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RESEARCH01-01-2017
The family in face of the elderly’s reality of living alone
Revista Brasileira de Enfermagem. 2017;70(2):235-241
Abstract
RESEARCHThe family in face of the elderly’s reality of living alone
Revista Brasileira de Enfermagem. 2017;70(2):235-241
DOI 10.1590/0034-7167-2016-0398
Views0See moreABSTRACT
Objective:
to understand the family dynamics in face of the reality of the elderly living alone.
Method:
study of qualitative approach with theoretical reference of symbolic interactionism that involved interviews with families. Data were analyzed by thematic analysis.
Results:
six families participated in the study. The discourse analysis originated the following categories: The family respecting their decision making; The family organizing itself to the process of living alone after the age of 80 years; The family experiencing the freedom of living alone.
Conclusion:
in this study, it was possible to identify the facilitation of the possibility of living alone with preparation and agreements between the family during the family life cycle, leading to the feeling of freedom and quality of life of all members. Nursing, as a science responsible for elaborating care strategies, should work together with families to assist in the planning of care plans based on the individual social reality of the family.
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LETTER TO THE EDITOR01-01-2017
Dimensioning the instrumentation: Exploratory or confirmatory factor analysis?
Revista Brasileira de Enfermagem. 2017;70(2):233-234
Abstract
LETTER TO THE EDITORDimensioning the instrumentation: Exploratory or confirmatory factor analysis?
Revista Brasileira de Enfermagem. 2017;70(2):233-234
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01-01-2017
Viral hepatitis: a challenge for nursing
Revista Brasileira de Enfermagem. 2017;70(2):231-232
Abstract
Viral hepatitis: a challenge for nursing
Revista Brasileira de Enfermagem. 2017;70(2):231-232
DOI 10.1590/0034-7167.2017700201
Views0The 20th century unveiled the mystery of the etiology of viral hepatitis, with the identification of five different agents responsible for these infections: the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). These viruses account for one million deaths every year. HBV, […]See more -
01-01-2017
Hepatites Virais: um desafio para enfermagem
Revista Brasileira de Enfermagem. 2017;70(2):231-232
Abstract
Hepatites Virais: um desafio para enfermagem
Revista Brasileira de Enfermagem. 2017;70(2):231-232
DOI 10.1590/0034-7167.2017700201
Views0O século XX desvendou os mistérios sobre a etiologia das hepatites virais, identificando cinco agentes distintos responsáveis por essas viroses: vírus da hepatite A (HAV), vírus da hepatite B (HBV), vírus da hepatite C (HCV), vírus da hepatite D (HDV) e vírus da hepatite E (HEV). Esses vírus são responsáveis por um milhão de mortes […]See more -
01-01-2017
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(1):242-242
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(1):242-242
DOI 10.1590/0034-7167.20177001e01
Views0Article “Accessibility assessment of assistive technology for the hearing impaired”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, v69(5):781-7, page 781 that read:“Luciana Vieira de CaravalhoI”.[…]See more -
01-01-2017
From silence to voice: book review
Revista Brasileira de Enfermagem. 2017;70(1):240-241
Abstract
From silence to voice: book review
Revista Brasileira de Enfermagem. 2017;70(1):240-241
DOI 10.1590/0034-7167-2016-0066
Views1The book() is a translation of the original titled From silence to voice(), published by Cornell Paperbacks in 2006. Bernice Burech and Susanne Gordon are journalists and took the nursing profession as the object of study. The authors have diagnosed silence in the profession, which motivated writing a work valuing the use of all types […]See more -
01-01-2017
Reflections in the light of the complexity theory and nursing education
Revista Brasileira de Enfermagem. 2017;70(1):236-239
Abstract
Reflections in the light of the complexity theory and nursing education
Revista Brasileira de Enfermagem. 2017;70(1):236-239
DOI 10.1590/0034-7167-2016-0239
Views0See moreABSTRACT
Objective:
to reflect on nursing education, taking into account the principles of complex thinking proposed by Morin.
Method:
reflection based on the principles of the complexity theory by Edgar Morin.
Results:
the application of complexity in teaching proposes an emancipatory education based on questioning and social transformation. It comprises the education of nurses who interact with others as a characteristic of their work. It is necessary to prepare students to develop critical and reflective attitudes and actions to overcome the fragmentation and linearity of knowledge.
Conclusion:
nursing care has been based on a reductionist assistance, reflecting the Cartesian model. Thus, nursing education seeks to comprise shared knowledge and experiences so that no subject or professional overpowers another, accepting the uniqueness of professionals and patients.
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ORIGINAL ARTICLE11-28-2023
Geospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory
Revista Brasileira de Enfermagem. 2023;76:e20220216
Abstract
ORIGINAL ARTICLEGeospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory
Revista Brasileira de Enfermagem. 2023;76:e20220216
DOI 10.1590/0034-7167-2022-0216
Views1See moreABSTRACT
Objective:
To analyze the spatial pattern of tuberculosis in Indigenous peoples from the State of Pará and its correlation with income transfer.
Methods:
Ecological study, with 340 cases reported in Indigenous peoples in the State of Pará, Brazil, in the period 2016-2020. The study performed a descriptive analysis and calculation of incidence rates with smoothing by the local empirical Bayesian method. The Global Moran index assessed the autocorrelation of the rates with income transfer data, p<0,05.
Results:
The Marajó and metropolitan mesoregions of Belém had the highest tuberculosis rates, and a reduced number of people benefited from income transfer (high-low correlation). The study identified high rates, and a significant number of people benefited from financial aid (high correlation high), I=0.399, p=0.027 in the Southwest.
Conclusions:
The spatial autocorrelation between tuberculosis and access to income transfer programs constitutes a relevant subsidy for the formulation of social protection policies and may impact the disease control actions in Indigenous territories, valuing the epidemiological heterogeneity identified in the mesoregions.
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ORIGINAL ARTICLE11-13-2023
Vulnerability to physical inactivity: evidence of content validity and response processes
Revista Brasileira de Enfermagem. 2023;76:e20220563
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
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.
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ORIGINAL ARTICLE12-08-2023
The relationship between level of knowledge and vaginal discharge prevention behavior for nursing student
Revista Brasileira de Enfermagem. 2023;76:e20220602
Abstract
ORIGINAL ARTICLEThe relationship between level of knowledge and vaginal discharge prevention behavior for nursing student
Revista Brasileira de Enfermagem. 2023;76:e20220602
DOI 10.1590/0034-7167-2022-0602
Views0See moreABSTRACT
Objective:
Reproductive health in adolescent girls is very important. To determine the relationship between the level of knowledge and the behavior of preventing vaginal discharge among nursing students.
Methods:
a quantitative, cross-sectional study, with 155 first-year female students at a private faculty of nursing. Data were collected from February to March 2022, using an electronic questionnaire.
Results:
98.1% of participants have a good level of knowledge and 92.3% of participants practice good vaginal discharge prevention behavior.
Conclusion:
good knowledge produces appropriate prevention behavior. The result of this study can be used as a contribution of thoughts and references as a more in-depth study of the factors that influence the level of knowledge and behavior about the disease of the genitalia and the dangers of pathological vaginal discharge.
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ORIGINAL ARTICLE11-13-2023
Access of people with pulmonary tuberculosis to government programs: Primary Care professionals’ perceptions
Revista Brasileira de Enfermagem. 2023;76:e20220716
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
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.
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ORIGINAL ARTICLE12-08-2023
Fear of COVID-19 when experiencing pregnancy or childbirth in the pandemic: what are the associated factors?
Revista Brasileira de Enfermagem. 2023;76:e20220755
Abstract
ORIGINAL ARTICLEFear of COVID-19 when experiencing pregnancy or childbirth in the pandemic: what are the associated factors?
Revista Brasileira de Enfermagem. 2023;76:e20220755
DOI 10.1590/0034-7167-2022-0755
Views0See moreABSTRACT
Objective:
to identify factors associated with fear of COVID-19 among women who experienced pregnancy or childbirth during the pandemic.
Methods:
a cross-sectional study, nested within a prospective cohort, using an online survey, from August 2021 to February 2022, based on descriptive data analysis.
Results:
of the 431 participants, 52.8% were postpartum women and 20.1% were pregnant women. With regard to fear of COVID-19, a mean score of 20.46 was obtained (moderate fear). The highest fear scores were present in women whose newborns were admitted to hospital in neonatal critical units (p=0.032), and the lowest among those covered by supplementary health (insurance) (p=0.016).
Conclusion:
among pregnant and postpartum women, high fear of COVID-19 translated into the possibility of having newborns admitted to hospital in a critical unit. The importance of supporting actions to support pregnant/postpartum women’s mental health in relation to COVID-19 or other threats that may influence the neonatal outcome stands out.
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ORIGINAL ARTICLE11-21-2023
Coping strategies for chronically ill children and adolescents facing the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20230045
Abstract
ORIGINAL ARTICLECoping strategies for chronically ill children and adolescents facing the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20230045
DOI 10.1590/0034-7167-2023-0045
Views0See moreABSTRACT
Objective:
to understand the experiences and coping strategies of children and adolescents with chronic illnesses during the COVID-19 pandemic.
Methods:
a descriptive study, with a qualitative approach, carried out with six children and adolescents at the reception of an outpatient clinic of a pediatric hospital in the state of Ceará. Data collection took place from April to September 2021, using story-drawing, analyzed in light of Coutinho’s criteria.
Results:
two thematic categories emerged: Situations experienced by children and adolescents in times of COVID-19; Coping strategies for children and adolescents in their chronic illness process during the COVID-19 pandemic.
Final considerations:
understanding the experiences and coping strategies of children and adolescents with chronic illness demonstrated the expression of creative imagination, incorporated by subjective components, which brings to light an approximation with the reality perceived and interpreted in a context of the COVID-19 pandemic.
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ORIGINAL ARTICLE12-08-2023
Simulation-based training in Leprosy: development and validation of a scenario for community health workers
Revista Brasileira de Enfermagem. 2023;76:e20230114
Abstract
ORIGINAL ARTICLESimulation-based training in Leprosy: development and validation of a scenario for community health workers
Revista Brasileira de Enfermagem. 2023;76:e20230114
DOI 10.1590/0034-7167-2023-0114
Views0See moreABSTRACT
Objectives:
To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection.
Methods:
Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed.
Results:
A simulated scenario with a simulated participant was developed — a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components.
Conclusions:
The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global “Towards Zero Leprosy” strategy.
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ORIGINAL ARTICLE12-08-2023
Knowledge and practices about health among Quilombola men: contributions to health care
Revista Brasileira de Enfermagem. 2023;76:e20230138
Abstract
ORIGINAL ARTICLEKnowledge and practices about health among Quilombola men: contributions to health care
Revista Brasileira de Enfermagem. 2023;76:e20230138
DOI 10.1590/0034-7167-2023-0138
Views1See moreABSTRACT
Objective:
to analyze health knowledge and practices among Quilombola men.
Methods:
a qualitative, descriptive study, carried out with 40 men from two Quilombola communities in Santa Izabel do Pará, state of Pará, Brazil. Individual interviews were carried out using a semi-structured script. Text corpus was subjected to analysis with Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires 0.6, alpha 3, through Descending Hierarchical Classification.
Results:
among participants, eight (20.00%) were aged 55 to 59 years. 382 text segments were identified, with 299 (78.27%) being used, generating five lexical classes, which made up two subcorpora. The classes were organized into four thematic axes, covering knowledge about health and practices to prevent and solve health problems.
Final considerations:
men highlighted popular/traditional wisdom permeated by biomedical knowledge, translating their understanding of how to act to remain or become healthy.
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ORIGINAL ARTICLE12-05-2019
Elderly caregiver: knowledge, attitudes and practices about falls and its prevention
Revista Brasileira de Enfermagem. 2019;72:119-126
Abstract
ORIGINAL ARTICLEElderly caregiver: knowledge, attitudes and practices about falls and its prevention
Revista Brasileira de Enfermagem. 2019;72:119-126
DOI 10.1590/0034-7167-2018-0276
Views0See moreABSTRACT
Objective:
investigate the knowledge, attitudes and practices of informal elderly caregivers about falls and its prevention.
Method:
this is a descriptive cross-sectional study conducted with 97 informal elderly caregivers residents in areas covered by five Health Strategy Units (ESF) in Cuiabá.
Results:
more than half of the participants are aware of falls and identify them as a problem, as well as they identify some risk factors and prevention measures. Regarding attitudes, more than half of the caregivers do not seem to act effectively to prevent falls. Most of them report adopting practices to prevent falls of the elderly, supervising the activities of their daily lives.
Conclusion:
caregivers know about falls and its prevention, but in a superficial way, and it seems to influence their attitudes and practices regarding the prevention of this event.
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ORIGINAL ARTICLE09-21-2020
The care provided by the family to the premature newborn: analysis under Leininger’s Transcultural Theory
Revista Brasileira de Enfermagem. 2020;73:e20190644
Abstract
ORIGINAL ARTICLEThe care provided by the family to the premature newborn: analysis under Leininger’s Transcultural Theory
Revista Brasileira de Enfermagem. 2020;73:e20190644
DOI 10.1590/0034-7167-2019-0644
Views0See moreABSTRACT
Objective:
To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger’s transcultural theory.
Methods:
Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire® and the Bardin Content Analysis technique.
Results:
Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care.
Conclusion:
The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.
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EXPERIENCE REPORT07-13-2020
Military Nursing in “Operation Return to Brazil”: aeromedical evacuation in the coronavirus pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200297
Abstract
EXPERIENCE REPORTMilitary Nursing in “Operation Return to Brazil”: aeromedical evacuation in the coronavirus pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200297
DOI 10.1590/0034-7167-2020-0297
Views0See moreABSTRACT
Objective:
to describe the experience of military nursing in “Operation Return to Brazil” in an aeromedical evacuation.
Method:
this is an experience report of the nursing staff in the Aeromedical Evacuation of potentially-contaminated Brazilians who were in Wuhan, China, after the outbreak of the new coronavirus.
Results:
the report was constructed from nursing care performed in three stages: pre-flight, screening, and flight. Pre-flight care would include aircraft configuration and material prediction. In screening, the staff was concerned with being properly attired. In the health assessment of returnees, in-flight, attention was focused on Personal Protective Equipment handling to minimize the risk of contamination by prolonged contact with potentially-contaminated passengers.
Final considerations:
nursing was committed to planning all the actions of this mission, which was one of the longest, strenuous and unprecedented in the history of aeromedical transport in Brazil.
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ORIGINAL ARTICLE09-21-2020
Adolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections
Revista Brasileira de Enfermagem. 2020;73:e20190242
Abstract
ORIGINAL ARTICLEAdolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections
Revista Brasileira de Enfermagem. 2020;73:e20190242
DOI 10.1590/0034-7167-2019-0242
Views0See moreABSTRACT
Objective:
To analyze the association between vulnerabilities to Sexually Transmitted Infections (STIs/HIV/AIDS) of adolescents in poverty and their level of resilience.
Method:
Cross-sectional study with 287 students between 11 and 17 years old in a school in the outskirts of Fortaleza-Ce. The study was conducted from August to October 2016. Three instruments related to characterization, vulnerability to STIs/HIV/AIDS and resilience were used. The association between the instruments was calculated using the Mann-Whitney and Kruskal-Wallis tests. Association between vulnerability to STIs/HIV/AIDS and resilience was assessed through the Spearman’s correlation coefficient. Statistical significance was set at p<0.05.
Results:
There was a significant association between the factors “housing” (p=0.022), “family income” (p=0.037) and vulnerability to STIs/HIV/AIDS. Adolescents whose father has completed high school (p=0.043) have moderately high resilience.
Conclusion:
Adolescents with low socioeconomic status and who live on less than a minimum wage tends to be more susceptible to vulnerabilities to STIs/HIV/AIDS and to have low resilience.
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REFLECTION06-04-2021
Care in pediatric nursing from the perspective of emotions: from Nightingale to the present
Revista Brasileira de Enfermagem. 2021;74(4):e20200377
Abstract
REFLECTIONCare in pediatric nursing from the perspective of emotions: from Nightingale to the present
Revista Brasileira de Enfermagem. 2021;74(4):e20200377
DOI 10.1590/0034-7167-2020-0377
Views0See moreABSTRACT
Objective:
Reflect on the evolution of pediatric nursing care from the perspective of emotions, from the conceptions of Florence Nightingale to the present.
Method:
Reflective study based on theoretical and experiential aspects of emotional care in pediatric nursing.
Results:
From Nightingale, there were many definitions regarding the nursing care in an integrative and humanist logic; and with certain bond to emotional dimension. That time, nursing care was based on the religious conceptions of charity and love of our neighbor and, despite the conceptualization that shapes nursing science today, such conceptions have not ceased to be its attribute, mainly in the care of pediatric nurses.
Final considerations:
In pediatric nursing, nurture care with affection and facilitate emotions management in each interaction nurse-child-family is crucial for caring. This emotional care should evolve into a competence that recognizes the expertise and merit of professional action.
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EXPERIENCE REPORT09-29-2022
Mobile pre-hospital care reorganization during the COVID-19 pandemic: experience report
Revista Brasileira de Enfermagem. 2022;75:e20200826
Abstract
EXPERIENCE REPORTMobile pre-hospital care reorganization during the COVID-19 pandemic: experience report
Revista Brasileira de Enfermagem. 2022;75:e20200826
DOI 10.1590/0034-7167-2020-0826
Views0See moreABSTRACT
Objective:
To describe the reorganization of Belo Horizonte’s Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool.
Methods:
Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process.
Results:
Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine.
Final considerations:
The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.
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ORIGINAL ARTICLE12-13-2019
Factors associated with low Apgar in newborns in birth center
Revista Brasileira de Enfermagem. 2019;72:297-304
Abstract
ORIGINAL ARTICLEFactors associated with low Apgar in newborns in birth center
Revista Brasileira de Enfermagem. 2019;72:297-304
DOI 10.1590/0034-7167-2018-0924
Views1See moreABSTRACT
Objective:
to analyze factors associated with Apgar of 5 minutes less than 7 of newborns of women selected for care at the Center for Normal Birth (ANC).
Method:
a descriptive cross-sectional study with data from 9,135 newborns collected between July 2001 and December 2012. The analysis used absolute and relative frequency frequencies and bivariate analysis using Pearson’s chi-square test or the exact Fisher.
Results:
fifty-three newborns (0.6%) had Apgar less than 7 in the 5th minute. The multivariate analysis found a positive association between low Apgar and gestational age less than 37 weeks, gestational pathologies and intercurrences in labor. The presence of the companion was a protective factor.
Conclusion:
the Normal Birth Center is a viable option for newborns of low risk women as long as the protocol for screening low-risk women is followed.
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ORIGINAL ARTICLE07-31-2020
Factors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73:e20180996
Abstract
ORIGINAL ARTICLEFactors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73:e20180996
DOI 10.1590/0034-7167-2018-0996
Views0See moreABSTRACT
Objectives:
to investigate the factors associated with the mode of delivery in pregnant women in the city of Belo Horizonte.
Methods:
cross-sectional study developed with data from the study “Being born in Belo Horizonte: survey on childbirth and birth” carried out in seven maternity hospitals in Belo Horizonte – Minas Gerais. The final sample consisted of 1088 pregnant/postpartum women. In this study, to verify the magnitude of the association between the outcome variable and its possible determinants (exposure variables) logistic regression models were constructed to estimate the Odds Ratio.
Results:
increasing age, the lack of companionship, the hospital’s private financing for performing delivery and being a first-time pregnant woman increased the chance of delivery by cesarean section.
Final Considerations:
the knowledge of factors associated with the prevalence of cesarean sections can support reflections among health professionals about this surgical procedure in certain situations, especially when there are no precise clinical indications.
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