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ORIGINAL ARTICLE03-11-2024
Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
Abstract
ORIGINAL ARTICLEEthnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
DOI 10.1590/0034-7167-2023-0350
Views0See moreABSTRACT
Objective:
To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic.
Method:
A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software.
Results:
Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children.
Final considerations:
The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.
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ORIGINAL ARTICLE03-11-2024
Experiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
Abstract
ORIGINAL ARTICLEExperiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
DOI 10.1590/0034-7167-2023-0290
Views0See moreABSTRACT
Objective:
To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.
Methods:
Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.
Results:
Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.
Final Considerations:
Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.
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03-11-2024
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201pt
Views0Recentemente, mais um caso de dano grave associado ao cuidado em saúde foi reportado pela mídia. Uma jovem grávida teve a mão e o punho amputados depois de dar à luz ao terceiro filho em um hospital do Rio de Janeiro(). Após o incidente ocasionado pelo acesso vascular, a mulher apresentou hemorragia e foi reinternada.Os […]See more -
REVIEW03-11-2024
Continuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
Abstract
REVIEWContinuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
DOI 10.1590/0034-7167-2023-0094
Views0See moreABSTRACT
Objectives:
to analyze continuing nursing education actions in the scientific literature in the face of homophobia.
Methods:
an integrative literature review with structured search in June 2022 in eight databases, using the descriptors Nursing Education, Homophobia, Sexual and Gender Minorities. Final sample consisted of six primary studies.
Results:
continuing nursing education actions are supported by strategies such as use of teaching materials, lectures, case studies and focus groups, addressing content such as gender identity issues and affective-sexual orientation, health disparities and their relationship with homophobia in healthcare settings.
Final considerations:
carried out in various healthcare settings, continuing education actions proved to be successful in raising nurses’ awareness in facing homophobia in health services, however, their expansion is necessary to create health spaces that meet the specific needs of these people.
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03-11-2024
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201
Views0Recently, another case of serious harm associated with healthcare was reported by the media. A young pregnant woman had her hand and wrist amputated after giving birth to her third child in a hospital in Rio de Janeiro(). After the incident caused by vascular access, the woman suffered hemorrhage and was readmitted.The harm caused to […]See more -
03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more
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ORIGINAL ARTICLE08-08-2022
Social and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil
Revista Brasileira de Enfermagem. 2022;75(6):e20210482
Abstract
ORIGINAL ARTICLESocial and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil
Revista Brasileira de Enfermagem. 2022;75(6):e20210482
DOI 10.1590/0034-7167-2021-0482
Views0See moreABSTRACT
Objective:
To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years.
Methods:
Ecological and exploratory study of children’s mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification.
Result:
The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population.
Conclusion:
The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.
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ORIGINAL ARTICLE12-08-2023
Construction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
DOI 10.1590/0034-7167-2023-0048
Views1See moreABSTRACT
Objectives:
to construct and validate an educational technology in comic book format about the human papillomavirus vaccine aimed at adolescents.
Methods:
a methodological study, with a quantitative approach, through the agreement method. It was carried out in two phases: educational technology construction and content validity. Participants are expert judges in the health field. Data collection took place in a virtual environment, through a questionnaire. Data analysis was performed by calculating the Content Validity Index. A Content Validity Index of at least 80% was accepted.
Results:
the comic book’s overall Content Validity Index was 82%, reaching the minimum limit established to be validated.
Conclusions:
comics are fundamental in the teaching-learning process, aiming to catch adolescents’ attention. Therefore, it is characterized as a valid tool to inform, in a playful manner, about the human papillomavirus vaccine.
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ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
DOI 10.1590/0034-7167.20247701e03
Views2In the article “Nurses in the labor market: professional insertion, competencies and skills”, with DOI number: , published in Revista Brasileira de Enfermagem, 2017;70(6):1220-6, on page 1225:Include before REFERENCES:[…]See more -
ORIGINAL ARTICLE01-10-2024
Nursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
Abstract
ORIGINAL ARTICLENursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
DOI 10.1590/0034-7167-20230254
Views1See moreABSTRACT
Objective:
To characterize nursing care management strategies for addressing the COVID-19 pandemic.
Method:
A descriptive, qualitative study conducted with 22 nurse professionals at a University Hospital in Southern Brazil. Data collection through interviews in June and August 2021, analyzed according to Bardin’s Content Analysis and the theoretical framework of complex thinking.
Results:
The identified strategies were organized into four categories: Reorganization of health services; People management and emergency admission; Multiprofessional articulation; and Bedside nursing care.
Final Considerations:
Professional performance revealed a complex interplay between leadership and care management practices, even in the face of working condition restrictions, and were understood as crucial in the pandemic scenario.
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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
Views1See 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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01-01-2016
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
Abstract
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
DOI 10.1590/0034-7167.2016690314i
Views1See moreABSTRACT
Objective:
to analyze the discourses about the care provided by nurses operating in Specialized HIV/Aids Outpatient Services in four public institutions of the city of Fortaleza, Ceará, Brazil.
Method:
descriptive and exploratory study with a qualitative approach, which used as a method the discourse analysis.
Results:
when titling the “care as negative”, such title came from the analogy proposed by Freud (1912) with the photographic negative, represented by what that care can configure from the unconscious movement, since nurses did not perceive themselves in the care actions developed by supporting the work of other occupational categories, contributing to maintain the ideology of biomedicine.
Conclusion:
it is necessary to justify and theorize a nursing clinical practice from epistemological issues of the profession, in such a way that nurses can understand their relevance within the care provided.
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ORIGINAL ARTICLE04-16-2021
Practices used by a home care team: implications for caregivers
Revista Brasileira de Enfermagem. 2021;74(2):e20190794
Abstract
ORIGINAL ARTICLEPractices used by a home care team: implications for caregivers
Revista Brasileira de Enfermagem. 2021;74(2):e20190794
DOI 10.1590/0034-7167-2019-0794
Views0See moreABSTRACT
Objectives:
to analyze the practices of a home care team and their implications for caregivers’ performance.
Methods:
qualitative study with data obtained from observation of 21 users, 30 caregivers and 6 professionals from the home health care service in a municipality in Minas Gerais, from February to June 2018. The material was analyzed from the perspective of discourse analysis according to Michel Foucault.
Results:
team interference upon caregivers is exercised by disciplinary practices and prescriptive, authoritative and surveilling behaviors. The team’s knowledge-power relationship determines caregivers’ acceptance through convincing or through difficulty of understanding assigned orientations. Educational practices would enable caregivers to be constituted as active, participative, empowered and reflective subjects.
Final Considerations:
team practices interfere with caregivers’ ways of acting and being and they have implications in objectification and subjectification processes.
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08-16-2021
Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
Abstract
Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
DOI 10.1590/0034-7167-2020-1243
Views1See moreABSTRACT
Objectives:
to describe the contribution of pregnant women to the construction and evaluation of educational technology.
Methods:
a participatory study developed in three stages, which occurred between March 2018 and June 2019 for identifying the content, construction, and evaluation of the comic. Non-directive interviews were conducted in educational groups with 34 pregnant women. After the comic was built by a team, including a designer, an instrument was applied to 41 pregnant women to evaluate the items Objectives, Organization, Writing style, Appearance, and Motivation.
Results:
the comic contains 40 pages of contents, illustrations, and quizzes (word search, cross-puzzle, seven mistakes, etc). The pregnant women evaluated it as easy to understand, self-explanatory, aesthetically attractive, and capable of motivating good care practices during pregnancy, obtaining a minimum agreement of 92.1%.
Final Considerations:
the innovation of the educational technology consisted of incorporating the voices of pregnant women in prenatal care, with the potential to stimulate reflections and the learning process of this target audience.
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REVIEW07-29-2020
Frailty syndrome in the elderly: conceptual analysis according to Walker and Avant
Revista Brasileira de Enfermagem. 2020;73:e20190601
Abstract
REVIEWFrailty syndrome in the elderly: conceptual analysis according to Walker and Avant
Revista Brasileira de Enfermagem. 2020;73:e20190601
DOI 10.1590/0034-7167-2019-0601
Views0See moreABSTRACT
Objective:
To analyze the concept of “frailty syndrome” in the literature, according to the method proposed by Walker and Avant.
Methods:
It is a concept analysis, guided by the method proposed by Walker and Avant, made operational through an integrative literature review. The search in a scientific database was carried out using the descriptors: Frail elderly, syndrome, phenotype, geriatric assessment, and aging. The literary corpus comprised 66 studies. Results: The study found the antecedents and attributes (categorized as physical, sociodemographic, and behavioral/environmental) that integrate the signs and symptoms evidenced in the “frailty syndrome,” as well as the consequences of this concept. The variables were analyzed with emphasis on the conceptions that influence the frailty process of the elderly.
Conclusion:
The study demonstrated the complexity arising from the multifactorial genesis of the referred syndrome, emphasizing the specificities of the elderly’s frailty. However, we recommend conducting further research involving the phenomenon in question to understand the construct better.
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ORIGINAL ARTICLE09-16-2019
Tuberculosis: health care and surveillance in prisons
Revista Brasileira de Enfermagem. 2019;72(5):1304-1310
Abstract
ORIGINAL ARTICLETuberculosis: health care and surveillance in prisons
Revista Brasileira de Enfermagem. 2019;72(5):1304-1310
DOI 10.1590/0034-7167-2018-0260
Views0See moreABSTRACT
Objective:
To identify tuberculosis-related health care and surveillance actions in Prison Health Units.
Method:
Cross-sectional study, of quantitative, exploratory and descriptive character. We visited 13 Teams of Prison Health, and nurses and technicians were interviewed regarding epidemiological surveillance instruments, physical structure and materials.
Results:
Search for respiratory symptoms in admission was reported by 6 (46.2%) of the teams, and the smear microscopy was the most requested test. The Logbook of Respiratory Symptoms and the Logbook for Monitoring Tuberculosis Cases were used in 7 (53.8%) institutions. Two of them (15.4%) had a location for sputum collection and 1 (7.7%) had a radiographer. The Directly Observed Therapy was reported in 7 (53.8%) units.
Conclusion:
Health care actions related to the search for respiratory symptoms and Directly Observed Therapy should be expanded, as well as surveillance actions and recording in official documents of the National Tuberculosis Control Program.
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04-14-2021
COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention
Revista Brasileira de Enfermagem. 2021;74:e20201185
Abstract
COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention
Revista Brasileira de Enfermagem. 2021;74:e20201185
DOI 10.1590/0034-7167-2020-1185
Views0See moreABSTRACT
Objective:
to perform the content and face validation of a checklist and a banner on pressure injury prevention in patients in prone position.
Method:
this is a methodological study of content and face validation with 26 nurses with specialization. Professionals assessed the checklist and the banner in relation to clarity, theoretical relevance, practical relevance, relation of the figures to the text and font size. The Content Validity Index was calculated for each item, considering one with a value equal to or greater than 0.8 as valid.
Results:
all the actions described in the checklist and in the banner had a Content Validity Index greater than 0.80, with standardization of verbal time and esthetic adjustments in the banner’s layout, as suggested.
Conclusions:
the checklist and the banner were validated and can be used in clinical practice to facilitate pressure injury preventions in patients in prone position.
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02-10-2020
Development of middle-range theories in nursing
Revista Brasileira de Enfermagem. 2020;73(1):e20170893
Abstract
Development of middle-range theories in nursing
Revista Brasileira de Enfermagem. 2020;73(1):e20170893
DOI 10.1590/0034-7167-2017-0893
Views0See moreABSTRACT
Objective:
To identify in the literature how Middle-Range Theories (MRT) are being developed in Nursing.
Method:
Integrative review on the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed portal, using the keywords middle range theory and nursing, as well its Portuguese correspondents (Lilacs), and the Boolean operator AND. The sample included 25 articles.
Results:
All articles presented concepts related to MRT. Most developed a synthesis picture. Some theories have formulated specific propositions, hypotheses, and names. Only 16 articles cited the methodological framework, while 22 used theories or models for theoretical foundation and 11 carried out literature reviews.
Final considerations:
The development of MRT included the presentation of fundamental concepts, synthesis, propositions, hypotheses and specific name. The MRT is recognized as a way of developing knowledge to guide the nursing practice.
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09-16-2019
Construct validation: coping with HIV/AIDS in Primary Health Care
Revista Brasileira de Enfermagem. 2019;72(5):1173-1181
Abstract
Construct validation: coping with HIV/AIDS in Primary Health Care
Revista Brasileira de Enfermagem. 2019;72(5):1173-1181
DOI 10.1590/0034-7167-2018-0734
Views0See moreABSTRACT
Objective:
To validate the construct and measure the trustworthiness of a questionnaire aimed at assessing HIV/AIDS coping actions developed by health professionals in Primary Health Care.
Method:
A methodological study carried out with 397 primary health care professionals in two municipalities in the Northeast region of Brazil. The construct validity was developed by the exploratory and confirmatory factor analysis, and the reliability analyzed by the reliability and reproducibility.
Results:
The validation determined six factors retention that composed the six domains of the questionnaire. Internal consistency was 0.91 and quality of the confirmatory analysis adjustment was 0.998 for Goodness of Fit Index. The domains presented Kappa values between 0.833 and 0.997.
Conclusions:
The final questionnaire was composed of 18 items and presented feasibility of application, and potential to evaluate actions for HIV/AIDS control in Primary Health Care.
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ORIGINAL ARTICLE02-10-2020
Stress and health risk behaviors among university students
Revista Brasileira de Enfermagem. 2020;73(1):e20180035
Abstract
ORIGINAL ARTICLEStress and health risk behaviors among university students
Revista Brasileira de Enfermagem. 2020;73(1):e20180035
DOI 10.1590/0034-7167-2018-0035
Views0See moreABSTRACT
Objective:
To analyze the level of stress and its relationship with health risk behaviors among university students.
Method:
Cross-sectional analytical study carried out at a higher education institution in Picos-PI. A total of 377 students were evaluated for socio-demographic and academic variables, stress profile, sleep quality, alcohol use, smoking habits and level of physical activity. The Statistical Package for the Social Sciences (SPSS), version 20.0 was used for data processing and analysis.
Results:
Sleep quality was poor for 65.3% of the subjects, and sleep disturbances were found in 17.0%. Stress was observed in 68.7% of the sample. Stress was associated with the following variables: gender, time in the institution, poor sleep quality.
Conclusion:
Most of the students evaluated present some level of stress associated with poor sleep quality, which is a risk to the quality of life of these individuals.
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ORIGINAL ARTICLE03-24-2021
Self-care of people with intestinal ostomy: beyond the procedural towards rehabilitation
Revista Brasileira de Enfermagem. 2021;74(1):e20200088
Abstract
ORIGINAL ARTICLESelf-care of people with intestinal ostomy: beyond the procedural towards rehabilitation
Revista Brasileira de Enfermagem. 2021;74(1):e20200088
DOI 10.1590/0034-7167-2020-0088
Views0See moreABSTRACT
Objectives:
to interpret the self-care experience of people with intestinal ostomy registered in an ostomy program, based on the framework of the Social Model of Disability.
Methods:
qualitative exploratory research, with the participation of nine people with intestinal ostomy, based on the Social Model of Disability.
Results:
majority were elderly, married, male with colostomy due to colorectal neoplasia. The self-care of these people was analyzed in two thematic groups: “Interdisciplinary assistance needed for people with intestinal ostomy” and “Self-care for the rehabilitation of the person with intestinal ostomy”. It was proved that there was a need for a specialized health team, offering information on disabilities, teaching self-care and perioperative follow-up.
Final Considerations:
when the social barriers of physical disabilities are overcome in the context of assistance for health and life, self-care will go beyond the reductionist vision of procedural care, towards comprehensive care, favoring the achievement of rehabilitation and the quality of survival.
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03-19-2021
Production and validation of educational technology on nursing care for syphilis prevention
Revista Brasileira de Enfermagem. 2021;74:e20190694
Abstract
Production and validation of educational technology on nursing care for syphilis prevention
Revista Brasileira de Enfermagem. 2021;74:e20190694
DOI 10.1590/0034-7167-2019-0694
Views0See moreABSTRACT
Objectives:
Validate script and storyboard of a video for educational intervention on nursing care for the prevention and management of syphilis.
Methods:
Methodological design study, with quantitative analysis approach. The content and appearance of the educational video script and storyboard was validated by a committee of experts on the subject and video. They were considered validated from the agreement of 78%, calculated by means of the Content Validity Index.
Results:
There were suggestions, which were analyzed; and, where relevant, the script and storyboard were changed. The degree of agreement among the expert judges on the subject obtained a Content Validity Index (CVI) of 100%, while, with the technical experts in video, all the questions in the educational material obtained the percentage above the recommended minimum of 78%.
Conclusion:
The validated video is an important technological production and could be used in the context of health care.
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