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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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RESEARCH01-01-2015
Risk classification in pediatrics: development and validation of a guide for nurses
Revista Brasileira de Enfermagem. 2015;68(5):913-922
Abstract
RESEARCHRisk classification in pediatrics: development and validation of a guide for nurses
Revista Brasileira de Enfermagem. 2015;68(5):913-922
DOI 10.1590/0034-7167.2015680521i
Views0See moreABSTRACT
Objective:
to develop and validate a short guide for the protocol to user embracement with risk classification in pediatrics.
Method:
methodological study developed in two stages: development of the guide, and face and content validation. The development involved the stratification of the protocol contents into five risk indicators according to the level of complexity; subsequently it was submitted to validation by nine experts divided in two groups: professors who were also researchers, and nurses.
Results:
in the face validation the experts considered the 25 items of the guide clear and understandable, with agreement levels above 70%. In the content validation, 17 (68%) items were considered relevant by 88.9% of the experts. The eight items considered irrelevant were changed according to suggestions of the experts, yielding an overall content validity index of 0.98.
Conclusion:
the study resulted in a guide for the classification of risks in pediatrics that is valid to assess children in emergency services.
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RESEARCH01-01-2015
Components of social learning theory in a tool for teaching Nursing
Revista Brasileira de Enfermagem. 2015;68(5):906-912
Abstract
RESEARCHComponents of social learning theory in a tool for teaching Nursing
Revista Brasileira de Enfermagem. 2015;68(5):906-912
DOI 10.1590/0034-7167.2015680520i
Views0See moreABSTRACT
Objective:
to identify key components of the social learning theory in a computational tool to aid in teaching the reasoning process for the preparation of a nursing diagnosis.
Method:
qualitative study that analyzed the statements collected through a focus group of 18 teachers and students from two Brazilian nursing schools.
Results:
the themes were grouped into four categories related to the components of the theory and into 13 subcategories.
Conclusion:
the meaning of learning can be extended by the teacher’s didactics and corroborated by the relationship between systematization and reasoning. To learn by doing, some prerequisites are required as is a process of motivation and qualification, which are also inherent to learning by forming an identity in the group. In the feeling of belonging to a particular group, aspects related to the profession become visible as opposed to the aspects of belonging to a community of practice of learning.
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RESEARCH01-01-2015
Telephone call for post-discharge surveillance: validation and application of tool for video-assisted surgery
Revista Brasileira de Enfermagem. 2015;68(5):899-905
Abstract
RESEARCHTelephone call for post-discharge surveillance: validation and application of tool for video-assisted surgery
Revista Brasileira de Enfermagem. 2015;68(5):899-905
DOI 10.1590/0034-7167.2015680519i
Views0See moreABSTRACT
Objective:
to validate an instrument for post-discharge surveillance by telephone for video assisted surgeries.
Method:
a multi-method study with development, validation and application of the instrument. The validation was performed by experts considering the relevance, clarity and completeness of the contents in the calculation of the content validity index and valid questions that demonstrated 80% agreement. For the application of the instrument, the sample consisted of 68 women undergoing video-assisted surgery, and we conducted a descriptive analysis.
Results:
there was disagreement among experts in the first evaluation, and the instrument was redesigned obtaining agreement in the second evaluation. The response rate to the telephone contact was 88.2% (60/68). Complaints of abdominal pain, bleeding and incisional edema were more frequent. No patients presented with infection.
Conclusion:
the questionnaire was validated and applied and is available for use.
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RESEARCH01-01-2015
Managerial competences of coordinators of undergraduate nursing courses
Revista Brasileira de Enfermagem. 2015;68(5):890-898
Abstract
RESEARCHManagerial competences of coordinators of undergraduate nursing courses
Revista Brasileira de Enfermagem. 2015;68(5):890-898
DOI 10.1590/0034-7167.2015680518i
Views0See moreABSTRACT
Objective:
to analyze the experiences of how the managerial competences of coordinators, ideal and real, of undergraduate nursing course coordinators from the city of Belo Horizonte, Minais Gerais.
Method:
the theoretical framework presented a conceptual model of eight managerial roles (director, producer, monitor, coordinator, mentor, facilitator, broker and innovator) and three specific competences to the exercise of each one of them. Descriptive and qualitative research with 14 interviews conducted using semi-structured scripts, whose data were subjected to content analysis.
Results:
we highlighted the roles: mentor, director and facilitator as the most prominent, whose competences can be continually improved as a result of differentiated and permanent demands which the subject face, in addition to the natural ambiguities and contradictions of management function.
Conclusion:
the higher education institution can adjust their selection and evaluation processes for this position, including the difficulties of professional competences training required in the exercise of managerial function.
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RESEARCH01-01-2015
Participação familiar para a reabilitação de idosos com fratura de fêmur
Revista Brasileira de Enfermagem. 2015;68(5):883-889
Abstract
RESEARCHParticipação familiar para a reabilitação de idosos com fratura de fêmur
Revista Brasileira de Enfermagem. 2015;68(5):883-889
DOI 10.1590/0034-7167.2015680517i
Views1See moreRESUMEN
Objetivo:
verificar si el modo de cuidar adoptado por los cuidadores favoreció la recuperación de la independencia funcional de los ancianos con y sin la presencia de enfermedad en el sistema nervioso y trastornos mentales y comportamentales y si enfermedades interfirieron en la independencia funcional.
Método:
estudio trasversal, con seguimiento por 12 meses de 89 ancianos brasileños (≥ 60 años), sometidos a cirugía de fémur proximal y sus cuidadores familiares.
Resultados:
los scores de la Medida de Independencia Funcional disminuyeron 0,7 puntos por año vivido y, en el caso de enfermedad en el sistema nervioso y trastorno mental y comportamental, esa pérdida aumentó para 20,5 puntos. El incentivo a la deambulación aumentó 18,9, al autocuidado 12,8 y al ocio 11,5 puntos de la Medida de Independencia Funcional.
Conclusión:
se recomienda el incentivo al movimiento y a la deambulación, al autocuidado y a las actividades de ocio, principalmente en aquellos ancianos con enfermedades en el sistema nervioso y trastorno mental y comportamental.
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RESEARCH01-01-2015
Family participation to elderly rehabilitation with femoral fracture
Revista Brasileira de Enfermagem. 2015;68(5):883-889
Abstract
RESEARCHFamily participation to elderly rehabilitation with femoral fracture
Revista Brasileira de Enfermagem. 2015;68(5):883-889
DOI 10.1590/0034-7167.2015680517i
Views0See moreABSTRACT
Objective:
verify if the mode of care adopted by caregivers favored functional independence recovery by elderly with and without the presence of nervous system disease and mental and behavioral disorders; and, if disease interfered with their functional independence.
Method:
transversal study, with 12-month follow-up of 89 Brazilian elders (≥ 60 years) after proximal femoral surgery, and their family caregiver.
Results:
the Functional Independence Measure scores decreased by 0.7 points per year of life, and in the case of presenting nervous system disease and mental and behavioral disorders, this loss amounted to 20.5 points.
Conclusion:
The incentive to ambulate increased by 18.8 for self-care, 12.8 for self-care, and 11.5 for leisure activities on the Functional Independence Measure. Encouraging movement and ambulation, self-care and leisure activities, especially with those elderly with nervous system diseases and mental and behavioral disorders, is recommended.
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RESEARCH01-01-2015
Absenteeism – illness of the nursing staff of a university hospital
Revista Brasileira de Enfermagem. 2015;68(5):876-882
Abstract
RESEARCHAbsenteeism – illness of the nursing staff of a university hospital
Revista Brasileira de Enfermagem. 2015;68(5):876-882
DOI 10.1590/0034-7167.2015680516i
Views0See moreABSTRACT
Objective:
to analyze absenteeism – illness of the nursing staff.
Method:
this was a retrospective study of a university hospital in the city of Goiânia, Goiás, Brazil, using a quantitative approach. Data were collected from functional records of the staff during the period from 2008 to 2012.
Results:
of 602 workers, 435 had 1574 medical certifi cates. Diseases of the musculoskeletal system and connective tissue, followed by mental and behavioral disorders were the major diseases for sick leave. The occupation with the highest number of medical certifi cates was the nursing technician. Females and the age group between 41-50 years prevailed in the sample. Ambulatory was the area with most frequent events, followed by the medical clinic and emergency room.
Conclusion:
absenteeism-illness affects the functioning of the service, the nursing staff and users, promoting work overload, and interfering in the quality of nursing care.
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RESEARCH01-01-2015
The nurse faced with early weaning in child nursing consultations
Revista Brasileira de Enfermagem. 2015;68(5):869-875
Abstract
RESEARCHThe nurse faced with early weaning in child nursing consultations
Revista Brasileira de Enfermagem. 2015;68(5):869-875
DOI 10.1590/0034-7167.2015680515i
Views0See moreABSTRACT
Objective:
analyze the role of the nurse regarding early weaning in children younger than 6 months old.
Method:
qualitative and descriptive study. The nurses who performed the study did nursing consultation to children programmatically in family health units in Cuiabá – Mato Grosso. Data were collected in January and February 2012, through participant observation of nursing consultations. For data analysis, content analysis was used.
Results:
that nurses, in most cases, used appropriate strategies for the management of common problems in breastfeeding, although some behaviors have not yet proven scientifi c evidence about the benefi ts and/or damage to its practice.
Conclusion:
nurses addressed important aspects of breastfeeding during consultations and worked for the promotion and resumption of exclusive breastfeeding.
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ORIGINAL ARTICLE01-30-2023
Adverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
Revista Brasileira de Enfermagem. 2023;76(1):e20220161
Abstract
ORIGINAL ARTICLEAdverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
Revista Brasileira de Enfermagem. 2023;76(1):e20220161
DOI 10.1590/0034-7167-2022-0161
Views0ABSTRACT
Objective:
to associate the presence and grading of adverse dermatoneurological events (peripheral neuropathy and hand-foot syndrome) and the interference in the activities of daily living of patients with gastrointestinal neoplasms undergoing systemic antineoplastic treatment.
Method:
this is a longitudinal, prospective study, using instruments to assess hand-foot syndrome and peripheral neuropathy.
Results:
there were 36 patients: 66.7% diagnosed with colon cancer and 83.2% on combination therapy. From cycle 5 onwards, all of them had hand-foot syndrome, with a majority of grade 1, unrelated to interference in activities of daily living. Regarding peripheral neuropathy, there was a moderate to strong correlation from cycle 1 of treatment.
Conclusion:
peripheral neuropathy negatively affects activities of daily living. The monitoring of dermatoneurological events by oncology nurses contributes to the clinical practice of nursing and subsidizes the development of advanced practice in the country.
Keywords:Activities of Daily LivingAdverse EventsAntineoplasticGastrointestinal NeoplasmsNursing OncologySee more -
ORIGINAL ARTICLE01-30-2023
Pressure injury prevention in older people: construction and validation of an instrument for caregivers
Revista Brasileira de Enfermagem. 2023;76(1):e20210930
Abstract
ORIGINAL ARTICLEPressure injury prevention in older people: construction and validation of an instrument for caregivers
Revista Brasileira de Enfermagem. 2023;76(1):e20210930
DOI 10.1590/0034-7167-2021-0930
Views0ABSTRACT
Objectives:
to construct and validate an instrument to assess the knowledge, attitudes, and practices related to pressure injury prevention among caregivers of institutionalized older people.
Methods:
this is a three-stage methodological study that consisted of instrument construction, analysis by experts, and semantic and appearance analysis, with 78 participants, observing the validation process steps for psychometric instruments in the criteria of clarity and relevance.
Results:
in the Delphi I round, the validity index of the general content in the clarity criterion was 0.66, in relevance 0.85, and the Kappa value was >0.76. In Delphi II, clarity was 0.95, relevance 1.00, and the Kappa value was >0.97.
Conclusions:
this is a valid instrument in terms of content and appearance, which allows further analysis of its reliability for the measurement of the constructs for which it is intended. Therefore, it can be considered a tool for care management in pressure injury prevention.
Keywords:AttitudesCaregiversHealth KnowledgeNursing Methodology ResearchPracticePressure UlcerValidation StudySee more -
ORIGINAL ARTICLE01-30-2023
Educational material production and validity: educational instrument for home care for premature newborns
Revista Brasileira de Enfermagem. 2023;76(1):e20210648
Abstract
ORIGINAL ARTICLEEducational material production and validity: educational instrument for home care for premature newborns
Revista Brasileira de Enfermagem. 2023;76(1):e20210648
DOI 10.1590/0034-7167-2021-0648
Views0ABSTRACT
Objective:
to produce and validate a booklet, based on Jean Watson’s Theory, on home care for premature newborns, based on caregivers’ experiences.
Method:
a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts.
Results:
the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet “Booklet for Premature Newborns: Demystifying Home Care”. The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity.
Final considerations:
the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers’ autonomy in providing home care to newborns.
Keywords:Educational and Promotional MaterialsHealth EducationInfantIntensive Care UnitsNeonatalPrematureValidation StudySee more -
ERRATUM01-06-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(2):e2023n2e01
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(2):e2023n2e01
DOI 10.1590/0034-7167.20237601e01
Views0In the article “Development and validity of an educational folder for pulmonary tuberculosis sputum collection”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(1):e202220194, on page 8:Delete:[…]See more -
ORIGINAL ARTICLE12-16-2023
School Nursing Guide for student health promotion: construction and validity
Revista Brasileira de Enfermagem. 2023;76(1):e20220260
Abstract
ORIGINAL ARTICLESchool Nursing Guide for student health promotion: construction and validity
Revista Brasileira de Enfermagem. 2023;76(1):e20220260
DOI 10.1590/0034-7167-2022-0260
Views0See moreABSTRACT
Objectives:
to describe the process of construction and validity of a School Nursing Guide for student health promotion.
Methods:
a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender’s Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance.
Results:
the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997.
Conclusions:
the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.
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ORIGINAL ARTICLE12-16-2023
Cardiac anxiety in the perioperative period of patients undergoing cardiac surgical procedures: an observational study
Revista Brasileira de Enfermagem. 2023;76(1):e20220250
Abstract
ORIGINAL ARTICLECardiac anxiety in the perioperative period of patients undergoing cardiac surgical procedures: an observational study
Revista Brasileira de Enfermagem. 2023;76(1):e20220250
DOI 10.1590/0034-7167-2022-0250
Views0See moreABSTRACT
Objective:
to compare cardiac anxiety symptoms in patients undergoing coronary artery bypass graft and valve surgery repair in the preoperative period, on the day of hospital discharge and on the first return visit after hospital discharge.
Methods:
an observational study, carried out in inpatient units and in outpatient clinic of a university hospital. Data were collected through interviews. Cardiac anxiety symptoms were assessed using the Cardiac Anxiety Questionnaire.
Results:
we observed the effect of time on cardiac anxiety symptoms of patients undergoing coronary artery bypass graft in the total score and in the “Avoidance” domain at discharge and at the first return visit. In patients undergoing valve repair surgery, the effect of time on symptoms was observed only in the first return visit, when compared with the preoperative period.
Conclusion:
the findings revealed increased cardiac anxiety symptoms in the postoperative period, discharge and first return, when compared to the preoperative period.
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ORIGINAL ARTICLE12-16-2023
Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District
Revista Brasileira de Enfermagem. 2023;76(1):e20220170
Abstract
ORIGINAL ARTICLEElderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District
Revista Brasileira de Enfermagem. 2023;76(1):e20220170
DOI 10.1590/0034-7167-2022-0170
Views0See moreABSTRACT
Objectives:
To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District.
Methods:
Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%.
Results:
There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999).
Conclusions:
Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.
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REVIEW12-16-2023
Educational interventions in child development and health literacy assumptions: an integrative review
Revista Brasileira de Enfermagem. 2023;76(1):e20220116
Abstract
REVIEWEducational interventions in child development and health literacy assumptions: an integrative review
Revista Brasileira de Enfermagem. 2023;76(1):e20220116
DOI 10.1590/0034-7167-2022-0116
Views0See moreABSTRACT
Objectives:
to analyze scientific evidence in the literature that addresses educational interventions conducted by health professionals on early childhood development in a community context and to identify which health literacy assumptions are present during the implementation of interventions.
Method:
an integrative review in PubMed, CINAHL and Web of Science databases. Of 300 studies found, we selected 11 for the sample.
Results:
health professionals are trained to implement interventions with parents/caregivers to promote child development in community settings. Parents are encouraged to develop an environment that is encouraging and conducive to the development of their children. The main dimensions of health literacy found were access and apply.
Conclusion:
it confirms the importance of training health professionals, with skills and communicative skills to guide parents/caregivers to encourage the development of their children in their family environment with playful and interactive activities.
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