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ORIGINAL ARTICLE11-28-2023
Nursing protocol in chronic kidney disease prevention in older adults in primary care
- Fernanda Ferreira Krepker
, - Cristina Arreguy-Sena ,
- Luciene Muniz Braga ,
- Paula Krempser ,
- Jéssica de Castro Santos , [ … ],
- Herica Silva Dutra
Abstract
ORIGINAL ARTICLENursing protocol in chronic kidney disease prevention in older adults in primary care
Revista Brasileira de Enfermagem. 2023;76(1):e20220052
DOI 10.1590/0034-7167-2022-0052
- Fernanda Ferreira Krepker ,
- Cristina Arreguy-Sena ,
- Luciene Muniz Braga ,
- Paula Krempser ,
- Jéssica de Castro Santos ,
- Herica Silva Dutra
Views0See moreASBTRACT
Objectives:
to develop a protocol for Nursing Process operationalization in approaching older adults with vulnerability to chronic kidney disease in Primary Health Care, based on Neuman’s stressors.
Methods:
a methodological study, carried out in two stages: 1) synthesis of evidence using an inductive strategy (mixed method study) and 2) protocol development to support the nursing process operationalization with older adults enrolled in a Basic Health Unit, using a deductive strategy (Neuman’s stressor concepts, NANDA, NIC, and NOC taxonomies, Risner’s line of reasoning, and cross-mapping), described according to A Step-by-Step Guide to Developing Protocols.
Results:
102 older adults participated, and 17 diagnoses, 34 interventions and 26 nursing outcomes were identified.
Conclusions:
the protocol developed is a technology that makes it possible to operationalize the Nursing Process, based on Neuman’s stressors and on taxonomy, conceptual and care frameworks, guiding care and nursing records.
- Fernanda Ferreira Krepker
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ORIGINAL ARTICLE11-28-2023
The Chronic Care Model and its implications for Specialized Outpatient Care
- Francielle Renata Danielli Martins Marques ,
- Grazieli Adrieli Rodrigues Pires ,
- José Luís Guedes Dos Santos ,
- Vanessa Denardi Antoniassi Baldissera ,
- Maria Aparecida Salci
Abstract
ORIGINAL ARTICLEThe Chronic Care Model and its implications for Specialized Outpatient Care
Revista Brasileira de Enfermagem. 2023;76(1):e20210315
DOI 10.1590/0034-7167-2021-0315
- Francielle Renata Danielli Martins Marques ,
- Grazieli Adrieli Rodrigues Pires ,
- José Luís Guedes Dos Santos ,
- Vanessa Denardi Antoniassi Baldissera ,
- Maria Aparecida Salci
Views0See moreABSTRACT
Objective:
to assess the Chronic Care Model implementation in Specialized Outpatient Care and its repercussions for health care.
Methods:
qualitative evaluative research, conducted by the Chronic Care Model. We used observation techniques, document analysis and interviews with 21 health professionals from specialized care. Analysis was conducted by triangulation, with the aid of MAXQDA software for initial and focused coding. All ethical aspects were respected.
Results:
professionals recognized that the model reorganized service care and administrative practices, presenting positive repercussions for the health of people assisted. The absence of continuing education for service professionals compromised the complete model implementation.
Final considerations:
the implementation, even if partial, of the model brings contributions to service improvement. The weaknesses that are still present are compatible with professionals’ difficulty in distancing themselves from the biomedical model.
- Francielle Renata Danielli Martins Marques
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ORIGINAL ARTICLE11-28-2023
Effects of the COVID-19 pandemic on nurses’ psychological well being in an emergency room
Revista Brasileira de Enfermagem. 2023;76:e20220171
Abstract
ORIGINAL ARTICLEEffects of the COVID-19 pandemic on nurses’ psychological well being in an emergency room
Revista Brasileira de Enfermagem. 2023;76:e20220171
DOI 10.1590/0034-7167-2022-0171
Views0See moreABSTRACT
Objectives:
to assess the level of anxiety of nurses in an emergency room in view of the new Coronavirus and describe the relationship between the degrees of anxiety and their sociodemographic variables.
Methods:
quantitative descriptive-correlational study with a sample of 60 nurses. A questionnaire was used as a data collection instrument based on the Hamilton Anxiety Assessment Scale.
Results:
the nurses’ average anxiety is mild. A statistically significant relationship was found between anxiety and the variables “sex” and “children”, with women having higher levels of anxiety than men, and nurses who do not have children showing mild, moderate, or severe anxiety.
Conclusions:
COVID-19 triggers anxiety in nurses, sometimes at pathological levels. Being female and not having children increase the anxiety experienced. Sex can be considered the determining factor for the level of anxiety experienced.
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ORIGINAL ARTICLE11-28-2023
Construction and validation of an algorithm for disinfection of ambulances transporting patients with contagious infectious diseases
Revista Brasileira de Enfermagem. 2023;76:e20220081
Abstract
ORIGINAL ARTICLEConstruction and validation of an algorithm for disinfection of ambulances transporting patients with contagious infectious diseases
Revista Brasileira de Enfermagem. 2023;76:e20220081
DOI 10.1590/0034-7167-2022-0081
Views0See moreABSTRACT
Objectives:
to develop and validate an algorithm to guide professionals in cleaning and disinfecting ambulances after transferring patients with contagious infectious diseases.
Methods:
the study was conducted between September and November 2021. The developed algorithm was validated by 104 judges, including nurses, physical therapists, and physicians who care for patients with contagious infectious diseases. It used the Delphi technique and content validity index.
Results:
in the first evaluation, the judges considered the algorithm “unsuitable” and “fully suitable”. The algorithm reviewed according to the judges’ suggestions was rated between “suitable” and “fully suitable” in the second evaluation. The overall content validity index was 0.960 and 0.998 in the first and second evaluations.
Conclusions:
the algorithm to guide the cleaning and disinfection of ambulances after transferring patients with contagious infectious diseases was developed and validated by specialists in the field, with consensus among the judges in the second evaluation.
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ORIGINAL ARTICLE11-28-2023
Geospatialization of tuberculosis and income transfer programs among Indigenous peoples in an endemic territory
- Ingrid Bentes Lima ,
- Laura Maria Vidal Nogueira ,
- Lidiane de Nazaré Mota Trindade ,
- Ivaneide Leal Ataide Rodrigues ,
- Suzana Rosa André , [ … ],
- Ana Inês Sousa
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
- Ingrid Bentes Lima ,
- Laura Maria Vidal Nogueira ,
- Lidiane de Nazaré Mota Trindade ,
- Ivaneide Leal Ataide Rodrigues ,
- Suzana Rosa André ,
- Ana Inês Sousa
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.
- Ingrid Bentes Lima
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ORIGINAL ARTICLE11-28-2023
Remote consultation with people with eating disorders during the COVID-19 pandemic
- Camila Biscacio Falco ,
- Maria Angélica de Almeida Peres ,
- Jose Carlos Appolinario ,
- Livia Lopes Menescal ,
- Izabella de Góes Anderson Maciel Tavares
Abstract
ORIGINAL ARTICLERemote consultation with people with eating disorders during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220197
DOI 10.1590/0034-7167-2022-0197
- Camila Biscacio Falco ,
- Maria Angélica de Almeida Peres ,
- Jose Carlos Appolinario ,
- Livia Lopes Menescal ,
- Izabella de Góes Anderson Maciel Tavares
Views0See moreABSTRACT
Objectives:
to analyze subjective experiences related to adaptation to remote care by users with eating disorders during the COVID-19 pandemic.
Methods:
a descriptive study with a qualitative approach conducted with users of an eating disorders outpatient clinic. A semi-structured remote interview was applied using the Google Meet application. The data were submitted to lexical analysis using ALCESTE software and discussed in the light of scientific evidence.
Results:
the remote appointment is a positive strategy but not a substitute for the face-to-face modality. The research cited financial savings, closer contact with professionals, and flexibility of service schedules as advantages. It pointed out the difficulty in clinical evaluation concerning weight, vital signs, and poor mastery of technology as limitations.
Final Considerations:
the study induces discussion about the systematization of remote care, which, during the COVID-19 pandemic, were responsible for providing a greater sense of support to people with eating disorders.
- Camila Biscacio Falco
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11-28-2023
Efeitos da pandemia de COVID-19 no bem-estar psicológico dos enfermeiros de um serviço de urgência
Revista Brasileira de Enfermagem. 2023;76:e20220171
Abstract
Efeitos da pandemia de COVID-19 no bem-estar psicológico dos enfermeiros de um serviço de urgência
Revista Brasileira de Enfermagem. 2023;76:e20220171
DOI 10.1590/0034-7167-2022-0171
Views0See moreRESUMEN
Objetivos:
evaluar nivel de ansiedad de enfermeros de un servicio de urgencia frente al nuevo coronavirus y describir la relación entre niveles de ansiedad y variables sociodemográficas.
Métodos:
estudio cuantitativo descriptivo-correlacional con una muestra de 60 enfermeros. Recorrido a la aplicación de una encuesta como instrumento de recolecta de datos basándose en la Escala de Evaluación de Ansiedad de Hamilton.
Resultados:
el escore mediano de ansiedad de los enfermeros es leve. Verificado que hay una relación estadísticamente significante entre la ansiedad y la variable “sexo” e “hijos”, con mujeres presentando niveles de ansiedad superiores a los hombres y los enfermeros sin hijos presentando niveles de ansiedad leve, moderada o severa.
Conclusiones:
la COVID-19 desencadena ansiedad en los enfermeros, por veces a niveles patológicos; y ser del sexo femenino y no tener hijos la aumenta. Es posible afirmar que el sexo fue el factor determinante para el nivel de ansiedad experimentado.
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ORIGINAL ARTICLE11-27-2023
Mental suffering in family daily life: a temporal journey according to Merleau-Ponty
- Patricia Anjos Lima de Carvalho ,
- Vanessa Thamyris Carvalho dos Santos ,
- Marlene Gomes Terra ,
- Márcia Aparecida Ferreira de Oliveira ,
- Ricardo Henrique Soares , [ … ],
- Edite Lago da Silva Sena
Abstract
ORIGINAL ARTICLEMental suffering in family daily life: a temporal journey according to Merleau-Ponty
Revista Brasileira de Enfermagem. 2023;76(5):e20230258
DOI 10.1590/0034-7167-2023-0258
- Patricia Anjos Lima de Carvalho ,
- Vanessa Thamyris Carvalho dos Santos ,
- Marlene Gomes Terra ,
- Márcia Aparecida Ferreira de Oliveira ,
- Ricardo Henrique Soares ,
- Edite Lago da Silva Sena
Views1See moreABSTRACT
Objectives:
to describe the family’s experience in relation to daily life with a family member experiencing mental suffering.
Methods:
a qualitative, descriptive, phenomenological study grounded in Merleau-Ponty’s ontology of experience was conducted in ten households in a city in the state of Bahia, Brazil, where 24 participants of the Intersubjectivity Wheels reside. The descriptions produced were subjected to the Ambiguity Analytics technique.
Results:
the descriptions were categorized into: absence as a creative power of the sense of “being” and “not being a family”; and exclusion and acceptance as expressions of mental suffering in the family context.
Final Considerations:
the experience of mental suffering in the family’s daily life is marked by ambiguous feelings, such as joy and sadness, disappointment and satisfaction, lack of love and love. However, experiencing these feelings can mobilize the desire to “become” a family, increase the sense of autonomy and independence, and drive the formation of new family configurations.
- Patricia Anjos Lima de Carvalho
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ORIGINAL ARTICLE02-05-2021
Homeless people: health aspects and experiences with health services
- Michely Aline Rodrigues do Prado ,
- Marcela Gonçalves ,
- Simone Santana da Silva ,
- Poliana Silva de Oliveira ,
- Karen da Silva Santos , [ … ],
- Cinira Magali Fortuna
Abstract
ORIGINAL ARTICLEHomeless people: health aspects and experiences with health services
Revista Brasileira de Enfermagem. 2021;74(1):e20190200
DOI 10.1590/0034-7167-2019-0200
- Michely Aline Rodrigues do Prado ,
- Marcela Gonçalves ,
- Simone Santana da Silva ,
- Poliana Silva de Oliveira ,
- Karen da Silva Santos ,
- Cinira Magali Fortuna
Views0See moreABSTRACT
Objectives:
to analyze the understanding of homeless people living in a city in the countryside of São Paulo about what health is and about their experiences in health services.
Methods:
a qualitative exploratory study developed through interviews with homeless people and a field diary. The data were organized by themes and the findings were compared to a collective health framework.
Results:
the explored themes were: “Being healthy for the homeless population”, “The search for health services” and “Being a user of health services from the perspective of homeless people”. We present the interviewees’ understanding of health and their experiences in healthcare services. Along this path, we outline aspects that show the network’s weaknesses, permeated by prejudices and discrimination.
Final Considerations:
this population has conceptions about health and needs that need to be singularly taken into consideration to facilitate access and care.
- Michely Aline Rodrigues do Prado
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09-16-2019
Leprosy educational practices with adolescents: an integrative literature review
- Bruna Hinnah Borges Martins de Freitas ,
- Fabiane Blanco e Silva ,
- Jéssica Maria Ferreira de Jesus ,
- Maria Angélica Brum Alencastro
Abstract
Leprosy educational practices with adolescents: an integrative literature review
Revista Brasileira de Enfermagem. 2019;72(5):1397-1404
DOI 10.1590/0034-7167-2017-0458
- Bruna Hinnah Borges Martins de Freitas ,
- Fabiane Blanco e Silva ,
- Jéssica Maria Ferreira de Jesus ,
- Maria Angélica Brum Alencastro
Views0See moreABSTRACT
Objectives:
to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents.
Method:
an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using “adolescent”; “leprosy”; “health education”; “public health”, and “public health practice” as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.
- Bruna Hinnah Borges Martins de Freitas
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ORIGINAL ARTICLE07-18-2022
Cultural adaptation and content validity evidence of the Nutritional Literacy Scale Brazilian version
- Christiane Pineda Zanella ,
- Helena Alves de Carvalho Sampaio ,
- José Wellington Oliveira de Lima ,
- Thereza Maria Magalhães Moreira
Abstract
ORIGINAL ARTICLECultural adaptation and content validity evidence of the Nutritional Literacy Scale Brazilian version
Revista Brasileira de Enfermagem. 2022;75(6):e20210657
DOI 10.1590/0034-7167-2021-0657
- Christiane Pineda Zanella ,
- Helena Alves de Carvalho Sampaio ,
- José Wellington Oliveira de Lima ,
- Thereza Maria Magalhães Moreira
Views0See moreABSTRACT
Objective:
To investigate the evidence of content validity and reliability of the Brazilian version of the Nutritional Literacy Scale (NLS) after the cultural adaptation process.
Methods:
Psychometric study of 1,197 users of the National Health Service (Brazilian SUS). The NLS was culturally adapted to Brazilian Portuguese and six items of the original scale were modified to improve its understanding, giving rise to the Brazilian version of the scale named NLS-BR. The analysis of evidence of content validity of the NLS-BR was performed using the Item Response Theory (IRT).
Results:
The final version of the NLS-BR had 23 items and proved to be adequate to assess nutritional literacy in adults assisted by the Brazilian SUS.
Final considerations:
The NLS-BR proved to be of adequate understanding and demonstrated evidence of content validity and reliability for users of the Brazilian SUS.
- Christiane Pineda Zanella
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ORIGINAL ARTICLE12-13-2019
Factors related to quilombola attendance to child follow-up appointments
- Elenilda Farias de Oliveira ,
- Climene Laura de Camargo ,
- Nadirlene Pereira Gomes ,
- Telmara Menezes Couto ,
- Luana Moura Campos , [ … ],
- Patricia Santos de Oliveira
Abstract
ORIGINAL ARTICLEFactors related to quilombola attendance to child follow-up appointments
Revista Brasileira de Enfermagem. 2019;72:9-16
DOI 10.1590/0034-7167-2017-0605
- Elenilda Farias de Oliveira ,
- Climene Laura de Camargo ,
- Nadirlene Pereira Gomes ,
- Telmara Menezes Couto ,
- Luana Moura Campos ,
- Patricia Santos de Oliveira
Views0See moreABSTRACT
Objective:
To understand factors interfering with the attendance of quilombola children to growth and development follow-up appointments.
Method:
It is a qualitative research based on Symbolic interactionism, during which 14 mothers of children bellow 1 year-old were interviewed, who attended to the Family Health Unit at Ilha de Maré, Bahia, Brazil.
Results:
Appointment attendance is affected by factors intrinsic to mothers (meaning of child health follow-up; association between appointments and children falling ill; personal issues) and extrinsic factors, related to the service (availability, long waiting time for appointments and its quality).
Final considerations:
An administration prioritizing the service’s organization is required, which can prioritize attendances and the reduction of waiting time, specially given the personal issues that compromise going to the unit.
- Elenilda Farias de Oliveira
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ORIGINAL ARTICLE02-02-2022
The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols
- Alissa Xavier da Costa Furtado Abi ,
- Elaine Dhemer de Almeida Cruz ,
- Letícia Pontes ,
- Tatiane dos Santos ,
- Jorge Vinícius Cestari Felix
Abstract
ORIGINAL ARTICLEThe Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols
Revista Brasileira de Enfermagem. 2022;75(3):e20210153
DOI 10.1590/0034-7167-2021-0153
- Alissa Xavier da Costa Furtado Abi ,
- Elaine Dhemer de Almeida Cruz ,
- Letícia Pontes ,
- Tatiane dos Santos ,
- Jorge Vinícius Cestari Felix
Views0See moreABSTRACT
Objectives:
to identify, classify, and analyze modes of failure in the medication process.
Methods:
evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers.
Results:
207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities.
Conclusions:
the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.
- Alissa Xavier da Costa Furtado Abi
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ORIGINAL ARTICLE07-06-2020
Prevention of infections associated with peripheral catheters: construction and validation of clinical scenario
- Raissa Silva Souza ,
- Patrícia Peres de Oliveira ,
- Ana Angélica Lima Dias ,
- Delma Aurélia da Silva Simão ,
- Aline Eloá Barbosa Pelizari , [ … ],
- Rosely Moralez de Figueiredo
Abstract
ORIGINAL ARTICLEPrevention of infections associated with peripheral catheters: construction and validation of clinical scenario
Revista Brasileira de Enfermagem. 2020;73(5):e20190390
DOI 10.1590/0034-7167-2019-0390
- Raissa Silva Souza ,
- Patrícia Peres de Oliveira ,
- Ana Angélica Lima Dias ,
- Delma Aurélia da Silva Simão ,
- Aline Eloá Barbosa Pelizari ,
- Rosely Moralez de Figueiredo
Views0See moreABSTRACT
Objectives:
to describe the process of construction and content validation of a clinical setting for teaching and learning the recommended practices for preventing bloodstream infection, associated with peripheral venous catheters, for nursing professionals.
Methods:
methodological study of the construction of the scenario based on the National League Nursing Jeffries Simulation Theory, International Nursing Association for Clinical Simulation and Learning, and the Brazilian Health Regulatory Agency. Twelve experts performed content validation. We used to assess the degree of agreement between them, the Content Validity Index, and a descriptive analysis of the suggestions presented.
Results:
all the requirements of the simulated clinical scenario reached an agreement between judges of more than 80% in terms of clarity and relevance.
Conclusions:
the steps adopted in the construction and validation of the clinical scenario proved to be adequate and relevant, and the scenario is suitable for training professionals.
- Raissa Silva Souza
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ORIGINAL ARTICLE07-01-2020
Perceptions of pharmaceutical services among elderly people on polymedication
Revista Brasileira de Enfermagem. 2020;73(5):e20190305
Abstract
ORIGINAL ARTICLEPerceptions of pharmaceutical services among elderly people on polymedication
Revista Brasileira de Enfermagem. 2020;73(5):e20190305
DOI 10.1590/0034-7167-2019-0305
Views0See moreABSTRACT
Objectives:
Describe the importance of guidelines provided during pharmaceutical consultation about compliance with medication therapy based on interviews with polymedicated elderly patients.
Methods:
A qualitative methodological study carried out during consultations with 40 elderly patients of both genders at the Health Care Center for Elderly Patients and Caregivers. The study used the technique of content analysis, applying a questionnaire with two open questions.
Results:
Two categories and eight subcategories emerged after the transcription of interviews and exhaustive reading of the data. The category “Pharmaceutical consultation as an education instrument for the self-care of polymedicated elderly patients” presented the highest frequency. The subcategory with the highest frequency was “Concern of elderly patients about self-care”.
Final Considerations:
In the case of polymedicated elderly patients, pharmaceutical consultation is an important education instrument which, through the provision of pharmaceutical guidelines, allows the minimization of concerns about pharmacotherapy, contributing to compliance and self-care.
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07-05-2021
Factors associated with urinary tract infection in a Nursing Home
- João Luis Almeida da Silva ,
- Cassiane Dezoti da Fonseca ,
- Eniva Miladi Fernandes Stumm ,
- Roseanne Montargil Rocha ,
- Myria Ribeiro da Silva , [ … ],
- Dulce Aparecida Barbosa
Abstract
Factors associated with urinary tract infection in a Nursing Home
Revista Brasileira de Enfermagem. 2021;74:e20200813
DOI 10.1590/0034-7167-2020-0813
- João Luis Almeida da Silva ,
- Cassiane Dezoti da Fonseca ,
- Eniva Miladi Fernandes Stumm ,
- Roseanne Montargil Rocha ,
- Myria Ribeiro da Silva ,
- Dulce Aparecida Barbosa
Views1See moreABSTRACT
Objective:
to analyze the factors associated with urinary tract infection occurrence in institutionalized elderly.
Methods:
this is a cross-sectional, analytical, quantitative study with 116 elderly people from a Nursing Home. Urinary tract infection diagnosis was carried out through urine culture and clinical assessment. Demographic data and associated factors were obtained from medical records. Statistical analysis included bivariate analysis and logistic regression models.
Results:
the factors associated with urinary tract infection (p<0.05) were being female; wheelchair user; diaper use; diuretic use; urinary and bowel incontinence; type 1 diabetes; benign prostatic hyperplasia; dehydration.
Conclusion:
this study revealed that it is important to consider non-modifiable factors such as sex and clinical comorbidities; however, dehydration, a modifiable factor, increased the chances of developing urinary tract infections by 40 times among institutionalized elderly and demands greater attention from the health team.
- João Luis Almeida da Silva
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