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ORIGINAL ARTICLE11-13-2023
Elaboration and validity of the Instrumento para Avaliação de Modelos metodológicos voltados ao Desenvolvimento de Tecnologias
- Cléton Salbego
, - Elisabeta Albertina Nietsche ,
- Patrícia Bitencourt Toscani Greco ,
- Nara Marilene Oliveira Girardon-Perlini ,
- Silvana Bastos Cogo , [ … ],
- Andrei Pompeu Antunes
Abstract
ORIGINAL ARTICLEElaboration and validity of the Instrumento para Avaliação de Modelos metodológicos voltados ao Desenvolvimento de Tecnologias
Revista Brasileira de Enfermagem. 2023;76:e20230046
DOI 10.1590/0034-7167-2023-0046
- Cléton Salbego ,
- Elisabeta Albertina Nietsche ,
- Patrícia Bitencourt Toscani Greco ,
- Nara Marilene Oliveira Girardon-Perlini ,
- Silvana Bastos Cogo ,
- Tierle Kosloski Ramos ,
- Andrei Pompeu Antunes
Views0See moreABSTRACT
Objective:
to elaborate and validate the Instrumento para Avaliação de Modelos metodológicos voltados ao Desenvolvimento de Tecnologias.
Methods:
a methodological study, developed in three stages: instrument structuring through documentary research and researchers’ expertise; instrument validity with a panel of 11 expert judge nurses; and instrument final composition.
Results:
the instrument, after validity by experts, consisted of 30 items, divided into the content (26 items) and appearance (four items) domains. In the initial instrument validity process, 11 items were modified and seven were withdrawn, as they had a percentage of agreement below 0.80. The instrument showed excellent internal consistency, with values greater than 0.90 in its psychometric criteria.
Conclusion:
the instrument produced and validated aimed at assessing research methodological models for technological development showed good reliability, and may contribute to the methodological rigor of technological development research in nursing.
- Cléton Salbego
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ORIGINAL ARTICLE11-13-2023
Educational technology on tuberculosis: construction shared with Primary Health Care nurses
- Aloma Sena Soares ,
- Laura Maria Vidal Nogueira ,
- Erlon Gabriel Rego de Andrade ,
- Élida Fernanda Rêgo de Andrade ,
- Ivaneide Leal Ataíde Rodrigues
Abstract
ORIGINAL ARTICLEEducational technology on tuberculosis: construction shared with Primary Health Care nurses
Revista Brasileira de Enfermagem. 2023;76:e20230025
DOI 10.1590/0034-7167-2023-0025
- Aloma Sena Soares ,
- Laura Maria Vidal Nogueira ,
- Erlon Gabriel Rego de Andrade ,
- Élida Fernanda Rêgo de Andrade ,
- Ivaneide Leal Ataíde Rodrigues
Views0See moreABSTRACT
Objective:
to develop, in a participatory way, an educational technology to assist nurses in the management of tuberculosis cases in Primary Health Care.
Methods:
methodological research with a qualitative approach. Data were collected between June and October 2022, in 25 Basic Health Units, with 41 nurses interviewed individually. Thematic content analysis was carried out to guide technology elaboration.
Results:
three empirical categories were organized, demonstrating the facilities and difficulties in tuberculosis management, the conceptions about educational technology as a facilitator of the teaching-learning process in Primary Health Care and participatory development of technology. Nurses were in favor of constructing an instructional guide technology, and made suggestions to encourage its creation and use in daily service routine.
Final considerations:
the participatory process made it possible to create technology to assist nurses in the teaching-learning process in Primary Health Care about caring for people with tuberculosis.
- Aloma Sena Soares
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ORIGINAL ARTICLE11-13-2023
Access of people with pulmonary tuberculosis to government programs: Primary Care professionals’ perceptions
- Hildegard Soares Barrozo de Lima ,
- Vitória Regina Domingues Sodré ,
- Cleide Aparecida Alves Souza ,
- Mirian Domingos Cardoso ,
- Crhistinne Cavalheiro Maymone Gonçalves , [ … ],
- Ethel Leonor Noia Maciel
Abstract
ORIGINAL ARTICLEAccess of people with pulmonary tuberculosis to government programs: Primary Care professionals’ perceptions
Revista Brasileira de Enfermagem. 2023;76:e20220716
DOI 10.1590/0034-7167-2022-0716
- Hildegard Soares Barrozo de Lima ,
- Vitória Regina Domingues Sodré ,
- Cleide Aparecida Alves Souza ,
- Mirian Domingos Cardoso ,
- Crhistinne Cavalheiro Maymone Gonçalves ,
- Laura Maria Vidal Nogueira ,
- Ivaneide Leal Ataíde Rodrigues ,
- Erlon Gabriel Rego de Andrade ,
- Alexandre Aguiar Pereira ,
- Maria Catarina Salvador da Motta ,
- Maria Helena do Nascimento Souza ,
- Regina Célia Gollner Zeitoune ,
- Ethel Leonor Noia Maciel
Views0See moreABSTRACT
Objective:
to analyze Primary Health Care professionals’ perceptions about the access of people with pulmonary tuberculosis to government social support and income transfer programs.
Methods:
multicenter/qualitative study, carried out in Family Health Units in four Brazilian capitals: Belém/Pará, Campo Grande/Mato Grosso do Sul, Recife/Pernambuco and Rio de Janeiro/Rio de Janeiro. Fifty-eight professionals participated (social workers, dentists, nurses, pharmacists, physicians and nursing technicians), who provided assistance to people with pulmonary tuberculosis. Individual interviews were conducted, and the content analysis technique was used.
Results:
among the participants, 45/77.6% were women and 33/56.9% were between 25 and 40 years old. Two thematic categories were organized, demonstrating the perceptions about the possibilities of access to government programs by people with pulmonary tuberculosis in vulnerable situations and the obstacles inherent to this context.
Final considerations:
it is necessary to move forward in improving patient access to social programs.
- Hildegard Soares Barrozo de Lima
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ORIGINAL ARTICLE11-13-2023
Vulnerability to physical inactivity: evidence of content validity and response processes
- Déborah Santana Pereira ,
- Raquel Sampaio Florêncio ,
- Virna Ribeiro Feitosa Cestari ,
- Thereza Maria Magalhães Moreira
Abstract
ORIGINAL ARTICLEVulnerability to physical inactivity: evidence of content validity and response processes
Revista Brasileira de Enfermagem. 2023;76:e20220563
DOI 10.1590/0034-7167-2022-0563
- Déborah Santana Pereira ,
- Raquel Sampaio Florêncio ,
- Virna Ribeiro Feitosa Cestari ,
- Thereza Maria Magalhães Moreira
Views0See moreABSTRACT
Objective:
To analyze content validity evidence and response processes of a bank of items for measuring vulnerability to physical inactivity in adults.
Method:
Methodological study, with 13 specialists and 46 representatives of the target population. The Content Validity Index (CVI) and binomial test were calculated; data obtained through validity based on response processes were collected through interviews.
Results:
Of the 105 constructed items, 16 were excluded (CVI<0.78); 89 items showed agreement <80% in the psychometric criteria, being modified. Of the 101 items that remained (CVI>0.78), 34 were changed and 4 were deleted after evaluating the evidence of response processes. In the end, 97 items remained, with a global CVI of 0.92, organized into two dimensions: Subject (CVI=0.91) and Social (CVI=0.94).
Conclusion:
The items presented adequate parameters and evidence of validity; and can subsidize the construction of instruments that consider the subject’s and social vulnerability in understanding physical inactivity.
- Déborah Santana Pereira
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REVIEW11-13-2023
Ocular dryness in intensive care: proposal for a new nursing diagnosis
- Jéssica Naiara de Medeiros Araújo ,
- Ana Paula Nunes de Lima Fernandes ,
- Ana Clara Dantas ,
- Marcos Antonio Ferreira Júnior ,
- Marcos Venícios de Oliveira Lopes , [ … ],
- Allyne Fortes Vitor
Abstract
REVIEWOcular dryness in intensive care: proposal for a new nursing diagnosis
Revista Brasileira de Enfermagem. 2023;76:e20220698
DOI 10.1590/0034-7167-2022-0698
- Jéssica Naiara de Medeiros Araújo ,
- Ana Paula Nunes de Lima Fernandes ,
- Ana Clara Dantas ,
- Marcos Antonio Ferreira Júnior ,
- Marcos Venícios de Oliveira Lopes ,
- Allyne Fortes Vitor
Views0See moreABSTRACT
Objective:
to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences.
Methods:
a methodological study carried out through concept analysis, operationalized by scoping review.
Results:
the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume.
Conclusions:
this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.
- Jéssica Naiara de Medeiros Araújo
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11-13-2023
Digital technology for the prevention of healthcare-related infections in critical care
- Letícia Pontes ,
- Bárbara Alessandra Tibério ,
- Jéssica de Fátima Gomes Pereira ,
- Renata Rodrigues da Luz
Abstract
Digital technology for the prevention of healthcare-related infections in critical care
Revista Brasileira de Enfermagem. 2023;76:e20220528
DOI 10.1590/0034-7167-2022-0528
- Letícia Pontes ,
- Bárbara Alessandra Tibério ,
- Jéssica de Fátima Gomes Pereira ,
- Renata Rodrigues da Luz
Views0See moreABSTRACT
Objective:
To develop digital technology for patient and family integration into the Intensive Care Unit care team, aiming to subsidize decision-making for the prevention of infections related to healthcare.
Method:
Methodological research of technological production in three phases: pre-production, production, and post-production in a teaching hospital in southern Brazil. Sixteen intensive care unit nurses participated.
Results:
The research produced six videos: general guidelines on the Intensive Care Unit, Preventing infections: hand hygiene; Pneumonia associated with mechanical ventilation; Catheter-associated primary bloodstream infection; Catheter-related urinary tract infection.
Final considerations:
The proposed technology was developed and aims to assist nurses in bringing patients and families closer to the routines of the intensive care environment to provide safety in the contact of the patient of intensive care units with family members and in the active participation for the prevention of infections related to healthcare.
- Letícia Pontes
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11-10-2023
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreRESUMEN
Objetivos:
analizar la efectividad del uso de libros interactivos multimodales en enfermería pediátrica sobre los resultados de aprendizaje de los estudiantes en la implementación del Programa Merdeka Belajar.
Métodos:
investigación cuasi-experimental con un diseño de grupo de control posterior a la prueba. En este estudio, la muestra incluyó 52 estudiantes de enfermería del cuarto semestre del Instituto de Ciencias de la Salud Suaka Insan Banjarmasin que recibieron el curso de Enfermería Pediátrica. Fue utilizada la técnica de muestreo total y la prueba t dependiente en el análisis de datos.
Resultados:
el libro interactivo multimodal de enfermería pediátrica fue efectivo en la mejora del logro de aprendizaje de los estudiantes de cuarto semestre con un valor de significancia de 0,015 < 0,05. Hay una diferencia en el valor promedio de los cursos de enfermería pediátrica para la clase A y la clase B, que es de 3,173.
Conclusiones:
el uso de libros multimodales interactivos es muy bueno para que los profesores los apliquen en la enseñanza para ayudar a los estudiantes a comprender el material que están aprendiendo.
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ERRATUM11-10-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04
Views0In the article “First graduate of the Master of Nursing in Advanced Practice in Oncology in Chile”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023(Suppl 4):e76suppl401, in the second paragraph:Where it read:[…]See more
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02-05-2021
Contents related to nursing professionals during the COVID-19 pandemic on the Youtube™ platform
- Evanilda Souza de Santana Carvalho ,
- Paulo Roberto Lima Falcão doVale ,
- Karina Araújo Pinto ,
- Sílvia Lúcia Ferreira
Abstract
Contents related to nursing professionals during the COVID-19 pandemic on the Youtube™ platform
Revista Brasileira de Enfermagem. 2021;74:e20200581
DOI 10.1590/0034-7167-2020-0581
- Evanilda Souza de Santana Carvalho ,
- Paulo Roberto Lima Falcão doVale ,
- Karina Araújo Pinto ,
- Sílvia Lúcia Ferreira
Views0See moreABSTRACT
Objective:
to characterize the content of Youtube™ videos related to nursing professionals during the COVID-19 pandemic.
Method:
a qualitative study that examined 47 videos on Youtube™ posted between 11/03 and 11/04 2020, which were subjected to thematic analysis.
Results:
four categories emerged: “the role of nurses in care production during the pandemic”, which addresses the management of services and individual care; “Overview of the pandemic from the perspective of nurses in different countries”, presenting experiences and encouraging physical distance; “Tributes and motivation to mobilize the category”, in addition to targeted tributes, calls for nurses to claim their rights; “Criticisms and demands to improve working conditions”, which highlights the insecurity of care provision settings.
Final considerations:
nursing work conditions in different countries, recognition of the importance of professionals during the pandemic, and claims of the category to improve working conditions were the main content found on Youtube™.
- Evanilda Souza de Santana Carvalho
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REVIEW07-13-2020
Prevention and control measures for neonatal COVID-19 infection: a scoping review
- Bruna Hinnah Borges Martins de Freitas ,
- Mayrene Dias de Sousa Moreira Alves ,
- Maria Aparecida Munhoz Gaíva
Abstract
REVIEWPrevention and control measures for neonatal COVID-19 infection: a scoping review
Revista Brasileira de Enfermagem. 2020;73:e20200467
DOI 10.1590/0034-7167-2020-0467
- Bruna Hinnah Borges Martins de Freitas ,
- Mayrene Dias de Sousa Moreira Alves ,
- Maria Aparecida Munhoz Gaíva
Views0See moreABSTRACT
Objective:
to identify with the literature the measures to prevent and control neonatal infection by COVID-19.
Methods:
a scope review carried out by searching for studies in databases and institutional health websites. The final sample was 25 articles.
Results:
among the main measures are the use of masks by suspected or infected people in contact with healthy newborns, hand hygiene before and after each care and feeding as well as the tools used for milking. It is indispensable to use personal protective equipment by health professionals in neonatology services to maintain a private room for infected newborns or to use physical barriers. Early diagnosis and timely case management is essential to reduce virus transmissibility.
Conclusions:
the research contributed to elucidate health and nursing actions in preventing and controlling neonatal infection by COVID-19.
- Bruna Hinnah Borges Martins de Freitas
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REVIEW06-17-2020
Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review
- João Marcos Alves Melo ,
- Patrícia Peres de Oliveira ,
- Raíssa Silva Souza ,
- Deborah Franscielle da Fonseca ,
- Thaís Fonseca Gontijo , [ … ],
- Andrea Bezerra Rodrigues
Abstract
REVIEWPrevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review
Revista Brasileira de Enfermagem. 2020;73(4):e20190008
DOI 10.1590/0034-7167-2019-0008
- João Marcos Alves Melo ,
- Patrícia Peres de Oliveira ,
- Raíssa Silva Souza ,
- Deborah Franscielle da Fonseca ,
- Thaís Fonseca Gontijo ,
- Andrea Bezerra Rodrigues
Views0See moreABSTRACT
Objectives:
to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses.
Methods:
scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way.
Results:
a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients.
Conclusions:
the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.
- João Marcos Alves Melo
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REFLECTION09-07-2020
Training and work process in Multiprofessional Residency in Health as innovative strategy
- Mariana da Silva Bernardo ,
- Greici Capellari Fabrizzio ,
- Marina Leite Souza ,
- Thiago Oliveira dos Santos ,
- Selma Regina de Andrade
Abstract
REFLECTIONTraining and work process in Multiprofessional Residency in Health as innovative strategy
Revista Brasileira de Enfermagem. 2020;73(6):e20190635
DOI 10.1590/0034-7167-2019-0635
- Mariana da Silva Bernardo ,
- Greici Capellari Fabrizzio ,
- Marina Leite Souza ,
- Thiago Oliveira dos Santos ,
- Selma Regina de Andrade
Views0See moreABSTRACT
Objectives: To
reflect about education in health and work process on three programs of multiprofessional residency in Florianópolis/SC.
Method:
Reflexive study about Multiprofessional Residency Health Programs of Florianópolis.
Results:
Multiprofessional Residency characterizes training health professionals through service education. Developing these professionals’ specialization with assignments that promote professional exercise and magnifies multiprofessional work at the same time, for excellency in unabridged healthcare.
Final Considerations:
Multiprofessional Residency Programs make interdisciplinary education, sharing knowledge between residents and other professionals stimulating development of innovation skills.
- Mariana da Silva Bernardo
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ORIGINAL ARTICLE06-08-2020
Understanding the dramatic therapeutic play session: a contribution to pediatric nursing
Revista Brasileira de Enfermagem. 2020;73(4):e20180812
Abstract
ORIGINAL ARTICLEUnderstanding the dramatic therapeutic play session: a contribution to pediatric nursing
Revista Brasileira de Enfermagem. 2020;73(4):e20180812
DOI 10.1590/0034-7167-2018-0812
Views0See moreABSTRACT
Objectives:
to understand how the dramatic therapeutic play session occurs within the care of hospitalized children.
Methods:
qualitative multiple case study, using theoretical references, such as symbolic interactionism and Vygotsky’s theory of symbolic play. Twenty play sessions performed with six children from 3 to 10 years old were analyzed, each corresponding to one case.
Results:
these sessions demonstrated that a dramatic therapeutic play session is a process of four interdependent and complementary steps: bonding, exploring, dramatizing, and play cessation. They also revealed the imaginary situations externalized by the child, the importance of the exploration step for which they manage the imaginary situation and catharsis, and how her higher psychological faculties are articulated during this process.
Final Considerations:
the results contribute to the understanding of the conduct and analysis of the dramatic therapeutic play session, reinforcing the importance of its use in pediatric nursing care practice.
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ORIGINAL ARTICLE02-10-2020
Motivation and difficulties to reduce or quit smoking
- Maria Odete Pereira ,
- Bianca Cristina Silva de Assis ,
- Natália de Magalhães Ribeiro Gomes ,
- Alisson Rubson Alves ,
- Amanda Márcia dos Santos Reinaldo , [ … ],
- Mark Anthony Beinner
Abstract
ORIGINAL ARTICLEMotivation and difficulties to reduce or quit smoking
Revista Brasileira de Enfermagem. 2020;73(1):e20180188
DOI 10.1590/0034-7167-2018-0188
- Maria Odete Pereira ,
- Bianca Cristina Silva de Assis ,
- Natália de Magalhães Ribeiro Gomes ,
- Alisson Rubson Alves ,
- Amanda Márcia dos Santos Reinaldo ,
- Mark Anthony Beinner
Views0See moreABSTRACT
Objective:
To understand what factors motivate people to reduce or stop tobacco use and what difficulties they face in this process.
Method:
Qualitative, empirical and interpretative research that used a focal group technique for data collection and Discourse Analysis as a theoretical reference for analysis.
Results:
The responses centered on the following aspects: motivation for reduction or cessation of smoking, family and community support received during treatment, benefits from cessation of tobacco, difficulties encountered and strategies for overcoming triggers.
Final Considerations:
The results showed that the users expressed their desire for cessation of tobacco use and that to achieve this goal, family and group support, professional help and changing habits are key factors for this process.
- Maria Odete Pereira
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ORIGINAL ARTICLE02-10-2020
Common mental disorders in nursing students of the professionalizing cycle
- Elias Barbosa de Oliveira ,
- Regina Célia Gollner Zeitoune ,
- Cristiane Helena Gallasch ,
- Eugenio Fuentez Pérez Júnior ,
- Alexandre Vicente da Silva , [ … ],
- Thiago Carvalho de Souza
Abstract
ORIGINAL ARTICLECommon mental disorders in nursing students of the professionalizing cycle
Revista Brasileira de Enfermagem. 2020;73(1):e20180154
DOI 10.1590/0034-7167-2018-0154
- Elias Barbosa de Oliveira ,
- Regina Célia Gollner Zeitoune ,
- Cristiane Helena Gallasch ,
- Eugenio Fuentez Pérez Júnior ,
- Alexandre Vicente da Silva ,
- Thiago Carvalho de Souza
Views0See moreABSTRACT
Objectives:
to verify the suspicion of common mental disorders in nursing students of the professionalizing cycle and the association with sociodemographic features.
Method:
cross-sectional study with a sample of 85 students from a public university in the state of Rio de Janeiro (RJ) who responded to the Self-Report Questionnaire-20 and sociodemographic questions.
Results:
the suspicion prevalence of common mental disorders (CMD) in the sample was 55.3% and it was identified the association with the consumption of alcohol. Of the most frequent SRQ-20 complaints, 95.3% reported “feeling nervous, tense or worried”, 72.9% “having difficulty making decisions”, 60% “sleeping poorly” and 37.6% “having lost interest by things “.
Conclusion:
high prevalence of CMD in the sample and the association with the consumption of alcohol requires preventive and therapeutic actions among the students that minimize the possibility of severe mental disorders related to the consumption of alcohol and other drugs.
- Elias Barbosa de Oliveira
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ORIGINAL ARTICLE06-27-2019
Insertion of central vascular catheter: adherence to infection prevention bundle
- Eliana Ofelia Llapa-Rodríguez ,
- Júlian Katrin Albuquerque de Oliveira ,
- Fernanda Carneiro Melo ,
- Gilvan Gomes da Silva ,
- Maria Cláudia Tavares de Mattos , [ … ],
- Vinicius Paraíso Macieira Jr
Abstract
ORIGINAL ARTICLEInsertion of central vascular catheter: adherence to infection prevention bundle
Revista Brasileira de Enfermagem. 2019;72(3):774-779
DOI 10.1590/0034-7167-2018-0124
- Eliana Ofelia Llapa-Rodríguez ,
- Júlian Katrin Albuquerque de Oliveira ,
- Fernanda Carneiro Melo ,
- Gilvan Gomes da Silva ,
- Maria Cláudia Tavares de Mattos ,
- Vinicius Paraíso Macieira Jr
Views0See moreABSTRACT
Objective:
To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis.
Method:
Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016.
Results:
The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day.
Conclusion:
Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.
- Eliana Ofelia Llapa-Rodríguez
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