Farmacêuticos e suas atividades em farmácias comunitárias: uma análise de perfil

The aim of this study was to establish the profile of the pharmacist technician responsible for community pharmacies in the city of Natal/RN, featuring personal elements, perceived their role and place of pharmaceutical care, levels of job satisfaction, type and quality of services provided in human and structural framework. To that end, we made an exploratory cross-sectional study applying a questionnaire containing open and closed questions, which was applied to pharmaceutical technicians responsible for community pharmacies in Natal/RN, from September 2010 to September 2011. The sample was established by calculating the simple random sample, with a confidence level of 95% and a significance level of 0.05. To evaluate the satisfaction level of the activities performed by pharmacists in community pharmacies was used Simple Satisfaction Scale (Likert, 1935). To assess the attitudes and perceptions of pharmacists in relation to aspects of pharmaceutical care, we used the Model Attitude toward the object (Fishbein, Ajzen, 1975). The answers were converted into data were analyzed statistically using Epi Info 3.5.2 The results showed that the strengths and weaknesses in relation to the profile of the pharmacist and their activities in community pharmacies in Natal/RN are not different in other cities in the country . The most important aspects were: 51% (n = 90) of the establishments visited, the pharmacist was absent; 46% (n = 80) did not have postgraduate and of those who are or have completed 33% (n = 51) are in the area of Clinical Analysis; 56% (n = 98) 08h for day work and 64% (n = 111) claim that this load influence its performance; 83% (n = 146) receive as salary, the floor pharmacist regarding the state of Rio Grande do Norte; 44% (n = 76) are unhappy about the salary, which is the main difficulty cited; 78% (n = 136) say they are always sought by users and the receptivity of these considered good (52%, n = 91). The activities of higher satisfaction are those related to pharmaceutical care and lower the administrative. As regards attitudes and perceptions, the score was more negative to the question 'if the pharmacist feels working as a team with the doctor', in which 59% (n = 103) responded 'never'. 49% (n = 86) reported being "able" to take questions from users and 39% (n = 68) are 'dissatisfied' with respect to the structure of the practice of pharmacy to pharmaceutical care. Action is needed on the obstacles to the exercise of the pharmacist in the solution and minimize the negative and positive stimulus to

Extração, caracterização e atividades biológicas de proteínas da espécie cnidoscolus urens (L.) Arthur

The extraction, chemical and structural characterization of a wide variety of compounds derived from plants has been a major source of bioactive molecules. Several proteases have been isolated in the plant kingdom, with numerous pharmacological and biotechnological applications. Among the proteases isolated from plants, are the fibrinogenolytic, with relevant application in the treatment of disorders in the coagulation cascade, in addition to potential use as a tool in clinical laboratories. In this study, in addition to evaluating the effects of the protein extract of Cnidoscolus urens (L.) Arthur (Euphorbiaceae) in the coagulation cascade also investigates the presence of antimicrobial activity and characterizes the proteolytic activity detected in this extract, aiming to determine their potential pharmacological and biotechnological application. In this way, crude protein extracts obtained from the leaves of C. urens in Tris-HCl 0.05M, NaCl 0.15M, pH 7.5, were precipitated in different concentrations of acetone, and assessed for the presence of proteolytic activity in azocaseína and fibrinogen. The most active fraction (F1.0) in these tests was chosen for assessment of biological activity and biochemical characterization. The Aα chain and Bβ of fibrinogen were completely cleaved at a concentration of 0.18 μg/μL of protein fraction in 4 minutes. Fibrinogenolytic activity presented total inhibition in the presence of E-64 and partial in the presence of EDTA. The fraction demonstrated coagulant activity in plasm and reduced the APTT, demonstrating acting on the factors coagulation of the intrinsic pathway and common, not exerting effects on the PT. Fibrinolytic activity on plasma clot was detected only in SDS-PAGE in high concentrations of fraction, and there were no defibrinating. Although several proteases isolated from plants and venomous animals are classically toxic, the fraction F1.0 of C. urens not expressed hemorrhagic nor hemolytic activities. Fraction F1.0 also showed no antimicrobial activity. In proteolytic activity on the azocasein, the optimal pH was 5.0 and optimum temperature of 60ºC. The enzyme activity has been shown to be sensitive to the presence of salts tested, with inhibition for all compounds. The surfactant triton did not influence the enzyme activity, but the tween-20 and SDS inhibited the activity. In the presence of reducing agents increase in enzyme activity occurred, a typical feature of enzymes belonging to the class of cysteine proteases. Several bands with proteolytic activity were detected in zymogram, in the region of high-molecular-weight, which were inhibited by E-64. In this study, we found that C. urens presents in its constitution cysteine proteases with fibrinogenolytic and procoagulant activity, which may be isolated, with potential application in treatment of bleeding disorders, thrombolytic and clinical laboratory

Caracterização dos marcadores químicos e avaliação de atividades biológicas do extrato de Spondias mombim

Spondias mombin is a fruitful species dispersed in tropical regions of America, Africa and Asia. In Brazil, the species can be found mainly in the northern and northeastern regions. Scarce chemical and pharmacological studies have been reported for S. mombin and until this moment studies about chemical markers were not developed. In this context, the aims of this study were to characterize the chemical markers from S. mombin leaves and evaluate their anti-inflammatory, antioxidant and antiproliferative potentials. The chemical profile of the hydroethanolic extract from S. mombin leaves analyzed by HPLC-DAD, through a validated method, allowed the identification and quantification of ellagic acid and chlorogenic acid. This extract showed anti-inflammatory potential in acute peritonitis model induced by carrageenan. The hydroethanolic extract from S. mombin leaves was subjected to a liquid-liquid partition with the solvents: n-hexane, dichloromethane, ethyl acetate and n-butanol. Regarding the anti-inflammatory potential of the fractions obtained they were active; however, ethyl acetate fraction at 200 mg/kg showed highlighted results. The compounds ellagic acid and chlorogenic acid also inhibited the leukocyte migration to the site of inflammation at 2.5, 5 and 10 mg/kg. The hydroethanolic extract, fractions and the chemical markers showed significant antioxidant potential when evaluated in different assays: DPPH Free-Radical Scavenging, Superoxide Radical Scavenging, Hydroxyl Radicals Scavenging and Reducing Power. Taken together our results showed that hydroethanolic extract of S. mombin leaves has ellagic acid and chlorogenic acid as bioactive markers and it demonstrated antiinflammatory and antioxidant properties besides no cytotoxicity against 3T3 cells. It enables us to suggest S. mombin as an important species to develop herbal drugs

O princípio constitucional da legalidade administrativa e os limites do controle das atividades-fim das agências reguladoras pelo Tribunal de Contas da União

Analysis of the role of the Union Accounts Court on the control of regulatory agencies, with the objective of identifying the limits of the Institution s acting on the aim activities of the agencies, particularly the control limits of the Court on the merits of discretionary administrative actions, taking into account the autonomy of these entities in the model of regulatory state. Analyzes the principle of administrative legality, the control of public administration, state s action in the economy and facing regulatory agencies, their emergence, evolution and characteristics. Includes the study of jurisprudence and doctrinal differences, as for the limits of the powers conferred by the constitutional legislator to Federal Court of Audit, regarding the control of agencies aim activities, or, in other terms, their regulatory and inspector missions of market, under the principle of administrative legality. Performs analysis, based on case studies involving Court s audits on regulatory agencies. Are appreciated differences within the Institution about the their decisions effects - imposed or not - as regards the arrangements to be adopted by regulatory agencies to correct the flaws and omissions found during Court s inspections, in which content of the act of public agent, despite their technical nature, can happen the criterion of convenience and opportunity

Correlação da atividade de lactato desidrogenase e concentração de lactato com a classificação de efusões em cães

As efusões são problemas clínicos frequentes e que ocorrem em consequência de uma enfermidade que culmine com diminuição da pressão coloidosmótica intravascular, elevação da pressão hidrostática local, aumento da permeabilidade vascular e/ou comprometimento da drenagem realizada pelos vasos linfáticos. Dessa maneira, a avaliação laboratorial desse fluido torna-se relevante para que, em conjunto com os sinais clínicos apresentados pelo paciente, possa ser firmado um possível diagnóstico e instituída ação terapêutica adequada. Assim sendo, a classificação de uma efusão em transudato ou exsudato torna-se um dos pontos críticos para a elucidação do diagnóstico e condução do caso clínico. em Medicina Veterinária, o método tradicional de classificação de uma efusão é baseado na contagem celular e na concentração de proteínas do fluido. Contudo, diversos estudos evidenciam que tais parâmetros não são suficientes para a correta classificação de todas as efusões. Assim, o presente estudo foi conduzido com o objetivo de verificar a correlação de outros parâmetros bioquímicos com a diferenciação das efusões transudativas e exsudativas e, para tal, foram avaliadas as atividades de lacatato desidrogenase (LDH) das efusões, a relação de sua atividade fluido/soro, concentração de lactato das efusões, o gradiente de concentração de lactato do soro para o fluido e a concentração de proteínas das efusões. Os resultados obtidos permitiram observar que a atividade de LDH, a relação LDH efusão/soro, a concentração de lactato e o gradiente de concentração de lactato soro/efusão apresentam diferença estatisticamente significativa (P<0,05), bem como alta correlação com a classificação de uma efusão exsudativa.

Podem os programas sociais e de transferência de renda influenciar a oferta de trabalho em atividades não agrícolas? uma análise para as famílias em condição de pobreza no meio rural do nordeste

This study aims to analyze the main effect of social programs and cash transfers on the labor supply of non-farm family members in poverty in rural areas of the Northeast. Among the specific objectives, we sought to investigate the effects of these programs and individual characteristics on the decision of participation and allocation of working hours of parents and children in non-agricultural activities. It was assumed, as a theoretical basis, the model of neoclassical labor supply as well as the principle that the decision of allocation of working hours, non-agricultural, is subject to the initial choice of the worker devote or not the non-agricultural employment . The hypothesis assumes that access to social programs and income transfer contributes to the dismay of rural workers, in poverty, in its decision to participate and offer hours of work in non-agricultural activities. To achieve this objective, we applied the models of Heckman (1979) and Double Hurdle, of Cragg (1971), consisting of associating the decision to participate in the labor market with the decision on the amount of hours allocated. The database used was the National Survey by Household Sampling (PNAD) of 2006. The results of the heads of households showed that transfers of income, although they may have some effect on labor supply rural nonfarm, the magnitude has to say that there may be some dependence on benefits. The estimates for the joint children of 10 to 15 years showed that the programs have negatively influenced participation in suggesting an increase in school participation, although for the allocation of working hours the results were not significant on the incidence of child labor

Utilizando processos geométricos da história da matemática para o ensino de equações do 2º grau

The present work had as principal objective to analyze the, 9th grade students understanding about the solutions of an equation of the 2° degree, using geometric processes of the History of the Mathematics. To do so, the research had as base the elaboration and application of a group of teaching activities, based on Jean Piaget's construtivism. The research consisted of a methodological intervention, that has as subjects the students of a group of 9th grade of the State School José Martins de Vasconcelos, located in the municipal district of Mossoró, Rio Grande do Norte. The intervention was divided in three stages: application of an initial evaluation; development of activities‟ module with emphasis in constructive teaching; and the application of the final evaluation. The data presented in the initial evaluation revealed a low level of the students' understanding with relationship to the calculation of areas of rectangles, resolution of equations of the 1st and 2nd degrees, and they were to subsidize the elaboration of the teaching module. The data collected in the initial evaluation were commented and presented under descriptive statistics form. The results of the final evaluation were analyzed under the qualitative point of view, based on Richard Skemp's theory on the understanding of mathematical concepts. The general results showed a qualitative increase with relationship to the students' understanding on the mathematical concepts approached in the intervention. Such results indicate that a methodology using the previous student‟s knowledge and the development of teaching activities, learning in the construtivist theory, make possible an understanding on the part of the students concerning the thematic proposal

A teoria de Dienes no ensino de transformação de medidas de comprimento, área e volume no curso de pedagogia

The study was aimed to test a teaching module on the Zoltan Paul Dienes theory, focusing on the content: The transformation of measurements: length, areas and volumes. The study based on constructivist theory consisted in a methodological intervention with students of the 7th period of the Course of Pedagogy, in Central Campus, Federal University of Rio Grande do Norte (UFRN). A preliminary study with 40 students called diagnostic evaluation found that students did not understand the concept of measurements transformation and its processing steps. The latter was performed only with the help of the table of measurements transformation with no understanding of the content. He applied a pretest, a set of activities and a post-test. The latter was used as a tool for evaluation of the student learning process. The answers of these ones were evaluated according to the concept of reflective abstraction of Jean Piaget, one of the authors who influenced the Dienes theory

Custo social de oportunidade na trajetória de acesso ao ensino superior: o caso dos ingressantes na UFRN nos vestibulares de 2006 a 2010

Access is a problem of higher education in Brazil that has existed since the formalization of this has occurred since the installation of the Portuguese court in Brazil in 1808. Only 10% of young people between 18 and 24 years of age attending this level of education in 2000, arriving in 2010 just 15%, far from that determined the National Education Plan in 2001, triple that percentage by the year 2010. In addition, a majority of seats of public HEIs is populated by students from the private network, especially in high-demand courses. In this context, this study aims to identify the costs related to the trajectories of students who were successful in the vestibular UFRN editions from 2006 to 2010. Presents an overview of higher education in Brazil, a brief history of vestibular, as well as new forms of access, and some of the policies to expand such access, highlighting the argument Inclusion UFRN. Focusing on the theme of the paper presents the concepts of opportunity costs and social. After collecting data through a questionnaire and consultation of databases COMPERVE was developed to search for a descriptive and analytical, with the participation of 3,995 students, of whom 1642 (41.1%) had completed secondary education in schools public, and 2,078 (52%) in private schools. The profile indicates that 90% are single, about 50% are 21 years of age, are white and female. In the course of preparation for college entrance exams, 80% chose the course during or after completion of the last year of high school, and almost 70% said they had started preparing at that time. Findings related to the costs involved with this preparation indicate that, in most cases there were school fees and disbursements and workshops, and the purchase of books and other materials, with parents primarily responsible for this cost, the amount disbursed each month was up $ 300 for 64% of respondents and only 7% of them exceeded $ 1,000, the major non-financial costs were characterized by the following resignations: job opportunities (24%) or temporary work (20%) courses of languages (26%), leisure activities (48%), leisure travel (43%), and parties and / or shows (54%). Of social investments by the government, stand out in the tax waiver scholarships for study in private institutions, grant exemption from the registration fee of vestibular, the preparatory courses UFRN, and seminars by COMPERVE / UFRN with networks of high school. From the junction of the opportunity costs (private costs) and social costs (public costs), a new concept: the social opportunity cost, which measures the combined efforts of families and government to finance the opportunity to access higher education of an individual. This concept can and should be incorporated as a strategic vector for the sake of democratic university, which reflects the social model that is sought

As geometrias urbana e isoperimétrica: uma alternativa de uso em sala de aula

The main goal of the present study is to propose a methodological approach to the teaching of Geometry and, in particular, to the construction of the concepts of circle (circumference) and ellipse by 7th and 8th grade students. In order to aid the students in the construction of these concepts, we developed a module based on mathematical modeling, and both Urban Geometry (Taxicab Geometry) and Isoperimetric Geometry. Our analysis was based on Jean Piaget's Equilibrium Theory. Emphasizing the use of intuition based on accumulated past experiences, the students were encouraged to come up with a hypothesis, try it out, discuss it with their peers, and derive conclusions. Although the graphs of circles and ellipses assume different shapes in Urban and Isoperimetric Geometry than they do in the standard Euclidian Geometry, their definitions are identical regardless of the metric used. Thus, by comparing the graphs produced in the different metrics, the students were able to consolidate their understanding of these concepts. The intervention took place in a series of small group activities. At the end of the study, the 53 seventh grade and the 55 eighth grade students had a better understanding of the concepts of circle and ellipse

Efeitos de um programa de intervenção precoce baseado no modelo mais que palavras - HANEN, para crianças menores de três anos com risco de autismo

In the last decades, studies on early intervention involving children with autism have suggested that there is no single intervention model capable of addressing the needs of all individuals in the spectrum. The role of parents as active intervention agents is, however, highly recommended. The More Than Words-HANEN Program has been specifically created for parents of children, under five years of age, who are in the autism spectrum. This intervention aims at improving the social competence and language comprehension of the child, as well as their parents empowerment. Until now only three studies have been performed in order to evaluate the effectiveness of the HMTW program. The purpose of this investigation is to evaluate the effects of an early intervention program inspired on HMTW model on the level of caregiver responsiveness and child communication skills. The present study adds to the existing research literature on family-centered early intervention that uses a developmental paradigm. A two year boy in risk for autism, his mother and nanny took part in this investigation, which was carried out in the child´s home in Mossoró, Rio Grande do Norte. The caretakers were given one fifty-two hours of training, divided into thirteen weekly meetings. A quasi-experimental A-B-C design (baselineintervention- follow-up) showed improvement in the caretakers level of responsiveness and meaningful social-communicative gains in the child´s response

Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

Atividades profissionais da enfermagem no contexto hospitalar: influências nas relações de trabalho

The present study is based on an analysis of professional work relationships in the nursing team from the task/skills of its members as a contribution to understanding the work process in nursing. It is aimed to identify the skills of the nursing team members through the vision of nurses, technicians and nursing assistants, thus it attempts to find strategies to improve the health assistance to patients. It is a descriptive and analytical study with a qualitative approach grounded in theoretical and methodological framework of Symbolic Interactionism. The research was carried out in the participant work place, a Public Hospital of Reference for the SUS, located in the eastern health district of Natal/RN. Nineteen nursing professionals participated in the study, which seven was nurse and twelve nursing technician. As procedure to collect data we used an unstructured interview accompanied by a standard topic guide which was recorded and later transcribed. The content analysis was chosen as the main methodology to analyze the discussion, which gave rise to thematic categories that were considered relevant based on the theoretical framework of this study, and the interactionist theory. This study was in accordance with the ethical principles of the Resolution nº. 196/96, it has obtained an appropriate consent of the UFRN Research Ethics Committee. The results indicate that the professionals seen the nursing as a profession strongly attached to the health care process and as a profession that acquired a scientific status very recently. Regarding to the nursing functions in the work process in nursing, the professionals they identified the manage/administer category as the main activities developed by these professionals, thus the education and complex care in nursing categories. Concerning to the technicians and nursing assistants functions, it was figured out in the professional s opinion that there is not distinction among the attribution of these categories. The interviewed were unanimous in report that these professionals are more involved in direct patient health care through performance of basic duties in nursing care. Finally, with regard to the work relationship among nursing team members, the majority of those interviewed see this relationship as disharmony and quarrelsome and in general, there is not bond between categories that comprise the process of work in nursing. On the basis of our results we consider the importance of knowing the meaning of nursing given by these professionals; also their skills could be useful as basis to identify problems, which source could be detected in the power relationship, deviations of functions, gap between design (knowledge) and performance (doing) work, besides the loss of the global activities view in the process of nursing work

Biomassa e atividades microbianas em solo sob pastagem com diferentes lotações de ovinos

Os efeitos da lotação de animais na produção de ovinos têm sido bastante estudados. No entanto, informações sobre seus efeitos na biomassa e nas atividades microbianas e, em conseqüência, na fertilidade do solo de pastagens são escassas. Neste trabalho, os efeitos da lotação de ovinos (LO) na biomassa e nas atividades microbianas responsáveis pela transformação dos compostos do C e N em solo de clima subtropical foram avaliados. As amostras de solo foram coletadas nas camadas de 0-10 e 10-20 cm de pastos com baixa LO (5 animais ha-1), alta LO (40-50 animais ha-1) e com ausência de animais, em um delineamento inteiramente casualizado em parcelas subdivididas, com seis repetições. Os maiores valores de biomassa microbiana e das atividades respiratória, nitrificante e enzimática (urease e protease) foram encontrados nos solos dos pastos com baixa LO. Estes pastos também acumularam as maiores quantidades de matéria orgânica e N total. Essas variáveis foram reduzidas nos pastos sem animais ou com alta LO. Vegetação descontínua e intensa mineralização podem ter acarretado a diminuição dessas variáveis nos pastos com alta LO. Alta correlação foi obtida entre matéria orgânica, C orgânico e N total com as quantidades de biomassa microbiana e a atividade enzimática. A camada de 0-10 cm apresentou valores maiores das variáveis estudadas do que os encontrados na camada de 10-20 cm.

Validação de conteúdo do instrumento para consulta de enfermagem na visita domiciliar às pessoas com lesão medular: um enfoque no autocuidado

This study aimed to validate the contents of an Instrument for Nursing Consultation in the Home Visit of people with Spinal Cord Injury (INCEVDOP-LM), based on the Self-Care Deficit Theory. The methodological development study was conducted with spinal cord injured (SCI) people ascribed in the Family Health Units the city of Natal/RN/Brazil, and with the nurses of these institutions. The study was conducted from Januray 2012 to January 2013 in two phases: the first aimed to identify the need for self-care of persons with SCI, and the second to develop and validate the INCEVDOP-LM. The first phase consisted of a census study of people with SCI living in Natal/RN. In the second phase, a non-probabilistic convencience sample of subjects was selected to form two groups: First stage - Group 1 of the first stage was comprised by 73 adults with SCI diagnosed with paraplegia or tetraplegia, with cognitive function preserved and that were registered to some family health unit; Group 2 of the Second phase was composed of six experts that were nurses with doctoral formation, scientific experience in the area of technology development or assistance to persons with SCI, and with publications in periodicals Qualis A2. Data collection of the first phase was conducted through home visits of people with SCI that responded three instruments: Questionnaire I (comprised of demographic and socioeconomic variables), The Competency Rating Scale for Self-care (ASA) and the Barthel Index (an instrument for evaluation of functional capacity). The research for the second phase was conducted in two stages: I-construction of the INCEVDOP LM; II-validation of the INCEVDOP-LM. The instrument and an evaluation form were forwarded to the experts for the validation. The correlations between the responses were analyzed by the Kappa test, with accepting values of>0.75. The evaluation criteria were: organization, clarity, simplicity, readability, appropriateness of vocabulary, objectivity, accuracy, reliability and suitability and the positive responses with frequency values of≥90% were considered excellent. The chi-square test was used to investigate the differences between proportions. The study attended to the principles of Human Rights CNS Resolution 196/96. Results were reported by means of four articles derived from the study. The findings indicate that the items that showed disagreement among experts (k=0.02) were diagnoses, interventions and evaluation of the nursing features pertaining to the domains of Nutrition, Hygiene, Elimination, Physical, Social and Psychological, and of the Ability to perform work activities feature. Agreement among the experts were reported for the other items, with kappa ranging from 0.72 to 1. After removing items with disagreement, all criteria achieved excellent rates and no significant differences were observed between the proportions of responses of evaluation of experts (p>0.05). We conclude that the instrument shows validity to serve as a guide for nurses to conduct a systematic consultation during the home visit to people with spinal cord injury, with emphasis on self-care. The instrument must go through other levels of validation when applied in the clinical setting