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ORIGINAL ARTICLE02-26-2024
Technological prospecting of patents related to monitoring accidents due to falls in hospitals
Revista Brasileira de Enfermagem. 2024;77(1):e20230084
Abstract
ORIGINAL ARTICLETechnological prospecting of patents related to monitoring accidents due to falls in hospitals
Revista Brasileira de Enfermagem. 2024;77(1):e20230084
DOI 10.1590/0034-7167-2023-0084
Views0See moreABSTRACT
Objectives:
to map the production of technologies aimed at monitoring falls in a hospital environment protected by registered patents.
Methods:
a technological prospecting of international patents, with a quantitative approach, with search carried out between February and March 2022 in the Derwent Innovations Index database with descriptors fall, hospital, monitoring.
Results:
212 patents were found, with the majority filed and published since 2010, by Tran B (9) and Cerner Innovation Inc (9), focused on health technology. Universities were responsible for 13% of deposits. There was a predominance of records from the United States (43.4%), China (21.7%) and Japan (12.3%), in addition to technological strategies classified as devices for the environment (80.7%) and for preventing falls (66.5%) as well as trend towards resources with multiple functionalities in the same technology.
Conclusions:
the plurality of functions in the same device reflects the search for optimizing resources and the concern with comprehensive care.
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ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20230045
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20230045
DOI 10.1590/0034-7167.20247701e04
Views0In the article “Coping strategies for chronically ill children and adolescents facing the COVID-19 pandemic”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 2):e20230045, in the author:Where it read:[…]See more -
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
Views0In 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 ARTICLE01-24-2019
Active teaching model to promote critical thinking
Revista Brasileira de Enfermagem. 2019;72(1):293-298
Abstract
ORIGINAL ARTICLEActive teaching model to promote critical thinking
Revista Brasileira de Enfermagem. 2019;72(1):293-298
DOI 10.1590/0034-7167-2018-0002
Views0See moreABSTRACT
Objective:
To present the experience of elaboration and implementation of the Active Teaching Model to Promote Critical Thinking (MEAPC), associated to Problem-Based Learning (PBL), for undergraduate students in Nursing.
Method:
Case report on the experience of the educational intervention (MEAPC + PBL) with undergraduate students in Nursing, in a 20-hour course on Basic Life Support (BLS). The MEAPC was validated by judges to guide the analysis of clinical cases. Critical Thinking (CT) skills were assessed using the California Critical Thinking Skills Test.
Result:
The educational intervention took place in two phases: elaboration and implementation, allowing not only the production of knowledge about BLS, but also the development of CT and exchange of experiences for teaching-learning.
Conclusion:
The association of the MEAPC to the PBL in the course of BLS organized the learning, gave opportunity to acquire knowledge and to stimulate the skills of the CT.
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RESEARCH01-24-2017
Nurses in the labor market: professional insertion, competencies and skills
Revista Brasileira de Enfermagem. 2017;70(6):1220-1226
Abstract
RESEARCHNurses in the labor market: professional insertion, competencies and skills
Revista Brasileira de Enfermagem. 2017;70(6):1220-1226
DOI 10.1590/0034-7167-2016-0061
Views0See moreABSTRACT
Objective:
to characterize nurses graduated from the School of Nursing of the University of São Paulo, from 2006 to 2012; verify their entry, facilitating factors and difficulties of these graduates in the labor market and to consider their skills and competences in the world of work.
Method:
an exploratory, descriptive study with a qualitative approach.
Results:
out of 505 graduates, 172 (34.1%) participated in the research. Entry into the labor market was mainly via public hospital institutions, in the SE of Brazil, in the caregiving sectors. The greater part remained from one to two years in their first job. Most agreed that they were prepared to meet the health needs of the population. Furthermore, they had been encouraged to seek systematic and continuous improvement in a critical, reflexive and creative way, while combining technical-scientific knowledge and personal skills.
Conclusion:
the results show that the University of São Paulo has been preparing nurses for work in the labor market, in accordance with the provisions of the National Curricular Guidelines.
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ERRATUM01-15-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
DOI 10.1590/0034-7167.20247701e01
Views0En el artículo “La ética del cuidado de enfermería para personas transgénero”, con número DOI: , publicado en la Revista Brasileira de Enfermagem, 2023;76( Suppl 3):e20220797, en autoría:Onde se lia:[…]See more -
ERRATUM01-15-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e01
DOI 10.1590/0034-7167.20247701e01
Views1In the article “The ethics of nursing care for transgender people”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 3):e20220797, in authorship:Where it read:[…]See more -
EDITORIAL12-08-2024
Contexto ibero-americano da enfermagem: construindo e compartilhando conhecimento
Revista Brasileira de Enfermagem. 2024;77(1):e770101
Abstract
EDITORIALContexto ibero-americano da enfermagem: construindo e compartilhando conhecimento
Revista Brasileira de Enfermagem. 2024;77(1):e770101
DOI 10.1590/0034-7167.2024770101pt
Views0Na próxima semana, acontecerão dois grandes eventos científicos em Madri e Granada (Espanha). Serão atividades internacionais, específicas e de forma muito especial, embora não exclusivas do campo ibero-americano, organizadas e desenvolvidas por duas sociedades científicas de enfermagem muito importantes, como a Associação de Enfermagem Comunitária (AEC) e a Associação Latino-Americana de Escolas e Faculdades de […]See more
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ORIGINAL ARTICLE12-13-2024
Nurses’ experience regarding patient safety in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77(5):e20230529
Abstract
ORIGINAL ARTICLENurses’ experience regarding patient safety in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77(5):e20230529
DOI 10.1590/0034-7167-2023-0529
Views0See moreABSTRACT
Objectives:
to understand nurses’ experience regarding patient safety in mobile pre-hospital care.
Method:
a qualitative, exploratory and descriptive study, conducted with nurses active in mobile pre-hospital care services. Semi-structured interviews were conducted, audio-graved and submitted to Bardin’s content analysis.
Results:
from four thematic categories established, nurses reported the care and management skills necessary to work in this service. They demonstrated a commitment to ensuring safe care for patients, staff and spectators. They highlighted the actions taken to prevent and mitigate incidents. However, they based their experiences on practice protocols and individual actions, expressing the need to improve knowledge about patient safety.
Final Considerations:
mobile pre-hospital care nurses’ experience in relation to patient safety was limited, suggesting the need for training on the subject, alignment of work processes and implementation of strategies, aiming to guarantee safe care.
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ORIGINAL ARTICLE12-13-2024
Repercussions of the pandemic on tuberculosis control actions from the perspective of health professionals
Revista Brasileira de Enfermagem. 2024;77(5):e20230477
Abstract
ORIGINAL ARTICLERepercussions of the pandemic on tuberculosis control actions from the perspective of health professionals
Revista Brasileira de Enfermagem. 2024;77(5):e20230477
DOI 10.1590/0034-7167-2023-0477
Views0See moreABSTRACT
Objectives:
to analyze the repercussions of the COVID-19 pandemic on tuberculosis control actions from the perspective of primary health care professionals.
Methods:
this descriptive study with a qualitative approach was conducted from November 2022 to April 2023, using semi-structured interviews with 11 key informant professionals from primary health care units in a Brazilian capital. Data were organized using Atlas.ti 22.0 software and subjected to thematic-categorical content analysis.
Results:
the pandemic scenario caused alterations in the work process, necessitating abrupt adaptations, and led to detrimental impacts on the health of professionals and tuberculosis control actions, which were reduced or discontinued.
Final Considerations:
there was evident unpreparedness and a lack of resources from various governmental levels and health services to handle the public health emergency situation without severe harm to the provision of essential services.
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Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
Revista Brasileira de Enfermagem. 2024;77(5):e20230430
Abstract
Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
Revista Brasileira de Enfermagem. 2024;77(5):e20230430
DOI 10.1590/0034-7167-2023-0430
Views0See moreABSTRACT
Objectives:
to analyze the possibilities and potential of training indigenous nurses, given the Brazilian Health System (SUS), understanding the relationships between education and health.
Methods:
theoretical-reflective study, based on scientific literature, aligned with the experience, critical thinking of its authors and the Sustainable Development Goals in Brazil.
Results:
this text articulates three axes: Potential for including indigenous students in nursing training; Paths to achieving equity through inclusion and retention policies for indigenous students at different levels; and Implications of this for the SUS and global health.
Final Considerations:
indigenous students, beneficiaries of affirmative actions, face challenges of inclusion and retention in public universities that directly impact their academic training. Added to this are the difficulties identified in basic education, professor training and implementation of permanence policies, with consequences for services and training at other levels.
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ORIGINAL ARTICLE12-13-2024
Interobserver agreement in Reception and Risk Stratification in Obstetrics implementation
Revista Brasileira de Enfermagem. 2024;77(5):e20230361
Abstract
ORIGINAL ARTICLEInterobserver agreement in Reception and Risk Stratification in Obstetrics implementation
Revista Brasileira de Enfermagem. 2024;77(5):e20230361
DOI 10.1590/0034-7167-2023-0361
Views0See moreABSTRACT
Objectives:
to analyze interobserver agreement in the Reception and Risk Stratification in Obstetrics protocol implementation.
Methods:
a cross-sectional study carried out during Reception and Risk Stratification in Obstetrics implementation, conducted in a tertiary hospital in southern Brazil with 891 participants in January 2020. Descriptive and interobserver agreement analysis was carried out using the Kappa coefficient in the risk stratification assigned by the triage nurse and reviewed by the researcher.
Results:
around half of the calls (55.6%) were stratified as not very urgent (green), followed by urgent (yellow) (31.8%), very urgent (orange) (9.3%), not urgent (blue) (3.4%) and no emerging stratification (red). Agreement analysis of revised stratification found Kappa values of 0.20 (blue), 0.54 (green), 0.77 (yellow) and 0.80 (orange).
Conclusions:
most appointments were non-urgent. The agreement analysis between the revised and assigned risk stratification revealed greater interobserver agreement as the priority level increased.
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ORIGINAL ARTICLE12-13-2024
Adaptation and implementation of a Nursing care protocol for children in the Amazon Region
Revista Brasileira de Enfermagem. 2024;77(5):e20230245
Abstract
ORIGINAL ARTICLEAdaptation and implementation of a Nursing care protocol for children in the Amazon Region
Revista Brasileira de Enfermagem. 2024;77(5):e20230245
DOI 10.1590/0034-7167-2023-0245
Views0See moreABSTRACT
Objectives:
to describe the process of implementing an adapted protocol for pediatric nursing care in a health unit located in a municipality in the Amazon Region.
Methods:
methodological research conducted in a basic health unit with four family health teams in the state of Rondônia, involving seven nursing professionals. Data collection occurred between October 2020 and April 2022, following the research phases: situational diagnosis, exploratory phase, protocol definition, implementation, and evaluation.
Results:
the outcome was the adaptation and implementation of a nursing care protocol for children.
Final Considerations:
the adaptation and implementation process can be an effective approach to improving care, strengthening nursing as a profession with a solid foundation in scientific and clinical evidence. This facilitates early problem identification and appropriate guidance, leading to better health outcomes for children.
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ORIGINAL ARTICLE12-13-2024
Nurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities
Revista Brasileira de Enfermagem. 2024;77(5):e20230136
Abstract
ORIGINAL ARTICLENurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities
Revista Brasileira de Enfermagem. 2024;77(5):e20230136
DOI 10.1590/0034-7167-2023-0136
Views0See moreABSTRACT
Objectives:
to understand nurses’ experiences in caring for people with mental health problems hospitalized due to clinical comorbidities in non-psychiatric Inpatient Units.
Methods:
qualitative study, guided by Alfred Schutz’s social phenomenology. Sixteen phenomenological interviews were conducted. The content was analyzed and discussed based on the literature, through the composition of three categories of analysis.
Results:
three categories emerged in the study: Challenges in care faced by nurses; Fragmented care action; and Ideal care. The disarticulation of the clinic was revealed, as described by nurses, showing care as an action far removed from the comprehensiveness of a person. Nurses’ performance is guided predominantly by biomedical reference, disregarding appreciation of subjectivity.
Final Considerations:
it was observed that nurses attribute the responsibility for patient care to factors external to their life-world, when, in fact, these aspects should be components that help them in comprehensive care construction.
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REVIEW11-29-2024
Assessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
Abstract
REVIEWAssessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
DOI 10.1590/0034-7167-2023-0532
Views0ABSTRACT
Objective:
to identify evidence available in the literature on instruments and methodologies used to assess healthcare professionals’ knowledge about cancer care for the transgender population.
Methods:
a scoping review was conducted in seven databases, including studies that answered the question: what is the healthcare professionals’ level of knowledge about cancer care for the transgender population?
Results:
forty-one articles were selected that dealt specifically with healthcare professionals’knowledge in relation to care for the LGBTQIAPN+ population, especially the transgender population. Eighteen studies assessed patients’ perceptions of professionals’knowledge, whereas other studies used their own assessment tools, considering the global context of LGBTQIAPN+ health.
Conclusions:
there is no tested and validated instrument that assesses the knowledge about the transgender population’s oncological health, highlighting the need to construct and validate an instrument focused on this population’s needs.
Keywords:Health Services for Transgender PeopleNeoplasmsOncologyProfessional TrainingTransgender PeopleSee more
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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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