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REFLECTION01-01-2017
Bath for dependent patients: theorizing aspects of nursing care in rehabilitation
Revista Brasileira de Enfermagem. 2017;70(6):1337-1342
Abstract
REFLECTIONBath for dependent patients: theorizing aspects of nursing care in rehabilitation
Revista Brasileira de Enfermagem. 2017;70(6):1337-1342
DOI 10.1590/0034-7167-2016-0258
Views0See moreABSTRACT
Objective:
to produce a reflective essay on what has been produced in relation to bath as a procedure related to nursing care and diagnosis for dependent patients undergoing mediate and immediate rehabilitation processes after a traumatic event.
Method:
discursive, reflective study supported by classical content analysis consisting of the following stages: a) reading of the texts in their most comprehensive form; b) emphasizing the relevant elements produced about bathing; c) reflection on texts and what is produced about bathing.
Results:
the texts point out to three categories for nursing practice and reflection: Meaning to patients on the purposes of bathing; Representation for nurses in the work process; Representation for nurses in the management of care and nursing care planning.
Conclusion:
the reflection points out understandings on bathing as a care focused on the autonomy of nursing rehabilitation patients, requiring further investigations.
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REVIEW01-01-2017
Clinical indicators for nursing diagnosis Ineffective protection in adolescents with cancer
Revista Brasileira de Enfermagem. 2017;70(6):1330-1336
Abstract
REVIEWClinical indicators for nursing diagnosis Ineffective protection in adolescents with cancer
Revista Brasileira de Enfermagem. 2017;70(6):1330-1336
DOI 10.1590/0034-7167-2016-0571
Views0See moreABSTRACT
Objective:
To investigate scientific evidence related to the term protection and clinical indicators and etiologic factors for nursing diagnosis Ineffective protection in adolescents with cancer.
Method:
Integrative literature review in the databases of Scopus, Web of Science, National Library of Medicine and National Institutes of Health (PubMed) and Cochrane; by intersection of the descriptors protection and childhood cancer, which resulted in seven articles. These were insufficient for a comprehension of the term protection and aspects related to its impairment, therefore it was necessary to include a further three reference books.
Results:
Five clinical indicators and three etiologic factors associated to Ineffective protection were identified some of which were not cited in NANDA-International.
Conclusions:
There are clinical and etiologic factors important for the identification of ineffective protection in adolescents with cancer.
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REVIEW01-01-2017
Supported self-care for children and adolescents with chronic disease and their families
Revista Brasileira de Enfermagem. 2017;70(6):1318-1329
Abstract
REVIEWSupported self-care for children and adolescents with chronic disease and their families
Revista Brasileira de Enfermagem. 2017;70(6):1318-1329
DOI 10.1590/0034-7167-2016-0553
Views0See moreABSTRACT
Objective:
analyze the scientific production between 2006 and 2015 on strategies for supported self-care by children and adolescents with chronic disease and their families.
Method:
integrative review of the literature conducted July and August 2016 in the databases: BDENF, LILACS, IBECS, ADOLEC, MEDLINE/PubMed and SCIELO. The 27 selected studies were analyzed and categorized into the five pillars of supported self-care: evaluation, counseling, agreement, care and accompaniment.
Results:
only two studies covered all five pillars, evaluation was considered most, but accompaniment was essential for adherence to the therapeutics of the goal plan. There was a prevalence of actions to evaluate the emotional state of the child/adolescent/family and technological interventions to empower the individual in self-care.
Final considerations:
these actions are concentrated in countries with health systems directed to the health needs of people with chronic disease. In Brazil, this is still incipient, since the actions are focused on exacerbation.
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REVIEW01-01-2017
Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review
Revista Brasileira de Enfermagem. 2017;70(6):1309-1317
Abstract
REVIEWSystemic Arterial Hypertension in people living with HIV/AIDS: integrative review
Revista Brasileira de Enfermagem. 2017;70(6):1309-1317
DOI 10.1590/0034-7167-2016-0416
Views0See moreABSTRACT
Objective:
To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA).
Method:
Integrative literature review in six databases, held in March 2016. “AIDS” and “hypertension” were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were “prevalence of SAH in PLWHA,” “risk factors for SAH in PLWHA” and “adverse events of antiretroviral therapy (ART) that contribute to HAS.”
Results:
There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most.
Conclusion:
Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.
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REVIEW01-01-2017
Managing febrile neutropenia in adult cancer patients: an integrative review of the literature
Revista Brasileira de Enfermagem. 2017;70(6):1301-1308
Abstract
REVIEWManaging febrile neutropenia in adult cancer patients: an integrative review of the literature
Revista Brasileira de Enfermagem. 2017;70(6):1301-1308
DOI 10.1590/0034-7167-2016-0247
Views0See moreABSTRACT
Objective:
To analyze the interventions performed by health professionals with a view to managing chemotherapy-induced febrile neutropenia.
Method:
Integrative literature review, the sample of 12 primary articles was selected from the following databases: LILACS, SciELO, BVS, PubMed, CINAHL and Web of Science.
Results:
There was a prevalence of studies, realized by doctors, focused on pharmacological treatment and on the association of methods for greater diagnostic accuracy of febrile neutropenia. A study was found on pharmaceutical management regarding antibiotic dosing efficacy and a study indicating that nurses could contribute to the identification of elderly patients who would benefit from prophylactic use of growth factor.
Conclusion:
There was a shortage of studies involving the participation of other health professionals, besides the doctors, and a knowledge gap regarding interprofessional practice in the management of interventions specific to their area of specialism, joint interventions and non-pharmacological interventions.
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CASE STUDY01-01-2017
Neonatal appendicitis: a survival case study
Revista Brasileira de Enfermagem. 2017;70(6):1296-1300
Abstract
CASE STUDYNeonatal appendicitis: a survival case study
Revista Brasileira de Enfermagem. 2017;70(6):1296-1300
DOI 10.1590/0034-7167-2016-0610
Views0See moreABSTRACT
Objective:
To report a case of neonatal appendicitis in a children’s hospital in southern Brazil, demonstrating the impact on neonatal survival.
Method:
Case study with data collection from medical records, approved by the Institution and Ethics Committee for Research with Human Beings.
Results:
The clinical picture is initially characterized by food intolerance, evolving to hypoactivity, alteration of vital signs and septicemia due to intestinal perforation. Management is exclusively surgical, since no case described in the literature was diagnosed preoperatively and the findings usually point to acute abdomen.
Conclusion:
A focused clinical surveillance should be established when the infant presents peritoneal irritation. Follow-up of the evolution and the worsening of the symptoms by nurses, as part of the care team in partnership with the medical team, enables an early surgical intervention, thereby avoiding complications such as septicemia and death.
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CASE STUDY01-01-2017
Use of virtual reality for treating burned children: case reports
Revista Brasileira de Enfermagem. 2017;70(6):1291-1295
Abstract
CASE STUDYUse of virtual reality for treating burned children: case reports
Revista Brasileira de Enfermagem. 2017;70(6):1291-1295
DOI 10.1590/0034-7167-2016-0575
Views0See moreABSTRACT
Objective:
To report the use of virtual reality (VR) in pain intensity during dressing change of two burned children hospitalized in a Burn Treatment Center (BTC) in Southern Brazil.
Method:
Case report on the use of VR during dressing change of two burned children hospitalized in a BTC, from May to July 2016. For assessing pain, a facial pain rating scale was applied at four times: just before the dressing, during the dressing without the use of VR, during the dressing with the VR, and after the use of VR.
Results:
The use of goggles was easy to apply and well-accepted by the children, and also had a relevant effect reducing pain.
Conclusion:
VR can become an important nonpharmacological method for treating pain in burned children.
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RESEARCH01-01-2017
Perception of nursing professionals on patient safety culture
Revista Brasileira de Enfermagem. 2017;70(6):1284-1290
Abstract
RESEARCHPerception of nursing professionals on patient safety culture
Revista Brasileira de Enfermagem. 2017;70(6):1284-1290
DOI 10.1590/0034-7167-2016-0010
Views0See moreABSTRACT
Objective:
To evaluate nursing professionals’ perception on safety climate, to check if this perception differs between categories and if there is correlation between the Safety Attitude Questionaire (SAQ) domains and personal and professional variables.
Method:
Quantitative and transversal study held in a teaching hospital in the countryside of São Paulo, in Brazil. Data collection occurred in the period from April to July 2014, with the application of the SAQ.
Results:
259 professionals participated in the study. The domain job satisfaction obtained scores above 75 for both categories. The perception of safety climate differed between the categories for most areas, except for the recognition of stress, and there is correlation between five SAQ domains and the variables time of experience and intention to leave the profession.
Conclusion:
Knowing the professionals’ perception on safety climate will contribute to a secure assistance.
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03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
02-26-2024
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201pt
Views0A prática profissional da navegação de pacientes é algo incipiente no Brasil e, sendo assim, é indispensável uma ampla discussão com vários setores da sociedade, sendo essa a principal propositura deste editorial. Comecemos pela história.A navegação de pacientes foi definida em 1989 como uma intervenção de prestação de serviços baseada na comunidade, com o objetivo […]See more -
02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more -
ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
DOI 10.1590/0034-7167.20247701e02
Views0In the article “Active teaching model to promote critical thinking”, with DOI number: , published in Revista Brasileira de Enfermagem, 2019;72(1):293-8, on page 297:Include before REFERENCES:[…]See more -
REVIEW02-26-2024
Practice of immersion in hot water to relieve pain in neonatology: an integrative review
- Danton Matheus de Souza
, - Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça , [ … ],
- Lisabelle Mariano Rossato
Abstract
REVIEWPractice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
DOI 10.1590/0034-7167-2023-0260
- Danton Matheus de Souza ,
- Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça ,
- Lisabelle Mariano Rossato
Views0See moreABSTRACT
Objectives:
to identify immersion use in hot water to relieve pain in newborns.
Methods:
an integrative literature review, carried out in the PubMed, VHL, EMBASE, Scopus, CINAHL, Cochrane and SciELO databases, with investigations in English, Spanish, French or Portuguese, published between 2002 and 2022. The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used to answer the following question: what are the uses of hot water immersion in relieving pain in newborns?
Results:
nine studies were included, mainly Brazilian, experimental, with a predominance of strong and moderate levels of evidence. Hydrotherapy and bath use (immersion and bandaging) was observed, promising interventions in reducing pain scores, assessed using scales, physiological and endocrine parameters.
Conclusions:
hot water proved to be a promising non-pharmacological intervention in relieving pain in infants in different contexts.
- Danton Matheus de Souza
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ORIGINAL ARTICLE02-26-2024
Artificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
Abstract
ORIGINAL ARTICLEArtificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
DOI 10.1590/0034-7167-2023-0201
Views0See moreABSTRACT
Objectives:
to assess the predictive performance of different artificial intelligence algorithms to estimate bed bath execution time in critically ill patients.
Methods:
a methodological study, which used artificial intelligence algorithms to predict bed bath time in critically ill patients. The results of multiple regression models, multilayer perceptron neural networks and radial basis function, decision tree and random forest were analyzed.
Results:
among the models assessed, the neural network model with a radial basis function, containing 13 neurons in the hidden layer, presented the best predictive performance to estimate the bed bath execution time. In data validation, the squared correlation between the predicted values and the original values was 62.3%.
Conclusions:
the neural network model with radial basis function showed better predictive performance to estimate bed bath execution time in critically ill patients.
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REVIEW02-26-2024
Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas , [ … ],
- Indiara Sartori Dalmolin
Abstract
REVIEWEvidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
DOI 10.1590/0034-7167-2023-0134
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas ,
- Indiara Sartori Dalmolin
Views0See moreABSTRACT
Objectives:
to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.
Methods:
an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.
Results:
141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses’ competency to insert an intrauterine device; and Women’s access to intrauterine devices.
Conclusions:
nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.
- Lays Souza de Oliveira
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01-01-2015
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
Abstract
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
DOI 10.1590/0034-7167.2015680206i
Views0See moreABSTRACT
Objective:
a qualitative study that followed the principles of the grounded theory in order to analyze the professional identity of nursing academics through the analysis of the most disturbing critical incidents.
Method:
semi-structured interviews were conducted with seven nurses who worked as professors and researchers in a private university in Barcelona.
Results:
the resulting empirical material was organized into two categories: characterization of critical incidents and responsiveness to the incident.
Conclusion:
the professional identity of nurses regarding the academic area is still under construction and inexperience is the major obstacle in the management of critical incidents in the teaching career.
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01-01-2015
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
Abstract
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
DOI 10.1590/0034-7167.2015680205i
Views0See moreABSTRACT
Objective:
to investigate what is the best anthropometric predictor of arterial hypertension among private school students.
Method:
this was a cross-sectional study with 286 students between the ages of 10 and 14 from two private schools in the city of Paranavaí, Paraná, Brazil. The following variables were analyzed: body mass index, waist circumference and blood pressure. Statistical analysis was conducted with Pearson’s partial correlation test and multivariate logistic regression, with p<0.05.
Results:
both anthropometric indicators displayed weak correlation with systolic and diastolic levels, with coeffi cients (r) ranging from 0.27 to 0.36 (p < 0.001). Multivariate analysis showed that the only anthropometric indicator associated with arterial hypertension was waist circumference (OR= 2.3; 95% CI: 1.1-4.5), regardless of age or gender.
Conclusion:
this age group, waist circumference appeared to be a better predictor for arterial hypertension than body mass index.
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01-01-2015
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
Abstract
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
DOI 10.1590/0034-7167.2015680204i
Views0See moreABSTRACT
Objective:
this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process.
Method:
data were collected through interviews and analyzed by the Content Analysis proposed by Bardin’s theoretical framework.
Results:
managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual diffi culty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed.
Conclusion:
managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process.
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01-01-2015
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
Abstract
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
DOI 10.1590/0034-7167.2015680203i
Views0See moreABSTRACT
Objective:
to make across-cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” scale in Brazil.
Method:
the scale was tested regarding conceptual, item, semantic, and operational equivalence.
Results:
content validation was conducted by an expert committee with a minimum consensus level of 80%. This process resulted in a 35-item scale divided into 6 factors. The experts reached 100% consensus on the scale’s clarity of language, practical pertinence and theoretical relevance, as well as on the need for excluding one factor. Data were collected in 2013 in the city of Londrina, Paraná, Brazil.
Conclusion:
the instrument was cross-culturally adapted to Brazilian Portuguese and presented satisfactory content validity. We propose further studies on the scale’s psychometric properties, such as construct validity, internal consistency and reliability.
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01-01-2015
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
Abstract
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
DOI 10.1590/0034-7167.2015680202i
Views0See moreABSTRACT
Objective:
to analyze the development and mobilization of relational skills central to the caring process among nursing students throughout their professional training.
Method:
this was a quantitative study, descriptive and cross-sectional in design. The sample consisted of nursing undergraduate students from the Higher School of Health Sciences, in the city of Évora, Portugal. Data were collected using the previously validated Helping Relational Skills Inventory.
Results:
the students gradually acquired “generic skills”, “communication skills” and “contact skills”, presenting the highest mean score in the last year of the program. However, the highest mean score for the “empathetic skills” subscale was presented by second-year students.
Conclusion:
age and year in program were found to be decisive variables regarding the acquisition of specifi c skills (empathetic and communication) by nursing students.
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01-01-2015
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0The title of the 2015 Editor’s Comments could very well be from a journal published in decades past, a time when, in Brazil, all professional entities and civil society fought for the right to health, as was later established in the Brazilian Constitution of 1988. Twenty-five years later, despite its financial limitations and restricted operational […]See more -
01-01-2015
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0Este título do Editorial de 2015 bem poderia ser de uma revista publicada em décadas passadas, período em que todas as entidades profissionais e a sociedade civil lutaram pela saúde como direito, como conquistado na Constituição de 1988. Vinte e cinco anos depois, com o Sistema Único de Saúde capilarizado por todo o país, mesmo […]See more -
EXPERIENCE REPORT01-01-2015
Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
Abstract
EXPERIENCE REPORTNursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
DOI 10.1590/0034-7167.2015680121i
Views0See moreObjetivo:
descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva.
Método:
estudo de caso com coleta de dados retrospectiva no prontuário.
Resultados:
três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas.
Conclusão:
espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.
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