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RESEARCH01-01-2016
Peritoneal dialysis: family care for chronic kidney disease patients in home-based treatment
Revista Brasileira de Enfermagem. 2016;69(6):1172-1178
Abstract
RESEARCHPeritoneal 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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RESEARCH01-01-2016
Technology for self-care for ostomized women’s sexual and reproductive health
Revista Brasileira de Enfermagem. 2016;69(6):1164-1171
Abstract
RESEARCHTechnology 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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RESEARCH01-01-2016
Short-course therapy for tuberculosis: a discourse analysis
Revista Brasileira de Enfermagem. 2016;69(6):1154-1163
Abstract
RESEARCHShort-course therapy for tuberculosis: a discourse analysis
Revista Brasileira de Enfermagem. 2016;69(6):1154-1163
DOI 10.1590/0034-7167-2016-0330
Views0ABSTRACT
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.
Keywords:Directly Observed TherapyMedication AdherenceNursing, TeamPublic Health PracticeTuberculosisSee more -
Representações cotidianas de jovens sobre a periferia
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Views0Abstract
Representações cotidianas de jovens sobre a periferia
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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 -
RESEARCH01-01-2016
Aids in the elderly: reasons that lead to late diagnosis
Revista Brasileira de Enfermagem. 2016;69(6):1140-1146
Abstract
RESEARCHAids 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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RESEARCH01-01-2016
Storytelling: a care technology in continuing education for active ageing
Revista Brasileira de Enfermagem. 2016;69(6):1132-1139
Abstract
RESEARCHStorytelling: 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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RESEARCH01-01-2016
Nurse care practices in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(6):1124-1131
Abstract
RESEARCHNurse care practices in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(6):1124-1131
DOI 10.1590/0034-7167-2016-0273
Views0See 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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RESEARCH01-01-2016
Interdisciplinary care praxis in groups of people living with fibromyalgia
Revista Brasileira de Enfermagem. 2016;69(6):1115-1123
Abstract
RESEARCHInterdisciplinary 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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EDITORIAL03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
EDITORIALA 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 -
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 -
EDITORIAL02-26-2024
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
EDITORIALEnfermeiro 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 -
EDITORIAL02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
EDITORIALNurse 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
- Danton Matheus de Souza
, - Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça , [ … ],
- Lisabelle Mariano Rossato
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
- Danton Matheus de Souza ,
- Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça ,
- Lisabelle Mariano Rossato
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.
- Danton Matheus de Souza
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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
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas , [ … ],
- Indiara Sartori Dalmolin
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
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas ,
- Indiara Sartori Dalmolin
Views0ABSTRACT
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.
Keywords:Advanced Practice NursingIntrauterine DevicesLong-Acting Reversible ContraceptionNursesPrimary Health CareSee more
- Lays Souza de Oliveira
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ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
DOI 10.1590/0034-7167.20166901e02
Views0In the article “Conceptions of mid-level nursing professionals facing those with a chemical dependency”, with the number of DOI: 10.1590/0034-7167.2015680610i, published in the journal Revista Brasileira de Enfermagem, v68(6):755-60, page 760 that read:“8. Vargas D, Soares J. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev Esc […]See more -
ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
DOI 10.1590/0034-7167.20166901e01
Views0In the article “Using the theory of meaningful learning in nursing education”, with the number of DOI: 10.1590/0034-7167.2015680420i, published in the journal Revista Brasileira de Enfermagem, v68(4):626-35, page 627 that read:“Ausubel was descended from Jewish, born in New York in 1918 and died in 1994 at the age of 75. He thought and wrote until […]See more -
EXPERIENCE REPORT01-01-2016
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
EXPERIENCE REPORTNursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
DOI 10.1590/0034-7167.2016690126i
Views0See moreABSTRACT
Objective:
to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo.
Method:
multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions.
Conclusion:
This study will provide important empirical evidence on the factors involved in the nursing process documentation.
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EXPERIENCE REPORT01-01-2016
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
EXPERIENCE REPORTQualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
DOI 10.1590/0034-7167.2016690125i
Views0See moreABSTRACT
Objective:
this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner’s interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014.
Results:
data analysis process according to Benner’s framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction.
Conclusion:
The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.
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REVIEW01-01-2016
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
REVIEWNurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
DOI 10.1590/0034-7167.2016690124i
Views0See moreABSTRACT
Objective:
To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice.
Method:
qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses’ performance characteristics and effects of the expansion of nursing roles.
Results:
expansion of nurses’ roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings.
Conclusion:
benefits in expanding nursing roles, were visible, contributing to primary care quality.
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REVIEW01-01-2016
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
REVIEWMeleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
DOI 10.1590/0034-7167.2016690123i
Views0See moreABSTRACT
Objective:
to analyze the application of the theory evaluation model proposed by Meleis in Brazilian studies.
Method:
integrative review of online articles published from 2002 to 2012 in the databases LILACS and BDENF.
Results:
the 16 selected studies confirmed the use of only three of the five stages proposed for Meleis’ theories analysis: Description of the Theory, Criticism of the Theory and Analysis of the Theory, with a predominance of a single unit of analysis in each.
Conclusion:
the analysis of nursing theories provides support to nurses in the practice, research, education and administration of the different dimensions of care. Meleis’ model figures as very important by contributing to the development of knowledge of nursing discipline, considering that its use as a method allows several reflections on theories in order that they be revalidated to support a more theoretical and practical applicability.
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REVIEW01-01-2016
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
REVIEWClinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
DOI 10.1590/0034-7167.2016690122i
Views0ABSTRACT
Objective:
to identify the nursing diagnosis clinical indicators of sexual dysfunction in pregnant women.
Method:
it is an integrative literature review, with research in databases using the keywords “sexual*”, “pregnan*” and “function*”. Studies included had an abstract available for analysis, referring to pregnant women over 18 years old, written in Portuguese, French, Spanish and English, with publication date between 2010 and 2014. Studies that reporting pregnant women with an associated pathology were excluded.
Results:
sexual dysfunction in pregnant women is consistent in the literature. Nine defining characteristics were identified and 16 related factors, some not classified in NANDA International.
Conclusion:
clinical indicators can be added to the nursing diagnosis to favor an accurate diagnosis and effective interventions in the surveillance of pregnancy as a period of healthy sexual experience.
Keywords:Physiological Sexual Dysfunction, Psychogenic Sexual DysfunctionPregnant WomenReviewSexual BehaviorSee more
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RESEARCH01-01-2016
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
RESEARCHConditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
DOI 10.1590/0034-7167.2016690121i
Views0See moreABSTRACT
Objective:
to evaluate the conditions of functional health literacy of an elderly diabetics group.
Method:
cross-sectional and descriptive study, with diabetic’s elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson’s Chi-square were described by SPSS software (20.0) with α = 5% value.
Results:
the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001.
Conclusions:
the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.
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