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12-04-2023
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301pt
Views0A relação entre cronicidade e trabalho tem sido uma preocupação crescente na sociedade contemporânea. À medida que o número de doenças crônicas aumenta em todo o mundo, é fundamental compreender como essas condições impactam a saúde dos trabalhadores(). Neste editorial, exploraremos os impactos da cronicidade na saúde do trabalhador, destacando dados da Carga Global de […]See more -
12-04-2023
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301
Views0The relationship between chronicity and work has been a growing concern in contemporary society. As the number of chronic illnesses increases around the world, it is critical to understand how these conditions impact workers’ health(). In this editorial, we will explore the impacts of chronicity on workers’ health, highlighting data from the Global Burden of […]See more -
12-04-2023
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
Abstract
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
DOI 10.1590/0034-7167-2023-0126
Views0See moreABSTRACT
Objectives:
to reflect on the impacts of the General Personal Data Protection Law on Nursing practice.
Methods:
reflection article, through the intentional collection of materials relating to the topic.
Results:
legislation regulates confidentiality, processing and data sharing, requiring institutional protection measures. The nursing team is responsible for acting preventively, both in care and in the management role, in order to avoid the misuse of the patient’s personal data. The law allows academic research to be carried out as long as the purpose is clear, data collection occurs with an explicit purpose and data is anonymized.
Final Considerations:
although the General Personal Data Protection Law requires greater care in relation to data processing, it is established on precepts of good faith and respect for the rights of the individual, concepts aligned with the nursing code of ethics.
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REVIEW12-04-2023
Supervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
Abstract
REVIEWSupervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
DOI 10.1590/0034-7167-2023-0077
Views0See moreABSTRACT
Objectives:
to map studies that analyze the audit process of nursing councils.
Methods:
this is a scoping review, anchored in the JBI framework, with the guiding question: what is the evidence of the audit process of legal practice of nursing by class councils (COFEN/COREN system)? The searches were carried out in October and November 2022 without limitation of language and year.
Results:
of the 9 selected studies, all are Brazilian and published from 2014 onwards. Among the topics addressed are the role, challenges, costs and difficulties in nurse auditors’ daily work process, in addition to the contribution of the audit sector in Brazil.
Conclusions:
the studies gathered discuss aspects related to costs, challenges and difficulties, but there is no focus on corrective, disciplinary and educational activities as well as little is said about the audit process, its reporting, referral and outcomes.
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ORIGINAL ARTICLE12-04-2023
Overview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
Abstract
ORIGINAL ARTICLEOverview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
DOI 10.1590/0034-7167-2022-0808
Views0See moreABSTRACT
Objectives:
to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions.
Methods:
descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil.
Results:
153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women’s, Children’s, Adolescent’s, Adult’s and Older People’s Health, and Mental Health.
Final Considerations:
the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.
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12-04-2023
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
Abstract
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
DOI 10.1590/0034-7167-2022-0797es
Views0See moreRESUMEN
Objetivos:
debatir sobre aspectos éticos en la atención de enfermería a personas transgénero.
Métodos:
estudio reflexivo fundamentado sobre los dilemas que se plantean en los cuidados de enfermería a personas transgénero. El relato se ha estructurado en torno a los cuatro principios bioéticos.
Resultados:
la atención sanitaria a las personas trans es compleja, transversal a muchos dispositivos y especialidades y longitudinal en el tiempo por lo que precisa de la actuación coordinada. Existe un marco ético en el que se encuadran los cuidados de enfermería que se precisan en la atención a este colectivo.
Consideraciones Finales:
la enfermera como agente de salud puede asumir diversas líneas generales en la atención a pacientes transgénero. Para ello, se debe brindar formación adicional no solo a los profesionales, también a los estudiantes de enfermería y de las demás ciencias de la salud.
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12-04-2023
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
Abstract
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
DOI 10.1590/0034-7167-2022-0759
Views0See moreABSTRACT
Objectives:
to reflect on the ethical dilemmas involved in the care of patients at the end of their lives.
Methods:
this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari.
Results:
discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient’s autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care.
Final Considerations:
issues related to being, stemming from one’s reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.
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01-01-2017
Nursing process in mental health: an integrative literature review
Revista Brasileira de Enfermagem. 2017;70(1):220-230
Abstract
Nursing process in mental health: an integrative literature review
Revista Brasileira de Enfermagem. 2017;70(1):220-230
DOI 10.1590/0034-7167-2016-0031
Views0See moreABSTRACT
Objective:
to identify evidences from the literature on the application of nursing process in care developed by the nurse in mental health.
Method:
integrative literature review between 1990 and 2013, in the PubMed, Scopus, CINAHL and LILCACS bases. Descriptors: nursing processes, mental health, nursing care.
Results:
19 papers were identified. Limited and partial usage of the nursing process in care established by a therapeutic relationship that respects the patient’s individuality. We observe care proposals systematized for patients that present pathological aspects in the limits between the physical and psychical, which might be a response to the influence of the practice based on evidences.
Conclusion:
it was found an antagonistic movement between care based on the relationship and located in the standardization of diagnoses that respond to physical malaise. A lack of evidence was verified for the usage of the nursing process in mental health, and we point at the necessity for the creation of new possibilities for dialogue between relational and biological perspectives.
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01-01-2017
Nursing practice in home care: an integrative literature review
Revista Brasileira de Enfermagem. 2017;70(1):210-219
Abstract
Nursing practice in home care: an integrative literature review
Revista Brasileira de Enfermagem. 2017;70(1):210-219
DOI 10.1590/0034-7167-2016-0214
Views0See moreABSTRACT
Objective:
analyze scientific production on nursing practice in home care.
Method:
integrative review employing databases LILACS, BDENF, IBECS, and MEDLINE. Studies in Spanish, English, and Portuguese were included, regardless of publishing date.
Results:
after analyzing 48 articles, it was found that nursing practice in home care is complex, employing a multitude of actions by using three technologies: soft; soft-hard especially; and hard. Challenges related to the home-care training process are reported in the literature. Nurses use knowledge from their experience and scientific recommendations in conjunction with their reflections on the practice.
Conclusion:
home nursing practice is fundamental and widespread. Relational and educational actions stand out as necessary even in technical care, with a predominant need for home-care training.
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01-01-2017
Nonpharmacological interventions to improve quality of life in heart failure: an integrative review
Revista Brasileira de Enfermagem. 2017;70(1):198-209
Abstract
Nonpharmacological interventions to improve quality of life in heart failure: an integrative review
Revista Brasileira de Enfermagem. 2017;70(1):198-209
DOI 10.1590/0034-7167-2016-0112
Views0See moreABSTRACT
Objective:
to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature.
Method:
an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish.
Results:
twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices.
Conclusion:
these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals’ quality of life.
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01-01-2017
Quality of working life: assessment of intervention studies
Revista Brasileira de Enfermagem. 2017;70(1):189-197
Abstract
Quality of working life: assessment of intervention studies
Revista Brasileira de Enfermagem. 2017;70(1):189-197
DOI 10.1590/0034-7167-2015-0069
Views0See moreABSTRACT
Objective:
to analyze the production of knowledge about interventions on quality of working life.
Method:
integrative review study. The following databases were used for study selection: SciELO, Medline and PubMed.
Results:
the sample included 25 national and international articles that described programs and methods to acquire healthy habits at the workplace and attenuate its mental demands.
Conclusion:
by observing the number of businesses throughout the world, a low number of programs addressing workers’ health and well-being can be found, and the establishment of efficient policies at institutions could improve this situation.
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01-01-2017
Letramento em saúde para pessoas com HIV/Aids: revisão integrativa
Revista Brasileira de Enfermagem. 2017;70(1):180-188
Abstract
Letramento em saúde para pessoas com HIV/Aids: revisão integrativa
Revista Brasileira de Enfermagem. 2017;70(1):180-188
DOI 10.1590/0034-7167-2015-0052
Views1See moreRESUMEN
Objetivo:
analizar el conocimiento producido por la investigación sobre la salud de alfabetización para adultos con VIH/SIDA.
Método:
una revisión integradora de la literatura, con seis bases de datos, se llevó a cabo entre enero y abril de 2014. Los descriptores SIDA y Educación de la Salud se utilizaron, en portugués, inglés y español. Se encontró un total de 130 artículos y se seleccionaron 14. Se identificaron tres categorías: tecnologías de la educación y alfabetización de la salud para el VIH/SIDA; evaluación de conocimientos sobre la salud de los pacientes con VIH/SIDA; y conocimientos sobre la salud y la adherencia a la terapia antirretroviral.
Resultados:
análisis de los conocimientos sobre la salud, el estatus socioeconómico y nivel educativo de las personas que viven con el VIH / SIDA era esencial para la implementación de estrategias educativas que el aumento de la adherencia a la orientación de la salud.
Conclusión:
Este estudio demostró la importancia de la alfabetización en salud para trabajar con personas que viven con el VIH / SIDA, especialmente teniendo en cuenta a las personas que no poseen el mínimo necesario para la supervivencia, lo que hace que sea aún más relevante y alienta la investigación sobre el tema.
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REVIEW01-01-2017
Health literacy for people living with HIV/Aids: an integrative review
Revista Brasileira de Enfermagem. 2017;70(1):180-188
Abstract
REVIEWHealth literacy for people living with HIV/Aids: an integrative review
Revista Brasileira de Enfermagem. 2017;70(1):180-188
DOI 10.1590/0034-7167-2015-0052
Views0See moreABSTRACT
Objective:
to analyze knowledge produced by research about health literacy for adult with HIV/Aids.
Method:
an integrative literature review, using six databases, was conducted between January and April of 2014. The descriptors aids and Health Literacy were used, in Portuguese, English and Spanish. A total of 130 articles were found and 14 were selected. Three categories were identified: educational technologies and health literacy for HIV/Aids; assessment of health literacy of patients with HIV/Aids; and health literacy and adherence to antiretroviral therapy.
Results:
analysis of health literacy, socioeconomic status and educational level of people living with HIV/ Aids was essential for implementation of educational strategies that increased adherence to health guidance.
Conclusion:
this study showed the importance of health literacy for working with people living with HIV/Aids, especially considering individuals who did not possess the minimum necessary for survival, which makes it relevant and encourages further research on the topic.
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01-01-2017
Factors that interfere with the response of nurses in the monitoring of clinical alarms
Revista Brasileira de Enfermagem. 2017;70(1):172-179
Abstract
Factors that interfere with the response of nurses in the monitoring of clinical alarms
Revista Brasileira de Enfermagem. 2017;70(1):172-179
DOI 10.1590/0034-7167-2015-0092
Views0See moreABSTRACT
Objective:
The objective of the present study was to identify and synthesize the best empirical evidence found on factors that influence the response of nurses regarding clinical alarms.
Method:
An integrative literature review was conducted with searches undertaken in ten electronic databases restricted to the period from 2005 to 2016.
Results:
Eight articles were included by cross-checking the descriptors selected.
Conclusion:
In the analysis of the studies, the following possible factors that might interfere with the response of nurses in the monitoring of clinical alarms were found: high number of false alarms, inaudibility of alarms due to the competition of sounds, difficulty in distinguishing the urgency of alarms, and increase in noise caused by the raise in the number of alarms.
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01-01-2017
Discourses on discharge care for children with special healthcare needs
Revista Brasileira de Enfermagem. 2017;70(1):163-171
Abstract
Discourses on discharge care for children with special healthcare needs
Revista Brasileira de Enfermagem. 2017;70(1):163-171
DOI 10.1590/0034-7167-2016-0248
Views0See moreABSTRACT
Objectives:
analyze the discourse of healthcare professionals and families on the continuous and complex care for children with special healthcare needs; understand hospital discharge as a process centered on children demands and family learning.
Method:
qualitative research conducted between 2013 and 2015 through semi-structured interviews, document analysis and the sensitive creative method; the participants were ten children with special healthcare needs, six professionals and eleven family members from a public pediatric teaching hospital in Rio de Janeiro. The data underwent critical discourse analysis.
Results:
at discharge, family caregivers should learn innovative care to guarantee the maintenance of their children’s lives at home, but preparation is limited.
Conclusion:
the clinicians and the families pointed out Nurse as the most qualified professional for this preparation, since caring for these children requires nursing care skills.
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ORIGINAL ARTICLE09-06-2024
Factors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
Abstract
ORIGINAL ARTICLEFactors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
DOI 10.1590/0034-7167-2023-0510
Views0See moreABSTRACT
Objective:
to analyze the association between burnout and sociodemographic, work factors, lifestyle habits and health conditions of military police officers in a municipality in the state of Paraná, Brazil.
Method:
cross-sectional research with 131 military police officers. Data were analyzed using the Statistical Package for the Social Sciences software and the R program. Chi-square, Fisher’s exact and Poisson Generalized Linear Model tests were used.
Results:
most participants (65.6%) had a high level of burnout. In relation to protective factors, those who carried out leisure activities had a 33.6% chance of not developing burnout. Conjugality was also a protective factor. Not practicing physical activity and leisure activities are factors that can contribute to the occurrence of burnout.
Conclusions:
important factors and high rates of burnout were observed in the police officers investigated. It is necessary to implement public health policies to reduce burnout with attention focused on this professional category.
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ORIGINAL ARTICLE09-06-2024
Development and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
Abstract
ORIGINAL ARTICLEDevelopment and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
DOI 10.1590/0034-7167-2023-0502
Views0See moreABSTRACT
Objective:
Develop and validate the content of an instrument for patient risk classification in emergency services of Primary Health Care.
Method:
The study included two stages: item generation and content validity. A literature review and retrospective analysis of medical records were conducted to create the instrument items. The Content Validity Ratio (CVR) was used to assess agreement among judges during content validation.
Results:
In the first and second rounds, 75 and 71 judges validated the risk classification instrument, respectively. The minimum adherence score for the latent variable item based on the final number of judges was 0.22 and 0.18; thus, 52 items, divided into three classification categories (red, orange, and yellow), were retained.
Conclusion:
The instrument was considered valid regarding clarity, relevance, pertinence, and agreement regarding the severity indicated in the item.
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REVIEW09-06-2024
Nursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
Abstract
REVIEWNursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
DOI 10.1590/0034-7167-2023-0466
Views0See moreABSTRACT
Objective:
to identify the scientific evidence available in national and international literature on the relationships between nursing students’ mindfulness and emotional regulation.
Methods:
an integrative literature review, in four databases, with a time frame from January 2002 to December 2022. Articles in English, Spanish and Portuguese available in full were included.
Results:
the sample consisted of six original articles, predominantly with a quantitative approach, with cross-sectional designs standing out.
Conclusion:
the synthesis of scientific production revealed that there is a lack of research at national and international level on the subject with experimental and qualitative designs that enable conclusions about cause and effect and/or take into account subjective experiences of the applicability of mindfulness-based practice in nursing students’ emotional regulation.
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ORIGINAL ARTICLE09-06-2024
Nursing Process implementation in a gerontogeriatric context: qualitative research
Revista Brasileira de Enfermagem. 2024;77(4):e20230465
Abstract
ORIGINAL ARTICLENursing Process implementation in a gerontogeriatric context: qualitative research
Revista Brasileira de Enfermagem. 2024;77(4):e20230465
DOI 10.1590/0034-7167-2023-0465
Views0See moreABSTRACT
Objective:
to describe Nursing Process implementation in a faith-based senior living community.
Method:
strategic action research with 19 nursing professionals and three managers of a faith-based senior living community. Implementation took place in four phases: diagnosis, planning, implementation and assessment. The data collected through semi-structured interviews and focus groups were subjected to discursive textual analysis.
Results:
the central categories were constructed: Nursing Process in faith-based senior living community: diagnosis of knowledge and application; Nursing Process in faith-based senior living community: implementation; Nursing process in faith-based senior living community: assessment after its implementation.
Conclusion:
Nursing Process implementation made it possible to structure work management/organization, contributing to knowledge, organization and continuity of care for safety and professional support.
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ORIGINAL ARTICLE09-06-2024
Adherence to sepsis protocol in a high-risk maternity reference center
Revista Brasileira de Enfermagem. 2024;77(4):e20230453
Abstract
ORIGINAL ARTICLEAdherence to sepsis protocol in a high-risk maternity reference center
Revista Brasileira de Enfermagem. 2024;77(4):e20230453
DOI 10.1590/0034-7167-2023-0453
Views0See moreABSTRACT
Objective:
To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center.
Methods:
This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies.
Results:
Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases.
Conclusion:
The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.
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ORIGINAL ARTICLE09-06-2024
Effect of Brazilian green propolis in chronic ulcer treatment: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(4):e20230418
Abstract
ORIGINAL ARTICLEEffect of Brazilian green propolis in chronic ulcer treatment: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(4):e20230418
DOI 10.1590/0034-7167-2023-0418
Views0See moreABSTRACT
Objective:
to assess the effectiveness of 5% Brazilian green propolis (ointment) in individuals with chronic ulcers.
Methods:
a randomized clinical trial, developed with 40 patients randomized equally to control group (treated with essential fatty acid) and experimental group (treated with 5% green propolis) for 30 days. The outcomes of interest were sociodemographic, clinical and laboratory characteristics, lesion characteristics, such as type of tissue in the bed, presence of exudate, edge characteristics, microbial content and pain.
Results:
regarding sociodemographic, clinical and laboratory characteristics, the two groups did not show statistically significant differences. After assessment in 30 days, an effect was observed for both treated groups, but for the experimental group, greater effectiveness in terms of the type of tissue in the bed, type of exudate, edge characteristics, microbial content and pain.
Conclusion:
propolis-based ointment showed a healing effect, presenting itself as a potential tool in healing chronic ulcers.
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09-06-2024
Progress Test in nursing: perspectives for undergraduate education
Revista Brasileira de Enfermagem. 2024;77(4):e20230413
Abstract
Progress Test in nursing: perspectives for undergraduate education
Revista Brasileira de Enfermagem. 2024;77(4):e20230413
DOI 10.1590/0034-7167-2023-0413
Views0See moreABSTRACT
Objective:
to reflect on the perspectives of adopting the Progress Test in undergraduate nursing education.
Methods:
this is a reflective study, based on authors’ critical thinking and supported by national and international literature on the Progress Test application in undergraduate health courses.
Results:
the Progress Test is as a valuable teaching-learning strategy, with potential applications and benefits for students, professors, and academic management.
Final considerations:
systematic nursing education assessment indicates valuable information for different stakeholders. Understanding its potential benefits, the Progress Test is presented as a strategy that can be replicated in undergraduate nursing education, either individually, by institutions, or collaboratively, by the establishment of partnerships or consortiums of institutions.
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ORIGINAL ARTICLE09-06-2024
Physical and psychological changes of the COVID-19 infodemic by the older adult population
Revista Brasileira de Enfermagem. 2024;77(4):e20230339
Abstract
ORIGINAL ARTICLEPhysical and psychological changes of the COVID-19 infodemic by the older adult population
Revista Brasileira de Enfermagem. 2024;77(4):e20230339
DOI 10.1590/0034-7167-2023-0339
Views0See moreABSTRACT
Objective:
to analyze the physical and psychological changes of the COVID-19 infodemic for the older adult population of Rio de Janeiro.
Method:
a cross-sectional, web-based survey to find out about access to news and information about COVID-19 among older adult in Rio de Janeiro, between July and December 2020. Univariate analysis and bivariate analysis were carried out using non-parametric statistical methods.
Results:
390 older adults took part, predominantly female (75.1%), aged between 66 and 75 (35.4%), married (51.0%), white (60.3%), owning their own home (81.8%), located in urban areas (91%), with complete or incomplete primary education (31.8%) and retired or pensioners (79.2%). Younger people were significantly affected both physically and psychologically by social networks when compared to television (<0.001).
Conclusion:
Physical and psychological changes from exposure to information about COVID-19 have affected the lives of the older adult, having an impact on this population.
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