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ORIGINAL ARTICLE08-30-2024
Meanings attributed to changes experienced by individuals after COVID-19 hospitalization
- Camila Harmuch
, - Jéssica dos Santos Pini ,
- Paula Antunes Bezerra Nacamura ,
- Anny Caroline Ribeiro Devechi ,
- Vinícius Brito de Souza , [ … ],
- Marcelle Paiano
Abstract
ORIGINAL ARTICLEMeanings attributed to changes experienced by individuals after COVID-19 hospitalization
Revista Brasileira de Enfermagem. 2024;77:e20230122
DOI 10.1590/0034-7167-2023-0122
- Camila Harmuch ,
- Jéssica dos Santos Pini ,
- Paula Antunes Bezerra Nacamura ,
- Anny Caroline Ribeiro Devechi ,
- Vinícius Brito de Souza ,
- Juliana Graciela Vestena Zillmer ,
- Maria Aparecida Salci ,
- Marcelle Paiano
Views0See moreABSTRACT
Objectives:
to understand the meanings attributed to the experiences of individuals after hospitalization for COVID-19.
Methods:
qualitative study, with a theoretical framework based on Symbolic Interactionism and a methodological approach grounded in Grounded Theory. Nineteen participants who had moderate and severe forms of COVID-19 after hospitalization were interviewed. Data collection took place between April and November 2021 through online interviews, and the data were analyzed using initial and focused coding in the MAXQDA software.
Results:
the data illustrate new meanings attributed to different aspects of life after hospitalization, including relationships with others, the environment, physical and mental health, finances, identity, and interactions with a new social reality.
Conclusions:
the meanings are intrinsically linked to the value of interpersonal relationships, the perception of their impact, and the consequences after hospitalization. This allows professionals to understand the importance of this information to improve care and prepare for future epidemics.
- Camila Harmuch
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ORIGINAL ARTICLE08-30-2024
Patient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital
- Amanda Lobato Lopes ,
- Rosana Aparecida Pereira ,
- Laura Martins Valdevite Pereira ,
- Felippe Micheli Costa de Castilho ,
- Fernanda Raphael Escobar Gimenes
Abstract
ORIGINAL ARTICLEPatient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital
Revista Brasileira de Enfermagem. 2024;77:e20230187
DOI 10.1590/0034-7167-2023-0187
- Amanda Lobato Lopes ,
- Rosana Aparecida Pereira ,
- Laura Martins Valdevite Pereira ,
- Felippe Micheli Costa de Castilho ,
- Fernanda Raphael Escobar Gimenes
Views0See moreABSTRACT
Objectives:
to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture.
Methods:
a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened.
Results:
all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors.
Conclusions:
with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution’s leaders.
- Amanda Lobato Lopes
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REVIEW08-30-2024
Educational actions conducted during the pandemic with primary health care professionals: a scoping review
- Bruna Dias França ,
- Kênia Lara Silva ,
- Lilian Cristina Rezende ,
- Francisco Carlos Felix Lana ,
- Simone de Pinho Barbosa
Abstract
REVIEWEducational actions conducted during the pandemic with primary health care professionals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230352
DOI 10.1590/0034-7167-2023-0352
- Bruna Dias França ,
- Kênia Lara Silva ,
- Lilian Cristina Rezende ,
- Francisco Carlos Felix Lana ,
- Simone de Pinho Barbosa
Views0See moreABSTRACT
Objectives:
to map the educational actions conducted with primary health care professionals during the COVID-19 pandemic.
Methods:
a scoping review conducted in August 2023, which covered databases such as CINAHL, Medline, LILACS, IBECS, BDENF, and Web of Science. In total, 32 publications were analyzed through content analysis.
Results:
the primary beneficiaries of the educational actions included 69% physicians, 56% nurses, 25% pharmacists, 13% social workers and dentists, 9% psychologists, community health agents, and laboratory professionals, and 6% nursing technicians, nutritionists, and physical educators. The predominant educational interventions were training sessions (mentioned in 19 publications), followed by Continuing Health Education (10 publications) and Continuing Education (three publications).
Final Considerations:
the educational interventions demonstrated positive impacts on professional practice, particularly the Continuing Health Education actions, which were notable for stimulating critical problem-solving among professionals.
- Bruna Dias França
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ORIGINAL ARTICLE08-30-2024
Negative affectivity in university students and its relationship with academic performance and professional outlook after COVID-19
- Bruna de Oliveira Alves ,
- Bárbara Guimarães Lourenço ,
- Bianca Bacelar Assis Araújo ,
- Luana Vieira Toledo ,
- Rafael Lopes Chaves , [ … ],
- Caroline de Castro Moura
Abstract
ORIGINAL ARTICLENegative affectivity in university students and its relationship with academic performance and professional outlook after COVID-19
Revista Brasileira de Enfermagem. 2024;77:e20240040
DOI 10.1590/0034-7167-2024-0040
- Bruna de Oliveira Alves ,
- Bárbara Guimarães Lourenço ,
- Bianca Bacelar Assis Araújo ,
- Luana Vieira Toledo ,
- Rafael Lopes Chaves ,
- Érika de Cássia Lopes Chaves ,
- Tânia Couto Machado Chianca ,
- Caroline de Castro Moura
Views0See moreABSTRACT
Objectives:
to evaluate the prevalence of negative affectivity in university students in the post-COVID-19 pandemic context and its relationship with academic performance and professional outlook.
Methods:
a cross-sectional study was conducted with undergraduate students from a public university in Minas Gerais between September 2022 and September 2023. Data were collected using a sociodemographic and psychosocial characterization questionnaire and the Depression, Anxiety, and Stress Scale 21. The relationships between negative affectivity, academic performance, and professional outlook were verified using the Kruskal-Wallis test, with a significance level of 5%.
Results:
a total of 585 students participated in the study. A high prevalence of depression, anxiety, and stress was found among university students in the post-COVID-19 context, with a notable severity of anxiety. A negative association was detected between the investigated negative affectivity, academic performance, and professional outlook.
Conclusions:
the results indicate an emotional vulnerability in university students, with a relationship between negative affectivity and a decline in academic performance and professional outlook.
- Bruna de Oliveira Alves
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REVIEW08-30-2024
Impact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review
- Luciana de Alcantara Nogueira ,
- Cristiano de Oliveira Ribeiro ,
- Leonel dos Santos Silva ,
- Yasmin Hiorrana dos Santos ,
- Luciana Puchalski Kalinke
Abstract
REVIEWImpact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20240078
DOI 10.1590/0034-7167-2024-0078
- Luciana de Alcantara Nogueira ,
- Cristiano de Oliveira Ribeiro ,
- Leonel dos Santos Silva ,
- Yasmin Hiorrana dos Santos ,
- Luciana Puchalski Kalinke
Views0See moreABSTRACT
Objectives:
to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic.
Methods:
an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023.
Results:
out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative.
Conclusions:
the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients’ lives.
- Luciana de Alcantara Nogueira
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ORIGINAL ARTICLE08-30-2024
Risk of smoking cessation treatment dropout: a cohort to help (re)think care
- Janaina Pereira da Silva ,
- Adriana Ignácio de Pádua ,
- Ruan Víctor dos Santos Silva ,
- Felipe Lima dos Santos ,
- Poliana Silva de Oliveira , [ … ],
- Cinira Magali Fortuna
Abstract
ORIGINAL ARTICLERisk of smoking cessation treatment dropout: a cohort to help (re)think care
Revista Brasileira de Enfermagem. 2024;77:e20230537
DOI 10.1590/0034-7167-2023-0537
- Janaina Pereira da Silva ,
- Adriana Ignácio de Pádua ,
- Ruan Víctor dos Santos Silva ,
- Felipe Lima dos Santos ,
- Poliana Silva de Oliveira ,
- Priscila Norié Araujo-Betetti ,
- Joris Thievenaz ,
- Cinira Magali Fortuna
Views0See moreABSTRACT
Objectives:
to evaluate the relative risk of smoking cessation treatment dropout during its intensive phase.
Methods:
a retrospective and quantitative cohort study was developed from the electronic medical records of individuals who started smoking cessation treatment between 2015 and 2019 at a specialty clinic in a city in the interior of São Paulo, Brazil. The relative risk of dropping out of treatment was calculated using the Poisson regression model.
Results:
it was observed that out of the 396 (100.0%) individuals who started the treatment, 109 (27.5%) abandoned it before the end of the intensive phase. For each one-year increase in age, the risk of dropping out of smoking cessation treatment decreased by an average of 2%.
Conclusions:
the risk of dropping out of smoking cessation treatment is higher among younger individuals. It is necessary to rethink the care offered to younger adults to promote the continuity of treatment.
- Janaina Pereira da Silva
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ORIGINAL ARTICLE08-26-2024
Influence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
Abstract
ORIGINAL ARTICLEInfluence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
Revista Brasileira de Enfermagem. 2024;77(5):e20230293
DOI 10.1590/0034-7167-2023-0293
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
Views0See moreABSTRACT
Objectives:
to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department.
Methods:
retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses.
Results:
in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p<0.009), but was not dependent on the transfused blood component (p=0.124). The leukoreduction moment had no effect (p>0.050) on transfusion reactions, healthcare-associated infections, or mortality.
Conclusions:
patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.
- Natasha Dejigov Monteiro da Silva
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ORIGINAL ARTICLE08-26-2024
Driver’s license, head protection devices and severity of motorcyclists’ injuries in traffic accidents
Revista Brasileira de Enfermagem. 2024;77(5):e20230153
Abstract
ORIGINAL ARTICLEDriver’s license, head protection devices and severity of motorcyclists’ injuries in traffic accidents
Revista Brasileira de Enfermagem. 2024;77(5):e20230153
DOI 10.1590/0034-7167-2023-0153
Views0See moreABSTRACT
Objectives:
to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver’s license and use of helmets according to the severity of injuries.
Methods:
a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil.
Results:
170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14).
Conclusions:
people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.
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ORIGINAL ARTICLE02-10-2020
Mental health profile of the elderly community: a cross-sectional study
- Renata Cavalcanti Cordeiro ,
- Renata Clemente dos Santos ,
- Gleicy Karine Nascimento de Araújo ,
- Neyce de Matos Nascimento ,
- Rafaella Queiroga Souto , [ … ],
- Jeane da Silva Rocha Santos
Abstract
ORIGINAL ARTICLEMental health profile of the elderly community: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73(1):e20180191
DOI 10.1590/0034-7167-2018-0191
- Renata Cavalcanti Cordeiro ,
- Renata Clemente dos Santos ,
- Gleicy Karine Nascimento de Araújo ,
- Neyce de Matos Nascimento ,
- Rafaella Queiroga Souto ,
- Albanita Gomes da Costa de Ceballos ,
- Fabia Alexandra Pottes Alves ,
- Jeane da Silva Rocha Santos
Views0See moreABSTRACT
Objective:
to describe the mental health profile of the elderly registered in a Family Health Unit in the city of Recife, Pernambuco State.
Method:
it was a descriptive quantitative study, conducted with 159 elderly through the scales Geriatric Depression, Resilience, Social Support, Life Satisfaction, and Positive and Negative Affects, Mini-Mental State Examination, Stressful Events Inventory and Brazil Old Age Shedule.
Results:
females, young and literate elderly predominated. Most were satisfied with life, 52.2% without depressive symptoms, 68.6% without cognitive impairment, 67.9% high resilience and 95.8% high social support, but 62% of elderly with depressive symptoms showed cognitive deficit. Negative correlation was identified between depression and cognitive impairment, resilience, social support and life satisfaction.
Conclusion:
assessment of these indicators identifies triggers of psychological distress, assisting the nursing staff in the development of preventive and care actions.
- Renata Cavalcanti Cordeiro
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ORIGINAL ARTICLE01-27-2020
Factors associated with depressive symptoms in elderly caregivers with chronic pain
- Marielli Terassi ,
- Estefani Serafim Rossetti ,
- Bruna Moretti Luchesi ,
- Karina Gramani-Say ,
- Priscilla Hortense , [ … ],
- Sofia Cristina Iost Pavarini
Abstract
ORIGINAL ARTICLEFactors associated with depressive symptoms in elderly caregivers with chronic pain
Revista Brasileira de Enfermagem. 2020;73(1):e20170782
DOI 10.1590/0034-7167-2017-0782
- Marielli Terassi ,
- Estefani Serafim Rossetti ,
- Bruna Moretti Luchesi ,
- Karina Gramani-Say ,
- Priscilla Hortense ,
- Sofia Cristina Iost Pavarini
Views0See moreABSTRACT
Objective:
to identify factors associated with depressive symptoms in elderly caregivers with chronic pain.
Method:
the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression.
Results:
most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use.
Conclusion:
factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.
- Marielli Terassi
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EXPERIENCE REPORT10-26-2020
Collaborative practices from health care teams to face the covid-19 pandemic
- Adriano da Costa Belarmino ,
- Maria Eunice Nogueira Galeno Rodrigues ,
- Saiwori de Jesus Silva Bezerra dos Anjos ,
- Antonio Rodrigues Ferreira Júnior
Abstract
EXPERIENCE REPORTCollaborative practices from health care teams to face the covid-19 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200470
DOI 10.1590/0034-7167-2020-0470
- Adriano da Costa Belarmino ,
- Maria Eunice Nogueira Galeno Rodrigues ,
- Saiwori de Jesus Silva Bezerra dos Anjos ,
- Antonio Rodrigues Ferreira Júnior
Views0See moreABSTRACT
Objective:
To report the experience of collaborative practices facing the COVID-19 pandemic.
Methods:
This is a report about the experience of collaborative practices conducted by health care teams in emergency service in the Emergency Care Units facing of COVID-19 pandemic in the city of Fortaleza, State of Ceará, in the first semester of 2020.
Results:
Collaborative actions, cooperation and effective communication among nursing and medical team contribute to the management of mild and complex cases of COVID-19, as well as qualify them in suitable and necessary care and confrontation measures.
Final considerations:
The report shows the need for collaborative practices to minimize negative effects on the population in the face of the new coronavirus pandemic.
- Adriano da Costa Belarmino
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ORIGINAL ARTICLE07-08-2020
Spirituality and religiousity in the experience of suffering, guilt, and death of the elderly with cancer
- Raniele Araújo de Freitas ,
- Tânia Maria de Oliva Menezes ,
- Lucivalda Barbosa Santos ,
- Halanna Carneiro Guimarães Bastos Moura ,
- Marta Gabriele Santos Sales , [ … ],
- Fabiana Araújo Moreira
Abstract
ORIGINAL ARTICLESpirituality and religiousity in the experience of suffering, guilt, and death of the elderly with cancer
Revista Brasileira de Enfermagem. 2020;73:e20190034
DOI 10.1590/0034-7167-2019-0034
- Raniele Araújo de Freitas ,
- Tânia Maria de Oliva Menezes ,
- Lucivalda Barbosa Santos ,
- Halanna Carneiro Guimarães Bastos Moura ,
- Marta Gabriele Santos Sales ,
- Fabiana Araújo Moreira
Views0See moreABSTRACT
Objective:
to understand spirituality and religiosity in the experience of suffering, guilt, and death of the elderly with cancer.
Method:
qualitative research based on Viktor Frankl’s Existential Analysis. Twenty phenomenological interviews were conducted with people over 60 years old undergoing chemotherapy treatment at an oncology unit of a hospital in the city of Salvador, Bahia State, Brazil, between August and October 2018.
Results:
the following categories emerged: Experiences spirituality and religiosity in the face of the tragic triad and existential emptiness; Uses spirituality/religiosity as resilience strategies. After apprehension of ontic aspects, it was possible the ontological understanding of spirituality and religiosity in the face of suffering, guilt, and death experienced in the elderly with cancer’s daily life.
Final considerations:
spirituality and religiosity were understood as coping strategies used in the unstable experience of the elderly with cancer, providing comfort and resilience.
- Raniele Araújo de Freitas
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ORIGINAL ARTICLE12-05-2019
Quality of life of institutionalized aged with and without symptoms of depression
- Gerson Scherrer Júnior ,
- Meiry Fernanda Pinto Okuno ,
- Leticia Meazzini de Oliveira ,
- Dulce Aparecida Barbosa ,
- Angélica Castilho Alonso , [ … ],
- Angélica Gonçalves Silva Belasco
Abstract
ORIGINAL ARTICLEQuality of life of institutionalized aged with and without symptoms of depression
Revista Brasileira de Enfermagem. 2019;72:127-133
DOI 10.1590/0034-7167-2018-0316
- Gerson Scherrer Júnior ,
- Meiry Fernanda Pinto Okuno ,
- Leticia Meazzini de Oliveira ,
- Dulce Aparecida Barbosa ,
- Angélica Castilho Alonso ,
- Dayana Souza Fram ,
- Angélica Gonçalves Silva Belasco
Views0See moreABSTRACT
Objective:
compare the quality of life (QOL) of aged residents in homes for aged people with or without symptoms of depression, and identify social, physical activity; leisure; health and basic activities of daily living (ADL) variables that correlate with QOL scores.
Method:
cross-sectional study conducted with 101 institutionalized aged. Multiple linear regression was used for data analysis.
Results:
symptoms of depression changed negatively the QOL in the domains: autonomy; present, past and future activities; social participation; intimacy and total score. Dependent aged presented lower QOL for the performance of ADL in the domains: autonomy; social participation and total score; dancing without limitation of movement; liking the residential and not presenting symptoms of depression were the variables that positively influenced the QOL of the aged.
Conclusion:
social and psychological support, good living conditions and stimulating assistance can improve the QOL of institutionalized elderlies.
- Gerson Scherrer Júnior
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12-05-2019
Reality and challenges of ageing
Revista Brasileira de Enfermagem. 2019;72:1-2
Abstract
Reality and challenges of ageing
Revista Brasileira de Enfermagem. 2019;72:1-2
DOI 10.1590/0034-7167.2019-72suppl201
Views1The global population ageing has aroused growing interest, a search for an understanding of the situational consequences and possible adjustments that society will have to make. According to the Brazilian Institute of Geography and Statistics (IBGE – Instituto Brasileiro de Geografia e Estatística), in 2025, the country will place the 6th position in the world […]See more -
ORIGINAL ARTICLE08-10-2020
Transformational leadership in nursing practice: challenges and strategies
- Vanêska Brito Ferreira ,
- Simone Coelho Amestoy ,
- Gilberto Tadeu Reis da Silva ,
- Letícia de Lima Trindade ,
- Ises Adriana Reis dos Santos , [ … ],
- Patrícia Alves Galhardo Varanda
Abstract
ORIGINAL ARTICLETransformational leadership in nursing practice: challenges and strategies
Revista Brasileira de Enfermagem. 2020;73(6):e20190364
DOI 10.1590/0034-7167-2019-0364
- Vanêska Brito Ferreira ,
- Simone Coelho Amestoy ,
- Gilberto Tadeu Reis da Silva ,
- Letícia de Lima Trindade ,
- Ises Adriana Reis dos Santos ,
- Patrícia Alves Galhardo Varanda
Views0INTRODUCTIONLeadership stands out as one of the managerial skills necessary to nurses’ practice, especially in the current scenario of frequent overcrowding and scarcity of beds, material resource deficits and insufficient staffing. The reality of some public health services has weaknesses in serving the population and lacks nurses with the knowledge, skills and attitudes to act […]See more - Vanêska Brito Ferreira
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ORIGINAL ARTICLE05-15-2020
Stress and quality of sleep in undergraduate nursing students
- Kézia Katiane Medeiros da Silva ,
- Milva Maria Figueiredo de Martino ,
- Clarissa Maria Bandeira Bezerra ,
- Ângela Monic Lima de Souza ,
- Danila Maria da Silva , [ … ],
- Jacqueline Targino Nunes
Abstract
ORIGINAL ARTICLEStress and quality of sleep in undergraduate nursing students
Revista Brasileira de Enfermagem. 2020;73:e20180227
DOI 10.1590/0034-7167-2018-0227
- Kézia Katiane Medeiros da Silva ,
- Milva Maria Figueiredo de Martino ,
- Clarissa Maria Bandeira Bezerra ,
- Ângela Monic Lima de Souza ,
- Danila Maria da Silva ,
- Jacqueline Targino Nunes
Views0See moreABSTRACT
Objective:
to analyze the level of stress and sleep quality in nursing students according to terms of the nursing program.
Method:
descriptive and cross-sectional research developed in a higher education institution in Northeastern Brazil on 167 students. We used data collection, sociodemographic information, and a scale for assessing stress and sleep quality in nursing students.
Results:
we identified a statistically significant difference between domains of the stress scale and the terms of the undergraduate program, and between the quality of sleep and such terms such as as in the fourth and sixth semesters.
Conclusion:
different stress scores show that the semester which concerns students the most is the fifth. Quality of sleep was deemed good for the first, third, fifth, seventh, and eighth semesters; and poor for the fourth and sixth terms.
- Kézia Katiane Medeiros da Silva
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