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ORIGINAL ARTICLE01-30-2023
Adverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
Revista Brasileira de Enfermagem. 2023;76(1):e20220161
Abstract
ORIGINAL ARTICLEAdverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
Revista Brasileira de Enfermagem. 2023;76(1):e20220161
DOI 10.1590/0034-7167-2022-0161
Views0ABSTRACT
Objective:
to associate the presence and grading of adverse dermatoneurological events (peripheral neuropathy and hand-foot syndrome) and the interference in the activities of daily living of patients with gastrointestinal neoplasms undergoing systemic antineoplastic treatment.
Method:
this is a longitudinal, prospective study, using instruments to assess hand-foot syndrome and peripheral neuropathy.
Results:
there were 36 patients: 66.7% diagnosed with colon cancer and 83.2% on combination therapy. From cycle 5 onwards, all of them had hand-foot syndrome, with a majority of grade 1, unrelated to interference in activities of daily living. Regarding peripheral neuropathy, there was a moderate to strong correlation from cycle 1 of treatment.
Conclusion:
peripheral neuropathy negatively affects activities of daily living. The monitoring of dermatoneurological events by oncology nurses contributes to the clinical practice of nursing and subsidizes the development of advanced practice in the country.
Keywords:Activities of Daily LivingAdverse EventsAntineoplasticGastrointestinal NeoplasmsNursing OncologySee more -
ORIGINAL ARTICLE01-30-2023
Pressure injury prevention in older people: construction and validation of an instrument for caregivers
Revista Brasileira de Enfermagem. 2023;76(1):e20210930
Abstract
ORIGINAL ARTICLEPressure injury prevention in older people: construction and validation of an instrument for caregivers
Revista Brasileira de Enfermagem. 2023;76(1):e20210930
DOI 10.1590/0034-7167-2021-0930
Views0ABSTRACT
Objectives:
to construct and validate an instrument to assess the knowledge, attitudes, and practices related to pressure injury prevention among caregivers of institutionalized older people.
Methods:
this is a three-stage methodological study that consisted of instrument construction, analysis by experts, and semantic and appearance analysis, with 78 participants, observing the validation process steps for psychometric instruments in the criteria of clarity and relevance.
Results:
in the Delphi I round, the validity index of the general content in the clarity criterion was 0.66, in relevance 0.85, and the Kappa value was >0.76. In Delphi II, clarity was 0.95, relevance 1.00, and the Kappa value was >0.97.
Conclusions:
this is a valid instrument in terms of content and appearance, which allows further analysis of its reliability for the measurement of the constructs for which it is intended. Therefore, it can be considered a tool for care management in pressure injury prevention.
Keywords:AttitudesCaregiversHealth KnowledgeNursing Methodology ResearchPracticePressure UlcerValidation StudySee more -
ORIGINAL ARTICLE01-30-2023
Educational material production and validity: educational instrument for home care for premature newborns
Revista Brasileira de Enfermagem. 2023;76(1):e20210648
Abstract
ORIGINAL ARTICLEEducational material production and validity: educational instrument for home care for premature newborns
Revista Brasileira de Enfermagem. 2023;76(1):e20210648
DOI 10.1590/0034-7167-2021-0648
Views0ABSTRACT
Objective:
to produce and validate a booklet, based on Jean Watson’s Theory, on home care for premature newborns, based on caregivers’ experiences.
Method:
a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts.
Results:
the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet “Booklet for Premature Newborns: Demystifying Home Care”. The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity.
Final considerations:
the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers’ autonomy in providing home care to newborns.
Keywords:Educational and Promotional MaterialsHealth EducationInfantIntensive Care UnitsNeonatalPrematureValidation StudySee more -
ERRATUM01-06-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(2):e2023n2e01
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(2):e2023n2e01
DOI 10.1590/0034-7167.20237601e01
Views0In the article “Development and validity of an educational folder for pulmonary tuberculosis sputum collection”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(1):e202220194, on page 8:Delete:[…]See more -
ORIGINAL ARTICLE12-16-2023
School Nursing Guide for student health promotion: construction and validity
Revista Brasileira de Enfermagem. 2023;76(1):e20220260
Abstract
ORIGINAL ARTICLESchool Nursing Guide for student health promotion: construction and validity
Revista Brasileira de Enfermagem. 2023;76(1):e20220260
DOI 10.1590/0034-7167-2022-0260
Views0See moreABSTRACT
Objectives:
to describe the process of construction and validity of a School Nursing Guide for student health promotion.
Methods:
a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender’s Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance.
Results:
the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997.
Conclusions:
the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.
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ORIGINAL ARTICLE12-16-2023
Cardiac anxiety in the perioperative period of patients undergoing cardiac surgical procedures: an observational study
Revista Brasileira de Enfermagem. 2023;76(1):e20220250
Abstract
ORIGINAL ARTICLECardiac anxiety in the perioperative period of patients undergoing cardiac surgical procedures: an observational study
Revista Brasileira de Enfermagem. 2023;76(1):e20220250
DOI 10.1590/0034-7167-2022-0250
Views0See moreABSTRACT
Objective:
to compare cardiac anxiety symptoms in patients undergoing coronary artery bypass graft and valve surgery repair in the preoperative period, on the day of hospital discharge and on the first return visit after hospital discharge.
Methods:
an observational study, carried out in inpatient units and in outpatient clinic of a university hospital. Data were collected through interviews. Cardiac anxiety symptoms were assessed using the Cardiac Anxiety Questionnaire.
Results:
we observed the effect of time on cardiac anxiety symptoms of patients undergoing coronary artery bypass graft in the total score and in the “Avoidance” domain at discharge and at the first return visit. In patients undergoing valve repair surgery, the effect of time on symptoms was observed only in the first return visit, when compared with the preoperative period.
Conclusion:
the findings revealed increased cardiac anxiety symptoms in the postoperative period, discharge and first return, when compared to the preoperative period.
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ORIGINAL ARTICLE12-16-2023
Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District
Revista Brasileira de Enfermagem. 2023;76(1):e20220170
Abstract
ORIGINAL ARTICLEElderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District
Revista Brasileira de Enfermagem. 2023;76(1):e20220170
DOI 10.1590/0034-7167-2022-0170
Views0See moreABSTRACT
Objectives:
To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District.
Methods:
Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%.
Results:
There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999).
Conclusions:
Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.
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REVIEW12-16-2023
Educational interventions in child development and health literacy assumptions: an integrative review
Revista Brasileira de Enfermagem. 2023;76(1):e20220116
Abstract
REVIEWEducational interventions in child development and health literacy assumptions: an integrative review
Revista Brasileira de Enfermagem. 2023;76(1):e20220116
DOI 10.1590/0034-7167-2022-0116
Views0See moreABSTRACT
Objectives:
to analyze scientific evidence in the literature that addresses educational interventions conducted by health professionals on early childhood development in a community context and to identify which health literacy assumptions are present during the implementation of interventions.
Method:
an integrative review in PubMed, CINAHL and Web of Science databases. Of 300 studies found, we selected 11 for the sample.
Results:
health professionals are trained to implement interventions with parents/caregivers to promote child development in community settings. Parents are encouraged to develop an environment that is encouraging and conducive to the development of their children. The main dimensions of health literacy found were access and apply.
Conclusion:
it confirms the importance of training health professionals, with skills and communicative skills to guide parents/caregivers to encourage the development of their children in their family environment with playful and interactive activities.
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ORIGINAL ARTICLE11-22-2024
Prevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
Abstract
ORIGINAL ARTICLEPrevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
DOI 10.1590/0034-7167-2023-0327
Views0See moreABSTRACT
Objectives:
to assess pain management during labor.
Methods:
a cross-sectional study was carried out by reviewing medical records and conducting postpartum interviews. Prevalence and effectiveness of analgesia were assessed.
Results:
the prevalence of non-pharmacological analgesia was 61.86% of 215 women in labor in Obstetric Center and 82.51% of 62 in midwife-led unit. Prevalence of severe pain, on the Visual Analogue Scale, before and after non-pharmacological analgesia, was from 92.16% to 64.04% (p=0.00) in Obstetric Center and from 85.96% to 52.63% (p=0.01) in midwife-led unit. Prevalence of pharmacological analgesia in Obstetric Centers was 15.81%, with no variation in severe pain (p=0.57). Patients’ request for analgesia was associated with education (p=0.00) and pain intensity (p=0.02).
Conclusions:
non-pharmacological analgesia improved pain intensity. Prevalence of pharmacological analgesic prescription was lower than that identified in developed countries. Pain management needs to consider the preferences and needs of women in labor.
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ORIGINAL ARTICLE11-22-2024
Knowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
Abstract
ORIGINAL ARTICLEKnowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
DOI 10.1590/0034-7167-2023-0287
Views0ABSTRACT
Objective:
To analyze how management practices for sharing knowledge are developed in public hospitals in the context of nursing.
Methods:
Qualitative research, carried out with 15 nurse managers from six public hospitals, from July to September 2022. Data were collected through semi-structured interviews and analyzed according to content analysis and in a model for sharing knowledge at work.
Results:
Knowledge sharing in nursing occurs through intraand extra-organizational training (training, courses and events), use of digital communication tools (media and social networks) and individual and collective contact between professionals during the service (experiences, exchange of experiences and assessment feedback).
Final considerations:
Sharing knowledge is relevant to nursing work. To improve it, it must be understood that effective sharing occurs from person to person, in their daily practices, and must be conducted as a strategically planned process by nurse managers.
Keywords:Health Information ManagementHealth Services AdministrationKnowledge ManagementNursing Service, HospitalNursing Staff, HospitalSee more -
ORIGINAL ARTICLE11-22-2024
Transitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
Abstract
ORIGINAL ARTICLETransitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
DOI 10.1590/0034-7167-2023-0229
Views0See moreABSTRACT
Objective:
to understand the transitional processes that affect the adaptation of people who live with limitations resulting from leprosy.
Methods:
This is a qualitative study based on the precepts of Transition Theory, mediated by care-research, with 24 people with limitations resulting from leprosy in an ex-hospital colony in Piauí. Semi-structured interviews were carried out. The interviews were analyzed using Iramuteq software.
Results:
the researched-caregivers experienced the four types of transitions, including feelings of fear, worry, loneliness, hopelessness, guilt and a tendency to hide the diagnosis. Breakdowns and resignation were revealed, with spirituality, adaptation to the new life situation and acceptance as facilitating conditions for coping with the transitional process, with a consequent improvement in quality of life.
Final considerations:
the transitional processes had a positive significance, since they contributed to adaptation and the achievement of quality of life.
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ORIGINAL ARTICLE11-22-2024
Study for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
Abstract
ORIGINAL ARTICLEStudy for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
DOI 10.1590/0034-7167-2023-0112
Views0ABSTRACT
Objective:
To develop and validate indicators for the evaluation of computerized systems in vaccination rooms.
Methods:
Methodological study. From the construction of a logical model for managing information produced in computerized systems in vaccination rooms, an evaluation indicator matrix was developed, and its contents were validated by specialists using the Delphi method. The degree of relevance and clarity were judged, using the following parameters: agreement percentage ≥ 90%; content validity index > 0.78. Internal consistency was tested using Cronbach’s alpha coefficient of 0.93.
Results:
Of the 55 proposed indicators, 48 were validated and composed the final matrix, with 13 in the structure dimension, 29 in the process dimension, and six in the outcome dimension.
Conclusion:
The set of indicators shows validity and high reliability, and can be used to evaluate computerized systems in vaccination rooms throughout the country, as it adhered to the recommendations of the National Immunization Program.
Keywords:Delphi TechniquesElectronic Health RecordsImmunization ProgramsInformation TechnologyValidation StudySee more -
ORIGINAL ARTICLE11-22-2024
Interpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
Abstract
ORIGINAL ARTICLEInterpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
DOI 10.1590/0034-7167-2023-0081
Views0See moreABSTRACT
Objective:
To identify the frequency of notifications of interpersonal violence in Espírito Santo from 2011 to 2018, and the factors associated with this issue.
Methods:
This is a cross-sectional study in which all cases of interpersonal violence from the Information System for Notifiable Diseases in the state of Espírito Santo during the period from 2011 to 2018 were analyzed. Absolute and relative frequencies and 95% confidence intervals were calculated, as well as Poisson regression.
Results:
During the analyzed period, 27,277 cases were reported in Espírito Santo (P: 75%; 95% CI: 74.5-75.4), being more prevalent among females, children, and the elderly, individuals of black/mixed race, people without disabilities, and residents of urban areas. Regarding the perpetrator, there was a higher prevalence of individuals aged 25 years and older, males, with a current or former intimate partner relationship with the victim, and suspected alcohol use at the time of the aggression. In terms of the characteristics of the aggression, there was a higher prevalence of repeat violence, involving a single aggressor, and occurring in the residence.
Conclusions:
The notification of interpersonal violence in Espírito Santo showed a high prevalence and was associated with characteristics of the victim, aggressor, and event. This scenario reinforces the need for interventions such as professional qualification, expansion of intersectoral actions, and reformulation of public policies.
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ORIGINAL ARTICLE11-22-2024
Sociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
Abstract
ORIGINAL ARTICLESociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
DOI 10.1590/0034-7167-2024-0010
Views0See moreABSTRACT
Objective:
To analyze the sociodemographic and occupational influences on health professionals’ quality of life.
Method:
This descriptive-exploratory, cross-sectional, analytical, and quantitative study addressed 94 health workers, including nursing technicians, nurses, and physical therapists working in Intensive Care Units in a town in the extreme south of Brazil in 2023. The student’s t-test and Spearman correlation were used.
Results:
A significant positive correlation was found between being a woman and the psychological domain and between income and the social and environmental domain while working hours were inversely related to general QoL. Additionally, workload negatively impacted the physical, psychological, and general QOL, furniture negatively influenced the psychological domain, and equipment was negatively associated with the physical and psychological domain.
Conclusion:
The characteristics of the work environment interfere with several areas of quality of life.
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REVIEW11-22-2024
Concept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
Abstract
REVIEWConcept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
DOI 10.1590/0034-7167-2024-0002
Views0See moreABSTRACT
Objective:
To analyze the concept of “youth.”
Methods:
This is a concept analysis guided by the method proposed by Walker and Avant, operationalized through an integrative literature review. The search in scientific databases was carried out using the descriptors: youth; young; adolescence. To compose the literary corpus, 22 studies were selected.
Results:
Various factors were found in the antecedents that influence the separation of youth groups, contributing to the heterogenization of this population. The attributes include characteristics that comprise the formation of youth groups, especially the idea of shared experiences and social construction, as well as the consequences of the mentioned concept. After systematizing the variables, the analysis was conducted, highlighting the conceptions that influence youth.
Conclusion:
The study demonstrated the multifactorial complexity of the formulation of the concept of youth, highlighting various factors that contribute to this construction. For nursing, this conceptual field allows for an understanding of the population and effective engagement with this group.
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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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