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Johansson, Margareta
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Johansson, M., Hildingsson, I. & Fenwick, J. (2014). 'As long as they are safe- birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section. Women and Birth, 27(3), 208-213
Open this publication in new window or tab >>'As long as they are safe- birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section
2014 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, no 3, p. 208-213Article in journal (Refereed) Published
Abstract [en]

Background: Decision-making in childbirth involves considerations about both the mother and her unborn baby's wellbeing. For men the safety of both is paramount. Aim: To explore and describe Swedish fathers' beliefs and attitudes around the decision for a caesarean section. Methods: Qualitative descriptive study. Twenty one Swedish men whose partners had experienced elective or emergency caesarean participated in a telephone interview. Thematic data analysis was used. Findings: The theme, 'Childbirth is Risky', included "Caesarean birth has lots of advantages" and "Birth mode does not matter". In the context of having experienced a caesarean section male partners considered birth mode to be irrelevant. The majority considered caesarean to be a quick and efficient way of giving birth which equated to being safer. Most men could articulate some risks associated with caesarean but these were mainly minimised. The second theme, 'Simply a matter of trust: Birth mode is not my decision', reflected men's belief that they had little to contribute to the decisions made around birth mode. The decision for a caesarean section was considered to lie with the medical practitioner. Conclusion: Mode of birth was regarded as unimportant. The recommendation for a caesarean section was readily accepted and appreciated, and shifted responsibility for birth to the medical practitioner. Involving men in the decision-making process by means of giving them information was valued. Men's limited knowledge about the risks of a caesarean may contribute to birth mode decisions. Professionals need to provide balanced and correct information within the context of individual circumstances.

Keywords
Caesarean section, Decision-making process, Experiences, Fathers, Qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17528 (URN)10.1016/j.wombi.2014.03.003 (DOI)000342350000010 ()2-s2.0-84905739246 (Scopus ID)
Note

Available online 2 May 2014.

Available from: 2012-11-30 Created: 2012-11-30 Last updated: 2017-12-07Bibliographically approved
Hildingsson, I., Johansson, M., Fenwick, J., Haines, H. & Rubertsson, C. (2014). Childbirth fear in expectant fathers: findings from a regional Swedish cohort study.. Midwifery, 30(2), 242-247
Open this publication in new window or tab >>Childbirth fear in expectant fathers: findings from a regional Swedish cohort study.
Show others...
2014 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 242-247Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

DESIGN:

a regional cohort study. Data was collected by a questionnaire.

SETTING:

three hospitals in the middle-north part of Sweden PARTICIPANTS: 1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

MEASUREMENTS:

prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

FINDINGS:

the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6).

KEY CONCLUSIONS:

high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

IMPLICATIONS FOR PRACTICE:

engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.

Keywords
Childbirth, fathers, fear
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-19050 (URN)10.1016/j.midw.2013.01.001 (DOI)000331728400010 ()23455031 (PubMedID)2-s2.0-84894248741 (Scopus ID)
Note

Corrigendum published 29 March 2014:

 http://www.sciencedirect.com/science/article/pii/S0266613814000655

Error in Table 2

DOI: 10.1016/j.midw.2014.03.001

Available from: 2013-06-04 Created: 2013-06-04 Last updated: 2017-12-06Bibliographically approved
Hildingsson, I., Johansson, M., Karlström, A. & Fenwick, J. (2013). Factors associated with a positive birth experience: An exploration of Swedish women‘s experiences. International Journal of Childbirth, 3(3), 153-164
Open this publication in new window or tab >>Factors associated with a positive birth experience: An exploration of Swedish women‘s experiences
2013 (English)In: International Journal of Childbirth, ISSN 2156-5287, Vol. 3, no 3, p. 153-164Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The birth of a baby is a powerful life event that has implications for a woman's wellbeing and future health. A positive birth experience promotes a sense of achievement, enhances feeling of self-worth, and facilitates confidence—all of which are important for a healthy adaptation to motherhood and psychological growth. Understanding what constitutes a positive birth experience is critical to providing maternity care that meets childbearing women's individual needs, preferences, and priorities. OBJECTIVE: To explore the prevalence of Swedish women reporting a very positive birth experience 2 months and 1 year after childbirth and identify factors associated with this experience. In addition, the study aimed to identify whether women's assessment of their birth experience changed over time. METHOD: A prospective, longitudinal study where the main outcome variable was perceptions of a very positive birth experience. The study was undertaken in a Northern region of Sweden in 2007. Women were recruited at their ultrasound examination in midpregnancy. Data was collected via questionnaires. There were 928 women who responded to questions about their birth experience at 2 months postpartum. Nearly 83% of these women (n = 763) also completed the questionnaire package 1 year after birth. Descriptive statistics were used together with Friedman's test to detect changes over time. Logistic regression analysis was performed to reveal which factors contributed most to a very positive birth experience. RESULT: More than a third of the women reported a very positive birth experience. Women's assessment of birth changed over time with 22% of the women becoming more positive and 15% more negative. Important associated factors for a very positive birth experience included positive feelings about the approaching birth as well as feeling in control, using no or only cognitive forms of pain management, and achieving a spontaneous vaginal birth. Furthermore, how women rated their midwifery care was also shown to affect their assessment of their birth experience. CONCLUSION: This study found that women's birth experiences changed over time and most becoming more positive after 1 year. Factors associated with a very positive birth experience were related to women's prenatal attitudes, intrapartum procedures, pain relief used, and care received during labor and birth. Respectful individualized midwifery care that remains focused on the woman and keeping birth normal increases positive perceptions of the birth experience.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-19053 (URN)10.1891/2156-5287.3.3.153 (DOI)
Available from: 2013-06-04 Created: 2013-06-04 Last updated: 2014-04-24Bibliographically approved
Johansson, M., Hildingsson, I. & Fenwick, J. (2013). Fathers want to stay close to their partner and new baby in the early postnatal period: The importance of being able to room in after a surgical birth. Sexual & Reproductive HealthCare, 4(1), 35-36
Open this publication in new window or tab >>Fathers want to stay close to their partner and new baby in the early postnatal period: The importance of being able to room in after a surgical birth
2013 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 35-36Article in journal (Refereed) Published
Abstract [en]

The early postnatal period can be challenging for new fathers especially when their partner has experienced a caesarean section. The aim of this study was to describe men's perceptions and feelings of staying with their partner and new baby in the context of having experienced a surgical birth. Thematic analysis was employed to analyse telephone interviews collected from 21 Swedish fathers who had experienced elective or emergency caesarean section. Being involved, receiving support and providing support were main reasons men considered it important they be facilitated to stay with their partners. Postnatal care should be oriented towards the whole family.

Keywords
Caesarean section; Fathers; Postnatal period; Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17526 (URN)10.1016/j.srhc.2012.11.002 (DOI)000316091000007 ()2-s2.0-84874226393 (Scopus ID)
Available from: 2012-11-30 Created: 2012-11-30 Last updated: 2017-12-07Bibliographically approved
Johansson, M., Hildingsson, I. & Fenwick, J. (2013). Important factors working to mediate Swedish fathers' experiences of a caesarean section. Midwifery, 29(9), 1041-1049
Open this publication in new window or tab >>Important factors working to mediate Swedish fathers' experiences of a caesarean section
2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1041-1049Article in journal (Refereed) Published
Abstract [en]

Objective: to describe and explore fathers' experiences of theirpartner's caesarean section birth.Design: a qualitative descriptive design was employed. A self-selectedsample of 22 Swedish fathers who had experienced an elective oremergency caesarean section agreed to participate. Men were interviewedby telephone seven to 16 months after the birth of their baby. Thematicanalysis and the techniques of constant comparison were used to analysethe data.Findings: men were generally worried about the health and well-being oftheir baby and partner regardless of birth mode. As the reality of thecaesarean section approached men's anxiety escalated and remained highduring the procedure. The rapid nature of surgical birth was thereforeconsidered as an advantage; once the baby was born and cried men's feardissipated. Four factors were identified that mediated the men'sexperience. Men's perceptions of control, preparedness and how thehealth-care team behaved and interacted with them were integral to theirexperience. Knowing the date and time of birth also mediated theexperience by providing a sense of certainty to men's experiences of thecaesarean birth.Key conclusions: caesarean section was considered as a routine and safeprocedure that offered most fathers a sense of certainty, control andsafety lessening their sense of responsibility over ensuring a healthybaby. The communication patterns of staff played a key role in ensuringa positive caesarean birth experience.Implications for practice: ensuring that men have a positive birthexperience, regardless of birth mode, is important for familyfunctioning. However the findings also lend insight into how men mayreframe caesarean birth as normal and safe. This may have implicationsfor decision making around birth mode in a subsequent pregnancy furtherimpacting on rising repeat caesarean section rates. Health-careprofessionals need to provide balanced information about the risksassociated with caesarean birth. Any potential benefits need to becontextualised to the pregnant woman's own individual situation. Wherepossible, and appropriate, professional discourses should supportvaginal birth as the safest option for a woman and her baby.

Keywords
Birth experiences, Caesarean section, Fathers, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17527 (URN)10.1016/j.midw.2012.09.009 (DOI)000321744500004 ()2-s2.0-84880331326 (Scopus ID)
Available from: 2012-11-30 Created: 2012-11-30 Last updated: 2017-12-07Bibliographically approved
Johansson, M., Rubertsson, C., Rådestad, I. & Hildingsson, I. (2013). Improvements of postnatal care are required by Swedish fathers. International Journal of Health Care Quality Assurance, 26(5), 465-480
Open this publication in new window or tab >>Improvements of postnatal care are required by Swedish fathers
2013 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

DESIGN/METHODOLOGY/APPROACH: This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

FINDINGS: In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

PRACTICAL IMPLICATIONS: Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

ORIGINALITY/VALUE: The paper provides knowledge about postnatal service quality including fathers' needs.

Keywords
Care quality, Fathers, Medical care, Patient care, Personal needs, Postnatal care, Prospective longitudinal study, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-14936 (URN)10.1108/IJHCQA-08-2011-0052 (DOI)23905306 (PubMedID)2-s2.0-84879719178 (Scopus ID)
Available from: 2011-11-27 Created: 2011-11-27 Last updated: 2017-12-08Bibliographically approved
Johansson, M. & Hildingsson, I. (2013). Intrapartum care could be improved according to Swedish fathers: mode of birth matters for satisfcation. Women and Birth, 26(3), 195-201
Open this publication in new window or tab >>Intrapartum care could be improved according to Swedish fathers: mode of birth matters for satisfcation
2013 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, no 3, p. 195-201Article in journal (Refereed) Published
Abstract [en]

Background: Intrapartum care is expected to be shaped by parents' need and preferences. Aim: The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Methods: Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Results: Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Conclusions: Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported.

Keywords
Deficiency, Fathers, Intrapartum care, Parturition, Quality of health care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-19052 (URN)10.1016/j.wombi.2013.04.001 (DOI)000324013100006 ()2-s2.0-84881614912 (Scopus ID)
Available from: 2013-06-04 Created: 2013-06-04 Last updated: 2017-12-06Bibliographically approved
Fenwick, J., Bayes, S. & Johansson, M. (2012). A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be. Sexual & Reproductive HealthCare, 3(1), 3-9
Open this publication in new window or tab >>A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be
2012 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 3-9Article in journal (Refereed) Published
Abstract [en]

Aim: To explore and describe men's experiences of pregnancy and childbirth expectations. Background: There remains limited work exploring expectant father's perspectives. Design: Qualitative descriptive design. Twelve Australian expectant fathers participated in between 1 and 2 interviews during pregnancy and 1 after childbirth (32 in total). Six fathers also chose to submit a number of diary entries via e-mail. Thematic analysis was used to analyse the data set. Findings: Five themes emerged from the data. The themes pregnancy news: heralds profound change adjusting to pregnancy, and birth looming described how men processed the news of pregnancy, worked to accept their changed circumstances and negotiated the final week of the pregnancy. A fourth theme, labelled Feeling sidelined, outlined men's experiences of antenatal care and their feeling of isolation as a result of largely feeling ignored by health care professionals. The fifth theme represents men's childbirth expectations. Conclusion: Adjusting to the news of a pregnancy was a potentially unsettling time for an expectant father that was often associated with increased apprehension and anxiety. Regardless of whether they were a first or once again father most men engaged in a level of emotional work to come toterms with and accept the pregnancy. Understanding men's antenatal experiences and anxieties is an important step in the development of preventative paternal perinatal mental health measures. The significance of this work is situated within the reality that men's wellbeing is associated with maternal psychological well-being, positive peri-natal experiences and child development. © 2011 Elsevier B.V..

Keywords
Childbirth; Expectant fathers; Expectations; Men; Perinatal mental health; Pregnancy experiences
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-15672 (URN)10.1016/j.srhc.2011.11.001 (DOI)000312282000002 ()2-s2.0-84856768987 (Scopus ID)
Available from: 2012-01-18 Created: 2012-01-07 Last updated: 2017-12-08Bibliographically approved
Johansson, M. (2012). Becoming a father: Sources of information, birth preference, and experiences of childbirth and postnatal care. (Doctoral dissertation). Sundsvall: Mid Sweden University
Open this publication in new window or tab >>Becoming a father: Sources of information, birth preference, and experiences of childbirth and postnatal care
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att bli far- informationskällor, önskemål om förlossningssätt samt upplevelser av förlossning och eftervård
Abstract [en]

The period of pregnancy and childbirth is an important and sensitive time for men’s upcoming parenthood. Research into fathers’ experiences of childbearing has received less attention compared to maternal experiences. The purpose of this thesis was to study the sources fathers use to obtain information about pregnancy and childbirth, fathers’ preference for the mode of birth of their baby, and fathers’ childbirth experience and their perception of postnatal care quality.In 2007, 1105 expectant fathers were enrolled in the study when their partner had reached the middle of pregnancy. The fathers were followed until one year after the birth of their baby. The fathers were living in the county of Västernorrland in Sweden and their babies were born in one of the three hospitals in the county. Data was analysed using descriptive and inferential statistics, and content analysis. An index was created from a combination of fathers’ experiences of postnatal care quality.iiiCommon sources of information about pregnancy and childbirth used by prospective fathers were the Internet, their partners and the midwife. Fathers who were expecting their first baby (OR 1.4; 1.2-1.7), had a high level of education (OR 1.3; 1.2-1.5) and fathers with previous experience of caesarean section (OR 1.3; 1.1-1.6) were the greatest users of the Internet. Of the prospective fathers 71 (6.4%) desired caesarean section for the birth of their baby. Previous negative birth experience (PR 8.6; 2.6-28.3) and the experience of caesarean section (PR 5.7; 2.8-11.9) were factors associated with the wish that the baby would be born by caesarean section. A desire to plan the day of the baby’s birth (PR 6.0; 1.5-24.1) was associated with a preference for caesarean section for the men who were expecting their first baby. Two months after the birth of the baby 604 (74%) of the fathers in this group had had a positive birth experience. A correlation with a less-positive birth experience was with emergency caesarean section (OR 7.5; 4.1-13.6), instrumental vaginal birth (OR 4.2; 2.3-8.0) and if the man was unhappy with the medical care which the partner received (OR; 4.6; 2.7-7.8). Positive experience of healthcare professionals’ knowledge and attitudes was related to a satisfactory birth experience. The deficiencies in the postnatal care were mainly related to deficiencies in the information on the baby’s care and needs, and fathers’ experiences of their partners’ inadequate check-ups and medical care. A year after the birth 488 (79%) of the fathers were satisfied with the overall postnatal care, although they had pointed to deficiencies in the provision. Deficiencies in the attitude of the staff (OR 5.01; 2.80-8.98) and the medical care and check-ups their partner received were associated with fathers’ dissatisfaction with the overall postnatal care (OR 2.13; 1.25-3.62).ivMost fathers in this study had a positive birth experience and were happy with the postnatal care. The thesis highlights, however, opportunities for improvements in intrapartum and postnatal care. Healthcare professionals should be informed regarding the information provided via the web and to discuss the information that expectant fathers receive about pregnancy and childbirth. Prospective fathers should be given the opportunity to discuss their preferences and attitudes to the mode of birth. In addition, professionals should provide supportive information and be present in the delivery room. The information about the newborn baby’s care and needs can be strengthened, both before and after birth.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2012. p. 82
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 119
Keywords
Birth experience, Fatherhood, Mode of birth, Postnatal care, Preference, Social support, Transition, Quality of care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-15161 (URN)978-91-86694-91-3 (ISBN)
Public defence
2012-02-17, M 108, Holmgatan 10, Sundsvall, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2012-01-18 Created: 2011-12-12 Last updated: 2012-07-30Bibliographically approved
Johansson, M., Rubertsson, C., Rådestad, I. & Hildingsson, I. (2012). Childbirth - an emotionally demanding experience for fathers. Sexual & Reproductive HealthCare, 3(1), 11-20
Open this publication in new window or tab >>Childbirth - an emotionally demanding experience for fathers
2012 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 11-20Article in journal (Refereed) Published
Abstract [en]

Background: While attending birth mostly has a positive impact on becoming a father, it has also been described as including feelings of discomfort and is more demaning than expected. Objective: The objective was to explore Swedish fathers' birth experiences, and factors associated with a less-positive birth experience. Methods: Mixed methods including quantitative and qualitative data were used. Two months after birth 827 fathers answered a questionnaire and 111 (13%) of these commented on the birth experience. Data were analysed with descriptive statistics, chi-square test for independence, risk ratios with a 95% confidence interval, logistic regression and content analysis. Result: In total, 604 (74%) of the fathers had a positive or a very positive birth experience. Used method identified a less-positive birth experience associated with emergency caesarean section (RR 7.5; 4.1-13.6), instrumental vaginal birth (RR 4.2; 2.3-8.0), and dissatisfaction with the partner's medical care (RR 4.6; 2.7-7.8). Healthcare professionals' competence and approach to the fathers were also related to the birth experience. Conclusions: As the fathers' birth experiences were associated with mode of birth and experiences of the intrapartum medical care fathers should be respectfully and empathically treated during labour and birth. It is essential to better engage fathers during the intrapartum period through involvement and support to improve the likelihood of a positive birth experience.

Keywords
Birth experience; Content analysis; Father; Healthcare professional; Mixed methods; Mode of birth
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-11455 (URN)10.1016/j.srhc.2011.12.003 (DOI)000312282000003 ()2-s2.0-84856796040 (Scopus ID)
Available from: 2010-04-25 Created: 2010-04-25 Last updated: 2017-12-12Bibliographically approved
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