Examinando por Materia "Spain"
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Ítem Acceso abierto Academic performance of IX and(Universidad Privada Norbert Wiener, 2019-08-13) Quispe Pariona, Roxana; Calsin Pacompia, WilmerObjective: Determine the overall academic performance of students from IX and X Cycle of the UPNW Professional Academic School of Nursing, Semester 2016-I to 2018-II. Materials and Methods: systematic review, use of the Evaluation Record system of IX and X cycle students of the UPNW Professional Academic School of Nursing. Databases: Pubmed, Biomedic Sciences, Elvesier, Medline and Scielo. 40% cohort studies, 30% prospective study, 20% systematic review, 10% cross-sectional study. 60% of the articles are of high quality, strong strength of evidence, 30% moderate quality and strong strength of evidence, 10% low quality and weak strength of evidence. 29.4% belong to the United States, 26.5% Colombia, 17.6% Peru, 14.7% Spain, 5.9% Mexico and Chile, respectively. Results: All the articles reviewed systematically indicate that the nursing students during the internship presented an effective performance that in our categorization coincides with the notable categorization. All the articles reviewed systematically indicate effectiveness in the application of a preventive package to reduce surgical wound infections in the patient during the intraoperative period. Conclusions: The academic performance of the IX and X cycle students of the Professional Academic School of Nursing of the Norbert Wiener Private University, Semester 2016-I to 2018-II. It was rated as Notable.Ítem Acceso abierto Aspects related to effective communication between nurses and patients' families(Universidad Privada Norbert Wiener, 1905-07-09) Buendia Rojas, Claudio Dionisio; Chávez Pajuelo, Miriam Francisca; Gómez Gonzales, Walter EdgarObjectives: Determine the aspects related to effective communication between the nurse and the patients' families in the area. Methodology/Methods: Observational and retrospective systematic review, the search has been restricted to articles with full text, and the selected articles were subjected to a critical reading, using Jover's evaluation to identify their level of evidence. Results: In the final selection, 10 articles were chosen, we found that 40% (04) correspond to Spain, with 40% (04) we find Colombia, while with 10% (01) we find Peru and Mexico respectively. The majority of Cross-Sectional studies have been studied, with 90%, mainly in the countries of Spain, Colombia, Peru and Mexico. And with 10% we have quasi-experimental studies belonging to Spain. Where the aspects related to effective communication of the nurse with the family members considered in the majority of the articles analyzed were: Verbal aspects (Strategies to facilitate understanding), Non-verbal aspects (social skills), heterogeneous positions on the presence of the family , the identification of the nurse and finally the instrumental aspects. Conclusions: It was evident in the reviewed research that to carry out effective communication it is necessary to consider the aspects of communication.Ítem Acceso abierto Corrosion of surgical instruments due to the use of common water vs distilled water(Universidad Privada Norbert Wiener, 1905-07-09) Castillo Sánchez, Rosa María; Gómez Gonzales, Walter EdgarObjective: Determine if the corrosion of surgical instruments is produced by the use of common water vs. distilled water. Materials and Methods: Systematic Reviews are an observational and retrospective research design, which synthesizes the results of multiple primary investigations. They are an essential part of evidence-based nursing due to their rigorous methodology, identifying relevant studies to answer specific questions of clinical practice. Results: In the final selection, 13 articles were chosen, we found that 31% (4) correspond to Spain, 14% (2) correspond to Colombia and Chile, with 7% (1) Cuba, Mexico, Peru were found. , Venezuela and Brazil respectively. 69% were experimental studies from the countries of Spain, Peru, Mexico, Colombia, Venezuela and Chile. With 31% we have cross-sectional studies belonging to Brazil, Chile, Spain, and Cuba. Of the total number of articles analyzed, 80% concluded that plain water causes corrosion in surgical instruments. It was evident in the reviewed research that stainless steel instruments should not be subjected to cleaning, disinfection and sterilization processes, whose dilution component is common water, nor should they be immersed in a physiological salt solution. Prolonged contact and immersion in the solution causes corrosion pitting and forms stress corrosion cracking. Conclusion: It is recommended to use distilled water to avoid corrosion of surgical instruments, especially for final rinsing, after cleaning and disinfection.Ítem Acceso abierto Determination of the safe disinfectant Orthophthaldehyde versus Glutaraldehyde used by nurses in the High Level Disinfection Process(Universidad Privada Norbert Wiener, 1905-07-09) Idrogo Maita, Zaida Karina; Ruiz Campos, Deysi; Gómez Gonzales, Walter EdgarObjectives: Determine the safe disinfectant Orthophthaldehyde vs glutaraldehyde to be used by nurses in the high-level disinfection process. Materials and Methods: Observational and retrospective systematic review, the search has been restricted to 8 articles with full text, and the selected articles were subjected to critical reading. Published and indexed in scientific databases, dating back to the year 2000 and responding to articles published in Spanish, English and Portuguese. In the final selection, 4 articles were chosen, we found that 25% (01) corresponds to England, with 25% (01) to Spain, with 25% (01) to Brazil and while another 25% (01) we find Japan; Two systematic reviews and two cross-sectional studies were included. Results: 80% of the articles reviewed show that glutaraldehyde, compared to orthophthaldehyde, is the one that produces the most cytotoxicity at work, but that orthophthalaldehyde is still toxic. Orthophthaldehyde vs glutaraldehyde, in both cases its greatest adverse reaction when used is in the respiratory tract Conclusion: of the liquid chemical substances used as high-level disinfectants Orthophthaldehyde vs Glutaraldehyde It was evident that Glutaraldehyde is a volatile product that emanates cytotoxic substances causing effects adverse effects on the person who handles it, while Orthophthaldehyde, being exposed through inhalation, turns out to be a sensitizing this. The direct handling of high-level disinfectant substances focuses exposure on the inhalation route, requiring the use of personal protective equipment.Ítem Acceso abierto Effect of noise intensity on the newborn hospitalized in the neonatal ICU(Universidad Privada Norbert Wiener, 2021-02-28) Checglio Cusi, Jessica Sadith; Santamaría Olivos, Elida; Pretell Aguilar, Rosa MaríaObjective: Systematize the available evidence on the effect of noise intensity on newborns hospitalized in the neonatal ICU. Material and methods: Systematic observational and retrospective review, quantitative, the 10 articles found on the effect of noise intensity in the newborn hospitalized in the neonatal ICU, were found in the databases PubMed, Sciencedirect, Scielo, Wiley Online Library, Elsevier, Epistemonikos. Results: Of the total articles found, 60% were systematic reviews, 10% quasi-experimental, 20% descriptive and 10% experimental and all referred to the effect of noise intensity on newborns hospitalized in the neonatal ICU. 20% corresponds to Colombia and 10% to France, the United States, Spain, Mexico, Canada, Italy, Brazil and Iran with 10% respectively. Of the total evidence, 80% were of high quality and 20% of low quality. The intensity of noise in neonatal intensive care units affects the development of the hospitalized newborn. The evidence also mentions that noise affects the newborn, both physically and neurologically, leaving them hospitalized for several days. Studies indicate that not only the newborn is affected, but also the health personnel since they are the ones who spend most of the day in these units. Conclusion: The 10 articles show that the intensity of noise in the neonatal intensive care unit affects the development of the newborn physically and neurologically, leaving them hospitalized for several days.Ítem Acceso abierto Effective scale to assess the risk of pressure ulcer in pediatric patients(Universidad Privada Norbert Wiener, 1905-07-09) Calla Ruiz, Oriele; Salvador Valenzuela, Norma Haydeé; Gómez Gonzales, Walter EdgarSystematic, observational and retrospective review, the search has been restricted to articles with full text, and the selected articles were subjected to a critical reading, using the Grade evaluation to identify the degree of evidence. Results: In the final selection, 07 articles were chosen, 58% (4) correspond to Spain, with 14% (1) found in England, 14% Colombia and 14% Brazil. Likewise, according to the type of study, 43% correspond to Systematic Reviews, 14% Prospective Cohort, 29% Descriptive, 14% Cross-sectional Study. Conclusions: According to the results obtained from the systematic review, they show that of the total of 7 studies, equivalent to 58% corresponds to demonstrating that the Braden scale is effective in evaluating the risk of pressure ulcer in pediatric patients.Ítem Acceso abierto Effectiveness of a nutritional intervention program for pregnant women to improve early childhood development in children under three years of age(Universidad Privada Norbert Wiener, 2019-09-29) Huane Cabello, Carolina; Zavaleta Constantino, Sandra Marina; Bonilla Asalde, César AntonioThe countries that served as sources for the results of this study were: Spain (40%), Cuba (20%), Chile (20%), Peru (10%) and Argentina (10%). Results: 6 (60%) of the evidence found indicates that a nutritional intervention program for the pregnant woman guarantees adequate development of the child and thus ensures appropriate child development. Conclusion: A nutritional intervention program for pregnant women is effective in improving early childhood development in children under three years of age.Ítem Acceso abierto Effectiveness of activating a sepsis code to reduce in-hospital mortality in patients with severe sepsis/septic shock(Universidad Privada Norbert Wiener, 2020-08-02) Loayza Goicochea, Oscar Roger; Pretell Aguilar, Rosa MaríaObjective: Systematize the available evidence on the effectiveness of activating a sepsis code to reduce in-hospital mortality in patients with severe sepsis/septic shock. MATERIALS AND METHODS: The type of research is quantitative, the design is a systematic review of 10 articles that were obtained from the following databases: Pubmed, Biomedcentral, Sciencedirect, Medintensiva, Scielo. Of the 10 articles reviewed and analyzed, 50% (n= 5/10) are Quasi-experimental, 40% (n= 4/10) Cohort and 10% (n=1/10) are systematic reviews. According to the quality of the evidence, it was found to be 90% moderate and 10% high. According to the recommendation strength it is 90% weak and 10% strong. According to the country where the investigations were carried out, they correspond to Spain 70%, the United States 20% and Cuba 10%. Results: According to the review, it is evident that 100% of the articles (n = 10/10) indicate that the implementation of the sepsis code is effective in reducing in-hospital mortality in patients with severe sepsis and septic shock. Conclusion: It is concluded that 10 of 10 evidence reviewed and analyzed demonstrate that the activation of a sepsis code is effective in reducing in-hospital mortality in patients with severe sepsis/septic shock.Ítem Acceso abierto Effectiveness of an educational intervention in children to improve the level of knowledge, attitudes and practices about washing hands before consuming food(Universidad Privada Norbert Wiener, 2019-09-29) Francia Niño de Guzmán, Lourdes Durley; Bonilla Asalde, César AntonioObjective: Analyze the Effectiveness of an educational intervention in children to improve knowledge, attitudes and practices of hand hygiene before consuming food, interventions to improve healthy lifestyles. Materials and Methods: Simple, observational systematic verification of research results, identifying relevant studies to answer specific questions of community practice. The search was based on complete articles, which were used in critical reading, using the grade system to assign the strength of suggestion. The articles are: Israel 10% (01/10), Cuba 10% (01/10) Ethiopia 10% (01/10) Mexico 20% (02/10) Venezuela 10% (01/10) Spain 10% (01 /10) Australia 10% (01/10) Nepal 10% (01/10) and Brazil 10% (01/10). Results: The results related to hand washing before eating food indicate that not all children have the knowledge, adequate practices and hygiene materials required for adequate hygiene, therefore there will not be a complete and effective activity for the practice. healthy. Conclusions: The effectiveness of the level of knowledge, practices and attitudes about hand washing before eating food prevents diseases in children and their caregivers, is reflected in hygiene and hand washing practices.Ítem Acceso abierto Effectiveness of an educational program to strengthen knowledge for better self-care in patients with chronic kidney disease(Universidad Privada Norbert Wiener, 1905-07-09) Cardozo Alfaro, Linda Caroline; Napurí Bazalar, Bryan Jesús; Remuzgo Artezano, AnikaMaterial and methods: Observational and retrospective systematic review, the search has been restricted to articles with full text and the selected articles were subjected to a critical reading, using the hierarchy of the grade system to identify their level of evidence. Results: 10 scientific articles have been analyzed, mostly quasi-experimental studies in 80% and 20% systematic reviews. 30% of the research found is from Spain, 10% from Cuba, 10% from Nicaragua, 10% from Australia and 10% from China. 100% of the articles reviewed systematically agree that an educational program is effective to strengthen the self-care of patients with chronic kidney disease. The educational programs promote knowledge by carrying out a systematic and continuous plan to strengthen self-care, so that patients have a better quality of life.Ítem Acceso abierto Effectiveness of Continuous Versus Intermittent Enteral Nutrition in Intensive Care Patients(Universidad Privada Norbert Wiener, 1905-07-09) Bardales Rengifo, Augusto Daicoro; Manrique Aliaga, Lizzette Milagros; Calsin Pacompia, WilmerObjective: Determine the effectiveness of continuous versus intermittent enteral nutrition in intensive care patients. Materials and methods: The present study is quantitative with a Systematic Review, observational and retrospective design. Results: in the final selection, 6 articles were chosen, we found that 33.3% (2) correspond to Brazil, with 16.6% (1) we found the USA, China, Turkey respectively, most of them have been studied clinical trials with 50%, 33.6% experimental and among the systematic review we find Spain with 16.6%(1), of the total articles analyzed, 50% mention that continuous enteral nutrition is not more effective than intermittent enteral nutrition nor vice versa. Conclusions: according to the studies reviewed, it could not be defined which of them is the most effective, with 50% (3/6) mentioning that there are no statistically significant differences. 33.3% (2/6) conclude that in intermittent enteral nutrition they achieve better caloric intake and in less time compared to continuous enteral nutrition; Another study that corresponds to 16.6% (1/6) mentions that diarrhea and lung infections are more frequent with intermittent enteral tube feeding compared to continuous nutrition and finally in the review (18), concludes that enteral nutrition Intermittent therapy obtains better results both in nutritional status and in reducing bronchial aspiration.Ítem Acceso abierto Effectiveness of early-onset prolonged prone position in improving hypoxemia in patients with acute respiratory distress syndrome in the intensive care unit(Universidad Privada Norbert Wiener, 2020-02-29) González Gestro, Rosaluz Elcira; Barrantes Quiñones, Rocío del Pilar; Rivera Lozada de Bonilla, OrianaThe prone position for prolonged periods and early onset improves the risk of hypoxemia in patients with ARDS. In the present work, the existing evidence on the effectiveness in the application of the prone position was systematically analyzed, of which 13 scientific articles with GRADE recommendation and strength of evidence were identified; These respond to different designs: randomized clinical trials; meta-analysis and systematic reviews of the last 10 years in countries such as Spain, the United Kingdom, Great Britain, the United States, Korea, Canada and China. Results: Of the 13 scientific articles, 100% indicate that there is effectiveness in prone positioning therapy, being chosen early and in prolonged periods, improving the hypoxemia compromise in patients with severe lung injury: ARDS. Conclusion: Prolonged prone positioning with early onset improves the risk of hypoxemia in patients with ARDS.Ítem Acceso abierto Effectiveness of educational intervention in the control of overweight and obesity in schoolchildren(Universidad Privada Norbert Wiener, 1905-07-09) México Can, Alicia Nery Milagros; Bonilla Asalde, César AntonioMethodology: It is a Systematic Review of 10 articles, finding that 30% (3) correspond to Spain, 20% (2) correspond to Peru, 20% (2) correspond to Mexico, 20% (2) correspond to Chile and 10 % (1) corresponds to Colombia. Most of the studies have been quasi-experimental studies, being Peru, Chile and Mexico with 50% respectively, systematic review being Colombia and Spain with 20% respectively, clinical trial Spain with 20% and community trial Peru with 10%. Results: The percentage of overweight and obesity in schoolchildren is observed to have decreased in 80% of the 10 reviews studied with a tendency to improve if it increases in the 2 reviews with physical activities. The 80% reviewed were mixed activities, nutritional educational activities and physical activity, the remaining 20% were only nutritional educational activities. Conclusions: There is sufficient evidence to improve overweight and obesity in schoolchildren. With the mixed activities, I improved by 80% of the 10 reviews found related to the title of the research with educational talks regarding food, nutrition, healthy eating and physical activity. Only 20% were maintained and in some cases improved in BMI.Ítem Acceso abierto The effectiveness of educational intervention programs for the prevention of HIV and STIs in healthy adolescents in primary health care(Universidad Privada Norbert Wiener, 2019-09-22) Merlin Contreras, Dzhámilia Gaby; Aguilar Rueda, Edith Nancy; Matta Solis, Hernán HugoObjective: Systematize evidence on the effectiveness of educational intervention programs for the prevention of HIV and STIs in healthy adolescents in primary health care. Material and Method: The systematic review is a synthesis of the literature, which attributes high evidence on the effectiveness of interventions on related topics in the area of health, subjected to critical selection, using the GRADE evaluation system for the identification of the degree of evidence, disseminated in the following databases Scielo, Lilacs, Medline, Ebsco, Pubmed. Of the 10 scientific articles systematically reviewed, 20% (n=2/10) are systematic reviews and 80% (n=8/10) are quasi-experimental studies. According to the results obtained from the systematic review carried out in the present study, they come from the countries of Brazil (10%), Spain (10%) and Cuba (80%). Results: 10/10 of the articles reviewed show that an education program is effective for the prevention of HIV and STIs in healthy adolescents. Conclusions: an education program is effective for the prevention of HIV and STIs in healthy adolescents using participatory methodology that includes recreational activities, role plays, debates, use of technology, educational games and reflective activities. conferences, videos, round tables, posters, brochures, audiovisual spot programs.Ítem Acceso abierto Effectiveness of educational interventions in the prevention of breast cancer(Universidad Privada Norbert Wiener, 2019-09-22) Aguirre Pillaca, Sulmit Dionicia; Tarazona Flores, Carlos Liborio; Uturunco Vera, Milagros LizbethObjective: Systematize evidence on the effectiveness of educational interventions in the prevention of breast cancer. Materials and Methods: use of the GRADE system. Databases: Elservier, Cochrane, Google Scholar, Scielo, Medline and Pubmed, studies from Spain 30%, Cuba-20% and studies from Peru, Colombia, Mexico, Brazil and the United Kingdom account for 10% each. quasi-experimental 70% systematic reviews 20% and prospective observational 10%. Results: The articles agree on the effectiveness of educational interventions in the prevention of breast cancer Conclusions: The population must put into practice healthy lifestyles, practice self-care, which entails periodic medical examinations, self-examination, ruling out diseases, participation in health campaigns etc.Ítem Acceso abierto Effectiveness of educational nursing interventions for the prevention and control of bullying(Universidad Privada Norbert Wiener, 2019-08-25) Rodríguez Romero, Rosa Haydeé; Santa Cruz Suárez, Esther Verónica; Glenni Garay, Zarely ZabeliObjective: Systematize the evidence about the effectiveness of nursing educational interventions for the prevention and control of bullying. Material and methods: Systematic review that synthesizes the results of multiple investigations, identifying the most relevant to answer specific questions of daily practice. The search was restricted to articles with full text subjected to critical reading, using the GRADE system to assign the strength of recommendation. Results: In the final selection, 10 articles were chosen, finding according to the results obtained from the systematic review carried out in the present study, shown in the 10 articles systematically reviewed, 70% (n=7/10) are quasi-experimental and the 30% (n=3/10) are systematic reviews. These studies come from the countries of Brazil (40%), Portugal (20%), Spain (10%), Norway, Scotland and the USA (10%), Colombia (10%), Costa Rica (10%). Conclusions: nursing educational interventions have generated positive effects in prevention, showing that the participation of the nurse is essential, also for the detection and monitoring of cases of bullying.Ítem Acceso abierto Effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions and/or mortality in adult patients with heart failure(Universidad Privada Norbert Wiener, 2019-09-22) Rodas Correa, Isis Yohani; Romani Vila, Maribel Juana; Matta Solis, Eduardo PercyObjective: Systematize the evidence on the effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions and/or mortality in adult patients with heart failure. Materials and methods: A search was carried out for systematic reviews that are the reference standard for the synthesis of health evidence. The population was made up of 20 articles, of which through selection criteria such as: Evidence no older than 10 years, the degree of evidence of medium or high quality of which 10 articles were chosen that contain the main premises of the problem. in study. Results: The present systematic review consists of 10 scientific evidence linked to the effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions and/or mortality in adult patients with heart failure. Of the 10 articles reviewed, 70% are systematic reviews. and 30% is a systematic review and meta - analysis. 100% of the evidence is of high quality. According to the country of origin, 70% of the evidence comes from the United Kingdom and 30% from Spain. In this sense, 80% demonstrate the effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions as well as long-term mortality in adult patients with HF. 20% do not show effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions and/or mortality in adult patients with HF. Conclusions: 80% (n= 8/10) evidence the effectiveness of exercise-based cardiac rehabilitation in reducing hospital readmissions as well as long-term mortality in adult patients with heart failure.Ítem Acceso abierto Effectiveness of high-flow central venous catheter sealing with antimicrobials and VS anticoagulants. sealing with anticoagulant in the prevention of infections(Universidad Privada Norbert Wiener, 2020-02-22) Sosa Vilcachagua, Gladys Alicia; Avila Vargas Machuca, Jeannette GiselleObjective: Systematize the studies found regarding the difference between sealing with antimicrobial and anticoagulant solutions vs. sealing with anticoagulant for the prevention of high-flow central venous catheter infections. Materials and Methods: the search was restricted to studies of complete accessibility, articles that in total were 10 were classified according to high and moderate quality of evidence, and/or according to the type of study. 20% correspond to meta-analysis studies, 50% to systematic reviews, both types of studies with high evidence and strength of recommendation. 50% corresponds to Spain, 20% corresponds to the US and Chile, 10% corresponds to China. Results: 50% reported that the exclusive use of antibiotics reduces the risk of high-flow catheter infection, 30% reported that the use of antibiotics plus anticoagulant not only reduces the risk of catheter infection but also prevents dysfunctional catheters. and 10% that the use of antibiotics to seal the catheter favors antibiotic resistance. Conclusions: Seals with solutions containing antibiotics and antimicrobials are more effective in preventing high flow catheter infection, but if an anticoagulant is added they are better.Ítem Acceso abierto Effectiveness of nursing education to reduce anxiety levels in patients undergoing surgical intervention(Universidad Privada Norbert Wiener, 1905-07-09) Leonardo Amarillo, Angela Melina; Mendoza Taype, Isabel Juana; Gómez Gonzales, Walter EdgarObjectives: Determine the effectiveness of nursing education to reduce anxiety levels in patients undergoing surgical intervention Materials and Methods: 10 bibliographic and documentary reviews were carried out based on evidence due to its rigorous methodology, identifying relevant studies to answer specific questions. of clinical practices, in databases Scielo, Dialnet, Index, Pubmed, Virtual Health Library. Results: In the final selection, 10 articles were chosen, we found that 40% (04) correspond to Spain, with 20% (02) we find Colombia, while with 10% (01) we find Peru, Venezuela and Brazil. respectively. Most of the quasi-experimental studies have been studied, with 40%, mainly in the countries of Venezuela, Peru and Spain, with 30% we have clinical trial studies in the countries of Spain and Brazil and with 30% cross-sectional descriptive studies belonging to to Colombia and Brazil where of the total number of articles analyzed, 80% affirm that nursing education is effective in reducing anxiety levels in patients undergoing surgical intervention. Conclusions: Within all the systematic reviews, 80% (n=08/10) demonstrated that nursing education to reduce anxiety levels in patients undergoing surgical intervention was effective since it significantly helps in coping with the process in the patient. postoperative.Ítem Acceso abierto Effectiveness of Physical Exercise to improve the quality of life of people on hemodialysis(Universidad Privada Norbert Wiener, 1905-07-09) Roman Campos, Julissa Rosa; Vila Fabian, Juanita; Mendigure Fernández, JulioIt is a systemic review that included 11 articles no older than 10 years published in English and Spanish extracted from the databases Pubmed, Scielo, Journal Medical, Cochrane Plus and BVS whose main topic was the effectiveness of physical exercise to improve quality of life of people on hemodialysis. 66.6% of the articles come from Spain, 8.3% from Chile, Brazil, Korea and Taiwan respectively. Results: 66.6% of the articles demonstrate that physical exercise improves muscle strength, 41.6% reveal improvement in functional capacity. 100% of the articles demonstrated the improvement in the quality of life of people on hemodialysis, mostly in the physical (75%) and mental (41.6%) dimensions, other dimensions were also observed (emotional state, social functioning, general perception health, body pain) Conclusions: Physical exercise is effective in improving the quality of life in people on hemodialysis given that it has a positive impact on the dimensions: physical, mental, emotional, social functioning, general perception of health and pain bodily.
