausos būdu, ištyrus 370 Klaipėdos jūrininkų ligoninėje dėl privalomojo sveikatos patikrinimo besikreipiančius jūrininkus. Anoniminės anketinės apklausos būdu, naudojantis norvegų pasiūlytu Negatyvaus elgesio darbe klausimynu, buvo surinkta informacija apie jūrininkų patiriamo negatyvaus elgesio darbe formas, trukmę. Tiriamieji informavos apie diagnozuotus sveikatos sutrikimus. Tirta jūrininkų vidinė darna, potrauminio streso sutrikimo simptomai, minimalūs psichikos sveikatos sutrikimai. Tyrimo duomenys buvo analizuojami statistiškai, taikant SPSS 13,0 for Windows programą. Apskaičiuotas Spirmano koreliacijos koeficientas tikslu įvertinti jūrininkų patiriamo psichologinio teroro darbe sąsajas su gydytojo diagnozuotais fizinės sveikatos sutrikimais bei psichologinės sveikatos rodmenimis. Rezultatai: bent vieną negatyvaus elgesio aktą per 6 mėnesius patyrė 75 proc. jūrininkų savo darbe, 25 proc. jūrininkų nepatyrė nė vieno negatyvaus elgesio akto. Dažno psichologinio teroro jūrininkų darbe paplitimas siekė 3,8 proc., atsitiktinio – 10,1 proc. 2,3 proc. jūrininkų nurodė, kad labai jaučia stresą darbe. Stebėtos statistiškai reikšmingos sąsajos tarp jūrininkų patiriamo psichologinio teroro darbe ir arterinės hipertenzijos (r =0,154), kaklo/peties skausmų (r =0,138), migrenos (r =0,15... [toliau žr. visą tekstą] / Aims of the study–to evaluate the associations between psychological terror in the workplace and adverse health outcomes. Methods. totally 370 seafarers, attending the mandatory health examination in the Marine health care centre. The Lithuanian version of the Norwegian Negative Acts Questionnaire was used for the investigation of the prevalence and duration of negative acts among seafarers. The investigated seafarers were asked about diagnosed by the physician health outcomes over the last twelve months. The questionnaires on the sense of coherence, post-traumatic stress disorder and minor psychological disorders (psychological distress) were distributed as well. The statistical software SPSS 13.0 for Windows was used in the statistical analysis. The associations between psychological terror in the workplace and adverse health outcomes were evaluated by Spirman’s correlation coefficient. Results. 75.0% of the investigated seafarers were exposed to at least one negative act over the last six months, only 25.0% were not exposed. The prevealence of severe bullying was 3.8%, the prevalence of occasional bullying was 10.1%. 2.3% of the investigated seafarers perceived severe stress in the workplace. Statistically significant associations between psychological terror and arterial hypertension (r=0.154), neck/shoulder pain (r=0.138), migraine (r=0.158), diseases, prostate diseases (r=0.122), hand/arm pain (r=0.196), non allergic skin diseases (r=0.138) were observed... [to full text]

<p>This study aimed at identifying the factors contributing towards work related neck pain amongst university administrative staff, its impact on everyday life activities and in turn its prevalence. A quantitative descriptive cross sectional study design was used amongst the administrative staff at the University of The Western Cape, South Africa. Data collection was carried out with the help of a questionnaire which was administered by the researcher in person. Data was analysed with both descriptive and inferential statistics using SPSS and SAS for windows. Chi-square test and logistic regression analysis was done. The results of this study revealed a very high prevalence of work related neck pain amongst university administrative staff. </p>

AIM: The overall aim of this thesis was to examine the associations between dental anxiety, experiences of dental care, psychosocial factors and oral health among 15-year-olds, and to analyse changes in the prevalence of dental anxiety over time. MATERIALS AND METHODS: The thesis was based on two cross-sectional epidemiological studies in Jönköping, Sweden. Papers I, II, and III were based on a random sample of 15-year-old individuals. The total sample consisted of 221 individuals. Six questionnaires were used, one included items of background data, while the others were psychometric instruments measuring dental anxiety, temperament, general anxiety and depression, general fearfulness and attitudes to dental care. Paper IV was based on the Jönköping studies, a series of epidemiological studies from 1973, 1983, 1993, and 2003 in which random samples of 15-year-old individuals were included. The total sample consisted of 405 individuals. Questionnaires including background data and dental anxiety were used and clinical data were collected. RESULTS: Of the 15-year-old individuals 6.5% were classified as dentally anxious with girls proportionally more fearful than boys (Papers I-III). Dental anxiety correlated significantly with three of the temperament dimensions; emotionality, activity and impulsivity. Reported pain or unpleasant experiences during dental care treatment were clear predictors concerning dental anxiety (Paper I). Both symptoms of general anxiety and depression were significantly correlated with dental anxiety after controlling for other potential risk factors (Paper II). Dental anxiety was associated with both general fearfulness and with attitudes to dental care, where the strongest predictor of dental anxiety was general fearfulness (Paper III). A trend analysis over the 30-year period showed a gradient of statistically significantly decreasing dental anxiety prevalence, from 38.1% in 1973 to 12.8% in 2003. Over the period the 15-year-old individuals with dental anxiety had significantly higher number of filled tooth-surfaces than those with no dental anxiety, and also more caries in 1973. There were no such differences concerning plaque and gingivitis (Paper IV). CONCLUSIONS: Dental anxiety in 15-year-olds correlated with experiences of dental care, psychosocial factors as well as to oral health. Specifically, pain experiences related to dental care, attitudes to dental care and general fearfulness seem to have the strongest impact on dental anxiety. Dental anxiety showed a clear declining change over time. More girls than boys reported dental anxiety. The thesis shows that dental care providers need paying attention on providing a supportive dental care situation, in which the patients should not experience pain. One part may be adequate local anaesthesia during operative dentistry or similar dental treatments. Another part may be a good oral health to prevent negative experiences of dental care. There is a need for the understanding of psychological factors associated with dental care procedures. / SYFTE: Det övergripande syftet med denna avhandling var att bland 15-åringar undersöka sambanden mellan tandvårdsrädsla, erfarenheter av tandvård, psykosociala faktorer och oral hälsa, samt att analysera förändringar i förekomsten av tandvårdsrädsla över tid. MATERIAL OCH METOD: Avhandlingen baseraspå två epidemiologiska tvärsnittsstudier i Jönköping. I arbete I, II och III redovisas studier av 221 slumpmässigt utvalda 15-åriga individer. Deltagarna besvarade frågor avseende bakgrundsdata, tandvårdsrädsla, temperament, ångest och depression, generell rädsla samt attityder till tandvård. Arbete IV bygger på Jönköpingsstudierna, från 1973, 1983, 1993, och 2003, där sammanlagt 405 slumpmässigt utvalda 15-åriga individer ingick. Datainsamling gjordes med hjälp av frågeformulär, bestående av bakgrundsdata och tandvårdsrädsla, samt kliniska data. RESULTAT: Resultatet i arbete I, II och III visade att 6,5% av ungdomarna rapporterade hög tandvårdsrädsla, där en övervägande andel var flickor. I arbete I visade tandvårdsrädsla samband med tre av temperamenten; emotionalitet, aktivitet och impulsivitet. Rapporterad smärta eller obehagliga upplevelser under tandbehandling var tydliga prediktorer avseende tandvårdsrädsla. I arbete II visade både symtom på ångest och depression samband med tandvårdsrädsla, sedan effekterna av andra potentiella riskfaktorer hade kontrollerats för statistiskt. I arbete III visade tandvårdsrädsla starkt samband med både generell rädsla och med attityder till tandvård, där den starkaste prediktorn för tandvårdsrädsla var generell rädsla. I arbete IV visade en trendanalys en statistiskt säkerställd minskning gällande förekomsten av tandvårdsrädsla, från 38,1% år 1973 till 12,8% år 2003. Ungdomarna med tandvårdsrädsla hade signifikant fler fyllda tandytor än ungdomarna utan tandvårdsrädsla under 30-årsperioden, och år 1973 även mer karies. Det fanns inga sådana skillnader avseende plack och gingivit. SLUTSATSER: Resultatet visar att tandvårdsrädsla är relaterat till smärtsamma erfarenheter av tandvård, generell rädsla, och oral hälsa. Resultatet visar också att tandvårdsrädsla hos 15-åringar har minskat över tid och är vanligare hos flickor. Resultaten pekar på att tandvårdspersonalen har en viktig uppgift i att unga tandvårdspatienter inte utsätts för smärtsam behandling. Framtida forskning av intresse kan vara hur olika sätt att administrera lokalbedövning kan förändra uppfattningen av smärta och nivåer av tandvårdsrädsla.

The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers. The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses. In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more work- related facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents. The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS). / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 5 uppsatser.</p> / digitalisering@umu

Savireguliacijai gebėjimai yra labai svarbūs optimaliai vaiko raidai, todėl svarbu aiškintis, kokie veiksniai yra susiję su individualiais vaiko savireguliacijos skirtumais. Pagrindinis darbo tikslas yra įvertinti pagrindinius vaikų savireguliacijos biologinius ir psichosocialinius (šeimos aplinkos) veiksnius, kurie iš jų geriausiai paaiškina ketverių metų vaikų savireguliacijos gebėjimus. Darbas yra konceptualizuojamas remiantis ekologine ir transakcine teorija. Savireguliacijai tirti dimensijų lygmenyje yra pasirinktas „karštos“ ir „šaltos“ savireguliacijos modelis. Tyrime analizuojami duomenys apie 142 vaikus (71 berniuką ir 71 mergaitę). Empirinė medžiaga buvo renkama 8 tyrimo pjūviais: antrą – trečią dieną po vaiko gimimo, praėjus 3 mėn., 6 mėn., 12 mėn., 18 mėn., 2 metams, 3 metams ir 4 metams po gimimo. Savireguliacijai įvertinti buvo pasitelkti du informacijos šaltiniai: motinos stebėjimu paremti duomenys ir psichologinio testavimo rezultatai. Nustatyta, kad didesnė „karšta“ savireguliacija yra susijusi su tokiais veiksniais: mergaitės lytis, gimimas po skubaus cezario pjūvio ir gera motinos emocinė būsena antraisiais ir trečiaisiais vaiko gyvenimo metais, o didesnė „karšta“ savireguliacija savireguliacija – su vyresniu vaiko amžiumi, aukštesniu tėvų išsilavinimu, didesniais vaiko samprotavimo gebėjimais, planuotu nėštumu, motinos geriau įvertintais santykiais su sutuoktiniu antraisiais ir trečiaisiais vaiko gyvenimo metais. Motinos įvertintą vaikų savireguliaciją... [toliau žr. visą tekstą] / Self-regulatory abilities have a great significance for a child’s optimal development and so far it is important to explore which of the factors are associated with individual self-regulatory differences. The aim of the doctoral work is to explore the main biological and psychosocial (family environment) factors of self-regulation, which of them account for self-regulatory abilities at the age of four years. The work is conceptualized in the term of the ecological and transactional theory. On the level of dimensions the two-dimension model of hot and cool self-regulation is chosen. The participants of the study were 142 children (71 boy and 71 girls). The data collected on the second or third day after delivery, 3 months, 6 months, 12 months, 18 months, 2 years, 3 years and 4 years is reported. There were two sources of the information about children’s self-regulation at four years: maternal reports and observational measures. Higher hot self-regulation was related to female gender, delivery by emergency Caesarean section, and better maternal emotional state during the 2nd and 3rd years of the child’s life. Higher cool self-regulation was related to greater age, higher parental education, higher child’s reasoning ability, pregnancy planning, and better evaluated quality of a couple’s relationship. Maternal reports of self-regulation were directly predicted by maternal supportive responses and maternal self-efficacy, though the maternal early depression had an indirect effect... [to full text]

Self-regulatory abilities have a great significance for a child’s optimal development and so far it is important to explore which of the factors are associated with individual self-regulatory differences. The aim of the doctoral work is to explore the main biological and psychosocial (family environment) factors of self-regulation, which of them account for self-regulatory abilities at the age of four years. The work is conceptualized in the term of the ecological and transactional theory. On the level of dimensions the two-dimension model of hot and cool self-regulation is chosen. The participants of the study were 142 children (71 boy and 71 girls). The data collected on the second or third day after delivery, 3 months, 6 months, 12 months, 18 months, 2 years, 3 years and 4 years is reported. There were two sources of the information about children’s self-regulation at four years: maternal reports and observational measures. Higher hot self-regulation was related to female gender, delivery by emergency Caesarean section, and better maternal emotional state during the 2nd and 3rd years of the child’s life. Higher cool self-regulation was related to greater age, higher parental education, higher child’s reasoning ability, pregnancy planning, and better evaluated quality of a couple’s relationship. Maternal reports of self-regulation were directly predicted by maternal supportive responses and maternal self-efficacy, though the maternal early depression had an indirect effect... [to full text] / Savireguliacijai gebėjimai yra labai svarbūs optimaliai vaiko raidai, todėl svarbu aiškintis, kokie veiksniai yra susiję su individualiais vaiko savireguliacijos skirtumais. Pagrindinis darbo tikslas yra įvertinti pagrindinius vaikų savireguliacijos biologinius ir psichosocialinius (šeimos aplinkos) veiksnius, kurie iš jų geriausiai paaiškina ketverių metų vaikų savireguliacijos gebėjimus. Darbas yra konceptualizuojamas remiantis ekologine ir transakcine teorija. Savireguliacijai tirti dimensijų lygmenyje yra pasirinktas „karštos“ ir „šaltos“ savireguliacijos modelis. Tyrime analizuojami duomenys apie 142 vaikus (71 berniuką ir 71 mergaitę). Empirinė medžiaga buvo renkama 8 tyrimo pjūviais: antrą – trečią dieną po vaiko gimimo, praėjus 3 mėn., 6 mėn., 12 mėn., 18 mėn., 2 metams, 3 metams ir 4 metams po gimimo. Savireguliacijai įvertinti buvo pasitelkti du informacijos šaltiniai: motinos stebėjimu paremti duomenys ir psichologinio testavimo rezultatai. Nustatyta, kad didesnė „karšta“ savireguliacija yra susijusi su tokiais veiksniais: mergaitės lytis, gimimas po skubaus cezario pjūvio ir gera motinos emocinė būsena antraisiais ir trečiaisiais vaiko gyvenimo metais, o didesnė „šalta“ savireguliacija – su vyresniu vaiko amžiumi, aukštesniu tėvų išsilavinimu, didesniais vaiko samprotavimo gebėjimais, planuotu nėštumu, motinos geriau įvertintais santykiais su sutuoktiniu antraisiais ir trečiaisiais vaiko gyvenimo metais. Motinos įvertintą vaikų savireguliaciją tiesiogiai... [toliau žr. visą tekstą]

The diploma thesis deals with the influence of psychosocial factors on the leisure time of contemporary high school youth. The theoretic part analyses basic theoretic concepts and terms concerning problems of the leisure time, youth and psychosocial factors influencing leisure time behaviour of high school youth. The empirical part presents the qualitative research conducted using the methodology of semi-structured interview. The aim of this research was to provide a deeper look into the problem and to outline possible connections. The main focus of the diploma thesis was to discover what psychosocial factors influence the leisure time of contemporary high school youth. Research interviews were conducted with high school students accommodated in the Dormitory of the Polytechnic Secondary School in České Budějovice.

A leitura é um processo complexo, consequência de interações entre fatores ambientais, biológicos e cognitivos. Este estudo visou a investigar a relação entre fatores psicossociais (socioeconômicos e familiares) e cognitivos (memória de trabalho) e o desempenho em leitura de crianças participantes de uma coorte populacional. Foram realizados dois estudos relacionando o desempenho em leitura a: 1) fatores psicossociais e 2) fatores cognitivos. As 65 crianças avaliadas (9-11 anos) eram estudantes de 2ª a 5ª séries de escolas públicas de Porto Alegre-RS. Suas mães participaram de entrevistas sobre dados psicossociais da mãe e de desenvolvimento da criança, feitas aos 4 meses, 2 anos e 5/6 anos de idade das crianças. As crianças foram avaliadas em leitura, QI e memória de trabalho. No estudo 1, correlações significativas negativas foram encontradas entre morbidade psiquiátrica (escore do SRQ-20) da mãe e total de acertos na leitura de palavras irregulares da criança e entre o número de familiares que moravam em casa e o escore total na leitura de palavras da criança. Além disso, a renda familiar correlacionou-se significativa e positivamente com o escore em compreensão de leitura textual da criança. Nas análises de regressão linear apenas o número de familiares que moravam na mesma casa que a criança foi preditor do desempenho em leitura de palavras. Pode-se entender que quanto mais pessoas habitam uma mesma residência, menos recursos são disponibilizados para cada um e os pais podem não ter tempo suficiente para envolverem-se em atividades escolares com seus filhos, o que impacta no desempenho da leitura. No segundo artigo, as medidas de memória de trabalho não se correlacionaram significativamente às tarefas de leitura quando o subteste vocabulário (do WASI) foi controlado. Houve diferenças significativas nas comparações das médias das tarefas de leitura por série – os estudantes de 4ª série apresentaram maiores escores do que as de 3ª. Conclui-se que dos fatores estudados, houve contribuição de variáveis socioeconômicas e familiares para o desempenho em leitura de crianças de uma coorte populacional. A relação entre leitura e memória de trabalho foi intermediada pela linguagem (vocabulário). / Reading is a complex process, a consequence of interactions between environmental, biological and cognitive factors. This study aimed to investigate the relationship between psychosocial factors (socioeconomic and family) and cognitive (working memory) and reading performance of children participating in a population cohort. Two studies were related to reading performance: 1) psychosocial factors and 2) cognitive factors. The 65 evaluated children (9-11 years) were students from 2nd to 5th grade of public schools in Porto Alegre- RS. Their mothers participated in interviews regarding psychosocial data of mother and child development, at 4 months, 2 years and 5 / 6 year old children. Children were tested in reading, IQ and working memory. In one study, negative correlations were found between the psychiatric morbidity (score of SRQ-20) of the mother and the total score in the reading of irregular words between the child and the number of family members who lived in the same house as the child and the total score in words read by the child. Additionally, family income correlated significantly and positively with the reading comprehension text score of the child. In a linear regression analysis only the number of relatives who lived in the same house as the child was a predictor of performance in word reading. One can understand that as more people inhabit a single residence, fewer resources are available for each individual, and parents may not have enough time to get involved in school activities with their children, which impacts the performance of reading. In the second article, the measures of working memory did not correlate significantly with reading assignments when the vocabulary subtest (from the WASI) was controlled. There were significant differences in comparisons of the mean reading task of the series - the fourth grade students had higher scores than the 3rd grade students. We concluded that in the factors studied there was a correlation between the socioeconomic level and the family to the reading performance of children in a population cohort. The relationship between reading and working memory was mediated by language (vocabulary).