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REVIEW01-01-2015
Adverse events and safety in nursing care
Revista Brasileira de Enfermagem. 2015;68(1):144-154
Abstract
REVIEWAdverse events and safety in nursing care
Revista Brasileira de Enfermagem. 2015;68(1):144-154
DOI 10.1590/0034-7167.2015680120i
Views0See moreObjective:
to identify the scientific publications about adverse events in nursing care in adult hospitalized patients and discuss the main adverse events in nursing care.
Method:
Integrative revision with a qualitative approach. The data were collected at LILACS, MEDLINE, BDENF and the library SCIELO and were submitted to thematic analysis.
Results:
three categories were developed: Adverse events in nursing care; The main causes of the adverse events in nursing care; Attitude of nursing professionals in face of errors. The main events were identified in nursing care with emphasis on the medication error, the failure to perform dressings and falls of patients. The importance of instruments was emphasized for notification of adverse events in the institutions. However the fear of punishment on professionals stimulates the underreporting of events.
Conclusion:
it is important to discuss effective prevention strategies that ensure patient safety in healthcare institutions.
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REVIEW01-01-2015
Staphylococcus aureus meticilino resistente adquirido na comunidade: um problema mundial
Revista Brasileira de Enfermagem. 2015;68(1):136-143
Abstract
REVIEWStaphylococcus aureus meticilino resistente adquirido na comunidade: um problema mundial
Revista Brasileira de Enfermagem. 2015;68(1):136-143
DOI 10.1590/0034-7167.2015680119p
Views0Objetivo:
descrever a epidemiologia dos casos de CA-MRSA no Brasil de forma a compreender sua ocorrência, fatores de risco associados e formas de manejo em relação à situação mundial.
Método:
revisão integrativa e para seleção dos estudos utilizou-se as bases de dados: Scopus, Science direct, Isi Web of Knowledge, PUBMED e BVS.
Resultados:
foram identificados dez artigos nacionais que descreveram 21 casos de CA-MRSA principalmente em crianças, adolescentes e adultos com quadro de infecção de pele e tecidos moles evoluindo para infecções graves relacionados ao clone Oceania Southwest Pacific Clone (OSPC) que resultaram em hospitalização.
Conclusão:
apesar do CA-MRSA ser considerado um micro-organismo de relevância mundial verificou-se a escassez de dados publicados sobre sua epidemiologia no Brasil, o que dificultam o delineamento da realidade do país frente ao CA-MRSA.
Keywords:Controle de InfecçõesFarmacorresistência BacterianaInfecções Comunitárias AdquiridasStaphylococcus Aureus Resistente à MeticilinaSee more -
REVIEW01-01-2015
Prevention and non-pharmacological management of pain in newborns
Revista Brasileira de Enfermagem. 2015;68(1):131-135
Abstract
REVIEWPrevention and non-pharmacological management of pain in newborns
Revista Brasileira de Enfermagem. 2015;68(1):131-135
DOI 10.1590/0034-7167.2015680118i
Views0See moreObjective:
to describe the main non-pharmacological interventions for pain relief in newborns available in Neonatal Intensive Care Unit.
Method:
an exploratory search of the MedLine, Lilacs and Scielo online databases was conducted to retrieve references of studies published from 2004 to 2013.
Results:
several non-pharmacological interventions were shown to be effective, to represent low risk for neonates and to have a low operational cost. The ones most often discussed in the literature were: oral administration of glucose/sucrose, non-nutritive sucking, breastfeeding, skin-to-skin contact, facilitated tucking and swaddling.
Conclusion:
healthcare teams should be familiar with these methods and use them more effectively in Neonatal Intensive Care Unit daily routines, so as to ensure that newborns receive qualified and more human care.
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BANFISA e (IN)DICA-SUS na graduação em saúde: o lúdico e a construção de aprendizados
Revista Brasileira de Enfermagem. 2015;68(1):124-130
Abstract
BANFISA e (IN)DICA-SUS na graduação em saúde: o lúdico e a construção de aprendizados
Revista Brasileira de Enfermagem. 2015;68(1):124-130
DOI 10.1590/0034-7167.2015680117i
Views0See moreObjectives:
to analyze the learning built during the matches of the games by students of the subject Gestão de Políticas Públicas em Saúde at the Universidade de Brasília.
Method:
exploratory, descriptive research, in a qualitative approach, with 26 students from various graduation courses in health, using a questionnaire and participant observation.
Results:
participants reinvented rules, related issues addressed in the games to the reality, interacted with colleagues and had fun throughout the match. Comparing the games in relation to ludicity, the BANFISA was more attractive than the (IN) DICA-SUS, although they are complementary.
Conclusions:
learning constructed by the students goes beyond the content of the subject; involve the active participation in group and creativity.
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Chinese auriculotherapy to improve quality of life of nursing team
Revista Brasileira de Enfermagem. 2015;68(1):117-123
Abstract
Chinese auriculotherapy to improve quality of life of nursing team
Revista Brasileira de Enfermagem. 2015;68(1):117-123
DOI 10.1590/0034-7167.2015680116p
Views0See moreObjective:
to evaluated the effi cacy of auriculotherapy for improving quality of life and reducing stress in nursing staff.
Method:
single-blind radomizad clinical trail envolving 175 subjects randomized in: Control (G1), Protocol Group (G2) and without Protocol Group (G3). They were evaluated by the Stress Symptoms List and SF36v2 at baseline, after 12 sessions and follow up (30 days), between January and July 2012.
Results:
both intervention groups reduced stress (p <0.05) with greater effect for G3 (d = 1.15). G3 was also higher for improving life quality especially the physical domain (p = 0.05).
Conclusion:
individualized auriculotherapy (G3) had greater effect compared to the protocol auriculotherapy (G2) for reducing stress and improving life quality.
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Adherence to foot self-care in diabetes mellitus patients
Revista Brasileira de Enfermagem. 2015;68(1):111-116
Abstract
Adherence to foot self-care in diabetes mellitus patients
Revista Brasileira de Enfermagem. 2015;68(1):111-116
DOI 10.1590/0034-7167.2015680115p
Views0See moreObjective:
to analyze the self-care of patients with type 2 diabetes mellitus in the Family Health Strategy in Teresina-PI.
Method:
search cross selected by simple random sampling, 331 people with diabetes mellitus. Data collection took place from August to December 2012 with the use of Self-Care Activities Questionnaire with Diabetes and structured instrument for recording information socioeconomic and guidance received by the professional nurse.
Results:
the data revealed that patients have poor adherence to blood glucose monitoring, the physical exercise and foot care, but with good adherence to the medication. Only 38.7% of the sample examined the feet of fi ve to seven days a week. Statistically signifi cant association between self-care activities with their feet and orientations of nurses (p < 0,05).
Conclusion:
that there is need to raise awareness with regard to the development of skills for self-care.
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Patients with disorders of consciousness: vital, facial and muscular responses to music or messages
Revista Brasileira de Enfermagem. 2015;68(1):102-110
Abstract
Patients with disorders of consciousness: vital, facial and muscular responses to music or messages
Revista Brasileira de Enfermagem. 2015;68(1):102-110
DOI 10.1590/0034-7167.2015680114p
Views0See morePurposes:
to compare vital signs, facial expression and basal electroneurographic signs with measures during stimuli music, message or “silence” in coma patients, vegetative status or sedated; and relating the score of Glasgow Results Scale with the intervention realized.
Method:
a Monoblind Transversal Controlled Clinical Trial to researcher. The distribution, among the three groups, was randomized (experiment with music, experiment with message or control). Two assessments (sessions) were performed with interval of 40 minutes on the same day.
Results:
most of the 76 patients were male, between 18 to 36 years old and hospitalized due to trauma. Statistically signifi cant changes were found in the variables referred to temperature, facial expression, electroneurography and Glasgow Results Scale; more frequent alterations in second session, in coma and vegetative patients, in frontal muscles and in experiment group.
Conclusions:
the facial expression and the electroneurography seem to be more trustworthy variables than vital signs to evaluate consciousness.
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Prevalence of minor psychiatric disorders in socio-educational agents in the state of Rio Grande do Sul
Revista Brasileira de Enfermagem. 2015;68(1):93-101
Abstract
Prevalence of minor psychiatric disorders in socio-educational agents in the state of Rio Grande do Sul
Revista Brasileira de Enfermagem. 2015;68(1):93-101
DOI 10.1590/0034-7167.2015680113p
Views0See moreObjective:
to determine the prevalence and factors associated with minor psychiatric disorders (MPD) in socio-educational agents.
Method:
it is a cross-sectional study with 381 socio-educational agents the Centers for Socio-Educational Services in the State of Rio Grande do Sul, Brazil. The Brazilian versions of the Scale of Demand-control-social support at work and the Self Reporting Questionnaire-20 have been applied.
Results:
the results showed a prevalence of suspicion MPD of 50.1%. They showed to be related to suspicion of MPD : being female (55.7%), having age up to 44 years old (58.5%), no physical activity (57.4%), do not have time for leisure (75%), make use of medication (61.4%), require medical attention (56.9%) and psychological counseling (72.7%), not being satisfied with the workplace (61.7%) and need for time off from work (65.6%).
Conclusion:
the study provides important data about the mental health of agents, showing the need for the involvement of managers and of the health service of worker’s health in planning actions to promote health of these workers.
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EDITORIAL01-01-2017
Fundamentos e práticas do cuidar em Enfermagem Gerontológica
Revista Brasileira de Enfermagem. 2017;70(4):671-672
Abstract
EDITORIALFundamentos e práticas do cuidar em Enfermagem Gerontológica
Revista Brasileira de Enfermagem. 2017;70(4):671-672
DOI 10.1590/0034-7167.2017700401
Views0As intensas transformações sociais, econômicas, políticas, culturais, ambientais, epidemiológicas e demográficas, em conjunto com as aceleradas inovações tecnológicas, têm afetado significativamente a vida em sociedade, exigindo que as pessoas reflitam sobre as próprias concepções da natureza humana. Esse contexto de transformações tem estimulado os indivíduos a valorizar os avanços tecnológicos e a construção de relações […]See more -
EDITORIAL01-01-2017
Fundamentals and practice of care in Gerontological Nursing
Revista Brasileira de Enfermagem. 2017;70(4):671-672
Abstract
EDITORIALFundamentals and practice of care in Gerontological Nursing
Revista Brasileira de Enfermagem. 2017;70(4):671-672
DOI 10.1590/0034-7167.2017700401
Views0Intense social, economic, political, cultural, environmental, epidemiological, and demographical transformations, coupled with accelerated technological innovation, have significantly affected life in society, requiring people to reflect about the conceptions of human nature itself. This context of transformation has incentivized individuals to value technological advances and the construction of more autonomous, global, and unstable human relationships, outlining […]See more -
The importance of empathy in health and nursing care
Revista Brasileira de Enfermagem. 2017;70(3):669-670
Abstract
The importance of empathy in health and nursing care
Revista Brasileira de Enfermagem. 2017;70(3):669-670
DOI 10.1590/0034-7167-2016-0032
Views0“In her book “Cultivating Empathy”(), Kathleen Stephany, psychologist and professor at the College of Health Sciences at Douglas College, writes about empathy, which she considers to be the basis of effective communication and one of the most important skills to be developed by human beings. Empathy is the ability to put oneself in the place […]See more -
REFLECTION01-01-2017
Clinical reasoning in nursing: teaching strategies and assessment tools
Revista Brasileira de Enfermagem. 2017;70(3):662-668
Abstract
REFLECTIONClinical reasoning in nursing: teaching strategies and assessment tools
Revista Brasileira de Enfermagem. 2017;70(3):662-668
DOI 10.1590/0034-7167-2016-0509
Views0See moreABSTRACT
Objective:
To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice.
Method:
This is a theoretical reflection based on scientific studies.
Results:
Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning.
Conclusion:
The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making.
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REFLECTION01-01-2017
Continuing education in health from the perspective of Augustine of Hippo
Revista Brasileira de Enfermagem. 2017;70(3):656-661
Abstract
REFLECTIONContinuing education in health from the perspective of Augustine of Hippo
Revista Brasileira de Enfermagem. 2017;70(3):656-661
DOI 10.1590/0034-7167-2016-0484
Views0See moreABSTRACT
Objective:
To reflect about continuing education from the perspective of Augustine of Hippo and his theories based on the construction of knowledge and the learning process.
Method:
This is a theoretical reflection study whose aim is to propose dimensions of analysis, emphasizing the history and challenges of continuing education. Such dimensions analyze the production of knowledge in Augustinian pedagogy, its historical aspects and its close relationship with lifelong education in health professions.
Results:
The results show the difficulty of continuing education to reach adequate importance in health services, and that of academia in appropriating the thoughts of renowned philosophers such as Augustine. This is a result of ignorance about the convergence of these principles and their relevance.
Final considerations:
Continuing education and Augustinian pedagogy walk hand in hand in terms of care, meeting the needs that originate from practice and that are reflected in it, challenging isolated knowledge and putting different areas of knowledge to work together.
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REVIEW01-01-2017
Influence of hormonal contraceptives and the occurrence of stroke: integrative review
Revista Brasileira de Enfermagem. 2017;70(3):647-655
Abstract
REVIEWInfluence of hormonal contraceptives and the occurrence of stroke: integrative review
Revista Brasileira de Enfermagem. 2017;70(3):647-655
DOI 10.1590/0034-7167-2016-0056
Views0See moreABSTRACT
Objective:
To identify scientific evidence regarding the influence of hormonal contraceptive use and the occurrence of stroke.
Method:
Integrative review of the literature, through database search using the descriptors “contraceptive agents“, “contraceptive devices“, “contraceptives, Oral” and “Stroke”. Original studies in Portuguese, Spanish and English, published in full and available online were included. Studies that did not answer our guiding questions and duplicated studies were excluded.
Results:
Women using combined oral contraceptives have higher risk of stroke, even with a lower hormonal dosage and different types of progestogen, regardless of the duration of use. The use of contraceptives associated with smoking, hypertension, migraine, hypercholesterolemia, obesity and sedentary lifestyle increases the chance of stroke. Contraceptive patch and vaginal ring are associated to increased risk.
Conclusion:
Use of combined hormonal contraceptives, except for the injectable and the transdermal ones, increases the chance of occurrence of the event. Progestogen-only contraceptives were considered safe.
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RESEARCH01-01-2017
Health Conditions and Memory Performance: a study with older adult women
Revista Brasileira de Enfermagem. 2017;70(3):640-646
Abstract
RESEARCHHealth Conditions and Memory Performance: a study with older adult women
Revista Brasileira de Enfermagem. 2017;70(3):640-646
DOI 10.1590/0034-7167-2016-0529
Views0See moreABSTRACT
Objective:
to verify the correlation between health condition and memory performance of older adult women in the community.
Method:
Analytical cross-sectional study developed with 28 older adult women living in Cuiabá-MT. They answered the Mini-Mental State Examination (MMSE), and a shortened Geriatric Depression Scale (GDS-15) to screen for dementia and depression symptoms. Memory skills were assessed through Rey Auditory Verbal Learning Test (RAVLT).
Results:
The mean age was 66.36 years and 75% of the participants had educational level higher than 7 years. The MMSE mean score was 28.45. The correlations found were: educational level and immediate memory (r = 0.49; p = 0.008); delayed recall and immediate memory (r = 0.71; p < 0.001); memory recognition and immediate memory (r = 0.43; p = 0.021) and recognition memory with delayed recall (r = 0.47; p = 0.012).
Conclusion:
High scores in the MMSE and a satisfactory health perception among the participants were evident. There was no correlation between memory performance and health perception.
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RESEARCH01-01-2017
Comprehension of the education handout and health literacy of pacemaker users
Revista Brasileira de Enfermagem. 2017;70(3):633-639
Abstract
RESEARCHComprehension of the education handout and health literacy of pacemaker users
Revista Brasileira de Enfermagem. 2017;70(3):633-639
DOI 10.1590/0034-7167-2016-0336
Views0See moreABSTRACT
Objective:
To verify the comprehension of the education handout and the level of Functional Health Literacy of individuals with cardiac pacemaker (PM) and whether there is correlation between the comprehension and Functional Health Literacy (FHL).
Method:
Cross-sectional study with 63 individuals with PM who answered to comprehension tests of the handout, literacy assessment (SAHLPA-50) and cognition (MMSE). Measurements of dispersion, Pearson correlation and multiple linear regression were calculated.
Results:
Most women, study time ≤ 9 years, 66.21 (average age) presented no cognitive changes. An adequate literacy level was evidenced in 50.8% individuals with PM and satisfactory comprehension of the handout. No correlation was identified between FHL, handout comprehension, age, years of study and cognition.
Conclusion:
The handout comprehension assessed by individuals with appropriate FHL indicated that it can be a printed material suitable for use, aiming to improve care process and knowledge of individuals with PM.
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RESEARCH01-01-2015
Analysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
Abstract
RESEARCHAnalysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
DOI 10.1590/0034-7167.2015680414i
Views0ABSTRACT
Objective:
to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories.
Method:
qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis.
Results:
data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model.
Conclusion:
the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that infl uence and determine right decisions.
Keywords:Decision Support PracticesNursingNursing Administration ResearchPractice ManagementProfessional CompetenceSee more -
RESEARCH01-01-2015
Social representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
Abstract
RESEARCHSocial representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
DOI 10.1590/0034-7167.2015680413i
Views0See moreABSTRACT
Objective:
to know the social representations of sexuality for the elderly, based on the Social Representation Theory.
Method:
study performed in a Basic Family Health Unit in Maracanau-CE, Brazil, with 30 elderly adults. Data were collected from March through April of 2013, using the free word evocation technique. Data were organized and processed using the EVOC 2000.software
Results:
the subjects evoked 150 words associated with the evocator word “sexuality”. Out of these, 43 were different. At the possible core of the representation of sexuality for the elderly, the following words were found: love, affection and respect. Sex, companionship, understanding and coexistence composed the intermediate elements of representation.
Conclusion:
the performed analyses pointed to love, respect and affection as central elements that structured and organized the social representation of sexuality in the elder years for the group studied.
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RESEARCH01-01-2015
Post-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
Abstract
RESEARCHPost-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
DOI 10.1590/0034-7167.2015680412i
Views0ABSTRACT
Objective:
To identify post-accident conduct in the workplace by health professionals in caring for people with HIV/Aids.
Method:
A qualitative and descriptive research study with a socio-historical perspective (1986-2006), performed in a reference hospital for infectious diseases in the State of Santa Catarina. To collect data, interviews were conducted with oral history among 23 health workers and, for the treatment of data, Bardin’s content analysis was used.
Results:
Post-accident behaviors emerged that included assessment, accident records, chemoprophylaxis when necessary, support, monitoring of the injured worker, and mainly psychological support.
Conclusion:
In situations in which the accident could not be avoided, post-exposure behaviors were important biosecurity strategies mentioned by health workers caring for patients with HIV/Aids, in the sense of minimizing the possible transmission of the HIV virus.
Keywords:Acquired Immunodeficiency SyndromeHealth ProfessionalsOccupational AccidentsOccupational HealthOccupational RisksSee more -
RESEARCH01-01-2015
Nursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
Abstract
RESEARCHNursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
DOI 10.1590/0034-7167.2015680410i
Views0See moreABSTRACT
Objective:
to understand the interactions of nurses managing nursing care for the hospitalized child with a chronic condition.
Method:
Theoretical and methodological references were used, Complex Thought and grounded theory, respectively. In the study 18 subjects have participated arranged in three groups: nurses, nursing technicians and family members. A semi-structured interview was used as technique for data collection. The data analysis followed three stages of coding: open, axial and selective.
Results:
the category “Needing to manage nursing care to the hospitalized child with chronic condition in Pediatric Inpatient Unit” and their subcategories show the complex inter subjective bindings established by nurses that support the practice of nursing care management.
Conclusion:
There are difficulties for nursing professionals to interact with the child’s family and the dialogical order/disorder/interaction/organization in the implementation of the management process of care is.
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RESEARCH01-01-2015
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
Abstract
RESEARCHFunctional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
DOI 10.1590/0034-7167.2015680409i
Views0See moreABSTRACT
Objective:
to verify the prevalence of functional disability and associated socioeconomic and demographic factors in elderly patients of Campina Grande/PB.
Method:
cross-sectional study with elderly patients of both genders. The variables associated with functional disability were assessed using Poisson regression.
Results:
A total of 420 elderly patients were included (68.1% women). The highest prevalence of functional disability were found among females aged 80 or older, white, widowed, of economic classes D/E , who lived alone, with frequency of contacts of up to 224 people and diversity of contacts of up to 14 people. After multivariate analysis, statistically significant association was observed between functional disability, gender and age group.
Conclusion:
the association between functional disability gender and age group is shown to be an important guidance for health interventions since it will allow health services to plan actions aiming to improve, maintain or restore the functional capacity of the elderly population.
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RESEARCH01-01-2015
Hypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
Abstract
RESEARCHHypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
DOI 10.1590/0034-7167.2015680408i
Views0See moreABSTRACT
Objectives:
to evaluate the program proposed by the Reorganization Care Plan for Hypertension and Diabetes Mellitus on user’s view, and describe aspects of the trajectory of the participants correlating with the program’s evaluation.
Method:
evaluative study with a qualitative approach conducted in health units with the Family Health Strategy, in a city of the metropolitan region of Curitiba, in the period from September to March, 2012. A total of 30 adults with hypertension and/or Diabetes mellitus were interviewed. Data were analyzed through content analysis.
Results:
Four categories were identified: Disease diagnosis; Reasons for the program need; Knowledge of the program, and program evaluation.
Conclusion:
there was the recognition of the orientations, and the monitoring of activities developed, with emphasis in cost reduction for users.
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RESEARCH01-01-2015
Violence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
Abstract
RESEARCHViolence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
DOI 10.1590/0034-7167.2015680407i
Views0See moreABSTRACT
Objective:
to apply the methodology of Culture Circles on adolescents as a strategy for health education of nurses in the construction of the collective knowledge of the thematic violence.
Method:
action research type and qualitative study. Participants were 11 adolescents from a public school in Recife, PE, Brazil. Data production in Culture Circles included the participant observation with field diary, photographic recording and filming, as well as the photovoice technique. The analysis was performed by triangulating data in dialogue with the literature.
Results:
it was shown that the problematizing action provided by the Culture Circle made possible to create situations in which adolescents felt invited to critically refl ect on the phenomenon of violence in all its complexity.
Conclusion:
the health education intervention, performed by Culture Circles, added learning and mutual growth subsidizing nursing care actions that excel at leadership and autonomy of adolescents.
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