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RESEARCH01-01-2017
Adherence to standard precautions in a teaching hospital
Revista Brasileira de Enfermagem. 2017;70(1):96-103
Abstract
RESEARCHAdherence to standard precautions in a teaching hospital
Revista Brasileira de Enfermagem. 2017;70(1):96-103
DOI 10.1590/0034-7167-2016-0138
Views0ABSTRACT
Objective:
analyze related factors and the level of adherence to standard precautions of nursing professionals from the clinical medical division of a teaching hospital.
Method:
a quantitative, cross-sectional, analytical study was conducted with 54 nursing professionals using the Psychometric Scale of Adherence to Standard Precautions, translated and validated to Brazilian Portuguese.
Results:
the global score of adherence was intermediate (4.41); no statistically significant correlation was observed between adherence and professional category (p=0.404) and length of professional practice (p= 0.612). A correlation was observed between ‘Washes hands after removing disposable gloves’ (p=0.026) and professionals with nursing practice above 10 years.
Conclusion:
adherence to standard precautions by the nursing team was intermediate, with no statistically significant difference in relation to the professional category and length of professional practice.
Keywords:Exposure to Biological AgentsNursing, TeamOccupational RisksPersonal Protective EquipmentUniversal PrecautionsSee more -
RESEARCH01-01-2017
Analysis of adverse events following immunization caused by immunization errors
Revista Brasileira de Enfermagem. 2017;70(1):87-95
Abstract
RESEARCHAnalysis of adverse events following immunization caused by immunization errors
Revista Brasileira de Enfermagem. 2017;70(1):87-95
DOI 10.1590/0034-7167-2016-0034
Views0See moreABSTRACT
Objective:
to analyze adverse events following immunization (AEFI) caused by immunization error in the state of Paraná, Brazil, from 2003 to 2013.
Method:
this is a descriptive, documental, retrospective, and quantitative research using secondary data from the Adverse Event Following Immunization Information System and the Immunization Program Evaluation System. We included cases confirmed and/or associated with different types of vaccines. For the analysis, we collected frequencies and incidence rates, and used simple linear regression models with Student’s t-test.
Results:
it was observed an AEFI increase due to immunization errors, especially hot subcutaneous abscesses. BCG vaccine had the highest incidence of adverse events and children under one year old were the most affected individuals.
Conclusion:
the current scenario is worrisome because these are preventable AEFI – injuring patients due to bad vaccination practices – that may undermine the population’s confidence, reducing immunization coverage, and the progress in the control of vaccine-preventable diseases.
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RESEARCH01-01-2017
Nursing practice environment and work satisfaction in critical units
Revista Brasileira de Enfermagem. 2017;70(1):79-86
Abstract
RESEARCHNursing practice environment and work satisfaction in critical units
Revista Brasileira de Enfermagem. 2017;70(1):79-86
DOI 10.1590/0034-7167-2016-0211
Views0See moreABSTRACT
Objective:
to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU).
Method:
a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively.
Results:
a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. “Environment of practices”, “length of work in the ICU” and “willingness to work” were associated with work satisfaction.
Conclusion:
to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.
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RESEARCH01-01-2017
Emergency interventions for air medical services trauma victims
Revista Brasileira de Enfermagem. 2017;70(1):54-60
Abstract
RESEARCHEmergency interventions for air medical services trauma victims
Revista Brasileira de Enfermagem. 2017;70(1):54-60
DOI 10.1590/0034-7167-2016-0311
Views0See moreABSTRACT
Objective:
to analyze emergency interventions for air medical services trauma victims, considering the time at the scene of trauma and the severity of the victims.
Method:
This was a descriptive, correlational and quantitative study, conducted from October of 2014 to December of 2015. Six nurses participated, completing an instrument containing emergency interventions performed in the care of victims after the occurrence of trauma. The sample consisted of 97 treatments.
Results:
Among the 97 for whom care was provided, peripheral venipuncture was performed in 97.94% of the cases; immobilization, including a backboard, was used in 89.70% of cases. The most commonly used medications were dipyrone in 44.33%, and ondansetron in 76.29%. The time on the scene showed significance with the severity of the victims. The Glasgow Coma scores were inversely related to time on the scene.
Conclusion:
Further studies are necessary, focused on care protocols for trauma victims
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RESEARCH01-01-2017
Evaluation of the hospital accreditation program: face and content validation
Revista Brasileira de Enfermagem. 2017;70(1):47-53
Abstract
RESEARCHEvaluation of the hospital accreditation program: face and content validation
Revista Brasileira de Enfermagem. 2017;70(1):47-53
DOI 10.1590/0034-7167-2016-0184
Views0ABSTRACT
Objective:
to describe the results of face and content validation of the questionnaire entitled Quality Improvement Implementation Survey, and of two complementary scales as part of the adaptation process to the Brazilian language and culture.
Method:
included the following stages: (1) translation and synthesis of translations; (2) consideration by the expert committee; (3) back translation; (4) evaluation of verbal understanding by the target population.
Results:
the questionnaire was translated into Portuguese and its final version included 90 items. In the pre-test, the target population evaluated all items as easy to understand, with the global average of 4.58 (maximum value = 5).
Conclusion:
the questionnaire is currently translated into Portuguese and adapted to the Brazilian context. The adapted version maintained the semantic, idiomatic, conceptual and cultural equivalence, according to the assessment of the expert committee and the information provided by the target population, which confirmed the face and content validity.
Keywords:AccreditationAssurance of Health Care QualityHospital AdministrationOutcome Assessment (Health Care)Validation StudiesSee more -
RESEARCH01-01-2017
Adecuación de escalas para medir cargas de trabajo mediante metodología de calidad
Revista Brasileira de Enfermagem. 2017;70(1):39-46
Abstract
RESEARCHAdecuación de escalas para medir cargas de trabajo mediante metodología de calidad
Revista Brasileira de Enfermagem. 2017;70(1):39-46
DOI 10.1590/0034-7167-2016-0246
Views0RESUMEN
Objetivo:
Determinar cuál de las escalas evaluadas (NEMS y NAS), es más adecuada para Unidades de Cuidados Intensivos aplicando metodología de calidad.
Método:
Tras identificar como oportunidad de mejora la no adecuación de la escala NEMS para determinar cargas de trabajo de enfermería en UCI, se aplica metodología de los ciclos de mejora a dicha escala y a la NAS, como propuesta de mejora, evaluando los criterios: medición de cargas de trabajo al día y por turno, inclusión de todas las actividades enfermeras, y análisis por paciente y unidad.
Resultados:
Escala NEMS no muestra diferencias significativas en el cumplimiento (67%). Comparación NEMS-NAS, todos los criterios excepto el 1º, obtienen mejora significativa. NEMS sólo valora el criterio 1 (64,22%), y NAS todos con un cumplimiento para el 1º, 2º y 4º del 64,74%, y el 3º del 100%.
Conclusión:
La escala NAS es más adecuada para medir cargas de trabajo de enfermería en UCI.
Keywords:Carga de TrabajoControl de CalidadEnfermeríaGestión de la CalidadUnidades de Cuidados IntensivosSee more
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ERRATUM01-15-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
DOI 10.1590/0034-7167.20247701e01
Views1In the article “The ethics of nursing care for transgender people”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 3):e20220797, in authorship:Where it read:[…]See more -
ORIGINAL ARTICLE12-16-2024
The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
Abstract
ORIGINAL ARTICLEThe nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
DOI 10.1590/0034-7167-2023-0315
Views1See moreABSTRACT
Objectives:
to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.
Methods:
a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.
Results:
the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.
Conclusions:
the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.
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EDITORIAL03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
EDITORIALNursing 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 -
REVIEW12-16-2024
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
Abstract
REVIEWRecommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
DOI 10.1590/0034-7167-2024-0086
Views1See moreABSTRACT
Objectives:
to summarize the recommendations of guidelines for promoting mental health in the workplace.
Methods:
an umbrella review, according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses methodological assumptions. Data collection was carried out in January 2021 and updated in July 2023 in the American Psychological Association, Cochrane Library, EMBASE, National Library of Medicine, and Scopus databases. Systematic reviews that assessed guidelines with recommendations for mental health care for workers were included. PROSPERO registration CRD42023461845.
Results:
four systematic reviews published between 2015 and 2018 were identified. The abstracts highlighted actions that facilitate and inhibit the recommendations as well as three categories of intervention: primary prevention – worker protection; secondary prevention – promoting workers’ mental health; and tertiary prevention – supporting, monitoring and rehabilitating workers upon returning to work.
Conclusions:
the interventions are based on prevention, promotion and early recognition, support and rehabilitation of mental health problems.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
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ORIGINAL ARTICLE07-29-2024
Educational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
Abstract
ORIGINAL ARTICLEEducational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
DOI 10.1590/0034-7167-2023-0299
Views1See moreABSTRACT
Objectives:
to construct and assess an educational technology for managing patient waiting lists for multidisciplinary training.
Methods:
study supported by Instructional Design – ADDIE model, whose stages of construction of educational technology were developed in the form of a multi-professional training course. Its respective content assessment was carried out by a committee of experts from 2021 to 2022. The analysis occurred based on the proportion of content adequacy with 95% Confidence Interval.
Results:
seventeen products were created as educational technology learning objects: five storyboards; four videos; three comic books; two pedagogical action plans; a mind map; and a YouTube® playlist. Nine experts assessed content adequacy, which reached 0.89.
Conclusions:
this educational technology contributes to the performance of professionals who manage waiting lists by reducing inequalities, alleviating differences, in addition to promoting equity in care and good health for patients in the Brazilian Health System.
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ORIGINAL ARTICLE03-19-2021
Mobile application of the Terminology Subset for Coping with Domestic Violence Against Children
Revista Brasileira de Enfermagem. 2021;74:e20200287
Abstract
ORIGINAL ARTICLEMobile application of the Terminology Subset for Coping with Domestic Violence Against Children
Revista Brasileira de Enfermagem. 2021;74:e20200287
DOI 10.1590/0034-7167-2020-0287
Views1See moreABSTRACT
Objective:
to describe the development of a mobile application for the International Classification Terminology Subset for Nursing Practice for Coping with Domestic Violence Against Children.
Methods:
an applied research of technological development, based on the Analysis, Design, Development, Implementation and Evaluation model and on the terminological subset based on the Theory of Nursing Praxis Intervention in Collective Health framework.
Results:
the application is divided into: 1) “Definition”: characterizes the phenomenon of violence against children; 2) “Assistance”: electronic record of nursing care; 3) “Diagnosis Consultation”; 4) “Intervention Consultation”: nursing diagnoses, outcomes, and interventions related to children and their families, subdivided into Strengthening and Weariness group.
Final considerations:
built from scientific research, the application has the potential to support nursing care, presenting, in an organized and systematic manner, nursing diagnoses, outcomes, and interventions, in addition to enabling the registration of cases under monitoring.
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REVIEW08-05-2020
Communication of bad news in pediatrics: integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190059
Abstract
REVIEWCommunication of bad news in pediatrics: integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190059
DOI 10.1590/0034-7167-2019-0059
Views0See moreABSTRACT
Objectives:
to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics.
Methods:
integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included.
Results:
the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information).
Conclusions:
there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child’s right to know their condition.
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EDITORIAL03-15-2021
Advanced Practice Nursing in Latin America and the Caribbean: seeking its implementation
Revista Brasileira de Enfermagem. 2021;74:e74suppl601
Abstract
EDITORIALAdvanced Practice Nursing in Latin America and the Caribbean: seeking its implementation
Revista Brasileira de Enfermagem. 2021;74:e74suppl601
DOI 10.1590/0034-7167.202174suppl601
Views0Healthcare organizations are increasingly complex and specialized, seeking to optimize their quality and safety standards, and be able to meet the growing needs of their users. To face this reality, health professionals need to adapt to respond in time to the demands of the health context. In turn, the World Health Organization (WHO), through the […]See more -
ORIGINAL ARTICLE10-21-2019
Child and adolescent violence: oral story of women who attempted suicide
Revista Brasileira de Enfermagem. 2019;72(6):1450-1456
Abstract
ORIGINAL ARTICLEChild and adolescent violence: oral story of women who attempted suicide
Revista Brasileira de Enfermagem. 2019;72(6):1450-1456
DOI 10.1590/0034-7167-2017-0814
Views0See moreABSTRACT
Objective:
To unveil expressions of intrafamily violence experienced in childhood and/or adolescence by women who attempted suicide.
Method:
This is a study with a qualitative approach based on Oral Story. Participants were ten women with a history of suicide attempt, who experienced intrafamily violence in childhood and/or adolescence. The research was carried out at the Center for the Study and Prevention of Suicide, linked to a Toxicological Information Center in the city of Salvador, Bahia, Brazil.
Results:
From the orality of women, the study allowed the emergence of the following representative categories of intrafamily abuse experienced in childhood and/or adolescence: psychological violence, rejection, neglect, physical violence and sexual violence.
Final considerations:
The study alerts to intrafamily violence as an aggravation related to suicidal behavior, offering elements that help in the identification of their expressions, which will raise awareness to suicidal behavior and consequently suicide prevention.
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ORIGINAL ARTICLE03-30-2020
Meanings assigned by families about children’s chronic disease diagnosis
Revista Brasileira de Enfermagem. 2020;73(2):e20180742
Abstract
ORIGINAL ARTICLEMeanings assigned by families about children’s chronic disease diagnosis
Revista Brasileira de Enfermagem. 2020;73(2):e20180742
DOI 10.1590/0034-7167-2018-0742
Views0See moreABSTRACT
Objectives:
to understand the meanings assigned by family caregivers about children’s chronic disease diagnosis.
Methods:
qualitative study, which used as theoretical framework the Symbolic Interactionism, and methodological, the Grounded Theory. It was held in a pediatric unit in Southern Brazil, in 2016, through interviews submitted to open and axial analysis, with the participation of 20 family caregivers of hospitalized children.
Results:
relatives, interacting with the nursing/health staff, perceive children’s disease at birth. They are diagnosed with chronic disease by the physician and deny it. Subsequently, they accept and seek information on care.
Conclusions:
the results pointed out the stages that relatives experience by assigning meanings to about children’s chronic disease diagnosis. These meanings provide subsidies for nurses’ actions, which need to be aware of children’s and family’s needs in order to offer comprehensive and humanized care.
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REFLECTION09-29-2022
Health care of deaf persons during coronavirus pandemics
Revista Brasileira de Enfermagem. 2022;75:e20201036
Abstract
REFLECTIONHealth care of deaf persons during coronavirus pandemics
Revista Brasileira de Enfermagem. 2022;75:e20201036
DOI 10.1590/0034-7167-2020-1036
Views0See moreABSTRACT
Objective:
To reflect about the barriers experienced by the deaf population during the COVID-19 pandemic, the proposals to overcome communication barriers in health care and the role of public policies in effecting the social inclusion of deaf people.
Methods:
Reflection based on studies on health care for deaf people, the COVID-19 pandemic and public accessibility policies.
Results:
The global crisis of COVID-19 has deepened pre-existing inequalities in the world, in addition to highlighting the vulnerability of people with disabilities, including deaf. Government, institutional and social initiatives to mitigate difficulties in communicating to deaf people have been made, but they are still insufficient to guarantee protection for them in this pandemic and full inclusion in health care.
Final considerations:
Social inclusion, supported by law, and the linguistic accessibility of deaf people still need to generate broad and concrete actions so that deaf people can enjoy their rights as citizens.
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ORIGINAL ARTICLE09-18-2020
Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes
Revista Brasileira de Enfermagem. 2020;73:e20200260
Abstract
ORIGINAL ARTICLENursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes
Revista Brasileira de Enfermagem. 2020;73:e20200260
DOI 10.1590/0034-7167-2020-0260
Views0See moreABSTRACT
Objective:
to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes.
Method:
a study of experts’ recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem)
Results:
the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions.
Final considerations:
the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.
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ORIGINAL ARTICLE09-16-2019
Knowledge of nursing student on the prevention of sexually transmitted infections
Revista Brasileira de Enfermagem. 2019;72(5):1145-1152
Abstract
ORIGINAL ARTICLEKnowledge of nursing student on the prevention of sexually transmitted infections
Revista Brasileira de Enfermagem. 2019;72(5):1145-1152
DOI 10.1590/0034-7167-2017-0801
Views0See moreABSTRACT
Objective:
To identify the knowledge and self-care actions taken by nursing undergraduate students of a Federal University of the South of Brazil, against Sexually Transmitted Infections.
Method:
Exploratory qualitative study, conducted 40 interviews with undergraduate students at the beginning and end of the course. The analysis was thematic, resulting in three categories.
Results:
Knowledge about the subject is a decisive factor for self-care, and the more knowledge, the greater the prevention. The dissemination of knowledge of students at the end of the course not only influences self-care but also health promotion in the social sphere.
Final considerations:
Knowledge is important in self-care and caring for others. The dissemination of knowledge becomes evident according to the complexity of the course. Stable relationships may interfere with the use or disuse of condoms in sexual relationships, a misnomer present in today’s society.
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ORIGINAL ARTICLE04-22-2020
Men’s health care: construction and validation of a tool for nursing consultation
Revista Brasileira de Enfermagem. 2020;73(3):e20190013
Abstract
ORIGINAL ARTICLEMen’s health care: construction and validation of a tool for nursing consultation
Revista Brasileira de Enfermagem. 2020;73(3):e20190013
DOI 10.1590/0034-7167-2019-0013
Views0See moreABSTRACT
Objectives:
to elaborate and validate a data collection tool for nursing consultation with men in the context of Primary Health Care.
Method:
a methodological study developed in four stages. The first one consisted in tool elaboration, using databases and the Dorothea Orem’s theoretical model. In the second and third stages, content validation and tool appearance by 23 nurse judges took place. The Concordance Index was used for assessment. In the fourth stage, a pilot test was carried out with 20 men using Primary Health Care.
Results:
of the 145 indicators prepared, organized and submitted to validation process, items with the Concordance Index <0.80 were excluded. The final tool consisted of 156 items. An overall 0.88 Concordance Index calculation was obtained.
Conclusions:
the final tool presented content validity for data collection with men in Primary Health Care.
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