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03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
02-26-2024
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201pt
Views0A prática profissional da navegação de pacientes é algo incipiente no Brasil e, sendo assim, é indispensável uma ampla discussão com vários setores da sociedade, sendo essa a principal propositura deste editorial. Comecemos pela história.A navegação de pacientes foi definida em 1989 como uma intervenção de prestação de serviços baseada na comunidade, com o objetivo […]See more -
02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more -
ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
DOI 10.1590/0034-7167.20247701e02
Views0In the article “Active teaching model to promote critical thinking”, with DOI number: , published in Revista Brasileira de Enfermagem, 2019;72(1):293-8, on page 297:Include before REFERENCES:[…]See more -
REVIEW02-26-2024
Practice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
Abstract
REVIEWPractice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
DOI 10.1590/0034-7167-2023-0260
Views0See moreABSTRACT
Objectives:
to identify immersion use in hot water to relieve pain in newborns.
Methods:
an integrative literature review, carried out in the PubMed, VHL, EMBASE, Scopus, CINAHL, Cochrane and SciELO databases, with investigations in English, Spanish, French or Portuguese, published between 2002 and 2022. The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used to answer the following question: what are the uses of hot water immersion in relieving pain in newborns?
Results:
nine studies were included, mainly Brazilian, experimental, with a predominance of strong and moderate levels of evidence. Hydrotherapy and bath use (immersion and bandaging) was observed, promising interventions in reducing pain scores, assessed using scales, physiological and endocrine parameters.
Conclusions:
hot water proved to be a promising non-pharmacological intervention in relieving pain in infants in different contexts.
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ORIGINAL ARTICLE02-26-2024
Artificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
Abstract
ORIGINAL ARTICLEArtificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
DOI 10.1590/0034-7167-2023-0201
Views0See moreABSTRACT
Objectives:
to assess the predictive performance of different artificial intelligence algorithms to estimate bed bath execution time in critically ill patients.
Methods:
a methodological study, which used artificial intelligence algorithms to predict bed bath time in critically ill patients. The results of multiple regression models, multilayer perceptron neural networks and radial basis function, decision tree and random forest were analyzed.
Results:
among the models assessed, the neural network model with a radial basis function, containing 13 neurons in the hidden layer, presented the best predictive performance to estimate the bed bath execution time. In data validation, the squared correlation between the predicted values and the original values was 62.3%.
Conclusions:
the neural network model with radial basis function showed better predictive performance to estimate bed bath execution time in critically ill patients.
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REVIEW02-26-2024
Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
Abstract
REVIEWEvidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
DOI 10.1590/0034-7167-2023-0134
Views0See moreABSTRACT
Objectives:
to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.
Methods:
an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.
Results:
141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses’ competency to insert an intrauterine device; and Women’s access to intrauterine devices.
Conclusions:
nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.
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ORIGINAL ARTICLE11-22-2024
Temporal trends in neonatal mortality in Pernambuco
Revista Brasileira de Enfermagem. 2024;77(4):e20230451
Abstract
ORIGINAL ARTICLETemporal trends in neonatal mortality in Pernambuco
Revista Brasileira de Enfermagem. 2024;77(4):e20230451
DOI 10.1590/0034-7167-2023-0451
Views0See moreABSTRACT
Objective:
To verify the temporal trend of neonatal mortality in the health regions of Pernambuco between 2000 and 2020.
Method:
A time-series ecological study was conducted, analyzing the total neonatal mortality rate and its early and late components. For regression analysis, Joinpoint Regression was applied, trends were classified, and annual and average percentage changes were calculated for the period, with a significance level of 95%.
Results:
The average neonatal mortality rate in Pernambuco was 11.5 during the studied period. A decreasing trend in neonatal mortality rate was observed, especially in the early component. The region where the state capital is located showed the fastest decrease across all components.
Conclusion:
The temporal trend of neonatal mortality was decreasing; however, the rate of reduction was not uniform across the health regions of the state, and the implementation of the Mãe Coruja Pernambucana Program did not impact the trend in neonatal mortality.
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ORIGINAL ARTICLE11-22-2024
Evaluation of a video to promote HIV testing in sexual minorities
Revista Brasileira de Enfermagem. 2024;77(4):e20230320
Abstract
ORIGINAL ARTICLEEvaluation of a video to promote HIV testing in sexual minorities
Revista Brasileira de Enfermagem. 2024;77(4):e20230320
DOI 10.1590/0034-7167-2023-0320
Views0See moreABSTRACT
Objective:
To design and evaluate an educational video aimed at promoting HIV testing in gay men from the theoretical perspective of the Nola J. Pender Health Promotion Model.
Methods:
The design comprised five steps: 1.- Literature search; 2.- Formulation of the educational objective; 3.- Drafting of the script and location of the information in the theoretical components; 4.- Production; and 5.- Evaluation by experts and the target population.
Results:
The video “Living Without Fear” was produced, which presents the dilemma faced by gay men before taking a HIV test. The content validity index was 0.85, which indicated that the information was adequate and acceptable for promoting the rapid HIV test.
Final Considerations:
The results contribute to the scientific evidence aimed at promoting healthy behavior. In addition, the video was shown to be an acceptable educational tool.
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ORIGINAL ARTICLE11-22-2024
Development and validity of a mobile application prototype for hospital shift handover
Revista Brasileira de Enfermagem. 2024;77(4):e20230173
Abstract
ORIGINAL ARTICLEDevelopment and validity of a mobile application prototype for hospital shift handover
Revista Brasileira de Enfermagem. 2024;77(4):e20230173
DOI 10.1590/0034-7167-2023-0173
Views0See moreABSTRACT
Objective:
To develop and validate a mobile application prototype for nursing shift handover in a hospital inpatient unit.
Methods:
A methodological study of technological production, carried out from April 2020 to January 2022, for mobile application construction and validity through the Design Thinking methodology. The study involved the stages of prototype development and validity by experts.
Results:
The application for mobile nursing shift handover obtained a usability score of 79 points and a content validity coefficient of 0.7.
Conclusions:
The instrument obtained an excellent assessment according to usability and agreement among experts. However, future studies are needed to implement this technology in order to assess effectiveness, time optimization and failures during communication.
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ORIGINAL ARTICLE10-25-2024
Analysis of the vaccination situation against Mpox in people living with HIV/AIDS: an ecological study
Revista Brasileira de Enfermagem. 2024;77(5):e20230234
Abstract
ORIGINAL ARTICLEAnalysis of the vaccination situation against Mpox in people living with HIV/AIDS: an ecological study
Revista Brasileira de Enfermagem. 2024;77(5):e20230234
DOI 10.1590/0034-7167-2023-0234
Views0See moreABSTRACT
Objectives:
to analyze the vaccination situation against Mpox in people living with HIV/AIDS in Brazil.
Methods:
an ecological study on the vaccination status against Mpox in people living with HIV/AIDS (PLWHA) in Brazil. The data were collected in April 2023 through information from the Ministry of Health, using the “Microsoft app Power BI,” which is publicly accessible.
Results:
the data analysis revealed that in Brazil, 2,978 doses of the MVA-BN Jynneos Mpox vaccine were administered in PLWHA, resulting in a vaccination coverage of 18.3%, with the southern and southeastern regions showing the lowest and highest vaccination coverage, respectively. Gender-based evaluation showed a higher proportion of vaccinated males.
Conclusions:
we identified low vaccination coverage in all regions of Brazil, highlighting the need for intensified vaccination activities, especially for PLWHA.
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ORIGINAL ARTICLE10-11-2024
Indigenous women’s experiences about the pregnancy-puerperal cycle
Revista Brasileira de Enfermagem. 2024;77:e20230410
Abstract
ORIGINAL ARTICLEIndigenous women’s experiences about the pregnancy-puerperal cycle
Revista Brasileira de Enfermagem. 2024;77:e20230410
DOI 10.1590/0034-7167-2023-0410
Views0See moreABSTRACT
Objectives:
to understand the experiences of indigenous women regarding the pregnancy-puerperal cycle.
Methods:
qualitative, exploratory and descriptive research, carried out between May and August 2023 with 27 pregnant women from Indigenous Villages in Mato Grosso, Brazil, through open individual interviews. The data was analyzed using Reflexive thematic analysis.
Results:
data analysis resulted in the following themes: Cultivation of labor and birth in its natural and sacred path; Unique practices and beliefs associated with breastfeeding; Evolved or reductive thinking? The participants suggest inviolable practices and beliefs, which must be welcomed, respected and enhanced by indigenous health teams.
Final Considerations:
the experiences of indigenous women regarding the pregnancy-puerperal cycle are unique and motivated by inviolable cultural and religious beliefs, which transcend scientific knowledge, certainties and the linearity of contemporary approaches, normally established as order.
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REVIEW10-07-2024
Risk factors associated with the occurrence of the adverse event phlebitis in hospitalized adult patients
Revista Brasileira de Enfermagem. 2024;77(5):e20240162
Abstract
REVIEWRisk factors associated with the occurrence of the adverse event phlebitis in hospitalized adult patients
Revista Brasileira de Enfermagem. 2024;77(5):e20240162
DOI 10.1590/0034-7167-2024-0162
Views0See moreABSTRACT
Objectives:
to synthesize knowledge regarding risk factors associated with occurrence of adverse event phlebitis in hospitalized adult patients.
Methods:
an integrative literature review, carried out in the CINAHL, PubMed, Virtual Health Library, Embase, Web of Science and Scopus databases. The stages were carried out independently by two reviewers, and the data were analyzed descriptively.
Results:
from the analysis of 31 quantitative primary studies, the following risk factors were summarized: length of stay; use of antibiotics; peripheral intravenous catheter dwell time; receive less nursing care; catheter inserted multiple times; patients with infection and comorbidities; presence of pain at catheter insertion site; Teflon® catheter use; reduced patient mobility; quality of patient’s vein; skin elasticity; unsuccessful insertion.
Conclusions:
it is necessary to standardize the format for measuring occurrence of this adverse event and develop new studies with a higher level of evidence.
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ORIGINAL ARTICLE10-07-2024
Indicators of emotional distress and mindfulness in undergraduate students: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(5):e20230499
Abstract
ORIGINAL ARTICLEIndicators of emotional distress and mindfulness in undergraduate students: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(5):e20230499
DOI 10.1590/0034-7167-2023-0499
Views0See moreABSTRACT
Objectives:
to assess the association between indicators of emotional distress and dispositional mindfulness in health students at a Brazilian federal public university.
Methods:
a cross-sectional study, developed with university students in the health area of a public institution from May to June 2022. In the analysis, multiple linear regression was used using SPSS software.
Results:
the sample was mostly female, ≤ 22 years old, non-white, studying the first semesters, with a higher prevalence for the medicine course. Students presented moderate dispositional mindfulness scores. It was observed that the variables of stress, depression and current suicide risk were associated with the capacity for mindfulness.
Conclusions:
knowing the indicators of emotional distress that are related to the potential of mindfulness can contribute as a situational diagnosis to better design strategies that promote the improvement of emotional indicators of health students.
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ORIGINAL ARTICLE10-07-2024
Development and validation of a mobile application prototype for postoperative cardiac surgery
Revista Brasileira de Enfermagem. 2024;77(5):e20230491
Abstract
ORIGINAL ARTICLEDevelopment and validation of a mobile application prototype for postoperative cardiac surgery
Revista Brasileira de Enfermagem. 2024;77(5):e20230491
DOI 10.1590/0034-7167-2023-0491
Views0See moreABSTRACT
Objectives:
to develop and validate the content, appearance, and semantics of a prototype application for monitoring patients in the postoperative period of cardiac surgery.
Methods:
this is a technological development study based on Contextualized Instructional Design. The content and appearance evaluation was conducted by a committee of specialists, and semantic validation was carried out by patients from a cardiac surgery outpatient clinic.
Results:
the application prototype consisted of 43 screens, validated by 17 health specialists, with content validity ratio and appearance validity index results of 0.86 and 0.99, respectively. For semantic validation, 10 patients participated in data collection, with a total content validity index of 0.978.
Conclusions:
the prototype of the “VivaCor PósOp” application demonstrated evidence of content, appearance, and semantic validity, with the potential to stimulate self-care in patients in the postoperative period of cardiac surgery.
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01-01-2016
Peritoneal dialysis: family care for chronic kidney disease patients in home-based treatment
Revista Brasileira de Enfermagem. 2016;69(6):1172-1178
Abstract
Peritoneal dialysis: family care for chronic kidney disease patients in home-based treatment
Revista Brasileira de Enfermagem. 2016;69(6):1172-1178
DOI 10.1590/0034-7167-2016-0262
Views0See moreABSTRACT
Objective:
to propose a family care model for patients with chronic kidney disease in peritoneal dialysis based on evidence indicated by family members.
Method:
this was a qualitative descriptive study that used the Convergent Care Research method. It was conducted at a state hospital in Rio de Janeiro, including techniques for recording individual interviews and consisted of a group of 19 study participants. Data were analyzed according to the stages proposed by the method, generating a category that used a cultural question as the basis for patient care resulting in a proposal for home-based family care.
Results:
the patient care model proposed includes dialogue and reflection in sharing the knowledge of “professional” and “popular” systems, aiming to improve the patient’s quality of life.
Conclusion:
family members were able to promote care based on cultural preservation, accommodation and repatterning, as proposed by Leininger’s Sunrise Model.
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01-01-2016
Technology for self-care for ostomized women’s sexual and reproductive health
Revista Brasileira de Enfermagem. 2016;69(6):1164-1171
Abstract
Technology for self-care for ostomized women’s sexual and reproductive health
Revista Brasileira de Enfermagem. 2016;69(6):1164-1171
DOI 10.1590/0034-7167-2016-0302
Views0See moreABSTRACT
Objective:
to validate the technology of printed booklets on self-care for ostomized women’s sexual and reproductive health.
Method:
a methodological study was performed with a focus on the construction and validity of a printed booklet. The content of this booklet was validated by 11 specialist judges/nurses, according to a Content Validity Index (CVI) equal to or higher than 0.80. Appearance was validated by nine ostomized women, according to an assessment of the difficulty and convenience of the educational material.
Results:
the booklet was validated by specialists, with an overall mean CVI equal to 0.87. Moreover, the target population showed 100% of agreement in terms of the adequacy of organization, writing style, appearance and motivation of this booklet.
Conclusion:
the educational technology in question was validated according to content and appearance, thus representing an adequate, reliable and easily understandable resource to acquire knowledge about self-care for ostomized women’s sexual and reproductive health.
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01-01-2016
Short-course therapy for tuberculosis: a discourse analysis
Revista Brasileira de Enfermagem. 2016;69(6):1154-1163
Abstract
Short-course therapy for tuberculosis: a discourse analysis
Revista Brasileira de Enfermagem. 2016;69(6):1154-1163
DOI 10.1590/0034-7167-2016-0330
Views0See moreABSTRACT
Objective:
to analyze the meanings produced by nursing professionals in the directly observed treatment (DOT) for tuberculosis (TB) in the city of São Paulo.
Method:
this is a qualitative study, conducted in March and April 2014 through semi-directed interviews with nine nurses. The empirical material produced was analyzed according to the theoretical and methodological support of the Discourse Analysis of French matrix.
Results:
results have emerged as three discursive blocks: conditions for the production of tuberculosis control practices; production conditions facilitating the treatment of tuberculosis; and production conditions hindering the treatment of tuberculosis.
Conclusion:
these professionals’ words produce different meanings, which suggest that the practices of nursing professionals allow the patient to search for a cure, which is reinforced by incentives of a social nature, but permeated by the vicissitudes that are circumscribed in the ill person’s everyday production conditions.
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00-00-0000
Representações cotidianas de jovens sobre a periferia
. ;
Abstract
Representações cotidianas de jovens sobre a periferia
. ;
Views0RESUMOObjetivos:compreender as representações cotidianas de jovens sobre a periferia, com a finalidade de compor os temas para programas midiáticos de educação sobre drogas.Método:abordagem marxista, com pesquisa-ação emancipatória e participação em oficinas de 13 jovens de uma escola pública da periferia de São Paulo.Resultados:entre os jovens há representações cotidianas contraditórias sobre o papel do Estado, que, […]See more -
01-01-2016
Aids in the elderly: reasons that lead to late diagnosis
Revista Brasileira de Enfermagem. 2016;69(6):1140-1146
Abstract
Aids in the elderly: reasons that lead to late diagnosis
Revista Brasileira de Enfermagem. 2016;69(6):1140-1146
DOI 10.1590/0034-7167-2016-0370
Views0See moreABSTRACT
Objective:
to investigate elderly living with HIV/Aids and health professionals, what are the reasons that lead to late diagnosis of HIV infection in the elderly.
Method:
prospective, qualitative study, conducted at a specialized outpatient clinic with elderly living with HIV/Aids, diagnosed age over 60 years and in the Family Health Strategy units with nurses and physicians. Data were collected through interviews and verified by content analysis, using the theoretical framework of vulnerability.
Results:
a total of 11 elderly, 11 nurses and 12 physicians participated in the study. Three empirical categories emerged: the late diagnosis of HIV happens against the health service; invisibility of the sexuality of the elderly; and weaknesses in the anti-HIV serology request for the elderly.
Conclusion:
there are health professionals who see the elderly as asexual, causing the diagnosis of HIV to happen in the secondary and tertiary service instead of primary care.
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01-01-2016
Storytelling: a care technology in continuing education for active ageing
Revista Brasileira de Enfermagem. 2016;69(6):1132-1139
Abstract
Storytelling: a care technology in continuing education for active ageing
Revista Brasileira de Enfermagem. 2016;69(6):1132-1139
DOI 10.1590/0034-7167-2016-0390
Views0See moreABSTRACT
Objective:
assessing relevance and effectiveness of care/educational technology in the form of “storytelling” as a strategy in the cultivation of active ageing (AA) for elderly users of a Basic Health Unit (BHU), from the Amazon region.
Method:
convergent care research (CCR) held in a BHU in Belém, state of Pará, with eight elderly ladies for testing this technology. An active ageing assessment questionnaire and WHOQOL-BREF – quality of life assessment were applied. After training with a view to continuing education, elderly ladies told stories for an audience that addressed the question: “What did you learn from it for your life?”
Results:
tThe popular stories elicited reactions from which the following categories emerged: solidarity; respect for the other; imagination, dreams, hopes and culture of the Amazonian. This practice had a positive result, producing changes in the quality of life of the elderly, particularly in the psychological domain.
Conclusion:
“storytelling” proved to be an innovative technology, a relevant and effective resource in health education, especially for active ageing.
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01-01-2016
Nurse care practices in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(6):1124-1131
Abstract
Nurse care practices in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(6):1124-1131
DOI 10.1590/0034-7167-2016-0273
Views1See moreABSTRACT
Objective:
to analyze the practices of care of nurses working in teams of the family health strategy, from the perspective of users.
Method:
qualitative research conducted with 34 registered users in seven family health units of a municipality of Bahia from June to December 2014. The results were organized by the technique of content analysis.
Results:
users showed satisfaction with the nurse care due to listening, warmth and resolution of their health needs, despite the emphasis on procedures and programs targeted to populational groups. The dissatisfaction stems from the authoritarian, prescriptive and inflexible attitude in the nurse care. It was also emphasized that the home visits are directed to the bedridden and more restricted to preventive actions. Educational activities occur during the nursing consultation and in the health unit.
Conclusion:
there is urgent need of redefining the care as a structuring axis of the nurse practice.
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01-01-2016
Interdisciplinary care praxis in groups of people living with fibromyalgia
Revista Brasileira de Enfermagem. 2016;69(6):1115-1123
Abstract
Interdisciplinary care praxis in groups of people living with fibromyalgia
Revista Brasileira de Enfermagem. 2016;69(6):1115-1123
DOI 10.1590/0034-7167-2016-0279
Views0See moreABSTRACT
Objectives:
to analyze the integrated community therapy model for the empowerment of people living with fibromyalgia and discuss the impact of this interdisciplinary intervention in the health-disease process and self-care.
Method:
a participatory-approach qualitative study, developed in 2015 with 11 participants at the Laboratory of Physiology Applied to Physical Education of the Rio de Janeiro State University, RJ. Data production comprised World Café, participant observation and semi-structured interview. The analysis was performed according to Bardin, through data triangulation in dialogue with the relevant literature.
Results:
the integrated community therapy group is a driving force in building and expanding knowledge about fibromyalgia and in self-care empowerment.
Conclusion:
this group strategy proved to be an interdisciplinary praxis tool that enables the development of solidary care networks. Thus, shared knowledge was generated, transformed into a listening and reflection environment to manage personal and family obstacles.
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