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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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ORIGINAL ARTICLE07-29-2024
Evidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
Abstract
ORIGINAL ARTICLEEvidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
DOI 10.1590/0034-7167-2023-0386
Views0See moreABSTRACT
Objectives:
to analyze the validity evidence of the internal structure of the Risk Self-Medication Questionnaire Focused on Health Literacy.
Methods:
a psychometric study with 499 adults. The internal structure was assessed with exploratory and confirmatory factor analysis to prove the adjustment. Internal consistency was measured by composite reliability and McDonald’s omega coefficient (ω).
Results:
the parameters revealed a model of 35 items distributed across four factors, explaining 56% of the total variance, with factor loadings ranging from 0.31 to 0.85 and adequate communalities. Accuracy (0.79
Conclusions:
an instrument was obtained with good evidence of structural validity for measuring self-medication.
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ORIGINAL ARTICLE07-29-2024
Nurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
Abstract
ORIGINAL ARTICLENurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
DOI 10.1590/0034-7167-2023-0374
Views0See moreABSTRACT
Objectives:
To analyze nurses’ perspectives on nurses’ work methods in the hospital context.
Methods:
A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software.
Results:
Three thematic areas emerged: “Nurses’ work methods in a hospital context,” highlighting the conception and components of work methods and the methods in use; “Implementation of nurses’ work methods,” emphasizing influencing factors and challenges to implementation; and “Impact of nurses’ work methods on patients, nurses, and institutions.”
Final Considerations:
Nurses’ work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.
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ORIGINAL ARTICLE07-29-2024
Nursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
Abstract
ORIGINAL ARTICLENursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
DOI 10.1590/0034-7167-2023-0349
Views0See moreABSTRACT
Objective:
To analyze the knowledge of professionals working in a Nursing Home about the Nursing Process before and after the awareness workshop.
Methods:
This is strategic action research, developed with nursing professionals and managers of a Nursing Home in Rio Grande do Sul, Brazil. Data were collected between January and June 2023, through semi-structured interviews before and after an awareness workshop. Discursive textual analysis of the data was carried out.
Results:
The central category “Understanding about the Nursing Process in Nursing Homes” emerged, which was unitized into two units of meaning and three categories of analysis.
Conclusion:
Data revealed non-use and lack of knowledge of the Nursing Process before awareness raising. Afterwards, a deeper understanding of the topic and its importance was identified. Awareness-raising workshops contribute to transformation of knowledge.
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ORIGINAL ARTICLE07-29-2024
Excessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
Abstract
ORIGINAL ARTICLEExcessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
DOI 10.1590/0034-7167-2023-0332
Views0See moreABSTRACT
Objective:
to investigate excessive daytime sleepiness prevalence among nursing technicians and the association with sleep quality and memory.
Methods:
a cross-sectional, inferential study, carried out in a hospital unit in the state of Goiás between December 2020 and January 2021. Assessments were carried out using the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Prospective and Retrospective Memory Questionnaire, instruments validated for the Brazilian context. Bivariate and multivariate logistic regression analyzes were performed.
Results:
the sample consisted of 189 nursing technicians with a 40.9% excessive daytime sleepiness prevalence. In multivariate models, excessive daytime sleepiness was not associated with sleep quality, however there was a significant association with overall memory failures.
Conclusions:
study results demonstrate a high excessive daytime sleepiness occurrence, an association with overall memory failures and the need for psychosocial interventions for nursing technicians.
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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 ARTICLE07-29-2024
Fuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
Abstract
ORIGINAL ARTICLEFuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
DOI 10.1590/0034-7167-2023-0271
Views0ABSTRACT
Objective:
To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS.
Methods:
We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil.
Results:
The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement “Not disclosing sexual activity to healthcare professionals,” where individuals do not admit to having sex with women, had the least impact.
Conclusions:
Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.
Keywords:Fuzzy LogicHealth VulnerabilityReproductive HealthSexually Transmitted DiseasesWomen Who Have Sex With WomenSee more -
ORIGINAL ARTICLE07-29-2024
University Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
Abstract
ORIGINAL ARTICLEUniversity Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
DOI 10.1590/0034-7167-2023-0232
Views0See moreABSTRACT
Objectives:
to assess the University Student Depression Inventory, Brazilian version (USDI-BR), construct.
Methods:
a methodological study carried out with a snowball probabilistic sample, consisting of 334 undergraduate and graduate students. Confirmatory factor analysis, reliability using McDonald’s omega coefficient and Cronbach’s alpha were performed. Principal component analysis was performed using the varimax rotation and oblimin rotation, using the Kaiser-Meyer-Olkin criteria, Bartlett’s test of sphericity and scree plot.
Results:
the USDI-BR presented an internal consistency of items of ω = 0.95 and remained with 30 items, with the addition of 1 factor (Death wish and social withdrawal), totaling 4 factors.
Conclusions:
the USDI-BR has evidence that points to its validity and also its internal consistency, deserving that new studies be carried out to expand the evidence of its psychometric properties.
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ORIGINAL ARTICLE07-29-2024
Family refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
Abstract
ORIGINAL ARTICLEFamily refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
DOI 10.1590/0034-7167-2023-0209
Views0See moreABSTRACT
Objectives:
to analyze the trends and factors associated with family refusal of skin donation for transplantation.
Methods:
this cross-sectional study was conducted in the State of São Paulo, with family authorization terms collected from 2001 to 2020. The variables analyzed included year, age, gender, cause of death, and type of institution. Data were analyzed using linear and multiple logistic regression, with the Odds Ratio estimated at p<0.05 for statistical significance.
Results:
1,355 individuals refused skin donation. The trend of refusals decreased between 2001 and 2009 in the age groups of 0-11 years and 12-19 years, but increased in the group aged ≥60 years. This trend continued to decrease in the 0-11 years group from 2010 to 2020, and increased in the 20-40 years group. Males and the age groups of 20-40 years, 41-59 years, and ≥60 years exhibited 27%, 34%, 47%, and 53% lower chances of refusal, respectively.
Conclusions:
there is an urgent need for measures to mitigate the high number of refusals associated with skin donation.
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REVIEW01-01-2018
Family conference in palliative care: concept analysis
Revista Brasileira de Enfermagem. 2018;71(1):206-213
Abstract
REVIEWFamily conference in palliative care: concept analysis
Revista Brasileira de Enfermagem. 2018;71(1):206-213
DOI 10.1590/0034-7167-2016-0055
Views0See moreABSTRACT
Objective:
to analyze the attributes, antecedents and consequents of the family conference concept.
Method:
Walker and Avante’s method for concept analysis and the stages of the integrative review process, with a selection of publications in the PubMed, Cinahl and Lilacs databases focusing on the family conference theme in the context of palliative care.
Results:
the most cited antecedents were the presence of doubts and the need to define a care plan. Family reunion and working instrument were evidenced as attributes. With respect to consequents, to promote the effective communication and to establish a plan of consensual action were the most remarkable elements.
Final considerations:
the scarcity of publications on the subject was observed, as well as and the limitation of the empirical studies to the space of intensive therapy. Thus, by analyzing the attributes, antecedents and consequents of the concept it was possible to follow their evolution and to show their efficacy and effectiveness as a therapeutic intervention.
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REVIEW01-01-2018
Quality of life in adults with sickle cell disease: an integrative review of the literature
Revista Brasileira de Enfermagem. 2018;71(1):195-205
Abstract
REVIEWQuality of life in adults with sickle cell disease: an integrative review of the literature
Revista Brasileira de Enfermagem. 2018;71(1):195-205
DOI 10.1590/0034-7167-2016-0409
Views0See moreABSTRACT
Objective:
To identify the available evidence in the literature on health-related quality of life in adults with sickle cell disease.
Method:
integrative review of MEDLINE, CUMED, LILACS and SciELO databases, from articles developed in this area, published between 2005 and 2015, in English, Portuguese or Spanish.
Results:
22 articles were included, six scales were used to evaluate health-related quality of life scores: three generic and three specific. No specific scale for adults with sickle cell disease has been adapted to Brazilian Portuguese so far. Patients affected by frequent painful crises, with low adherence to treatment, had a compromised quality of life.
Conclusion:
Selected studies have shown that patients with sickle cell disease have worse scores than the general population. These indicators should be instrumental to the nurse in the proposal of interventions and strategies of assistance and socio-educational, with a view to improving the quality of life of this clientele.
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REVIEW01-01-2018
Care provided by the father to the child with cancer under the influence of masculinities: qualitative meta-synthesis
Revista Brasileira de Enfermagem. 2018;71(1):185-194
Abstract
REVIEWCare provided by the father to the child with cancer under the influence of masculinities: qualitative meta-synthesis
Revista Brasileira de Enfermagem. 2018;71(1):185-194
DOI 10.1590/0034-7167-2016-0671
Views0See moreABSTRACT
Objective:
To synthesize and interpret findings and conclusions of qualitative research addressing the experience of the father in the care of the child with cancer.
Method:
Meta-synthesis of 16 qualitative studies from six databases, analyzed through taxonomic analysis.
Results:
Child and adolescent cancer have several repercussions on the daily life of the father, especially related to the stigma around the disease, the fear of the unknown and the social and family role. Faced with the illness and the need to care for the child, the father seeks to recover normality in the family and transitions between hegemonic masculine behaviors and practices culturally recognized as female.
Final Considerations:
The complex experience of the father, influenced by masculinities, was evidenced. The limitations regard the restricted understanding of the contextual specificities of the experiences, due to the limited characteristics of the parents and children described in the studies. The knowledge produced is useful to promote involvement of fathers in the care of the child, as well as to strengthen and assist him in this task.
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RESEARCH01-01-2018
Naturalization, reciprocity and marks of marital violence: male defendants’ perceptions
Revista Brasileira de Enfermagem. 2018;71(1):178-184
Abstract
RESEARCHNaturalization, reciprocity and marks of marital violence: male defendants’ perceptions
Revista Brasileira de Enfermagem. 2018;71(1):178-184
DOI 10.1590/0034-7167-2016-0475
Views0See moreABSTRACT
Objective:
to analyze male criminals’ perception about marital violence.
Method:
An exploratory, descriptive, qualitative study undertaken with 23 men who were criminally prosecuted for marital violence. A multimethod data collection was conducted, with individual interview and focal group techniques combined, between May and December 2015. The data collected were initially categorized using the NVIVO® 11 software program, and then organized using the Collective Subject Discourse method.
Results:
the collective discourses reveal that, in the male’s perception, conjugal violence is inherent in a marital relationships: it is a private, reciprocal problem that leaves body marks.
Conclusion:
gender dissymmetry as a social construct is evidenced, signaling the need to create spaces for reflection and re-signification of men and women, from a gender perspective.
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RESEARCH01-01-2018
Impact of critical illness news on the family: hermeneutic phenomenological study
Revista Brasileira de Enfermagem. 2018;71(1):170-177
Abstract
RESEARCHImpact of critical illness news on the family: hermeneutic phenomenological study
Revista Brasileira de Enfermagem. 2018;71(1):170-177
DOI 10.1590/0034-7167-2016-0163
Views0See moreABSTRACT
Objective:
Understand the impact of critical-illness news on the experience of family members at an Intensive Care Unit.
Method:
Phenomenological approach according to Van Manen’s method. Open interviews were held with 21 family members. From analysis and interpretation of the data, three essential themes were identified: the unexpected; the pronouncement of death; and the impact on self-caring within the family. The study complied with the ethical principles inherent to research involving humans.
Results:
The unexpected news and death of the sick person influence the well-being and self-care of family members, affecting their ability for analysis and decision making. It was observed that the family experiences the news with suffering, mainly due to the anticipation arising from the events.
Final considerations:
The humanity of nurses was revealed in response to the needs of the family. In view of the requirements for information, it was verified that the information transmitted allowed them to become aware of themselves, to become empowered in their daily lives and to alleviate the emotional burden experienced.
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RESEARCH01-01-2018
Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality
Revista Brasileira de Enfermagem. 2018;71(1):163-169
Abstract
RESEARCHSurveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality
Revista Brasileira de Enfermagem. 2018;71(1):163-169
DOI 10.1590/0034-7167-2016-0607
Views0See moreABSTRACT
Objective:
To characterize approach methods for intradomiciliary contacts (IdC) of leprosy cases resident in Northern Brazil, during 2001-2012.
Method:
A cross-sectional and descriptive study in the state of Rondônia. Included IdC of leprosy cases diagnosed/reported in SINAN-Ministry of Health (MS), 2001-2012. A semi-structured instrument was applied to the IdCs, with six interventions: complete dermatological examination; complete neurological examination; BCG vaccination; instructions for return to the health unit; BCG guidance; and guidance to mobilize other contacts.
Conclusion:
Despite the favorable indicators of IdC examination coverage in the state, the evaluation process presents patterns that indicate operational quality failures.
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RESEARCH01-01-2018
Enhancing the process of teaching and learning homecare
Revista Brasileira de Enfermagem. 2018;71(1):156-162
Abstract
RESEARCHEnhancing the process of teaching and learning homecare
Revista Brasileira de Enfermagem. 2018;71(1):156-162
DOI 10.1590/0034-7167-2016-0541
Views0See moreABSTRACT
Objective:
to identify possibilities for improvement in the process of teaching and learning homecare in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy courses.
Method:
qualitative research using the Grounded Theory approach. Sixty-three semi-structured interviews were conducted with students, teachers and graduates of the six mentioned courses at a public university in the south of Brazil. Data analysis was performed through open, axial and selective coding.
Results:
the possibilities for improving the process of teaching and learning homecare included: scientific production in the area; use of different teaching techniques; development of extracurricular activities; extension projects; curricular reformulation; and laboratory simulation.
Final considerations:
the strategies cited in this study enable undergraduate courses in health to envisage the possibility of enhance the process of teaching and learning homecare.
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RESEARCH01-01-2018
Trends in the job market of nurses in the view of managers
Revista Brasileira de Enfermagem. 2018;71(1):148-155
Abstract
RESEARCHTrends in the job market of nurses in the view of managers
Revista Brasileira de Enfermagem. 2018;71(1):148-155
DOI 10.1590/0034-7167-2016-0103
Views0See moreABSTRACT
Objective:
to identify and interpret the main trends of the labor market for nurses in Rio Grande do Norte, based on the opinion of managers of training institutions and employers.
Method:
Data were collected through interviews with key informants, organized using Atlas.ti software resources and examined under the thematic content review.
Results:
the study showed six trends in the labor market of nurses: availability of professionals to the market; worsening working conditions with precariousness; indication for insertion in employment; unemployment for nurses; shortage of nurses; and the existence of a cooperative of nursing professionals.
Final considerations:
the current scenario of growth in the number of registered nurses without the expansion of the job supply has remained, unemployment tends to increase and work conditions will worsen.
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