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01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
DOI 10.1590/0034-7167.20166901e02
Views0In the article “Conceptions of mid-level nursing professionals facing those with a chemical dependency”, with the number of DOI: 10.1590/0034-7167.2015680610i, published in the journal Revista Brasileira de Enfermagem, v68(6):755-60, page 760 that read: “8. Vargas D, Soares J. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev […]See more -
01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
DOI 10.1590/0034-7167.20166901e01
Views0In the article “Using the theory of meaningful learning in nursing education”, with the number of DOI: 10.1590/0034-7167.2015680420i, published in the journal Revista Brasileira de Enfermagem, v68(4):626-35, page 627 that read:“Ausubel was descended from Jewish, born in New York in 1918 and died in 1994 at the age of 75. He thought and wrote until […]See more -
01-01-2016
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
DOI 10.1590/0034-7167.2016690126i
Views0See moreABSTRACT
Objective:
to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo.
Method:
multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions.
Conclusion:
This study will provide important empirical evidence on the factors involved in the nursing process documentation.
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01-01-2016
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
DOI 10.1590/0034-7167.2016690125i
Views0See moreABSTRACT
Objective:
this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner’s interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014.
Results:
data analysis process according to Benner’s framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction.
Conclusion:
The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.
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01-01-2016
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
DOI 10.1590/0034-7167.2016690124i
Views0See moreABSTRACT
Objective:
To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice.
Method:
qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses’ performance characteristics and effects of the expansion of nursing roles.
Results:
expansion of nurses’ roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings.
Conclusion:
benefits in expanding nursing roles, were visible, contributing to primary care quality.
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01-01-2016
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
DOI 10.1590/0034-7167.2016690123i
Views0See moreABSTRACT
Objective:
to analyze the application of the theory evaluation model proposed by Meleis in Brazilian studies.
Method:
integrative review of online articles published from 2002 to 2012 in the databases LILACS and BDENF.
Results:
the 16 selected studies confirmed the use of only three of the five stages proposed for Meleis’ theories analysis: Description of the Theory, Criticism of the Theory and Analysis of the Theory, with a predominance of a single unit of analysis in each.
Conclusion:
the analysis of nursing theories provides support to nurses in the practice, research, education and administration of the different dimensions of care. Meleis’ model figures as very important by contributing to the development of knowledge of nursing discipline, considering that its use as a method allows several reflections on theories in order that they be revalidated to support a more theoretical and practical applicability.
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01-01-2016
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
DOI 10.1590/0034-7167.2016690122i
Views0See moreABSTRACT
Objective:
to identify the nursing diagnosis clinical indicators of sexual dysfunction in pregnant women.
Method:
it is an integrative literature review, with research in databases using the keywords “sexual*”, “pregnan*” and “function*”. Studies included had an abstract available for analysis, referring to pregnant women over 18 years old, written in Portuguese, French, Spanish and English, with publication date between 2010 and 2014. Studies that reporting pregnant women with an associated pathology were excluded.
Results:
sexual dysfunction in pregnant women is consistent in the literature. Nine defining characteristics were identified and 16 related factors, some not classified in NANDA International.
Conclusion:
clinical indicators can be added to the nursing diagnosis to favor an accurate diagnosis and effective interventions in the surveillance of pregnancy as a period of healthy sexual experience.
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01-01-2016
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
DOI 10.1590/0034-7167.2016690121i
Views0See moreABSTRACT
Objective:
to evaluate the conditions of functional health literacy of an elderly diabetics group.
Method:
cross-sectional and descriptive study, with diabetic’s elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson’s Chi-square were described by SPSS software (20.0) with α = 5% value.
Results:
the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001.
Conclusions:
the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.
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01-01-2015
Analysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
Abstract
Analysis 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
Views0See moreABSTRACT
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.
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01-01-2015
Social representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
Abstract
Social 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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01-01-2015
Post-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
Abstract
Post-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
Views0See moreABSTRACT
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.
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01-01-2015
Social support towards the necessity of caring after myocardial infarction
Revista Brasileira de Enfermagem. 2015;68(4):649-655
Abstract
Social support towards the necessity of caring after myocardial infarction
Revista Brasileira de Enfermagem. 2015;68(4):649-655
DOI 10.1590/0034-7167.2015680411i
Views0See moreABSTRACT
Objective:
to know the received or assisted social support by the family towards the necessity of care after acute myocardial infarction.
Method:
qualitative and exploratory research. Data collection was carried out through observation and interviews with six families, from February to May, 2012. Data were also analyzed based on the thematic analysis.
Results:
three categories emerged: Immediate social support; Mediate social support; Late social support.
Conclusion:
social support follows the infarction trajectory, which attains the family members and favors the support according to the needs of care in each lived moments by the patient.
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01-01-2015
Nursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
Abstract
Nursing 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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01-01-2015
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
Abstract
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
DOI 10.1590/0034-7167.2015680409i
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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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01-01-2015
Hypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
Abstract
Hypertension 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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01-01-2015
Violence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
Abstract
Violence 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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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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