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01-01-2017
Alta prevalencia de enteroparasitosis en niños de Ribeirão Preto, São Paulo, Brasil
Revista Brasileira de Enfermagem. 2017;70(3):566-571
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01-01-2017
High prevalence of enteroparasites in children from Ribeirão Preto, São Paulo, Brazil
Revista Brasileira de Enfermagem. 2017;70(3):566-571
Abstract
High prevalence of enteroparasites in children from Ribeirão Preto, São Paulo, Brazil
Revista Brasileira de Enfermagem. 2017;70(3):566-571
DOI 10.1590/0034-7167-2016-0059
Views0See moreABSTRACT
Objective:
To determine the prevalence of intestinal parasites and possible associated factors.
Method:
Cross-sectional epidemiological study of 962 children (3-12-years) from an area within the scope of a basic health unit in Ribeirão Preto, São Paulo, Brazil. Data were collected by home interviews and three-sample stool analysis and evaluated with the chi-square and Fisher’s exact tests (p<0.05).
Results:
The prevalence of intestinal parasites was significantly high (57.5%). Giardia lamblia was the most prevalent (50.8%), followed by Ascaris lumbricoides (17.8%), Entamoeba histolytica, Hymenolepis nana, Entamoeba coli and Enterobius vermiculares (5.6-7.3%) and other parasites of lower prevalence, such as Schistosoma japonicum (1%) and Schistosoma mansoni (0.5%). No statistically significant associations were detected between prevalence and the risk factors analyzed.
Conclusion:
Since the area presents good conditions of environmental sanitation, health education programs should be implemented that emphasize hygiene procedures for the hands and for food and water to be consumed by the population.
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RESEARCH01-01-2017
Validation of the adherence questionnaire for Brazilian chronic kidney disease patients under hemodialysis
Revista Brasileira de Enfermagem. 2017;70(3):558-565
Abstract
RESEARCHValidation of the adherence questionnaire for Brazilian chronic kidney disease patients under hemodialysis
Revista Brasileira de Enfermagem. 2017;70(3):558-565
DOI 10.1590/0034-7167-2016-0437
Views0See moreABSTRACT
Objective:
To validate the evaluation questionnaire on adherence of chronic kidney disease (CKD) patients under hemodialysis.
Method:
We verified the following psychometric properties of the instrument: reliability (stability and internal consistency) and validity (face, content, and construct).
Results:
The intraclass correlation coefficient reached a value of 0.98 for the adherence questions and 0.91 for the perception questions. Regarding the kappa of the 14 questions examined, 12 had a value > 0.8, whereas the Cronbach’s alpha had a value of 0.57. Experts ensured the face and content validity of the instrument, giving it an overall content validity index of 0.96. Construct validity, analyzed by Mann-Whitney test, was achieved as all domains showed a significant association with p<0.01.
Conclusion:
We verified, by the presented results, that the instrument has been validated for use in Brazil.
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RESEARCH01-01-2017
The experience of rural families in the face of cancer
Revista Brasileira de Enfermagem. 2017;70(3):550-557
Abstract
RESEARCHThe experience of rural families in the face of cancer
Revista Brasileira de Enfermagem. 2017;70(3):550-557
DOI 10.1590/0034-7167-2016-0367
Views0See moreABSTRACT
Objective:
To understand the meanings of cancer within the experience of rural families and how such meanings influence family dynamics.
Method:
Qualitative study guided by Symbolic Interactionism as a theoretical framework and Grounded Theory as a methodological framework. Six rural families (18 participants) undergoing the experience of having a relative with cancer participated in the interview.
Results:
Constant comparative analysis of data allowed the elaboration of an explanatory substantive theory, defined by the main category Caregiving to support the family world, which represents the family’s symbolic actions and strategies to reconcile care for the patient and care for family life.
Final considerations:
Throughout the experience, rural families seek to preserve the interconnected symbolic elements that provide support for the family world: family unit, land, work and care.
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RESEARCH01-01-2017
Contributions of Public Health to nursing practice
Revista Brasileira de Enfermagem. 2017;70(3):543-549
Abstract
RESEARCHContributions of Public Health to nursing practice
Revista Brasileira de Enfermagem. 2017;70(3):543-549
DOI 10.1590/0034-7167-2016-0401
Views0See moreABSTRACT
Objective:
Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System.
Method:
Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis.
Results:
Thematic categories were established, namely: “Perceptions about Public Health” and “Contribution of Public Health to nursing practice in the Unified Health System”.
Final considerations:
Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care.
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RESEARCH01-01-2017
Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction
Revista Brasileira de Enfermagem. 2017;70(3):535-542
Abstract
RESEARCHCancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction
Revista Brasileira de Enfermagem. 2017;70(3):535-542
DOI 10.1590/0034-7167-2016-0084
Views0See moreABSTRACT
Objective:
To characterize cancellations of elective surgeries according to clinical and non-clinical reasons, as well as to verify seasonal influence and determine the estimated reduction of the index.
Method:
Quantitative, descriptive and retrospective study with secondary data extracted from the Public Hospital of the State of São Paulo database.
Results:
Out of the 8,443 (100%) elective surgeries scheduled, 7,870 (93.21%) were performed and 573 (6.79%) were canceled. Out of these 573 (100%) people, 48.33% were canceled for clinical reasons and 46.40% were for non-clinical reasons. Among the non-clinical reasons for surgery cancellations, those related to medical reasons stood out: at the request of the surgeon/change of approach (17.93%), followed by non-hospitalized patient (8.96%). There was no indication of seasonality regarding the reasons for cancellation in the assessed period.
Conclusion:
Although the rate of elective surgeries cancellations is lower than that of other hospitals with similar characteristics, it is still possible to reduce it from 6.79% to 1.36%, considering that 80% of the reasons for cancellation are avoidable.
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RESEARCH01-01-2017
Guide of attributes of the nurse’s political competence: a methodological study
Revista Brasileira de Enfermagem. 2017;70(3):526-534
Abstract
RESEARCHGuide of attributes of the nurse’s political competence: a methodological study
Revista Brasileira de Enfermagem. 2017;70(3):526-534
DOI 10.1590/0034-7167-2016-0483
Views0See moreABSTRACT
Objective:
To build and validate a guide of attributes of the nurse’s political competence.
Method:
Methodological research. This study comprised the construction of the instrument through literature review; experts validation of pre-established attributes for composing the guide; and clinical validation in the nurses work environment/reality. The data collection took place in the months from August to October 2014, and the analysis was based on the content analysis of Bardin and use of Epi info 3.5. All ethical precepts have been complied with.
Results:
From 29 attributes found in the literature, 25 have been validated by experts. Clinical/practical validation involved the participation of 43 nurses, who observed that the attributes are not articulated with the professional practices developed by them.
Conclusion:
The attributes of the nurse’s political competence were identified with support of literature. It is concluded that the professionals still have limited and fragmented perception of political competence, expressing difficulty/limitation.
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RESEARCH01-01-2017
Promoting oral care in the preschool child: effects of a playful learning intervention
Revista Brasileira de Enfermagem. 2017;70(3):519-525
Abstract
RESEARCHPromoting oral care in the preschool child: effects of a playful learning intervention
Revista Brasileira de Enfermagem. 2017;70(3):519-525
DOI 10.1590/0034-7167-2016-0237
Views0See moreABSTRACT
Objective:
To compare the number of appropriate behaviors for tooth brushing before and after a playful learning intervention with preschool children.
Method:
A quasi-experimental, quantitative, before and after study design was conducted in an early childhood educational institution, with children between three and five years of age. The intervention consisted of three meetings with educational activities about tooth brushing, whose outcome was evaluated by means of observation of ten behaviors suitable for tooth brushing.
Results:
Forty-four children participated in the study. The mean of adequate behaviors was 4.4 before the intervention, and 8.5 after the intervention. A significant increase in the adoption of appropriate behaviors for tooth brushing (p <0.01) was identified.
Conclusion:
Nurses can enhance oral health promotion actions with preschoolers in preschool institution using playful learning interventions
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ORIGINAL ARTICLE06-17-2024
Quality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
Abstract
ORIGINAL ARTICLEQuality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
DOI 10.1590/0034-7167-2023-0476
Views0See moreABSTRACT
Objectives:
to assess the physical and mental components of nursing professionals’ quality of life and associate them with individual, health and work characteristics.
Methods:
cross-sectional research, with nursing professionals from a university hospital in São Paulo. Own questionnaire and validated instruments were applied.
Results:
the overall quality of life was compromised. The physical component was lower in relation to low family income and among those who perceived greater control/pressure at work, and better for those who practiced physical activity and had support of leader and organization. The mental component was lower in professionals who reported dissatisfaction with work, worse self-rated physical health and were older. Scores for both components reduced due to work-related illnesses, worse work ability and increased daytime sleepiness.
Conclusions:
quality of life was statistically associated with controllable institutional factors and individual resources that, except age, can be promoted.
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ORIGINAL ARTICLE06-17-2024
Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão
Revista Brasileira de Enfermagem. 2024;77(3):e20230428
Abstract
ORIGINAL ARTICLESocial protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão
Revista Brasileira de Enfermagem. 2024;77(3):e20230428
DOI 10.1590/0034-7167-2023-0428
Views0See moreABSTRACT
Objectives:
to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão.
Methods:
this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits.
Results:
7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits.
Conclusions:
geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.
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ORIGINAL ARTICLE06-17-2024
Giving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
Abstract
ORIGINAL ARTICLEGiving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
DOI 10.1590/0034-7167-2023-0163
Views0See moreABSTRACT
Objectives:
to understand the meanings of violence internalized throughout life by older adults living in rural areas.
Methods:
a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.
Results:
it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.
Final Considerations:
older adults living in rural areas internalized the violence suffered in a unique way, and this scenario’s specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.
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ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views2In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
DOI 10.1590/0034-7167.20247702e05
Views2In the article “Educational technologies used to promote self-care for people with diabetes mellitus: integrative review”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 4):e20230049, in the title:Where it read:[…]See more -
REVIEW06-14-2024
Lean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
Abstract
REVIEWLean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
DOI 10.1590/0034-7167-2023-0431
Views0See moreABSTRACT
Objective:
To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period.
Methods:
Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay.
Results:
The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes.
Final considerations:
Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.
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ORIGINAL ARTICLE06-14-2024
Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
Abstract
ORIGINAL ARTICLEStrategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
DOI 10.1590/0034-7167-2023-0384
Views0See moreABSTRACT
Objective:
To learn the strategies used regarding underreporting of pesticide use in rural areas.
Methods:
A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis.
Results:
The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject.
Final considerations:
Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.
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06-14-2024
Teoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
Teoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreRESUMEN
Objetivo:
Construir una teoría de rango medio para el diagnóstico de enfermería Sobrepeso en adolescentes y adultos jóvenes.
Métodos:
Estudio metodológico a la luz de los marcos teóricos de Roy y de Lopes, Silva y Herdman. Un total de 3.925 artículos fueron recuperados y evaluados utilizando el software State of the Art Through Systematic Review. La muestra final fue de 28 artículos.
Resultados:
Los resultados convergieron en 3 atributos esenciales, 13 antecedentes y 7 consecuencias. Se construyó una teoría de rango medio compuesta por un diagrama ilustrado, 11 proposiciones y 12 relaciones causales.
Consideraciones finales:
A partir de la creación de la teoría, fue posible comprender mejor el diagnóstico de enfermería Sobrepeso en el contexto de adolescentes y adultos jóvenes. La comprensión de los fenómenos de enfermería contribuye para el avance y fortalecimiento de la ciencia de enfermería.
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01-01-2015
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
Abstract
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
DOI 10.1590/0034-7167.2015680624i
Views0See moreABSTRACT
Objective:
to identify the prevalence of low birth weight in the city of São Paulo.
Method:
epidemiological cross-sectional study with data collected by means of the Brazilian Live Birth Information System related to births occurred in the city of São Paulo between 2007 and 2013. Maternal, gestational, childbirth, and neonatal variables were analyzed descriptively and by association.
Results:
9.65% (1,342,655) of live births were underweight (mean of 3234.55 grams in the term group and 2312.17 in the pre-term group) with a mean maternal age of 27.53 years old. The risk factors identified include maternal age, not having a partner, low maternal level of education, other race rather than white, pre-term pregnancy, multiple births, low number of prenatal check-ups, and cesarean delivery.
Conclusion:
knowledge of this evidence favors planning the care provided by defining strategies to reduce it and consequently improve maternal and infant health care.
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01-01-2015
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
Abstract
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
DOI 10.1590/0034-7167.2015680623i
Views0See moreABSTRACT
Objective:
to investigate the association between gait speed and the cognitive score of elderly patients enrolled in a Basic Health Unit.
Method:
a quantitative cross-sectional study with 203 elderly, a sample calculated based on the estimated population proportion. Data were collected using a sociodemographic and clinical questionnaire, gait speed test (GS) and the Mini Mental State Examination (MMSE).
Results:
the illiterate patients had a mean MMSE=19.33(±3.7) and GS = 0.76m/s (±0.3); those with low/medium education had a MMSE = 25.43(±2.8) and GS = 0.92m/s (±0.2); and the elderly with higher education had a MMSE = 27.33(±2.9) and GS=1.12m/s (±0.3).There was a weak correlation (R2=00354) between gait speed and cognitive score, with statistical significance (Prob>F = 0.0072) and a positive linear trend.
Conclusion:
the better cognitive score the higher the gait speed; the illiterate elderly were those with lower gait speed, thereby indicating a poorer physical performance.
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01-01-2015
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
Abstract
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
DOI 10.1590/0034-7167.2015680622i
Views0See moreABSTRACT
Objective:
to identify self-care measures to manage fluid and dietary restrictions and assess their effectiveness.
Method:
descriptive-correlational study and cluster analysis with 254 chronic renal failure patients on regular hemodialysis program, handled by hemodiafiltration. We evaluated the effectiveness of self-care by interdialytic weight gain (IWG) and by potassium and phosphorus serum pre-dialysis serum levels.
Results:
several self-care measures were significantly correlated with a lower IWG and a lower level of pre-dialysis phosphorus. Patients most often use measures to reduce salt consumption than measures to restrict potassium and dietary phosphorus. The spouse provides important support dietary management. Subjects who use more often the self-care measure are mostly female, are older, less IWG and have a higher Kt/V.
Conclusion:
these results can contribute to the nursing educational support.
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01-01-2015
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
Abstract
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
DOI 10.1590/0034-7167.2015680621i
Views0See moreRESEARCH
Objective:
to verify the positioning indications of newborn sand build a standard operating procedure protocol for newborn positioning in Neonatal Intensive Care Unit (NICU).
Method:
for protocol validation, the Delphi technique was used ,in which expert nurses in the field reviewed the proposed procedure.
Results:
we present the results of this validation in a protocol form, to contribute to the discussion about newborn positioning in NICU and standardization of nursing care related to positioning. We evaluated ten indicators, in which there was agreementof100.0% in seven, and of80% in three, above the 60% recommended by the validation technique.
Conclusion:
given the importance of newborn positioning in NICU for its neuromuscular development, this study contributes to the adoption of an evidence-based practice for nursing.
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01-01-2015
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
Abstract
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
DOI 10.1590/0034-7167.2015680620i
Views0See moreABSTRACT
Objective:
evaluate the patient safety culture in the perspective of health professionals from a bone marrow transplantation unit of an oncology research center, at a reference hospital for cancer treatment in Santa Catarina, Brazil.
Method:
a quantitative cross-sectional study that used the Safety Attitudes Questionnaire was conducted between August and September 2013. The study analyzed 33 professional surveys. Statistical data analysis used descriptive and inferential statistics.
Results:
among the dimensions analyzed, only “job satisfaction” reached a mean score above 75, considered positive in terms of patient safety culture.
Conclusion:
the dimensions of safety culture present in the survey have to be valued by professionals and managers to allow safe patient care.
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01-01-2015
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
Abstract
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
DOI 10.1590/0034-7167.2015680619i
Views0See moreABSTRACT
Objective:
identify the determinants of job satisfaction of the nursing staff of a public university hospital.
Method:
secondary study with mixed data approach and simple and multiple linear regression. A total of 115 subjects participated in the study, 41 nurses and 74 nursing assistants and technicians. The data collection occurred in 2013 using the QST-Caism questionnaire.
Results:
education, hierarchical level and workplace constitute job satisfaction determinants. However, age, gender, job and work period did not show this relationship. More educated workers held low job satisfaction if exercised not graduated nursing functions.
Conclusion:
graduated workers who perform high school functions are more unsatisfied than those who have high school function and qualification.
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01-01-2015
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
Abstract
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
DOI 10.1590/0034-7167.2015680618i
Views0See moreABSTRACT
Objective:
the objective of this study is to identify how Medical Waste (MW) is managed in Mobile Prehospital Care (MPC) services in the state of São Paulo as well as characterize and quantify this waste.
Method:
exploratory and descriptive field study with data collection based on the methodology proposed by the Pan American Health Organization (PAHO), which was conducted over eight consecutive days to identify the production and characteristics of generated waste.
Results:
it was found that the MW management of the MPC is not yet in line with the requirements of RDC 306/04, which could affect the occupational safety of workers, patients, the community, and the environment.
Conclusion:
it is recommended for the health managers to focus on this issue. The lack of studies with regard to MPC also indicates the need for further studies on the waste management.
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01-01-2015
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
Abstract
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
DOI 10.1590/0034-7167.2015680617i
Views0See moreABSTRACT
Objective:
to identify characteristics of women who have suffered severe lactational mastitis.
Method:
a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics.
Results:
a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants.
Conclusion:
this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
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