Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 250

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 191-196
Assessment of dental satisfaction among school teachers in a metropolitan city


1 Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
2 Department of Public Health Dentistry, Government Dental College and Hospital, Hyderabad, Telangana, India

Click here for correspondence address and email

Date of Submission18-Apr-2019
Date of Decision17-Sep-2019
Date of Acceptance17-Oct-2019
Date of Web Publication19-May-2020
 

   Abstract 


Background and Aims: Dental satisfaction is a multi-dimensional concept, reflecting the total experience of health care and a major driving force of treatment seeking behaviour. At community level, school teachers, being the role model, also play a major role in public health. The aim of this study is to assess the dental satisfaction among school teachers in Hyderabad. Methods: A cross-sectional survey was carried out among 515 private school teachers in Hyderabad. The survey tool used was Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982). Data was analysed with SPSS (Statistical Package for the Social Sciences) version 22. Results: The study comprised of 123 (23.9%) males and 392 (76.1%) females. Based on age, significant relation was found only for subscales 'access', 'quality' and 'general satisfaction' (P = 0.01, P = 0.04, P = 0.03 respectively). Though female subjects had higher mean scores for all subscales, significant difference was found only for subscales 'cost', 'quality', 'access total', 'general satisfaction', and 'overall Dental Satisfaction Index' (DSI) (P < 0.001, P = 0.001, P = 0.008, P < 0.001, P = 0.001 respectively). Subjects who had visited a dentist had higher mean scores and significant relation was found for subscales 'access' and 'general satisfaction' (P = 0.04, P = 0.04 respectively). Furthermore, subjects who visited a private practitioner had higher mean scores for most of the subscales. Conclusion: Female subjects, subjects who had dental visit and those who had visited a private practitioner had higher dental satisfaction. Moreover, age and recent dental visit did not show any effect on dental satisfaction.

Keywords: Dental satisfaction, questionnaire, school teachers

How to cite this article:
Shulamithi PS, Kulkarni S, Doshi D, Reddy MP, Reddy BS, Srilatha A. Assessment of dental satisfaction among school teachers in a metropolitan city. Indian J Dent Res 2020;31:191-6

How to cite this URL:
Shulamithi PS, Kulkarni S, Doshi D, Reddy MP, Reddy BS, Srilatha A. Assessment of dental satisfaction among school teachers in a metropolitan city. Indian J Dent Res [serial online] 2020 [cited 2020 Jul 14];31:191-6. Available from: http://www.ijdr.in/text.asp?2020/31/2/191/284569



   Introduction Top


Kotler defined satisfaction as a “a person's feeling of pleasure or disappointment resulting from comparing a products perceived performance or outcome, in relation to his or her expectations”.[1] In dentistry, satisfaction can be regarded as health care recipient's reaction to salient aspects of the context, process and result of their dental service experience.[2] Dental satisfaction is a multi-dimensional concept, reflecting the total experience of health care and a major driving force of treatment seeking behaviour.[3] It is influenced by various factors such as nature, behaviour, communication skills and personality of dental health care providers.[1] This shows influence on general compliance, treatment and quality of care.[4]

It is hence an ongoing challenge to measure dental satisfaction reliably.[5] Measuring this, evaluates quality of care, provider-patient relationship, health systems, particularly comparisons between different models of health care delivery.[6]

Fulfilment of individual's expectation and demands as well as positive assurance, good responses and in resolving doubts and confusions provides better satisfaction.[1] This acts as the vital feature for value of care, in receiving a subsequent good quality of treatment and future utilization of dental services.[7] As individuals' attitude, expectations and demographics varies, it influences the satisfaction levels.

Dental satisfaction and dissatisfaction both have a significant impact on the success of any dental practice. Ensuring highly satisfied individuals would be a worthwhile task for all dental service providers.[4]

In the literature, many studies are conducted in the dental colleges to assess the patient's[1],[4],[5],[6],[7] and dental student's satisfaction[8],[9] regarding the dental treatment. As school teachers also play a role in public health and are the ones who lay foundation of education for the children,[10] and have close relationship with them, they not only teach, but also mould the character, personality of children.[10] So this profession is extremely challenging as they are expected to have a high degree of professional capabilities in order to manage, organise and perform specific tasks and behaviour,[11] which has a wide influence on children. Similarly, for an effective dental education, school teachers can play the role of oral health educators, as they stimulate children to seek dental services as effectively as dentists.[12] This is possible only if they are highly satisfied with dental care and have good knowledge, attitudes about the dental practice.

With a view to gain further knowledge about the dental satisfaction among school teachers, the present study was undertaken with an aim to assess the dental satisfaction among school teachers in Dilsukhnagar, Hyderabad.


   Methods Top


A cross-sectional questionnaire study was carried out to assess the dental satisfaction among school teachers in Dilsukhnagar, Hyderabad. Ethical clearance was obtained from the Institutional Review Board of Panineeya Institute of Dental Sciences and Research Centre (PMVIDS and RC/IEC/PHD/PR/0128-17) and the study was conducted in accordance with the Declaration of Helsinki.

A pilot study was done with a sample of 30 teachers from 3 different schools, which were randomly selected, for the sample size estimation. Based on the results of pilot study, sample size calculation was done by using the formula, N = 4Zα2 S2/d2, where d = expected precision = 2, S = Standard deviation of the variable = 6.5, Confidence level = 95%, Zα= Standard normal variate value = 1.96. The estimated sample size obtained was minimum of 162 subjects. The reliability and validity of the questionnaire were analysed with Cronbach's alpha, was 0.8.

Out of the 49 private schools in Dilsukhnagar, only 22 schools who gave written permission to conduct the questionnaire survey were included in the study. Permission to carry out the study was obtained from the school authority (Principal) prior to the survey procedure. A total of 589 private school teachers were present in 22 schools. Private school teachers teaching both primary and high school children who were present on the day of the survey were included in the study. School teachers who are not willing to participate, who did not provide written informed consent and incomplete or partially filled questionnaire were excluded from the study. A schedule for the survey was prepared prior to the data collection and was conducted within the working hours of the school, as per the time allotted by the principals of the respective schools.

The study was conducted for a period of 3 months from the month of March 2017 to May 2017. Participants are informed regarding the study and their written informed consent is taken prior to the distribution of the questionnaire. Anonymity and confidentiality of participants are maintained.

The information was gathered from the subjects by using the survey tool which comprised of Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982).[13] It is a 19-item questionnaire rated on a 5 point Likert–type scale with response categories: 1-strongly agree, 2-agree, 3-undecided, 4-disagree, 5-strongly disagree. DSQ has subscales: 'access' (items 5, 13, 15), 'availability/convenience' (items 7, 9), 'cost' (items 3, 10), 'continuity' (items 12), 'quality' (items 2, 6, 11, 14, 16, 17, 18), 'access total' (items 3, 5, 7, 9, 10, 13, 15), 'general satisfaction' (item 1) and 'pain management' (items 4, 8, 19). The items 1, 3, 4, 5, 8, 11, 13 and 17 are reversed scored. The overall Dental Satisfaction Index (DSI) is obtained by summing the 19 items ratings and so ranges from 19 to 95. The higher scores indicate higher satisfaction, whereas, lower scores indicate lower satisfaction.

In addition to the questionnaire, information on demographic details of the respondents were collected along with visit to a dentist (yes/no), recent dental visit (Less than a Year/a Year/More than a Year) and utilization of dental services (Dental Teaching Institution/Private Practitioner/Government hospital).

Statistical analysis

The collected data was analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Chi- square test was used to compare between categorical variables. Mann –Whitney U test was used for the mean comparison of subscales of DSQ for quantitative variables (age, gender and dental visit). Comparison of mean scores of subscales of DSQ with recent dental visit and utilization of dental services was done using Kruskal Wallis ANOVA test. Statistical significance was set at P < 0.05.


   Results Top


Out of 589 private school teachers, only 515 respondents willingly participated and completed the questionnaire and were included in the present study with response rate of 87.43%. The study comprised of 123 (23.9%) males and 392 (76.1%) females. Majority of the subjects, belonged to the age group 31-40 years [266 (51.7%)], and had visited a dentist [342 (66.4%)] with a recent dental visit of more than a year [203 (39.4%)]. Most of the subjects preferred to visit a private practitioner [237 (46.0%)] for dental checkup or treatment.

With respect to the item-wise response, a higher percentage of subjects opted the option of Agree (2) for all the items (1-19), except for the item 13 [It's hard to get an appointment for dental care right away], wherein majority of respondents preferred the option disagree (4) [209 (40.6%)].

With comparison based on age, subjects in the age group of 21-30 years had higher mean scores for the subscales 'cost' (4.92 ± 1.63) and for the overall 'DSI' (40.98 ± 8.07). Whereas, subjects in the age group of 31-40 years had higher mean scores for the subscale 'quality' (14.81 ± 3.15). Similarly, subjects in the age group of 41-50 years had higher mean scores for the subscales 'access' (8.34 ± 2.15), 'continuity' (2.58 ± 1.05) and 'pain management' (7.50 ± 1.94). Likewise, subjects in the age group 51-60 years had higher mean scores for the subscales 'availability' (4.32 ± 2.06), 'access total' (17.28 ± 3.73) and 'general satisfaction' (1.88 ± 0.88). However, significant relation was found only for subscales 'access' (P = 0.01), 'quality' (P = 0.04) and 'general satisfaction' (P = 0.03) with age group [Table 1].
Table 1: Mean comparison of subscales of Dental Satisfaction Questionnaire (DSQ) based on age

Click here to view


Based on gender, female subjects had higher mean scores for all the subscales of DSQ: 'access' (7.99 ± 2.96), 'cost' (4.89 ± 1.40), 'continuity' (2.58 ± 1.06), 'quality' (14.82 ± 3.07), 'access total' (16.93 ± 3.84), 'general satisfaction' (1.90 ± 0.65), 'pain management' (7.27 ± 1.95) and overall 'DSI' (41.09 ± 6.93) except for subscale 'availability' in comparison to male subjects. Nonetheless, significant relation was found only for the subscales 'cost' (P < 0.001), 'quality' (P = 0.001), 'access total' (P = 0.008), 'general satisfaction' (P < 0.001) and the overall 'DSI' (0.001) [Table 2].
Table 2: Mean comparison of subscales of Dental Satisfaction Index (DSQ) based on gender

Click here to view


With regards to dental visit, it was revealed that the subjects who had visited the dentist had higher mean scores for the subscales 'access' (8.08 ± 3.06), 'cost' (4.78 ± 1.42), 'continuity' (2.57 ± 1.12), 'general satisfaction' (1.82 ± 0.63) and 'pain management' (7.28 ± 1.93). On the other hand, subjects who did not visit the dentist had higher mean scores for the subscales 'availability' (4.50 ± 1.52), 'quality' (15.12 ± 3.48), 'access total' (16.83 ± 3.94) and over all 'DSI' (40.86 ± 7.96). Nevertheless, statistical significant relation was found only for the subscales 'access' (P = 0.04), 'availability' (P < 0.001) and 'general satisfaction' (P = 0.04) with respect to dental visit [Table 3].
Table 3: Mean comparison of subscales of Dental Satisfaction Questionnaire (DSQ) based on dental visit

Click here to view


Based on recent dental visit, subjects who had recent dental visit less than a year had higher mean scores for most of the subscales and the overall DSI. Yet, none of the subscales and overall DSI had significant relation with recent dental visit. Comparison based on utilization of dental services revealed that the subjects who had visited the dental teaching institute had higher mean scores for the subscale 'access' (8.22 ± 5.25). Similarly, subjects who had visited the private practitioner had higher mean scores for the subscale 'availability' (3.96 ± 1.38), 'cost' (4.82 ± 1.34), 'access total' (16.91 ± 3.23), 'general satisfaction' (1.83 ± 0.64) and 'pain management' (7.40 ± 1.81). Likewise, subjects who had utilized the government hospital had higher mean scores for the subscale 'continuity' (2.91 ± 1.17) and 'quality' (14.44 ± 3.36). Nevertheless, significant relation was found only for the subscales 'availability' (P = 0.04) and 'continuity' (P = 0.02) with the utilization of dental services [Table 4].
Table 4: Mean comparison of subscales of Dental Satisfaction Questionnaire (DSQ) based on utilization of dental services

Click here to view



   Discussion Top


Dental satisfaction is a central aspect of the quality of care, which further influences the future utilization of the dental services and in turn anticipated treatment quality.[2] They are relevant to all aspects of dental practice. In the present survey, an effort was made to analyse the various aspects of the different dental services. As these services can contribute towards ensuring dental satisfaction and help to determine factors that could lead to better satisfaction. A key task for all dental service providers is to satisfy the individuals who had utilized the dental services.

In the present study, the population chosen was school teachers, as they constitute one of the biggest organized forces.[14] They can be a cornerstone in encouraging, motivating and creating awareness among school children to maintain good oral health. As it is an economical and powerful means of raising the community health of the future generations.[12] Hence in the present study, an effort was made to assess the dental satisfaction among school teachers in Dilsukhnagar, Hyderabad.

Literature had shown that dental satisfaction has been affected by various factors and different measures can be used for assessing it, such as Dental Satisfaction Questionnaire (DSQ),[13] Dental Visit Satisfaction Survey (DVSS),[15] Dental Satisfaction Survey (DSS)[16] and additionally other study used the self designed questionnaires.[4] However, unlike the DSQ, these instruments were neither valid nor reliable in countries other than the one in which they originated. In the present study, the questionnaire used was DSQ which was developed by Davies and Ware (1982)[13] which is a 19-itemed instrument designed for self administration in about 5 minutes. It also has the advantage of measuring the dimensions of the dentist's technical competence, interpersonal aspects of care, pain management, quality, access and overall satisfaction of an individual. It also has good internal consistency, validity and reliability.

In the current study, out of 589 private school teachers, only 515 respondents participated with the response rate of 87.43%. This study achieved an acceptable response rate from the school teachers possibly due to the cooperativeness of the school authorities who encouraged participation allowing the questionnaire to be distributed, completed and collected on the day of survey.

The present study comprised of 123 (23.9%) males and 392 (76.1%) females. This is in agreement with the studies conducted in India (Mumbai- Mota et al.,[17] Chennai- Mary AV et al.,[18] Pondicherry- Sekhar V et al.[19]) and other countries (Trinidad- Ramroop V et al.,[20] Nigeria- Lawal FB et al.[21]) revealed female predominance among teaching profession. Majority of the subjects belonged to the age group 31-40 years. Similarly, a study conducted by Mota et al.[17] among school teachers in Mumbai, reported that majority belonged to 25-49 years.

On the positive note, in this study, 66.4% had visited a dentist, whereas Mary AV et al.[18] also reported that 71% of school teachers had visited a dentist. This reflects that school teachers had a good knowledge and positive attitude towards oral health and dentistry. The reasons for not visiting dentist might be no dental problem, no time to spend, fearful of pain, or any financial constraints

In the present scenario, majority of the study subjects preferred to visit private practitioner for a dental check up. This was in concurrence with the study conducted by Al Johara AA[22] among adolescent females in Riyadh city reported that 75.5% utilised the private practitioner. This might be due to modern dental clinic setup, quality of dental care and convenient appointment.

When subscales of DSQ, were taken into consideration, based on age, subjects aged 21-30 years showed higher means scores (40.98 ± 8.07) for overall Dental Satisfaction Index (DSI) but they are not statistically significance. A similar but high mean score of DSI (60.8 ± 8.5) was observed among 23 years Norwegian young adults by Skaret E et al.[23] This might be due to positive beliefs towards the dentist, low or moderate dental anxiety, perception of visiting a dentist and pleasant previous dental treatment.

Based on age, significant relation was found only for subscales of DSQ are access (41-50 years), quality (31-40 years) and general satisfaction (51-60 years). These results are in agreement with the study conducted by Kumar RVSK et al.[24] among general population in Nellore district, Andhra Pradesh revealed that the higher mean scores were observed for the age group of 35-50 years where as age group of 50-65 years showed lower mean scores. This could be that these age groups above 30 years will be having many dental problems as the expectations are met as they have received the better treatment like prosthesis which had restored their condition.

The existing study revealed that the females had higher mean scores for most of the subscales of DSQ. However, significant relation was noted for the subscales cost, quality, access total, general satisfaction and overall DSI. It is worth to be noted that female teachers are more satisfied, this could be due to positive attitude, good knowledge towards dentistry and greater exposure to dental services which would likely moderate their expectations, which in turn, are more likely to be met. This was contradictory to the findings of Skaret et al.,[23] wherein males are more satisfied than females.

In this study, subjects who had visited a dentist had higher mean scores for accessibility and are generally satisfied. Whereas, subjects who did not visit a dentist also showed higher mean scores for availability of dental services. This adds a positive impression towards school teachers that even without visiting the dentist, they are aware about the dental services available nearby.

In the present study, subjects who visited the private practitioner showed higher means scores for most of the subscales. This could be due to the interpersonal skills, shorter appointment time, availability, and comprehensive nature of care of private dental practice. In contrast, Thanveer K et al.,[16] Almutairi MA et al.[7] reported that patient satisfaction levels are good among patients attending dental schools.

The strength of the present study was a homogenous sample of school teachers from different schools. However, certain limitations are observed in this study. Firstly, we failed to measure the other relevant variables like self rated oral health status, reason for the dental visit etc., Secondly, it is based on self reported data, and this may subjected to recall bias and subjective nature of satisfaction. It should be realised that the same individual cannot have the same level of satisfaction for the similar treatment performed by the same doctor, even after a very short span. So, it varies.


   Conclusion Top


Based on findings of present study, female subjects, subjects who had dental visit and who had visited a private practitioner had higher dental satisfaction. Continuing dental education programmes and workshops should be conducted by dentists in schools to create awareness among school teachers as well as school children's. To increase or to prefer the dental teaching institute services, dental camps must be conducted at schools for a dental check up and for follow ups can be referred to institution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patel JY. A study on evaluation of patient satisfaction with dental health care services. IJSRP 2014;4:1-5.  Back to cited text no. 1
    
2.
Patil V, Chhabra Rs, Rajpurohit L, Deshpande R, Kamath A, Patil D. Assessment of standards for quality dental treatment and facilities provided for a child patient in a specialized pediatric dental clinic. J Dent Res Sci Dev 2016;3:7-11.  Back to cited text no. 2
    
3.
Armfield JM, Enkling N, Wolf CA, Ramseier CA. Dental fear and satisfaction with dental services in Switzerland. J Public Health Dent 2014;74:57-63.  Back to cited text no. 3
    
4.
Kumar G, Dileep CL. Dental care satisfaction among patients attending health care facilities in Dhanbad City, Jharkhand State, India. Indian J Dent Adv 2012;4:884-7.  Back to cited text no. 4
    
5.
Chattopadhyay A, Saha T, Karmakar P, Sengupta P, Boral K, Yasmin S. Patient satisfaction evaluation in CGHS dispensaries in Kolkata, India. IOSR-JDMS 2013;6:13-9.  Back to cited text no. 5
    
6.
Mascarenhas AK. Patient satisfaction with the comprehensive care model of dental care delivery. J Dent Educ 2001;65:1266-71.  Back to cited text no. 6
    
7.
Almutairi MA. Parents' satisfaction with pediatric dental care provided by dental college, Riyadh. J Int Soc Prev Community Dent 2016;6:542-8.  Back to cited text no. 7
    
8.
Priya H, Chauhan A, Kumar M. Factors affecting dental satisfaction among Malaysian dental students. Int J Dent Clin 2011;3:5-8.  Back to cited text no. 8
    
9.
Priya H, Purohit B, Acharya S, Bhat M, Kumar M. Factors affecting dental satisfaction among indian undergraduate dental students. Int J Dent Clin 2011;3:8-13.  Back to cited text no. 9
    
10.
Rao MN, Samiullah S. Job satisfaction and mental health among school teachers. Int J Humanit Soc Sci Res 2016;2:23-9.  Back to cited text no. 10
    
11.
Gkolia A, Belias D, Koustelios A. Teacher's job satisfaction and self efficacy: A review. Eur Sci J 2014;10:321-30.  Back to cited text no. 11
    
12.
Mary AV, Ebenezar AR, Kesavan R, Chaly PE, Reddy VC, Ingle N. Oral health perception and practices among school teachers in a South Indian City. J Appl Dent Med Sci 2015;1:26-32.  Back to cited text no. 12
    
13.
Davies AR, Ware JE. Development of a Dental Satisfaction Questionnaire for the Health Insurance Experiment. Santa Monica: The Rand Corporation; 1982.  Back to cited text no. 13
    
14.
Pai V, Sequeira PS, Rao A, Kundabala M. Dental awareness among kannada and english medium primary school teachers in Mangalore City. JIAPHD 2006;4:7-12.  Back to cited text no. 14
    
15.
Hakeberg M, Heidari E, Norinder M, Berggren U. A swedish version of the dental visit satisfaction scale. Acta Odontol Scand 2000;58:19-24.  Back to cited text no. 15
    
16.
Thanveer K, Krishan A, Hongal S. Treatment satisfaction among patients attending a private dental school in Vadodara, India. J Int Oral Health 2010;2:33-44.  Back to cited text no. 16
    
17.
Mota A, Oswal KC, Sajnani DA, Sajnani AK. Oral health knowledge, attitude, and approaches of pre-primary and primary school teachers in Mumbai, India. Scientifica 2016;2016:1-7.  Back to cited text no. 17
    
18.
Mary VA, Chaly PE, Reddy CV, Ingle NA, Ebenezar AR, Kessavan R. Oral health status and treatment needs of school teachers in Chennai. JIAPHD 2013;11:42-7.  Back to cited text no. 18
    
19.
Sekhar V, Sivsankar P, Easwaran MA, Subitha L, Bharath N, Rajeswary K, et al. Knowledge, attitude and practice of school teachers towards oral health in Pondicherry. J Clin Diagn Res 2014;8:ZC12.  Back to cited text no. 19
    
20.
Ramroop V, Wright D, Naidu R. Dental health knowledge and attitudes of primary school teachers toward developing dental health education. West Indian Med J 2011;60:576-80.  Back to cited text no. 20
    
21.
Lawal FB, Bankole OO. Oral health awareness and practices of primary school teachers in Ibadan, Nigeria. J West Afr Coll Surg 2014;4:47-65.  Back to cited text no. 21
    
22.
Al Johara A. Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City. Saudi Dent J 2010;22:19-25.  Back to cited text no. 22
    
23.
Skaret E, Berg E, Raadal M, Kvale G. Factors related to satisfaction with dental care among 23-year olds in Norway. Community Dent Oral Epidemiol 2005;33:150-7.  Back to cited text no. 23
    
24.
Kumar RVSK, Fareed N, Shanthi M, Nagarakanti S. Assessing patients' satisfaction with dental services provided by the dentists in Nellore District of Andhra Pradesh. J Indian Assoc Public Health Dent 2009;7:1-6.  Back to cited text no. 24
  [Full text]  

Top
Correspondence Address:
Dr. Pandi S Shulamithi
Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Road No 5, Kamala Nagar, Dilsukhnagar, Hyderabad, Telangana - 500 060
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_324_18

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed129    
    Printed0    
    Emailed0    
    PDF Downloaded28    
    Comments [Add]    

Recommend this journal