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ORIGINAL ARTICLE11-22-2024
Prevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
Abstract
ORIGINAL ARTICLEPrevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
DOI 10.1590/0034-7167-2023-0327
Views0See moreABSTRACT
Objectives:
to assess pain management during labor.
Methods:
a cross-sectional study was carried out by reviewing medical records and conducting postpartum interviews. Prevalence and effectiveness of analgesia were assessed.
Results:
the prevalence of non-pharmacological analgesia was 61.86% of 215 women in labor in Obstetric Center and 82.51% of 62 in midwife-led unit. Prevalence of severe pain, on the Visual Analogue Scale, before and after non-pharmacological analgesia, was from 92.16% to 64.04% (p=0.00) in Obstetric Center and from 85.96% to 52.63% (p=0.01) in midwife-led unit. Prevalence of pharmacological analgesia in Obstetric Centers was 15.81%, with no variation in severe pain (p=0.57). Patients’ request for analgesia was associated with education (p=0.00) and pain intensity (p=0.02).
Conclusions:
non-pharmacological analgesia improved pain intensity. Prevalence of pharmacological analgesic prescription was lower than that identified in developed countries. Pain management needs to consider the preferences and needs of women in labor.
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ORIGINAL ARTICLE11-22-2024
Knowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
Abstract
ORIGINAL ARTICLEKnowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
DOI 10.1590/0034-7167-2023-0287
Views0ABSTRACT
Objective:
To analyze how management practices for sharing knowledge are developed in public hospitals in the context of nursing.
Methods:
Qualitative research, carried out with 15 nurse managers from six public hospitals, from July to September 2022. Data were collected through semi-structured interviews and analyzed according to content analysis and in a model for sharing knowledge at work.
Results:
Knowledge sharing in nursing occurs through intraand extra-organizational training (training, courses and events), use of digital communication tools (media and social networks) and individual and collective contact between professionals during the service (experiences, exchange of experiences and assessment feedback).
Final considerations:
Sharing knowledge is relevant to nursing work. To improve it, it must be understood that effective sharing occurs from person to person, in their daily practices, and must be conducted as a strategically planned process by nurse managers.
Keywords:Health Information ManagementHealth Services AdministrationKnowledge ManagementNursing Service, HospitalNursing Staff, HospitalSee more -
ORIGINAL ARTICLE11-22-2024
Transitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
Abstract
ORIGINAL ARTICLETransitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
DOI 10.1590/0034-7167-2023-0229
Views0See moreABSTRACT
Objective:
to understand the transitional processes that affect the adaptation of people who live with limitations resulting from leprosy.
Methods:
This is a qualitative study based on the precepts of Transition Theory, mediated by care-research, with 24 people with limitations resulting from leprosy in an ex-hospital colony in Piauí. Semi-structured interviews were carried out. The interviews were analyzed using Iramuteq software.
Results:
the researched-caregivers experienced the four types of transitions, including feelings of fear, worry, loneliness, hopelessness, guilt and a tendency to hide the diagnosis. Breakdowns and resignation were revealed, with spirituality, adaptation to the new life situation and acceptance as facilitating conditions for coping with the transitional process, with a consequent improvement in quality of life.
Final considerations:
the transitional processes had a positive significance, since they contributed to adaptation and the achievement of quality of life.
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ORIGINAL ARTICLE11-22-2024
Study for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
Abstract
ORIGINAL ARTICLEStudy for the validation of evaluation indicators of electronic health records in immunization: Delphi technique
Revista Brasileira de Enfermagem. 2024;77(5):e20230112
DOI 10.1590/0034-7167-2023-0112
Views0ABSTRACT
Objective:
To develop and validate indicators for the evaluation of computerized systems in vaccination rooms.
Methods:
Methodological study. From the construction of a logical model for managing information produced in computerized systems in vaccination rooms, an evaluation indicator matrix was developed, and its contents were validated by specialists using the Delphi method. The degree of relevance and clarity were judged, using the following parameters: agreement percentage ≥ 90%; content validity index > 0.78. Internal consistency was tested using Cronbach’s alpha coefficient of 0.93.
Results:
Of the 55 proposed indicators, 48 were validated and composed the final matrix, with 13 in the structure dimension, 29 in the process dimension, and six in the outcome dimension.
Conclusion:
The set of indicators shows validity and high reliability, and can be used to evaluate computerized systems in vaccination rooms throughout the country, as it adhered to the recommendations of the National Immunization Program.
Keywords:Delphi TechniquesElectronic Health RecordsImmunization ProgramsInformation TechnologyValidation StudySee more -
ORIGINAL ARTICLE11-22-2024
Interpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
Abstract
ORIGINAL ARTICLEInterpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
DOI 10.1590/0034-7167-2023-0081
Views0See moreABSTRACT
Objective:
To identify the frequency of notifications of interpersonal violence in Espírito Santo from 2011 to 2018, and the factors associated with this issue.
Methods:
This is a cross-sectional study in which all cases of interpersonal violence from the Information System for Notifiable Diseases in the state of Espírito Santo during the period from 2011 to 2018 were analyzed. Absolute and relative frequencies and 95% confidence intervals were calculated, as well as Poisson regression.
Results:
During the analyzed period, 27,277 cases were reported in Espírito Santo (P: 75%; 95% CI: 74.5-75.4), being more prevalent among females, children, and the elderly, individuals of black/mixed race, people without disabilities, and residents of urban areas. Regarding the perpetrator, there was a higher prevalence of individuals aged 25 years and older, males, with a current or former intimate partner relationship with the victim, and suspected alcohol use at the time of the aggression. In terms of the characteristics of the aggression, there was a higher prevalence of repeat violence, involving a single aggressor, and occurring in the residence.
Conclusions:
The notification of interpersonal violence in Espírito Santo showed a high prevalence and was associated with characteristics of the victim, aggressor, and event. This scenario reinforces the need for interventions such as professional qualification, expansion of intersectoral actions, and reformulation of public policies.
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ORIGINAL ARTICLE11-22-2024
Sociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
Abstract
ORIGINAL ARTICLESociodemographic and occupational influences on health professionals’ quality of life
Revista Brasileira de Enfermagem. 2024;77(4):e20240010
DOI 10.1590/0034-7167-2024-0010
Views0See moreABSTRACT
Objective:
To analyze the sociodemographic and occupational influences on health professionals’ quality of life.
Method:
This descriptive-exploratory, cross-sectional, analytical, and quantitative study addressed 94 health workers, including nursing technicians, nurses, and physical therapists working in Intensive Care Units in a town in the extreme south of Brazil in 2023. The student’s t-test and Spearman correlation were used.
Results:
A significant positive correlation was found between being a woman and the psychological domain and between income and the social and environmental domain while working hours were inversely related to general QoL. Additionally, workload negatively impacted the physical, psychological, and general QOL, furniture negatively influenced the psychological domain, and equipment was negatively associated with the physical and psychological domain.
Conclusion:
The characteristics of the work environment interfere with several areas of quality of life.
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REVIEW11-22-2024
Concept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
Abstract
REVIEWConcept analysis of youth: understanding the plurality of subjects
Revista Brasileira de Enfermagem. 2024;77(4):e20240002
DOI 10.1590/0034-7167-2024-0002
Views0See moreABSTRACT
Objective:
To analyze the concept of “youth.”
Methods:
This is a concept analysis guided by the method proposed by Walker and Avant, operationalized through an integrative literature review. The search in scientific databases was carried out using the descriptors: youth; young; adolescence. To compose the literary corpus, 22 studies were selected.
Results:
Various factors were found in the antecedents that influence the separation of youth groups, contributing to the heterogenization of this population. The attributes include characteristics that comprise the formation of youth groups, especially the idea of shared experiences and social construction, as well as the consequences of the mentioned concept. After systematizing the variables, the analysis was conducted, highlighting the conceptions that influence youth.
Conclusion:
The study demonstrated the multifactorial complexity of the formulation of the concept of youth, highlighting various factors that contribute to this construction. For nursing, this conceptual field allows for an understanding of the population and effective engagement with this group.
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EDITORIAL01-01-2016
Discoveries of Biological Sciences and their implications for nursing practice
Revista Brasileira de Enfermagem. 2016;69(4):619-620
Abstract
EDITORIALDiscoveries of Biological Sciences and their implications for nursing practice
Revista Brasileira de Enfermagem. 2016;69(4):619-620
DOI 10.1590/0034-7167.2016690401i
Views1For the longest time, the production of knowledge in the field of biological sciences was viewed as the exclusive responsibility and competence of medical professionals. This scenario has changed in light of the worldwide trend of improvements in other health professions, which includes the need to implement the use of evidence-based methodology in nursing practice. […]See more -
EDITORIAL01-01-2016
Descobertas das Ciências Biológicas e as implicações para a prática da Enfermagem
Revista Brasileira de Enfermagem. 2016;69(4):619-620
Abstract
EDITORIALDescobertas das Ciências Biológicas e as implicações para a prática da Enfermagem
Revista Brasileira de Enfermagem. 2016;69(4):619-620
DOI 10.1590/0034-7167.2016690401i
Views0A produção de conhecimento na área das ciências biológicas, durante muito tempo, foi vista como de responsabilidade e competência exclusivamente de profissionais médicos. Esse cenário alterou-se frente à tendência mundial de aperfeiçoamento dos demais profissionais de saúde, incluindo-se a necessidade de se concretizar a utilização da metodologia da prática baseada em evidência na atuação do […]See more -
REVIEW01-01-2016
Effects from acupuncture in treating anxiety: integrative review
Revista Brasileira de Enfermagem. 2016;69(3):602-609
Abstract
REVIEWEffects from acupuncture in treating anxiety: integrative review
Revista Brasileira de Enfermagem. 2016;69(3):602-609
DOI 10.1590/0034-7167.2016690325i
Views0See moreABSTRACT
Objective:
to evaluate the scientific evidence that is available in the literature on the effects of acupuncture for treating anxiety and on the quality of such studies.
Method:
the study is an integrative review of CINAHL, LILACS, PUBMED-PICO, SciELO, and The Cochrane Library between 2001 and 2014. Keywords anxiety, acupuncture therapy, acupuncture, and anxiety disorders were combined among themselves to ensure a wide search of primary studies.
Results:
among 514 articles, 67 were selected to be fully read and 19 were included. Among these, 11 were found to have strong evidence levels. Among the six articles about randomized clinical studies, five were found to be of reasonable quality. Two studies used acupuncturist nurses to perform their interventions. Its results showed positive and statistically significant effects from using acupuncture for treating subjects with anxiety.
Conclusion:
acupuncture seems to be a promising treatment for anxiety; however, there is a need for improving the methodological quality of the research on this field.
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REVIEW01-01-2016
Palliative care and spirituality: an integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):591-601
Abstract
REVIEWPalliative care and spirituality: an integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):591-601
DOI 10.1590/0034-7167.2016690324i
Views0See moreABSTRACT
Objective:
to analyze scientifi c articles published in international online journals about palliative care and spirituality.
Methods:
an integrative literature review with data collected in September 2014 from the LILACS, SCIELO, MEDLINE/PubMed, and IBECS databases.
Results:
thirty-nine publications were identifi ed and their textual analysis facilitated through four thematic approaches: the meaning of spirituality in the context of palliative care; palliative care and spiritual support; spirituality and relief of pain and other symptoms in patients under palliative care; and instruments to evaluate the spiritual dimension of the scope of palliative care.
Conclusion:
this study examined the relevance of the spiritual dimension in the care of patients with palliative care and the need for developing new studies to disseminate knowledge about this topic.
Descriptors:
Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health.
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REVIEW01-01-2016
Educational technologies to encourage (self) care in postpartum women
Revista Brasileira de Enfermagem. 2016;69(3):582-590
Abstract
REVIEWEducational technologies to encourage (self) care in postpartum women
Revista Brasileira de Enfermagem. 2016;69(3):582-590
DOI 10.1590/0034-7167.2016690323i
Views0See moreABSTRACT
Objective:
to evaluate national and international literature regarding the use of educational technologies to encourage self care in postpartum women.
Method:
an integrative review of the literature. The articles were collected from the CINAHL, SCOPUS, PubMed, SciELO, LILACS and Cochrane databases; the time period for the articles referred to January/2004 to July/2014; the languages used in the articles were Portuguese, English, Spanish and French; the articles were selected from the following descriptors: postpartum care period, educational technology, nursing and self care. Twenty-seven articles were selected for analysis
Results:
based on the information found, the scales, counseling and home visits were among the most recommended educational technologies.
Conclusion:
the technologies promote communication, but are sometimes dependent on computer and internet access, which hinder their use by low-income women.
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RESEARCH01-01-2016
Patients with HIV/Aids and ulcer risk: nursing care demands
Revista Brasileira de Enfermagem. 2016;69(3):574-581
Abstract
RESEARCHPatients with HIV/Aids and ulcer risk: nursing care demands
Revista Brasileira de Enfermagem. 2016;69(3):574-581
DOI 10.1590/0034-7167.2016690322i
Views0See moreABSTRACT
Objective:
to analyze the demand for nursing care and the risk of pressure ulcers (PU) of patients with HIV/Aids.
Method:
quantitative survey, carried out from December 2012 to March 2013 in a public hospital of Teresina, state of Piauí, Brazil.
Results:
the sample of 31 patients was predominantly male, mean age 36.6 years, average care demand 49.4%, most showing some risk of developing PU. The variables correlated with PU risk were care demand and clinical outcome (death). Those associated with care demand were age and clinical outcome (death).
Conclusion:
the results showed that patients require moderate nursing care needs and most of them present risk of developing PU.
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EDITORIAL09-04-2023
Chronicity in the 21st century: facing the challenges of a changing society
Revista Brasileira de Enfermagem. 2023;76(4):e760401
Abstract
EDITORIALChronicity in the 21st century: facing the challenges of a changing society
Revista Brasileira de Enfermagem. 2023;76(4):e760401
DOI 10.1590/0034-7167.2023760401
Views0Currently, there is an increase in non-communicable diseases (NCDs), population aging and changes in lifestyle, which corroborates the increase in chronicity, one of the greatest challenges faced by contemporary society. In this editorial, we will examine chronicity in the 21st century and the need to address this problem in a comprehensive and sustainable way.In recent […]See more -
ORIGINAL ARTICLE09-04-2023
Impact of an educational intervention on standard precautions during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(4):e20220750
Abstract
ORIGINAL ARTICLEImpact of an educational intervention on standard precautions during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(4):e20220750
DOI 10.1590/0034-7167-2022-0750
Views0See moreABSTRACT
Objective:
To evaluate the impact of an educational intervention on the knowledge of nursing professionals regarding standard precautions.
Methods:
This is an almost experimental study conducted with 100 nursing professionals. Data collection was performed using a sociodemographic characterization instrument and the Standard Precautions Knowledge Questionnaire. The educational intervention was based on five moments, where the approach to questions with less than 70% accuracy was intensified.
Results:
There was a significant difference between the scores of healthcare professionals before (16.20 ± 1.51) and after (16.90 ± 1.31) the educational intervention (W=3.336; p < 0.05). Regarding knowledge about hand hygiene after glove use, an increase in knowledge from 83% to 93% was obtained.
Conclusions:
A positive effect on the professionals’ knowledge was recorded, demonstrating advances regarding the strengthening of already acquired knowledge and the understanding of new knowledge.
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ORIGINAL ARTICLE09-04-2023
Financial toxicity in people with chronic kidney disease undergoing hemodialysis treatment
Revista Brasileira de Enfermagem. 2023;76(4):e20220671
Abstract
ORIGINAL ARTICLEFinancial toxicity in people with chronic kidney disease undergoing hemodialysis treatment
Revista Brasileira de Enfermagem. 2023;76(4):e20220671
DOI 10.1590/0034-7167-2022-0671
Views0See moreABSTRACT
Objective:
to assess the financial toxicity of people with chronic kidney disease undergoing hemodialysis treatment.
Method:
a descriptive analytical cross-sectional study, carried out with 214 people, between February and May 2022. For data collection, a sociodemographic and clinical instrument and the COmprehensive Score for financial Toxicity were used. For analysis, the Odds Ratio, ANOVA and Cronbach’s alpha tests were used.
Results:
the mean financial toxicity score was 20.30. Women with a monthly family income of at most two minimum wages are more likely to have some degree of financial toxicity (Odds Ratio: 0.85; 0.76).
Conclusion:
financial toxicity was identified to different degrees and varied according to sociodemographic and clinical characteristics. Measuring financial toxicity can help nurses plan care and develop strategies to avoid interrupting treatment.
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ORIGINAL ARTICLE09-04-2023
Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21
Revista Brasileira de Enfermagem. 2023;76(4):e20220453
Abstract
ORIGINAL ARTICLEContent validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21
Revista Brasileira de Enfermagem. 2023;76(4):e20220453
DOI 10.1590/0034-7167-2022-0453
Views0See moreABSTRACT
Objective:
to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context.
Method:
a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors.
Results:
the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process.
Conclusion:
the final version was defined as “Lista de verificação de sintomas cognitivos relacionados ao trabalho – 22 itens”, showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.
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ORIGINAL ARTICLE08-21-2023
Percepciones, maltrato y religión como predictores del impacto psicoemocional en enfermeros durante la pandemia COVID-19
Revista Brasileira de Enfermagem. 2023;76(3):e20220768
Abstract
ORIGINAL ARTICLEPercepciones, maltrato y religión como predictores del impacto psicoemocional en enfermeros durante la pandemia COVID-19
Revista Brasileira de Enfermagem. 2023;76(3):e20220768
DOI 10.1590/0034-7167-2022-0768es
Views0See moreRESUMEN
Objetivos:
analizar la relación entre percepciones, maltrato y religión con el impacto psicoemocional en enfermeros durante la pandemia por covid-19.
Métodos:
estudio transversal descriptivo-analítico. Fue realizado entre los años 2020 y 2021; se encuestó a 319 enfermeros asistenciales de Perú mediante DASS-21; se evaluaron asociaciones mediante Rho de Spearman y regresión múltiple.
Resultados:
el 18,5 % presentó algún grado de estrés; el 50,2 %, ansiedad y el 29,1 %, depresión. La experiencia de maltrato, la autopercepción de la salud mental y la religión fueron predictores de estrés, ansiedad y depresión. El tiempo de experiencia laboral predice el estrés y ansiedad. Además, la autopercepción de la información y el género fueron predictores de la depresión.
Conclusiones:
los enfermeros peruanos presentaron altos niveles de estrés, ansiedad y depresión; y este impacto psicoemocional estuvo asociado a las percepciones, experiencias de maltrato y la religión.
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ORIGINAL ARTICLE08-21-2023
Perceptions, maltreatment and religion as predictors of the psycho-emotional impact on nurses during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(3):e20220768
Abstract
ORIGINAL ARTICLEPerceptions, maltreatment and religion as predictors of the psycho-emotional impact on nurses during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(3):e20220768
DOI 10.1590/0034-7167-2022-0768
Views0See moreABSTRACT
Objectives:
to analyze the relationship between perceptions, abuse and religion with the psycho-emotional impact on nurses during the COVID-19 pandemic.
Methods:
descriptive-analytical cross-sectional study. It took place between 2020 and 2021 and a total of 319 clinical nurses in Peru were interviewed using the DASS-21. Associations were assessed using Spearman’s Rho and multiple regression.
Results:
18.5% had some degree of stress; 50.2%, anxiety and 29.1%, depression. Experience of abuse, self-perception of mental health and religion were predictors of stress, anxiety and depression. The length of work experience predicts stress and anxiety. In addition, self-perception of information and gender were predictors of depression.
Conclusions:
peruvian nurses have high levels of stress, anxiety and depression, and this psycho-emotional impact was associated with perceptions, experiences of abuse and religion.
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ORIGINAL ARTICLE08-21-2023
Assessment of the Psychosocial Care Center multidisciplinary team from users’ and family members’ perspective
Revista Brasileira de Enfermagem. 2023;76(3):e20220645
Abstract
ORIGINAL ARTICLEAssessment of the Psychosocial Care Center multidisciplinary team from users’ and family members’ perspective
Revista Brasileira de Enfermagem. 2023;76(3):e20220645
DOI 10.1590/0034-7167-2022-0645
Views0ABSTRACT
Objectives:
to assess the multidisciplinary team of a Psychosocial Care Center I from users’ and family members’ perspective.
Methods:
an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software.
Results:
the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families.
Final Considerations:
the multidisciplinary team’s work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.
Keywords:Health Services EvaluationMental DisordersMental Health ServicesPatient Care TeamProfessional-Family RelationsSee more -
ORIGINAL ARTICLE08-21-2023
Effectiveness of educational intervention among seropositive women about knowledge about HIV sexual transmission
Revista Brasileira de Enfermagem. 2023;76(3):e20220371
Abstract
ORIGINAL ARTICLEEffectiveness of educational intervention among seropositive women about knowledge about HIV sexual transmission
Revista Brasileira de Enfermagem. 2023;76(3):e20220371
DOI 10.1590/0034-7167-2022-0371
Views0See moreABSTRACT
Objectives:
to assess the effectiveness of a group and telephone educational intervention with seropositive women about knowledge about HIV sexual transmission prevention.
Methods:
a quasi-experimental before-and-after study, carried out with 151 women living with HIV in a Specialized Care Service in a Brazilian capital. The educational intervention was carried out in three moments, with the assessment being carried out before the first and after the last moment.
Results:
97.4% of study participants were cisgender women aged between 18 and 58 years; 55.6% considered themselves brown; and 32.5% of interviewees had elementary school. Regarding knowledge about HIV sexual transmission, in 78.5% of items, there was an association (p<0.005) with increased participants’ knowledge after receiving the intervention.
Conclusions:
the educational intervention helped to increase the knowledge of women living with HIV about the sexual transmission of the infection.
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