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Öğe Akut hemorajik şokta hipertonik sodyum klorürün yeri(1995) Ak, Mehmet; Kaynak, AdnanHipovoleminin tek ve esas tedavisi sıvı infuzyonudur. Bu amaçla birbirinden özellikle Na+ konsantrasyonu ve onkotik basınç oluşturucu etkileriyle ayrılan çeşitli sıvılar kullanılabilir. Çalışmamızda köpeklerde oluşturulan hemorajik şok modelinde ringer laktat, hidroksietil nişasta ve %7,5'luk NaCl solüsyonlarının tedavi etkinlikleri ve oluşabilecek yan etkileri araştırıldı. Altışar köpekten meydana gelen 4 grupda denekler 10-15 dakika içinde 20 ml/kg kanatıldı. Kontrol grubuna(l. grup) srvı infüzyonu yapılmadı. Deney grublan 30 dakika şokta tutulduktan sonra 2. gruba hidroksietil nişasta ( Kanama miktarı kadar ), 3. gruba ringer laktat ( Kanamanın iki katı kadar ve 4. gruba %7,5'luk NaCl solüsyonu ( Kanama miktarının 1/4'ü kadar ) Infuzyon yapıldı. Tüm gruplarda kanama öncesi ( 0. dakika ), 30, 60, 120, 180. dakikalarda sistolik arter basınçları, pulmoner arter kama basınçları, hematokrit, sodyum, laktik asit düzeyleri ve idrar miktarları ölçüldü. 0. dakikada gruplar arasında ölçülen parametrelerde anlamlı fark yokken 30, 60, 120 ve 180. dakikalarda Na+ ve hematokrit düzeyleri hariç diğer bütün parametreler, kontrol grubuna göre anlamlı farklılık gösteriyordu. Ringer laktat, hidroksietil nişasta ve %7,5'luk NaCl solüsyonlarının hemodinamik vemetabolik sonuçları istatistiksel olarak karşılaştırıldığında en fazla idrar çıkışının ringer laktat grubunda olduğu gözlendi. Kanama miktarının 1/4'ü kadar hipertonik tuz solüsyonu ile resüsitasyon yapılan deneklerde idrar çıkışının yeterli düzeyde olduğu, sistolik arter basıncı ve pulmoner arter kama basıncının çok iyi kontrol edildiği, diğer grublara göre daha iyi hemodilüsyon sağladığı tesbit edildi. Laktik asit düzeyi de 30, 120 ve 180. dakikalarda daha düşük bulundu. Sonuç olarak hemorajik şokta kanama miktarının 1/4'ü kadar verilen hipertonik tuz46 solüsyonunun hemodinamik ve metabolik fonksiyonları düzeltiğini, aynı zamanda şokla erken dönemde mücadelede kolloid ve kristalloid sıvılardan daha etkili olduğu gözlendi Beklenen hipernatremi ve diğer yan etkilerinin olmadığı tesbit edildi. Ciddi hemorajik şoklu hastalarda erken dönemde kolayca uygulanabilecek hipertonik tuz solüsyonunun hayat kurtarıcı etkisi olabileceği kanaatine varıldı.Öğe The associations among smartphone addiction, general belongingness and happiness: A structural equation modelling(Klinik Psikiyatri Dergisi, 2019) Kozan, Hatice Irem Ozteke; Kayakli, Mehmet; Ak, Mehmet; Kesici, SahinObjective: The smartphone addiction has gained attention in recent years with the increase development in technology. People use smartphones for several purposes but this also result in pathological behavioral, emotional and cognitive problems. Aim of current study is to reveal the associations among smartphone addiction, general belongingness and happiness by using structural equation modelling. Method: Participants of study consists of 312 university students. In data collection process, Smartphone Addiction Inventory Short Form-, Oxford Happiness Scale and General Belongingness Scale were used. In data analysis correlation analysis and structural equation modelling were used to reveal the associations among smartphone addiction, general belongingness and happiness levels of participants. Results: Results of study revealed a negative significant correlation between smartphone addiction and hapiness levels of participants. Moreover a positive significant correlation was found between smartphone addiction and rejection -the dimension of general belongingness-, whereas no significant correlation was found smartphone addiction and acceptance -the dimension of general belongingness-. Happiness levels of participants were found to be positively and significantly correlated with acceptance and negatively correlated with rejection. Path analysis showed that general belongingness predicted smartphone addiction in a positive way. General belongingness also predicted happiness directly and smartphone addiction negatively predicted happiness. Discussion: In sum, smartphone addiction was significantly correlated with both happiness and general belongingness levels of participants. Moreover, a structural equation model among the smartphone addiction, general belongingness and happiness revealed an acceptable fit indexes. Lastly, findings were discussed and suggestions were given in line with the theorotical background and literature.Öğe Cognitive-behavioral therapy in pregnant women with generalized anxiety disorder: a retrospective cohort study on therapeutic efficacy, gestational age and birth weight(Assoc Brasileira Psiquiatria, 2021) Uguz, Faruk; Ak, MehmetObjective: To evaluate the efficacy of cognitive behavioral therapy in the treatment of generalized anxiety disorder during pregnancy and its effects on gestational age and birth weight. Methods: The sample included 28 untreated patients and 23 patients treated with CBT. Psychiatric diagnoses were determined through the Structured Clinical Interview for the DSM-IV. Symptom severity was assessed with standardized rating scales. Results: Post-treatment levels of anxiety symptoms were significantly lower than baseline. There was no significant difference in gestational age or newborn birth weight between the cognitive behavioral therapy group and the untreated group. Conclusions: Cognitive behavioral therapy appears to be a safe and effective treatment for generalized anxiety disorder during pregnancy.Öğe Cognitive-behavioral therapy in pregnant women with generalized anxiety disorder: a retrospective cohort study on therapeutic efficacy, gestational age and birth weight(Assoc Brasileira Psiquiatria, 2021) Uguz, Faruk; Ak, MehmetObjective: To evaluate the efficacy of cognitive behavioral therapy in the treatment of generalized anxiety disorder during pregnancy and its effects on gestational age and birth weight. Methods: The sample included 28 untreated patients and 23 patients treated with CBT. Psychiatric diagnoses were determined through the Structured Clinical Interview for the DSM-IV. Symptom severity was assessed with standardized rating scales. Results: Post-treatment levels of anxiety symptoms were significantly lower than baseline. There was no significant difference in gestational age or newborn birth weight between the cognitive behavioral therapy group and the untreated group. Conclusions: Cognitive behavioral therapy appears to be a safe and effective treatment for generalized anxiety disorder during pregnancy.Öğe Comparison of housekeeping genes for qPCR analysis in rat hippocampus: chronic depression model(Wiley, 2019) Kurar, E.; Eroglu, C.; FarukUguz; Ak, Mehmet; Koca, R. O.; Solak, H.; Koc, A.[Abstract Not Availabe]Öğe Dysregulation of hypothalamic modulation in olanzapine treated male rats(Pergamon-Elsevier Science Ltd, 2016) Sezlev-Bilecen, Deniz; Ak, Mehmet; Yanik, TulinThe mechanism of weight gain through application of olanzapine, a serotonin and dopamine receptor antagonist has not been fully understood. Weight gain and food intake are under the control of various neurohormones; POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are majorly synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus. In this study, the alteration of the ARC neurohormone levels in rats were determined as one of the weight gain mechanisms. To understand the underlying mechanism of olanzapine-induced weight gain, the drug was orally administrated to healthy male Wistar rats for analysis of both the hypothalamic gene expression and peripheral levels of those candidate neuropeptides. In rats hypothalamic mRNA levels of NPY, AgRP and POMC decreased while CART levels did not show any alteration. Consistently, circulating levels of NPY, AgRP and alpha-MSH decreased significantly yet CART levels were also reduced. In conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the onset for a dysregulation of the neurohormones secretion which may cause weight gain during treatment. (C) 2016 Elsevier Inc. All rights reserved.Öğe The Effect of COVID-19 Pandemic on Psychosomatic Complaints and Investigation of The Mediating Role of Intolerance to Uncertainty, Biological Rhythm Changes and Perceived COVID-19 Threat in this Relationship: A Web-Based Community Survey(Aves, 2020) Gica, Sakir; Kavakli, Mehmet; Durduran, Yasemin; Ak, MehmetBackground: The aim of the present study was to determine the increase in psychosomatic complaints during the COVID-19 pandemic and to identify the factors associated with psychosomatic complaints. Methods: Five-hundred and thirty-three participants were included in the study. The participants completed the following self-reported scales: Personal Information Form, Perceived COVID-19 Threat Form, Intolerance of Uncertainty Scale, Biological Rhythms Interview of Assessment in Neuropsychiatry and Patient Health Questionnaire-15 (PHQ-15). The data were gathered online. The participants filled PHQ-15 scale twice. In the one interrogation, they were asked to fill the scale according to the current time, and in the other interrogation, they were asked to retrospectively report their status before the COVID-19 outbreak started. Results: The psychosomatic symptom levels of the participants increased (M = 9.08, SD = 5.98) after the COVID-19 outbreak compared to before. The first and second PHQ scores were both positively related to perceived COVID-19 threat, intolerance of uncertainty and biological rhythms. However, the correlation coefficients of the second PHQ scores (after the outbreak) were higher than the first. Perceived COVID-19 threat predicted intolerance of uncertainty, but did not predict biological rhythms. The relationship between perceived COVID-19 threat and the present PHQ score was partially mediated by intolerance of uncertainty. Also, the relationship between perceived COVID-19 threat and present PHQ score were partially mediated by both intolerance of uncertainty and biological rhythms. Conclusion: Psychosomatic complaints were increased during the COVID-19 outbreak period, and the changes in perceived threat and biological rhythm, especially intolerance of uncertainty, were effective in this increase. Results of our study revealed the importance of including the patient's ability to tolerate uncertainty in therapeutic approaches during COVID-19 and similar pandemics. In addition, the importance of the attempt to protect the circadian rhythm in the quarantine process has been demonstrated once again in order to reduce mental influences of the COVID-19 outbreak.Öğe Effect of Pregnancy and Lactation Period on Depression Like Behaviour in Depressive Rats(Karger, 2018) Solak, Hatice; Koca, Raviye Ozen; Koc, Aynur; Sahin, Zafer; Uguz, Faruk; Ak, Mehmet; Kurar, Ercan[Abstract Not Availabe]Öğe Evaluation of the political psychological reflections of the COVID-19 process in the context of Turkey(Klinik Psikiyatri Dergisi, 2022) Koprulu, Gulsah; Ak, MehmetThe COVID-19 pandemic, with its rapid contagion and deadly effect, emerged in China and surrounded the whole world. This pandemic, unlike other pandemics has emerged in the global age. Due to the disappearance of borders as a result of globalization, both the physiological and psychological spread of the virus has been rapid. The transmission of the Covid-19 virus through contact and droplets has provided its physiological spread, while digital media channels have provided its psychological spread. The negativities experienced in health, economy, politics and cultural structures have shaken the societies in the context of political-psychology. Anxiety and fear caused by the pandemic have negatively affected the psychology of individuals and therefore the whole society. In this study, the effects of the COVID-19 process on Turkey and how Turkey responded to the pandemic were tried to be evaluated in the context of political psychology. By examining the researches published in the process, the improvements made in the field of health against the pandemic, the regulations covering the whole society and the measures to overcome the process with the least damage were mentioned. It has been concluded that, as a result of the negative factors that directly affect mental health such as compulsory social isolation, losses, death anxiety brought by the pandemic, as well as processes such as unemployment and bankruptcy caused by inadequate socio-economic policies, a pandemic of mental disorders may occur in future.Öğe Functional Cause of Dysphagia Improved with Cognitive Behavioural Treatment(Springer, 2018) Acikel, Burak; Ak, Mehmet[Abstract Not Availabe]Öğe Hiperbilirübinemili yenidoğanlarda fototerapinin serbest radikaller üzerine etkisi(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 1997) Ak, Mehmet; Koç, Hasanİndirek hiperbilirübinemili bebeklerde fototerapinin serbest radikaller üzerine olan etkisini araştırmak için bu çalışma yapıldı. Araştırmada; total bilirübini 10-15 mgr/dl arasında olan 25 bebek kontrol grubunu, 15 mgr/dl üzerinde olan 25 bebek fototerapi grubunu oluşturdu. Fototerapi grubuna ortalama 44 saat fototerapi uygulandı. Serbest radikal düzeyi, plazmada serbest oksijen radikalleri ve onların ürünlerinin kolorimetrik olarak belirlenmesi prensibiyle çalışan d-ROMs kiti kullanılarak ölçüldü. Bebeklerin maturasyon yaşları, ağırlıkları ve ilk numune alındığı zamanki yaşam süreleri sırasıyla fototerapi grubunda; 39,52 ±1,19 hafta, 3231 ± 443 gr ve 96 ± 18 saat, kontrol grubunda; 39,64 ±1,18 hafta, 3241 ± 694 gr ve 96 ± 16 saat olup aralarında istatistiksel fark yoktu (P>0.05). Bebeklerin total bilirubin, direk bilirubin, hematokrit ve ROM değerleri sırasıyla fototerapi grubunda; fototerapi öncesi 16,56 ± 1,22 mgr/dl, 0,54 ±0,14 mgr/dl, %56.80 ± 4,79 ve 322 ± 8 1 car unit, fototerapi sonrasında 8, 1 1 ± 1,5 1 mgr/dl, 0,43 ± 0,19 mgr/dl, %53,88 ± 5,38 ve 240 ± 64 car unit, kontrol grubunda; birinci numune 1 1,60 ± 2,55 mgr/dl, 0,36 ± 0,12 mgr/dl, %55,00 ± 4,79 ve 307 ± 92 car unit, ikinci numune 1 1,79 ± 1,90 mgr/dl, 0,40 ± 0,14 mgr/dl, % 51,52 ± 4,77 ve 314 ± 80 car unit idi. Fototerapi öncesi total bilirubin düzeyi diğer gruplardan, direk bilirubin düzeyi kontrol grubu iki numunesinden, hematokrit düzeyi kontrol grubu ikinci nu munesinden anlamlı olarak yüksekti (P < 0.05). Diğer gruplar arasında fark yoktu (P > 0.05). 30Fototerapi sonrası total bilirubin ve ROM düzeyi diğer gruplardan anlamlı olarak düşüktü (P < 0.05). Diğer gruplar arasında fark yoktu (P > 0.05). Sonuç olarak; hiperbilirübinemili bebeklerde bilirübinin antioksidan etkisi nedeniyle ROM değerinin sağlıklı erişkin düzeyinde olduğu görüldü. Bilirubin düzeyi ile antioksidan etki arasında korelasyon görülmedi. Çalışmamızda fototerapinin bilirübinle birlikte ROM'u da (= serbest radikalleri) düşürdüğü gözlenmiştir.Öğe Intra-ovarian stem cell transplantation in management of premature ovarian insufficiency: towards the induced Oogonial Stem Cell (iOSC)(C M B Assoc, 2020) Celik, Onder; Ak, Mehmet; Sahin, Erdem; Senturk, Senol; Ugur, Kader; Celik, Sudenaz; Celik, NiluferThe specialized resident-stem cells in gonads are tasked with restorating damaged ovarian cells following injury to maintain sequential reproductive events. When we talk about premature ovarian insufficiency (POI) we accept the existence of decreased stem cell and their regenerative abilities. The present study was to explain how restorating damaged ovarian cells following injury to maintain sequential reproductive events in evidence-based medicine indexed in PubMed and Web of Science. The exact mechanism is unclear stem cells transfer may improve compromised ovarian function and fertility outcome in women with POI. Soluble factors secreted by stem cell may rescue impaired mitochondrial function in oogonial stem cells, enhance metabolic capacity of resident stem cells, induce local neovascularization in the ovary, and activate gene shifting between transferred stem cells and germ cell precursors. This review may provide insight into how stem cells show some of their beneficial effects on compromised ovarian microenvironment and germ cell niche and paves the way for clinical trials for improving ovarian function of women with POI. We also had the opportunity to share our hypothesis about the design and development of induced oogonial stem cell (iOSC) and its use in POI.Öğe Intra-ovarian stem cell transplantation in management of premature ovarian insufficiency: towards the induced Oogonial Stem Cell (iOSC)(C M B Assoc, 2020) Celik, Onder; Ak, Mehmet; Sahin, Erdem; Senturk, Senol; Ugur, Kader; Celik, Sudenaz; Celik, NiluferThe specialized resident-stem cells in gonads are tasked with restorating damaged ovarian cells following injury to maintain sequential reproductive events. When we talk about premature ovarian insufficiency (POI) we accept the existence of decreased stem cell and their regenerative abilities. The present study was to explain how restorating damaged ovarian cells following injury to maintain sequential reproductive events in evidence-based medicine indexed in PubMed and Web of Science. The exact mechanism is unclear stem cells transfer may improve compromised ovarian function and fertility outcome in women with POI. Soluble factors secreted by stem cell may rescue impaired mitochondrial function in oogonial stem cells, enhance metabolic capacity of resident stem cells, induce local neovascularization in the ovary, and activate gene shifting between transferred stem cells and germ cell precursors. This review may provide insight into how stem cells show some of their beneficial effects on compromised ovarian microenvironment and germ cell niche and paves the way for clinical trials for improving ovarian function of women with POI. We also had the opportunity to share our hypothesis about the design and development of induced oogonial stem cell (iOSC) and its use in POI.Öğe Investigation of Some Nutrition-related Neuropeptide Expressions in Hypothalamus Tissues of Offspring Exposed to Maternal Depression and Sertraline Treatment.(Wiley, 2023) Solak, Hatice; Koca, Raviye Ozen; Gunes, Canan Eroglu; Uguz, Faruk; Ak, Mehmet; Sahin, Zafer; Kurar, Ercan[Abstract Not Availabe]Öğe Investigation of the effects of antidepressant treatment on hippocampus and hypothalamus endoplasmic reticulum stress in chronic mild stress induced depression in rats(Klinik Psikiyatri Dergisi, 2023) Karaagac, Mustafa; Ak, Mehmet; Kurar, Ercan; Uguz, Faruk; Kutlu, SelimObjective: This study aimed to examine the role of endoplasmic reticulum (ER) stress in the pathophysiology of depression in female rats exposed to the chronic mild stress model.Method: Chronic mild stress model was constituted in 48 female adult rats were and divided into 4 groups as control, depression, depression+1 mg/kg sertraline, and depression+10 mg/kg sertraline. Subcutaneous drug infusions were performed for 14 days using osmotic minipumps. Expression levels of genes in ER stress pathway were evalulated in hypothalamus and hippocampus tissues of rats. Results: It was found that ATF4 gene expression increased in depression in the hippocampus and decreased with treatment. Hippocampal GRP78 gene expression was downregulated after treatment. Hypothalamic and hippocampal CALR gene expression decreased with treatment, hypothalamic HSP47 gene expression decreased in both treatment groups. Hypothalamic and hippocampal XPB1 gene expression decreased with treatment, hippocampal XPB1 gene expression was further downregulated in the depression +10 mg/kg sertraline group compared to the depression+1 mg/kg sertraline group.Discussion: These findings show that the ER stress mechanism may have a role in the pathophysiology of depression and that this mechanism can be reversed with treatment. The results of our study have been encouraging for human studies and open the way for new projects to understand and accelerate the antidepressant effect.Öğe Low-Dose Imipramine for the Treatment of Panic Disorder During Postpartum Period A Retrospective Analysis of 6 Cases(Lippincott Williams & Wilkins, 2016) Uguz, Faruk; Aydin, Adem; Ak, Mehmet; Turgut, Keziban[Abstract Not Availabe]Öğe Low-Dose Mirtazapine in Major Depression Developed After Hyperemesis Gravidarum: A Case Series(Lippincott Williams & Wilkins, 2018) Uguz, Faruk; Turgut, Keziban; Aydin, Adem; Ak, Mehmet[Abstract Not Availabe]Öğe The mediating role of self-compassion in the relationship between perceived COVID-19 threat and death anxiety(Klinik Psikiyatri Dergisi, 2020) Kayakli, Mehmet; Ak, Mehmet; Uguz, Faruk; Turkmen, Osman OgulcanObjective: The COVID-19 pandemic is a new and highly detrimental event that has influenced the world over. Besides the obvious health risks, COVID-19 has also affected people psychologically. The high risk of contamination can increase the perceived COVID-19 threat and death anxiety in individuals. The aim of the present study was to investigate the mediating role of self-compassion in the relationship between perceived COVID-19 threat and death anxiety. Additionally, the study also investigated the role of gender, profession and income level in the perceived COVID-19 threat and death anxiety. Method: The research sample was composed of 562 individuals from the community. The data was gathered by using personal information form and the Perceived COVID-19 Threat Form, Self-Compassion Scale and Turkish Death Anxiety Scale. Results: The relationship between perceived COVID-19 threat and death anxiety was partially mediated by self-compassion. Moreover, people in the high income group had a lower level of perceived COVID-19 threat and death anxiety score compared to the low-income group. Perceived COVID-19 threat levels were lower among health care professionals compared to unemployed individuals. Female participants had a higher level of perceived COVID-19 threat and death anxiety score compared to male participants. Discussion: Self-compassion may be an essential variable to help cope with problems related to perceived COVID-19 threat and death anxiety. Improving our understanding of the psychological impacts of COVID-19 is necessary and essential.Öğe Metabolomics mapping changed after olanzapine therapy in drug-naive schizophrenia patients-the significant impact of gene polymorphisms(Oxford Univ Press, 2022) Karahalil, Bensu; Elkama, Aylin; Ak, Mehmet; Nemutlu, EmirhanOxidative stress may contribute to the development of schizophrenia and antipsychotics used in schizophrenia treatment may also cause oxidative stress. Gene polymorphisms on antioxidant and repair enzymes are responsible for individual variations and may change the efficacy of olanzapine treatment among schizophrenia patients. In our study, we assessed oxidative stress-related metabolite changes due to genetic polymorphisms on first diagnosed-schizophrenia patients treated with olanzapine. Blood samples (n = 30 patients) were taken before treatment (T1), after 10 +/- 1 days (T2), and after 3 +/- 1 months (T3). T1 served as control for T2 and T3, since it is advantageous to perform on same patient to evaluate the impact of olanzapine only. GSTs (GSTM1, GSTT1, and GSTP1) and OGG1 gene polymorphisms were analyzed by polymerase chain reaction. Changes in metabolites were detected with metabolomics profiling by gas chromatography-mass spectrometry according to each genotype before and after treatment. Multivariate analysis showed that metabolomics profiles differed after olanzapine treatment regardless gene polymorphisms. Tryptophan could be a biomarker in response to olanzapine treatment since its levels were increased after treatment. GSTM1 gene polymorphism caused significant changes in some metabolites after treatment. Urea, palmitic acid, and caprylic acid levels increased and alanine levels decreased in patients with GSTM1 null genotypes after olanzapine. In future, targeted metabolomics with these prominent metabolites and assessing gene expressions of GSTs will be beneficial to understand the mechanism of action.Öğe Metacognitive Beliefs and Coping Strategies of Suicide Attempters(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2019) Yazihan, Naksidil Torun; Cinar, Orhan; Canbaz, Hayri; Ak, MehmetObjective: Metacognition is an essential process regarding decision-making and coping with stressful life events. In this present study, we aimed to examine the metacognitive beliefs and coping strategies of suicide attempters with subthreshold depressive symptoms. Methods: Thirty suicide attempters (mean age of 25.50 +/- 7.66 years) with subthreshold depressive symptoms and 30 healthy participants (mean age of 28.27 +/- 7.13 years) were compared with regard to Metacognition Questionnaire-30 (MCQ-30) and COPE Questionnaire. Results: The MANOVA results revealed significant differences between the groups for the subscales of MCQ-30 namely, negative beliefs about thoughts, need to control thoughts and lack of cognitive confidence. The results also indicated significant difference regarding positive reinterpretation, seeking social support for instrumental reasons, active coping, planning, and problem-focused coping, behavioral disengagement, alcohol-drug disengagement and dysfunctional coping subscales of COPE Questionnaire. In addition, moderate correlations were found between the MCQ-30 and the COPE subscales based on the Pearson's correlation coefficients. Conclusions: This study revealed the effect of particular metacognitive beliefs and type of coping style on suicidal behavior. This study is important for identifying risk factors and explaining how metacognitive beliefs and coping strategies are related to suicidal behavior. Maladaptive metacognitions may lead to overestimation of perceived stress and underestimation of cognitive resources and coping skills which may prevent individulas to produce adaptive coping strategies against stressful life events.
