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ORIGINAL ARTICLE10-01-2022
Career commitment and career entrenchment among Primary Health Care workers
- Luciano Garcia Lourenção
, - Jacqueline Flores de Oliveira ,
- Francisco Rosemiro Guimarães Ximenes Neto ,
- Carlos Leonardo Figueiredo Cunha ,
- Sandra Verónica Valenzuela-Suazo , [ … ],
- Cláudia Eli Gazetta
Abstract
ORIGINAL ARTICLECareer commitment and career entrenchment among Primary Health Care workers
Revista Brasileira de Enfermagem. 2022;75(1):e20200144
DOI 10.1590/0034-7167-2021-0144
- Luciano Garcia Lourenção ,
- Jacqueline Flores de Oliveira ,
- Francisco Rosemiro Guimarães Ximenes Neto ,
- Carlos Leonardo Figueiredo Cunha ,
- Sandra Verónica Valenzuela-Suazo ,
- Márcio Andrade Borges ,
- Cláudia Eli Gazetta
Views0INTRODUCTION In Brazil, the large contingent that makes up the workforce of Primary Health Care (PHC) workers experiences intense social and labor vulnerability. The literature reports the precarious working conditions of these workers, with weak or temporary job contracts, low salaries, not job position or salary plans, increased outsourcing, high turnover, and illnesses. All these […]See more
- Luciano Garcia Lourenção
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10-01-2022
Benchmarking of mobile apps on heart failure
- Virna Ribeiro Feitosa Cestari ,
- Raquel Sampaio Florêncio ,
- Thiago Santos Garces ,
- Vera Lucia Mendes de Paula Pessoa ,
- Thereza Maria Magalhães Moreira
Abstract
Benchmarking of mobile apps on heart failure
Revista Brasileira de Enfermagem. 2022;75(1):e20201093
DOI 10.1590/0034-7167-2020-1093
- Virna Ribeiro Feitosa Cestari ,
- Raquel Sampaio Florêncio ,
- Thiago Santos Garces ,
- Vera Lucia Mendes de Paula Pessoa ,
- Thereza Maria Magalhães Moreira
Views0INTRODUCTIONHeart failure (HF) is an emerging global threat, with a current prevalence of 64.34 million cases on the planet (8.52 per 1,000 inhabitants), representing 9.91 million years lost due to disability and spending of US$346.17 billion(), with a prospect of an increase despite therapeutic advances. These data alert to the prioritization of preventive actions and […]See more
- Virna Ribeiro Feitosa Cestari
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ORIGINAL ARTICLE10-01-2022
Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship
- Gerlania Rodrigues Salviano Ferreira ,
- Lia Raquel de Carvalho Viana ,
- Cláudia Jeane Lopes Pimenta ,
- Cleane Rosa Ribeiro da Silva ,
- Tatiana Ferreira da Costa , [ … ],
- Kátia Neyla de Freitas Macedo Costa
Abstract
ORIGINAL ARTICLESelf-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship
Revista Brasileira de Enfermagem. 2022;75(1):e20201257
DOI 10.1590/0034-7167-2020-1257
- Gerlania Rodrigues Salviano Ferreira ,
- Lia Raquel de Carvalho Viana ,
- Cláudia Jeane Lopes Pimenta ,
- Cleane Rosa Ribeiro da Silva ,
- Tatiana Ferreira da Costa ,
- Jacira dos Santos Oliveira ,
- Kátia Neyla de Freitas Macedo Costa
Views1INTRODUCTIONChronic non-communicable diseases are the main causes of death and health problems in the world, causing about 41 million deaths each year, which corresponds to approximately 71% of all deaths. Among these diseases, diabetes mellitus has stood out due to the increase in its incidence and prevalence().Estimates indicate that 463 million people live with diabetes […]See more - Gerlania Rodrigues Salviano Ferreira
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ORIGINAL ARTICLE10-01-2022
Factors associated with presenteeism in nursing workers
- Bruno da Silva Santos ,
- Fernanda Ludmilla Rossi Rocha ,
- Juliano Bortolini ,
- Fábio de Souza Terra ,
- Marília Duarte Valim
Abstract
ORIGINAL ARTICLEFactors associated with presenteeism in nursing workers
Revista Brasileira de Enfermagem. 2022;75(1):e20201290
DOI 10.1590/0034-7167-2020-1290
- Bruno da Silva Santos ,
- Fernanda Ludmilla Rossi Rocha ,
- Juliano Bortolini ,
- Fábio de Souza Terra ,
- Marília Duarte Valim
Views0See moreABSTRACT
Objective:
to analyze factors associated with presenteeism in nursing workers with sociodemographic variables, health and work conditions, productivity and musculoskeletal symptoms.
Methods:
this is a cross-sectional, descriptive and analytical study, with 306 nursing workers from a hospital and municipal emergency room in a Brazilian capital. The Stanford Presenteeism Scale, the Work Limitations Questionnaire, the Nordic Musculoskeletal Questionnaire and a demographic questionnaire on nursing professionals’ working conditions and health were used. Bivariate and multivariate analyzes were performed, respecting a significance level of 5%.
Results:
presenteeism was found in 43.8% of professionals and significant associations with CLT work (p=0.002), workplace – Intensive Care Units (p=0.008), physical exercise twice a week (p=0.008), presence of musculoskeletal symptoms, with low back pain being representative (p=0.001). The productivity loss was 8.8.
Conclusions:
the study confirms a high rate of presenteeism among nursing workers.
- Bruno da Silva Santos
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ORIGINAL ARTICLE09-29-2022
Relationship between family functionality and the quality of life of the elderly
- Edison Vitório de Souza Júnior ,
- Eduarda Raquel Viana ,
- Diego Pires Cruz ,
- Cristiane dos Santos Silva ,
- Randson Souza Rosa , [ … ],
- Namie Okino Sawada
Abstract
ORIGINAL ARTICLERelationship between family functionality and the quality of life of the elderly
Revista Brasileira de Enfermagem. 2022;75(2):e20210106
DOI 10.1590/0034-7167-2021-0106
- Edison Vitório de Souza Júnior ,
- Eduarda Raquel Viana ,
- Diego Pires Cruz ,
- Cristiane dos Santos Silva ,
- Randson Souza Rosa ,
- Lais Reis Siqueira ,
- Namie Okino Sawada
Views0See moreABSTRACT
Objective:
To analyze the correlation between family functionality and the quality of life of the elderly.
Method:
Sectional and correlational study conducted with 692 Brazilian elderly between July and October 2020. The elderly filled three instruments: biosociodemographic, family APGAR and WHOQOL-Old. The tests Kruskal-Wallis, Pearson correlation, and linear regression analyzed the data. The study considered a 95% confidence interval (p < 0.05) for all analyses.
Results:
The elderly with mild and severe family dysfunction presented worse quality of life when compared to the elderly with a functional family. All facets of quality of life correlated positively with family functionality.
Conclusion:
Family functionality is positively correlated with the quality of life of the elderly, therefore requiring the inclusion of the family in health care plans to identify potential family stressors early and plan interventions to solve the problems raised.
- Edison Vitório de Souza Júnior
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ORIGINAL ARTICLE09-29-2022
Implementation of evidence-based practices in the perineal pain management in the postpartum period
Revista Brasileira de Enfermagem. 2022;75(2):e20210084
Abstract
ORIGINAL ARTICLEImplementation of evidence-based practices in the perineal pain management in the postpartum period
Revista Brasileira de Enfermagem. 2022;75(2):e20210084
DOI 10.1590/0034-7167-2021-0084
Views0See moreABSTRACT
Objectives:
To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices.
Methods:
Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women.
Results:
Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices.
Conclusion:
There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.
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EXPERIENCE REPORT09-29-2022
Support group for families with children in a pediatric intensive care unit
- Erika Sana Moraes ,
- Camila Cazissi da Silva ,
- Luciana de Lione Melo ,
- Ana Márcia Chiaradia Mendes-Castillo
Abstract
EXPERIENCE REPORTSupport group for families with children in a pediatric intensive care unit
Revista Brasileira de Enfermagem. 2022;75(2):e20210097
DOI 10.1590/0034-7167-2021-0097
- Erika Sana Moraes ,
- Camila Cazissi da Silva ,
- Luciana de Lione Melo ,
- Ana Márcia Chiaradia Mendes-Castillo
Views0See moreABSTRACT
Objective:
To describe the process of creating and implementing a support group for families with children in a pediatric intensive care unit.
Methods:
A professional experience report described using a management and planning tool.
Results:
This is a pioneering initiative in the hospital. The application of the tool enabled the delineation of the scope, justification, location, frequency, responsible persons, approach, and budget. After its implementation, the group enables significant interaction between health professionals-families and families-families, favoring the formation of therapeutic bonds and stimulating social and emotional support networks.
Conclusion:
The tool effectively planned the group and highlighted its effects on family coping and the relationships between professionals and families.
- Erika Sana Moraes
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ORIGINAL ARTICLE09-29-2022
Profile of nursing diagnoses in indigenous older adults in the community: a cross-sectional study
- Carlos Jordão de Assis Silva ,
- Tarcísio Tércio das Neves Júnior ,
- Eloisa Araújo de Carvalho ,
- Valéria Gomes Fernandes da Silva ,
- Sheyla Gomes Pereira de Almeida , [ … ],
- Rejane Maria Paiva de Menezes
Abstract
ORIGINAL ARTICLEProfile of nursing diagnoses in indigenous older adults in the community: a cross-sectional study
Revista Brasileira de Enfermagem. 2022;75(2):e20210128
DOI 10.1590/0034-7167-2021-0128
- Carlos Jordão de Assis Silva ,
- Tarcísio Tércio das Neves Júnior ,
- Eloisa Araújo de Carvalho ,
- Valéria Gomes Fernandes da Silva ,
- Sheyla Gomes Pereira de Almeida ,
- Rejane Maria Paiva de Menezes
Views0See moreABSTRACT
Objective:
to describe the profile of nursing diagnoses evidenced in indigenous elderly in the community.
Methods:
this is a cross-sectional study, carried out with 51 indigenous elderly people of Potiguara ethnicity, through a nursing consultation. The clinical data, obtained from the consultation, were analyzed following Risner’s diagnostic reasoning process and the NANDA-I Taxonomy (2018-2020). For greater accuracy, the diagnoses obtained underwent peer review by a specialist.
Results:
37 diagnoses were identified, such as Impaired dentition (98.0%), Risk for impaired skin integrity (66.7%), Chronic pain (64.7%), Risk for deficient fluid volume (54.9%), Impaired swallowing (45.1%), Impaired walking (45.1%), Disturbed sleep pattern (43.1%), Stress urinary incontinence (41.2%), Risk for falls (35.3%), and Sexual dysfunction (33.3%).
Conclusion:
the diagnoses identified were predominantly from Safety/protection domain and result from factors that negatively influence indigenous elderly’s functional capacity.
- Carlos Jordão de Assis Silva
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REVIEW03-07-2022
Gender violence perpetrated against trans women
- Izabel Cristina Brito da Silva ,
- Ednaldo Cavalcante de Araújo ,
- Alef Diogo da Silva Santana ,
- Jefferson Wildes da Silva Moura ,
- Marclineide Nóbrega de Andrade Ramalho , [ … ],
- Paula Daniella de Abreu
Abstract
REVIEWGender violence perpetrated against trans women
Revista Brasileira de Enfermagem. 2022;75:e20210173
DOI 10.1590/0034-7167-2021-0173
- Izabel Cristina Brito da Silva ,
- Ednaldo Cavalcante de Araújo ,
- Alef Diogo da Silva Santana ,
- Jefferson Wildes da Silva Moura ,
- Marclineide Nóbrega de Andrade Ramalho ,
- Paula Daniella de Abreu
Views0See moreABSTRACT
Objectives:
to identify scientific evidence on gender violence perpetrated against trans women.
Methods:
integrative review, carried out in June 2020, without time frame, in the Scopus, MEDLINE, Embase, CINAHL, WoS, PsycInfo and LILACS databases. The controlled descriptors of DeCS, MeSH and their entry terms were used: “Transgender People”, “Transgender”, “Gender Identity”, “Transsexuality”, “Gender Violence”, “Aggression”, “Sexual Offenses”, “Rape”, “Violence”, “Domestic Violence”. The presentation and synthesis of the results were presented in the PRISMA-2009 flowchart.
Results:
the final sample, consisting of 16 articles, identified different types of violence (sexual, physical, verbal, psychological and financial), perpetrated by family members, strangers, police officers, intimate partners, health professionals, acquaintances, or friends.
Conclusions:
trans women suffer violence and social exclusion that result from stigma and discrimination due to gender identity and result in unrestricted damage to physical health.
- Izabel Cristina Brito da Silva
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ORIGINAL ARTICLE07-01-2020
Quality of life and osteomuscular symptoms in workers of primary health care
- João Roberto Cordioli Junior ,
- Dezolina Franciele Cardin Cordioli ,
- Claudia Eli Gazetta ,
- Albertina Gomes da Silva ,
- Luciano Garcia Lourenção
Abstract
ORIGINAL ARTICLEQuality of life and osteomuscular symptoms in workers of primary health care
Revista Brasileira de Enfermagem. 2020;73(5):e20190054
DOI 10.1590/0034-7167-2019-0054
- João Roberto Cordioli Junior ,
- Dezolina Franciele Cardin Cordioli ,
- Claudia Eli Gazetta ,
- Albertina Gomes da Silva ,
- Luciano Garcia Lourenção
Views1See moreABSTRACT
Objectives:
to evaluate the quality of life and musculoskeletal symptoms in primary care workers.
Methods:
descriptive, correlational and cross-sectional study with 85 workers using the WHOQOL-Bref and Nordic Osteomuscular Symptoms Questionnaire.
Results:
lower quality of life for the Environment domain and higher for Social Relationships. Workers reported pain in lower back, neck, shoulders, wrists/hands/fingers and knees. Neck pain influenced Physical (p=0.015) and Psychological (p=0.030) domains; shoulder pain (p=0.004) and dorsal region (p=0.013) influenced the Physical domain; pain in knees influenced Physical (p=0.000) and Environment (p=0.032) domains; pain in the ankles/feet influenced Physical (p=0.000), Psychological (p=0.032) and Environment (p=0.007) domains; pain in the dorsal region influenced the Physical domain (p=0.013).
Conclusions:
workers evaluated their quality of life as good or very good and reported to be satisfied or very satisfied with their health. They also reported pains in lower back, neck, shoulders, wrists/hands/fingers and knees. Pain has influenced the quality of life.
- João Roberto Cordioli Junior
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ORIGINAL ARTICLE10-01-2022
Factors associated with presenteeism in nursing workers
- Bruno da Silva Santos ,
- Fernanda Ludmilla Rossi Rocha ,
- Juliano Bortolini ,
- Fábio de Souza Terra ,
- Marília Duarte Valim
Abstract
ORIGINAL ARTICLEFactors associated with presenteeism in nursing workers
Revista Brasileira de Enfermagem. 2022;75(1):e20201290
DOI 10.1590/0034-7167-2020-1290
- Bruno da Silva Santos ,
- Fernanda Ludmilla Rossi Rocha ,
- Juliano Bortolini ,
- Fábio de Souza Terra ,
- Marília Duarte Valim
Views0See moreABSTRACT
Objective:
to analyze factors associated with presenteeism in nursing workers with sociodemographic variables, health and work conditions, productivity and musculoskeletal symptoms.
Methods:
this is a cross-sectional, descriptive and analytical study, with 306 nursing workers from a hospital and municipal emergency room in a Brazilian capital. The Stanford Presenteeism Scale, the Work Limitations Questionnaire, the Nordic Musculoskeletal Questionnaire and a demographic questionnaire on nursing professionals’ working conditions and health were used. Bivariate and multivariate analyzes were performed, respecting a significance level of 5%.
Results:
presenteeism was found in 43.8% of professionals and significant associations with CLT work (p=0.002), workplace – Intensive Care Units (p=0.008), physical exercise twice a week (p=0.008), presence of musculoskeletal symptoms, with low back pain being representative (p=0.001). The productivity loss was 8.8.
Conclusions:
the study confirms a high rate of presenteeism among nursing workers.
- Bruno da Silva Santos
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EXPERIENCE REPORT04-03-2020
Use of webQDA software on qualitative nursing research: an experience report
Revista Brasileira de Enfermagem. 2020;73(3):e20180411
Abstract
EXPERIENCE REPORTUse of webQDA software on qualitative nursing research: an experience report
Revista Brasileira de Enfermagem. 2020;73(3):e20180411
DOI 10.1590/0034-7167-2018-0411
Views0See moreABSTRACT
Objectives:
to report the user experience of the webQDA software in the support of qualitative data analysis about health literacy of older adults.
Methods:
quasi-experimental research developed from January 2014 to January 2015, with 118 older adults, all of whom were interviewed to assess the level of health literacy. Interviews were carried out before and after four educational interventions, according to Freire’s method named Culture Circle. The interviews were transcribed and entered in the software, which highlighted the analytical categories.
Results:
the systems of sources, interpretative encoding and questioning of the data available in the software allowed the construction of three categories for the literacy levels and four categories for their dimensions.
Final considerations:
We concluded that the webQDA software enables the structured encoding of qualitative materials, ensuring faster and effective management of data with systematization and analytical transparency.
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03-03-2021
Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis
- Leonel Alves do Nascimento ,
- Aline Korki Arrabal Garcia ,
- Marilia Ferrari Conchon ,
- Marcos Venícios de Oliveira Lopes ,
- Lígia Fahl Fonseca
Abstract
Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis
Revista Brasileira de Enfermagem. 2021;74(1):e20200065
DOI 10.1590/0034-7167-2020-0065
- Leonel Alves do Nascimento ,
- Aline Korki Arrabal Garcia ,
- Marilia Ferrari Conchon ,
- Marcos Venícios de Oliveira Lopes ,
- Lígia Fahl Fonseca
Views1See moreABSTRACT
Objectives:
to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International.
Methods:
a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines.
Results:
41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst.
Final Considerations:
concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.
- Leonel Alves do Nascimento
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ORIGINAL ARTICLE02-25-2022
Factors associated with stress, anxiety and depression in nursing professionals in the hospital context
- Bianca Bacelar de Assis ,
- Cissa Azevedo ,
- Caroline de Castro Moura ,
- Patrick Gonçalves Mendes ,
- Larissa Lucas Rocha , [ … ],
- Tânia Couto Machado Chianca
Abstract
ORIGINAL ARTICLEFactors associated with stress, anxiety and depression in nursing professionals in the hospital context
Revista Brasileira de Enfermagem. 2022;75:e20210263
DOI 10.1590/0034-7167-2021-0263
- Bianca Bacelar de Assis ,
- Cissa Azevedo ,
- Caroline de Castro Moura ,
- Patrick Gonçalves Mendes ,
- Larissa Lucas Rocha ,
- Aline Alves Roncalli ,
- Nayara Ferreira Mota Vieira ,
- Tânia Couto Machado Chianca
Views0See moreABSTRACT
Objective:
to determine the factors associated with stress, anxiety and depression, concomitantly, in nursing professionals who work in the hospital context.
Methods:
a quantitative and cross-sectional study with 353 nursing professionals from a hospital. A sociodemographic questionnaire and the Depression, Anxiety and Stress Scale-21 were used. Data were subjected to descriptive statistical analysis, difference and correlation tests.
Results:
the main factors associated with stress, anxiety and depression, concomitantly, were being female, compromised family and social support, lack of autonomy at work, hostile relationship with colleagues, lack of professional recognition and satisfaction, feeling of being overwhelmed and insecurity.
Conclusions:
demographic, physiological, social and work factors impact the levels of stress, anxiety and depression in nursing professionals. The adoption of coping strategies for modifiable factors should be considered, in order to provide better quality of life for these professionals.
- Bianca Bacelar de Assis
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ORIGINAL ARTICLE09-06-2022
Evaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults
- Fábio Luiz Mialhe ,
- Katarinne Lima Moraes ,
- Helena Alves de Carvalho Sampaio ,
- Virgínia Visconde Brasil ,
- Vanessa da Silva Carvalho Vila , [ … ],
- Flávio Rebustini
Abstract
ORIGINAL ARTICLEEvaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults
Revista Brasileira de Enfermagem. 2022;75(1):e20201320
DOI 10.1590/0034-7167-2020-1320
- Fábio Luiz Mialhe ,
- Katarinne Lima Moraes ,
- Helena Alves de Carvalho Sampaio ,
- Virgínia Visconde Brasil ,
- Vanessa da Silva Carvalho Vila ,
- Gustavo Hermes Soares ,
- Flávio Rebustini
Views0See moreABSTRACT
Objective:
To translate and adapt the eHealth Literacy Scale for the cultural reality of Brazil and to evaluate the psychometric properties of its Brazilian Portuguese version.
Methods:
The instrument was translated and adapted to Brazilian Portuguese and applied to a sample of 502 individuals from 18 to 80 years old who lived in the surrounding areas of six Family Health Units of a city in the countryside of the state of São Paulo, Brazil. The data was evaluated using exploratory and confirmatory factor analysis, item response theory, and instrument reliability measures (Cronbach’s alpha and McDonald’s omega).
Results:
The eHealth Literacy Scale – Brazilian version (eHEALS-Br) presented an excellent internal consistency (α = 0.95 e ω = 0.95), with only one dimension and an explained variation of 81.79%.
Conclusions:
The Brazilian version of the instrument showed excellent psychometric properties to measure the levels of digital health literacy in adults from the country.
- Fábio Luiz Mialhe
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ORIGINAL ARTICLE03-07-2022
Women’s perception of labor and birth care: obstacles to humanization
- Diego Pereira Rodrigues ,
- Valdecyr Herdy Alves ,
- Angela Maria e Silva ,
- Lucia Helena Garcia Penna ,
- Bianca Dargam Gomes Vieira , [ … ],
- Maria Bertilla Lutterbach Riker Branco
Abstract
ORIGINAL ARTICLEWomen’s perception of labor and birth care: obstacles to humanization
Revista Brasileira de Enfermagem. 2022;75:e20210215
DOI 10.1590/0034-7167-2021-0215
- Diego Pereira Rodrigues ,
- Valdecyr Herdy Alves ,
- Angela Maria e Silva ,
- Lucia Helena Garcia Penna ,
- Bianca Dargam Gomes Vieira ,
- Sílvio Éder Dias da Silva ,
- Laena Costa dos Reis ,
- Maria Bertilla Lutterbach Riker Branco
Views0See moreABSTRACT
Objectives:
to understand women’s perception regarding the care received during labor and birth.
Methods:
this is a descriptive-exploratory, qualitative study carried out with 54 postpartum women from hospitals in the Metropolitan Region II of the state of Rio de Janeiro, from January to December 2018, using semi-structured interviews submitted to content analysis.
Results:
puerperal women’s perceptions about the childbirth care they received indicated the use of interventions, such as pressure maneuvers on the uterine fundus during the expulsion period – Kristeller maneuver, episiotomy and repeated vaginal examination and without consent. The use of institutional routines, such as zero diet, horizontal birth and disrespect.
Final Considerations:
despite the encouragement of public humanization policies, the technocratic model is still present in obstetric care during childbirth. The humanization of obstetric care requires changes in attitudes and care paradigms, in order to guarantee respect and the right to quality care.
- Diego Pereira Rodrigues
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