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ORIGINAL ARTICLE10-18-2022
Humanized childbirth: the values of health professionals in daily obstetric care
- Diego Pereira Rodrigues
, - Valdecyr Herdy Alves ,
- Cristiane Cardoso de Paula ,
- Bianca Dargam Gomes Vieira ,
- Audrey Vidal Pereira , [ … ],
- Maria Bertilla Lutterbach Riker Branco
Abstract
ORIGINAL ARTICLEHumanized childbirth: the values of health professionals in daily obstetric care
Revista Brasileira de Enfermagem. 2022;75(2):e20210052
DOI 10.1590/0034-7167-2021-0052
- Diego Pereira Rodrigues ,
- Valdecyr Herdy Alves ,
- Cristiane Cardoso de Paula ,
- Bianca Dargam Gomes Vieira ,
- Audrey Vidal Pereira ,
- Laena Costa dos Reis ,
- Giovanna Rosário Soanno Marchiori ,
- Maria Bertilla Lutterbach Riker Branco
Views0See moreABSTRACT
Objective:
To understand health professionals’ values in the process of thinking and feeling about obstetric care, based on their experienced needs in the care process.
Methods:
Phenomenological study based on the Schelerian framework, with 48 health professionals from four maternity hospitals within the Metropolitan Region II of the state of Rio de Janeiro. Data collection was done through a phenomenological interview; and the analysis, with the Ricoeurian methodological framework.
Results:
The vital value was signified in care centered on physiological processes, for an individualized and safe monitoring. The ethical value was signified in the attitudes that provide women with autonomy in their way of giving birth, and recognize dialogue as a process of sympathy, affection, and bonding.
Conclusion:
The resignification of obstetric practice, articulated with public policies in the field of delivery and birth, supported by a vital ethical value, positively contributes to the humanization of care for women.
- Diego Pereira Rodrigues
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ORIGINAL ARTICLE10-18-2022
Methods for measuring venous peripherally inserted central catheters in newborns
- Andreia Tomazoni ,
- Patrícia Kuerten Rocha ,
- Mavilde da Luz Gonçalves Pedreira ,
- Elisa da Conceição Rodrigues ,
- Bruna Figueiredo Manzo , [ … ],
- Luciano Marques dos Santos
Abstract
ORIGINAL ARTICLEMethods for measuring venous peripherally inserted central catheters in newborns
Revista Brasileira de Enfermagem. 2022;75(2):e20210045
DOI 10.1590/0034-7167-2021-0045
- Andreia Tomazoni ,
- Patrícia Kuerten Rocha ,
- Mavilde da Luz Gonçalves Pedreira ,
- Elisa da Conceição Rodrigues ,
- Bruna Figueiredo Manzo ,
- Luciano Marques dos Santos
Views0See moreABSTRACT
Objective:
to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods.
Methods:
this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data.
Results:
modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events.
Conclusions:
between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.
- Andreia Tomazoni
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ORIGINAL ARTICLE10-18-2022
Clinical simulation as a Nursing Fundamentals teaching method: a quasi-experimental study
- Fernanda Letícia da Silva Campanati ,
- Laiane Medeiros Ribeiro ,
- Izabel Cristina Rodrigues da Silva ,
- Paula Regina de Souza Hermann ,
- Guilherme da Costa Brasil , [ … ],
- Silvana Schwerz Funghetto
Abstract
ORIGINAL ARTICLEClinical simulation as a Nursing Fundamentals teaching method: a quasi-experimental study
Revista Brasileira de Enfermagem. 2022;75(2):e20201155
DOI 10.1590/0034-7167-2020-1155
- Fernanda Letícia da Silva Campanati ,
- Laiane Medeiros Ribeiro ,
- Izabel Cristina Rodrigues da Silva ,
- Paula Regina de Souza Hermann ,
- Guilherme da Costa Brasil ,
- Karen Karoline Gouveia Carneiro ,
- Silvana Schwerz Funghetto
Views0See moreABSTRACT
Objectives:
to evaluate students’ knowledge gain after the implementation of clinical simulation in Nursing Fundamentals disciplines.
Methods:
a quasi-experimental intervention was carried out with 60 students, distributed in comparison and intervention groups, who underwent traditional teaching and traditional teaching associated with simulated teaching, respectively. Pre-test and post-test instruments were applied to both groups.
Results:
after analyzing the students’ performance through the applied instruments, both groups had a cognitive evolution along with the taught content, however, when compared, the intervention group obtained a higher knowledge gain than the comparison group (p = 0.016), demonstrating progressive and increasing improvement with the use of the methodology.
Conclusions:
simulated teaching significantly helps students in gaining technical-cognitive knowledge. Therefore, it is recommended to adhere to the use of this methodology for teaching Nursing Fundamentals.
- Fernanda Letícia da Silva Campanati
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REFLECTION10-18-2022
The act of playing as a signifier for the application of the dramatic Therapeutic Toy performed by the nurse: theoretical reflection
- Giulia Delfini ,
- Rafaela Rovigatti de Oliveira Oriente Pereira ,
- Luciana de Lione Melo ,
- Ana Paula Rigon Francischetti Garcia
Abstract
REFLECTIONThe act of playing as a signifier for the application of the dramatic Therapeutic Toy performed by the nurse: theoretical reflection
Revista Brasileira de Enfermagem. 2022;75(2):e20210062
DOI 10.1590/0034-7167-2021-0062
- Giulia Delfini ,
- Rafaela Rovigatti de Oliveira Oriente Pereira ,
- Luciana de Lione Melo ,
- Ana Paula Rigon Francischetti Garcia
Views0See moreABSTRACT
Objective:
To reflect on the possible contributions of the act of playing as a signifier in the use of dramatic Therapeutic Toy performed by the nurse.
Methods:
Theoretical-reflexive study, based on three moments: The language of the unconscious that emerges as a signifier when playing; How the dramatic Therapeutic Toy is used by the nurse; and the act of playing as a signifier during the application of the dramatic Therapeutic Toy: contributions to nursing practice.
Results:
Through the intervention of the nurse in the sessions, the act of playing mediated by the dramatic Therapeutic Toy provides the child with the opportunity to elaborate on signifier elements that had not been meant by him.
Final considerations:
Through the dramatic Therapeutic Toy, the articulation of the child’s organism with his reality in the formation of the self constitutes an advance for the production of knowledge and nursing assistance to the child, enabling complete care and allowing the elaboration of their anxieties, which collaborates so that the child constitutes himself as a subject.
- Giulia Delfini
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ORIGINAL ARTICLE10-18-2022
Information and communication technologies: interfaces the nursing work process
- Luana dos Santos Costa ,
- Ítalo Rodolfo Silva ,
- Thiago Privado da Silva ,
- Marcelle Miranda da Silva ,
- Isabel Amélia Costa Mendes , [ … ],
- Carla Arena Aparecida Ventura
Abstract
ORIGINAL ARTICLEInformation and communication technologies: interfaces the nursing work process
Revista Brasileira de Enfermagem. 2022;75(2):e20201280
DOI 10.1590/0034-7167-2020-1280
- Luana dos Santos Costa ,
- Ítalo Rodolfo Silva ,
- Thiago Privado da Silva ,
- Marcelle Miranda da Silva ,
- Isabel Amélia Costa Mendes ,
- Carla Arena Aparecida Ventura
Views0See moreABSTRACT
Objectives:
to unveil the meanings that nurses attribute Information and Communication Technologies for the nursing work process
Methods:
qualitative research, theoretically and methodologically based on the Complexity Theory and on the Grounded Theory, respectively. Research with 19 participants, being 12 clinical nurses, and 7 resident nurses. Semi-structured interviews were used for data collection.
Results:
the results revealed the meanings that clinical nurses attribute to Information and Communication Technologies and, thus, the motivations and limitations for the use of these technologies, pointing out possibilities and strategies that impact the nursing work process, based on the interactions promoted by the official and non-official use of these resources.
Final Considerations:
the meanings that nurses attribute to Information and Communication Technologies are dependent on their ability to successfully employ those technologies and their importance to the work process developed by the professionals.
- Luana dos Santos Costa
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REFLECTION10-18-2022
Improvement of Educational Products Validation form in professional postgraduate programs
Revista Brasileira de Enfermagem. 2022;75(2):e20210063
Abstract
REFLECTIONImprovement of Educational Products Validation form in professional postgraduate programs
Revista Brasileira de Enfermagem. 2022;75(2):e20210063
DOI 10.1590/0034-7167-2021-0063
Views0See moreABSTRACT
Educational Product and Technical-Technological Product constitute a specificity of postgraduate programs in the professional modality, a product that must be carefully evaluated by the programs and recorded on platforms of evaluating bodies. In 2019, a working group from the teaching area was assembled to create a Validation Form for these products. Thus, this article aims to present a proposal for improving this Validation Form for Educational/Technical-Technological Products, based on reflections treated in scientific articles and scientific events from the area, focusing on the relevance and need for this type of evaluation in a standardized way. It is intended to collaborate with the improvement of the evaluation processes and procedures of Educational/Technical-Technological Products for the necessary accuracy, representativeness, and homogeneity, which will allow the real dimensioning of the contributions of these products. This involves not only training qualified professionals, but also transforming practices in the Sistema Único de Saúde (SUS) [Brazil’s Unified Health System], promoting advances in science and in its fields of application.
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10-18-2022
COVID-19 and the nursing labor market: lessons learned by analogies between historical events
Revista Brasileira de Enfermagem. 2022;75(2):e20200328
Abstract
COVID-19 and the nursing labor market: lessons learned by analogies between historical events
Revista Brasileira de Enfermagem. 2022;75(2):e20200328
DOI 10.1590/0034-7167-2020-0328
Views0INTRODUCTIONThe nursing labor market in Brazil is experiencing a paradox. There is, at the same time, both a strong pent-up demand for nursing workers and a large supply of unemployed nursing workers, in addition to workers who have left their profession to work in another field(). Major financial crises, such as the one that the […]See more -
10-18-2022
Clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus: scoping review
- Diego Schaurich ,
- Oclaris Lopes Munhoz ,
- Angelo Ramos Junior ,
- Angelica Dalmolin ,
- Gabriela Oliveira , [ … ],
- Luiza Cremonese
Abstract
Clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus: scoping review
Revista Brasileira de Enfermagem. 2022;75(2):e20201380
DOI 10.1590/0034-7167-2020-1380
- Diego Schaurich ,
- Oclaris Lopes Munhoz ,
- Angelo Ramos Junior ,
- Angelica Dalmolin ,
- Gabriela Oliveira ,
- Luiza Cremonese
Views0See moreABSTRACT
Objectives:
to map the production of scientific knowledge on the clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus (HIV).
Methods:
scoping review, with search strategies in MEDLINE, Scopus, Embase, Web of Science, and LILACS. Dual independent data extraction and analysis of the material with similarity compilation and narrative synthesis.
Results:
sample consisted of 35 articles. Fever, cough, and dyspnea were the most prevalent signs/symptoms. Recurrent complications involved desaturation/worsening of oxygen desaturation and pneumonia. No standard pharmacological treatment was identified, and the main interventions involved the provision of supplemental oxygen and mechanical ventilation. The studies recommended preventive, care, and pharmacological practices.
Conclusions:
the clinical manifestations, complications, and treatments/assistance care for people coinfected with SARS CoV-2/HIV are similar to those of the general population. Coinfection, overall, does not infer a worse prognosis.
- Diego Schaurich
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REVIEW07-10-2020
Acute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review
- Matheus Santos Moitinho ,
- Angélica Gonçalves da Silva Belasco ,
- Dulce Aparecida Barbosa ,
- Cassiane Dezoti da Fonseca
Abstract
REVIEWAcute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20200354
DOI 10.1590/0034-7167-2020-0354
- Matheus Santos Moitinho ,
- Angélica Gonçalves da Silva Belasco ,
- Dulce Aparecida Barbosa ,
- Cassiane Dezoti da Fonseca
Views0See moreABSTRACT
Objective:
to assess scientific evidence on SARS-CoV-2 Acute Kidney Injury in patients with COVID-19.
Methods:
an integrative review, with adoption of PICO strategy and classification of the level of evidence, carried out on April 10, 2020 in the PubMed database, of articles available between December 2019 and April 2020.
Results:
the sample consisted of six original, five observational and one experimental articles. Observational studies addressed the clinical findings of patients with COVID-19 and association between kidney damage, infection, and morbidity-mortality.
Conclusion:
the studies addressed the mechanism of intracellular infection of SARS-CoV-2, its cytopathic effects on kidney cells and incidence of acute kidney injury in patients infected with SARS-CoV-2. Acute kidney injury is associated with increased mortality and morbidity in these patients. This review realizes the need for new research that can mention kidney care to patients with COVID-19.
- Matheus Santos Moitinho
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ORIGINAL ARTICLE03-24-2021
Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists
- Angélica Olivetto de Almeida ,
- Sônia Regina Pérez Evangelista Dantas ,
- Maria Angela Boccara de Paula ,
- Juliany Lino Gomes Silva ,
- Ednalda Maria Franck , [ … ],
- Ana Railka de Souza Oliveira-Kumakura
Abstract
ORIGINAL ARTICLEDevelopment, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists
Revista Brasileira de Enfermagem. 2021;74(1):e20200360
DOI 10.1590/0034-7167-2020-0360
- Angélica Olivetto de Almeida ,
- Sônia Regina Pérez Evangelista Dantas ,
- Maria Angela Boccara de Paula ,
- Juliany Lino Gomes Silva ,
- Ednalda Maria Franck ,
- Ana Railka de Souza Oliveira-Kumakura
Views0See moreABSTRACT
Objectives:
to build and validate three clinical simulation scenarios and report the application with candidates for the specialist’s degree in stomatherapy.
Methods:
methodological study, building three scenarios and evaluation checklists; content validation with judges, using content validity index and Modified Kappa Coefficient; pre-test and application.
Results:
scenarios built based on nursing care for: 1. insufficiency and venous ulcer; 2. demarcation of intestinal stomia; and 3. Clean intermittent catheterization. In the content validation of the 24 items appreciated, 83%, 80%, and 92% were validated without change. In the pre-test, the objectives and checklists were adjusted. In the application, to standardize the evaluation, actors and evaluators were trained previously, and each candidate passed the three stations.
Conclusions:
scenarios built and with validated content, based on evidence and covering the three areas of stomatherapy. The pre-test allowed for adjustments in the scenarios, and the candidates achieved the expected objectives.
- Angélica Olivetto de Almeida
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ORIGINAL ARTICLE07-15-2020
Cultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil
- Fernanda Garcia Bezerra Góes ,
- Beatriz Cabral Ledo ,
- Andressa Silva Torres dos Santos ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Aline Cerqueira Santos Santana da Silva , [ … ],
- Marialda Moreira Christoffel
Abstract
ORIGINAL ARTICLECultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil
Revista Brasileira de Enfermagem. 2020;73:e20190103
DOI 10.1590/0034-7167-2019-0103
- Fernanda Garcia Bezerra Góes ,
- Beatriz Cabral Ledo ,
- Andressa Silva Torres dos Santos ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Aline Cerqueira Santos Santana da Silva ,
- Marialda Moreira Christoffel
Views0See moreABSTRACT
Objectives:
to translate and culturally adapt the Infant Feeding Intentions Scale for pregnant women in Brazil.
Methods:
methodological study that included stages of translation, synthesis, face and content validation, back translation and semantic assessment. In the face and content and semantic validation stages, we used the Content Validity Index for individual items and for the overall scale for clarity and representativeness.
Results:
nine (100.0%) experts participated in face and content validation, and the average index obtained was 85.0% for representativeness. In the semantic assessment, performed with 31 (100.0%) pregnant women, the tool was considered clear, obtaining an average index of 91.0%.
Conclusions:
the Brazilian version of the scale was considered representative and clear. After assessing psychometric properties, the scale is expected to be valid and reliable to assess maternal intention to breastfeed exclusively until the infant’s six months of life in different Brazilian settings.
- Fernanda Garcia Bezerra Góes
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ORIGINAL ARTICLE03-30-2020
Parental care for infants with feeding tube: psychosocial repercussions
- Fábio Luiz Banhara ,
- Francely Tineli Farinha ,
- Gesiane Cristina Bom ,
- Ana Paula Ribeiro Razera ,
- Maria de Lourdes Merighi Tabaquim , [ … ],
- Armando dos Santos Trettene
Abstract
ORIGINAL ARTICLEParental care for infants with feeding tube: psychosocial repercussions
Revista Brasileira de Enfermagem. 2020;73(2):e20180360
DOI 10.1590/0034-7167-2018-0360
- Fábio Luiz Banhara ,
- Francely Tineli Farinha ,
- Gesiane Cristina Bom ,
- Ana Paula Ribeiro Razera ,
- Maria de Lourdes Merighi Tabaquim ,
- Armando dos Santos Trettene
Views0See moreABSTRACT
Objectives:
to understand the psychosocial repercussions experienced by caregiving parents, resulting from care for the child with dysphagic cleft lip and palate.
Methods:
qualitative study, developed in a tertiary hospital in September 2016. The sample defined by theoretical saturation consisted of seven mothers. Data collection was performed by unstructured interview, being audio-recorded and fully transcribed. Symbolic Interactionism was used as theoretical framework, and Thematic Content Analysis as methodological framework.
Results:
the following themes emerged: diagnosisimpact and coping; coping with overload and stress; interaction between caregivers as an acceptance and coping strategy; impact on family and social life of caregivers; and curiosity coping, and family and community prejudice.
Final considerations:
despite the physical and emotional overload, the mother figure plays the main and determining role in care, reflecting the complexity of care.
- Fábio Luiz Banhara
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ORIGINAL ARTICLE03-30-2020
Stomized children care practices: narratives of relatives
- Manuela Costa Melo ,
- Bárbara Natália Ferreira Vilas-Boas ,
- Brenda Limeira Martins ,
- Allan Willis Albernáz Vasconcellos ,
- Ivone Kamada
Abstract
ORIGINAL ARTICLEStomized children care practices: narratives of relatives
Revista Brasileira de Enfermagem. 2020;73(2):e20180370
DOI 10.1590/0034-7167-2018-0370
- Manuela Costa Melo ,
- Bárbara Natália Ferreira Vilas-Boas ,
- Brenda Limeira Martins ,
- Allan Willis Albernáz Vasconcellos ,
- Ivone Kamada
Views0See moreABSTRACT
Objectives:
to understand the practices adopted by relatives regarding ostomized children care.
Methods:
qualitative approach, conducted with 11 relatives of ostomized children. Methodological framework was used as narrative technique; NVivo® software for data categorization and information analysis; content analysis technique.
Results:
participants revealed unpreparedness in dealing with children, lack of knowledge about handling materials and equipment inherent to ostomy and challenges faced in the daily life of children in school. They are unanimous in telling they feel encouraged and strengthened by receiving support from nurses in child care. They suggested the development of strategies to guide ostomized children care, such as educational material use.
Conclusions:
to understand family members’ experience made it possible to support training and qualification of nursing professionals, and to establish priorities in care. Evidence found may contribute to reflections that aid health promotion and prevention of complications in ostomized children care.
- Manuela Costa Melo
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ORIGINAL ARTICLE06-16-2021
Family interview for organ and tissue donation: good practice assumptions
- Neide da Silva Knhis ,
- Sabrina Regina Martins ,
- Aline Lima Pestana Magalhães ,
- Saulo Fábio Ramos ,
- Camila Telemberg Sell , [ … ],
- Laura Calvacanti de Farias Brehmer
Abstract
ORIGINAL ARTICLEFamily interview for organ and tissue donation: good practice assumptions
Revista Brasileira de Enfermagem. 2021;74(2):e20190206
DOI 10.1590/0034-7167-2019-0206
- Neide da Silva Knhis ,
- Sabrina Regina Martins ,
- Aline Lima Pestana Magalhães ,
- Saulo Fábio Ramos ,
- Camila Telemberg Sell ,
- Clarice Koerich ,
- Laura Calvacanti de Farias Brehmer
Views0See moreABSTRACT
Objectives:
to identify information that can support creating good practice assumptions to develop family interview for organ and tissue donation.
Methods:
this scoping study, conducted in two Brazilian hospitals in the southern, between April and December 2017, included integrative review and consultation with 15 families who experienced interview for organ donation. For data analysis, thematic content analysis was used.
Results:
three categories emerged: communication of death, which shows the need to know the history of hospitalization of patients; emotional support, the team must have mastery of the stages of mourning; information about donation, professionals need to know the stages of the donation process and respect families’ time.
Final Considerations:
good practice assumptions point to the need for team training, respect for family time and the use of simple language.
- Neide da Silva Knhis
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ORIGINAL ARTICLE12-13-2019
Perception of women with breast cancer undergoing chemotherapy: a comprehensive analysis
- Marlise Barros de Medeiros ,
- Rose Mary Costa Rosa Andrade Silva ,
- Eliane Ramos Pereira ,
- Sérgio Henrique da Silva Melo ,
- Fabiana Lopes Joaquim , [ … ],
- Ticiane Roberta Pinto Goés
Abstract
ORIGINAL ARTICLEPerception of women with breast cancer undergoing chemotherapy: a comprehensive analysis
Revista Brasileira de Enfermagem. 2019;72:103-110
DOI 10.1590/0034-7167-2018-0165
- Marlise Barros de Medeiros ,
- Rose Mary Costa Rosa Andrade Silva ,
- Eliane Ramos Pereira ,
- Sérgio Henrique da Silva Melo ,
- Fabiana Lopes Joaquim ,
- Bianca Marques dos Santos ,
- Ticiane Roberta Pinto Goés
Views0See moreABSTRACT
Objective:
To comprehensively analyze the perception of women with breast cancer on the experience of undergoing chemotherapy.
Method:
This was a qualitative, descriptive, phenomenological study, supported by the Merleau-Ponty philosophy. It was conducted in a chemotherapy outpatient clinic with 20 participants who completed a phenomenological interview.
Results:
The phenomenological data analysis demonstrated that the perception of women about the experience of chemotherapy is about change, not only of the physical body, but of their identity, and that it considers existential aspects. Three categories emerged from the experience of alopecia, fatigue, and spirituality, respectively: the body itself, the current and habitual body, and transcendence.
Final considerations:
Bodily changes, and the existential implications perceived by the women in this study, analyzed from the Merleau-Ponty perspective, makes it possible to consider body concept, and provides support for humanized care based on singularity and the socio-cultural context.
- Marlise Barros de Medeiros
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REVIEW07-14-2021
Symptom management theory applied to nursing care: scoping review
Revista Brasileira de Enfermagem. 2021;74(3):e20201004
Abstract
REVIEWSymptom management theory applied to nursing care: scoping review
Revista Brasileira de Enfermagem. 2021;74(3):e20201004
DOI 10.1590/0034-7167-2020-1004
Views0See moreABSTRACT
Objectives:
to identify publications about the applicability of the Symptom Management Theory in nursing care to pediatric, adolescent, adult and elderly patients.
Methods:
scoping review following the steps: definition of the objective, research question and inclusion criteria; search, selection and analysis of publications; synthesis of results. The search occurred in the VHL, SciELO, CAPES and PubMed Journals Portal bases, contemplating publications between 1994 and July 2020.
Results:
out of 3,286 studies, ten were selected, published between 2008 and 2019. They described the relationships between the participants and the domains (person, environment, health and disease), components (symptom experience, management strategies, results) and presented strategies for symptom management.
Conclusions:
the Symptom Management Theory was considered applicable to the participants of the studies and to nursing care. It was concluded that understanding the interaction of these elements is essential to plan actions aimed at controlling symptoms effectively.
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