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ORIGINAL ARTICLE12-16-2024
Respectful care for postpartum women with sickle cell disease: a netnographic study
- Zannety Conceição Silva do Nascimento Souza
, - Luana Gabriella Pinheiro Barrêto ,
- Paulo Roberto Lima Falcão do Vale ,
- Elysangela Dittz Duarte ,
- Cristiane dos Santos Silva , [ … ],
- Evanilda Souza de Santana Carvalho
Abstract
ORIGINAL ARTICLERespectful care for postpartum women with sickle cell disease: a netnographic study
Revista Brasileira de Enfermagem. 2024;77(6):e20230545
DOI 10.1590/0034-7167-2023-0545
- Zannety Conceição Silva do Nascimento Souza ,
- Luana Gabriella Pinheiro Barrêto ,
- Paulo Roberto Lima Falcão do Vale ,
- Elysangela Dittz Duarte ,
- Cristiane dos Santos Silva ,
- Evanilda Souza de Santana Carvalho
Views1See moreABSTRACT
Objectives:
to analyze principles of respectful maternity care in narratives of postpartum women with sickle cell disease, relating them to Sustainable Development Goals.
Methods:
netnographic study, with two videos published in 2020. Deductive iconographic and thematic analysis by Respectful Maternity Care Charter, organized in MAXQDA.
Results:
principles identified were the right to: freedom from harm and ill-treatment; information, informed consent, refusal of medical procedures, and respect for their choices and preferences including companion; be considered a person from birth, with dignified and respectful treatment; health at the highest possible level; newborns being with their parents or guardians. The Sustainable Development Goals for women by 2030 were not positively contemplated in postpartum women’s experience.
Final Considerations:
it is appropriate that health workers qualify themselves to provide respectful maternity care, with qualified listening, understanding, and resolution of unique demands of postpartum women with sickle cell disease, seeking equality in care for women.
- Zannety Conceição Silva do Nascimento Souza
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12-16-2024
GerenciaDOR™: development of digital technology by nurses for the assessment of patients with chronic pain
Revista Brasileira de Enfermagem. 2024;77(6):e20240050
Abstract
GerenciaDOR™: development of digital technology by nurses for the assessment of patients with chronic pain
Revista Brasileira de Enfermagem. 2024;77(6):e20240050
DOI 10.1590/0034-7167-2024-0050
Views0See moreABSTRACT
Objectives:
to develop a digital technological solution (prototype) for assessing patients with chronic pain.
Methods:
this is a methodological and technological development study based on the Human-Centered Design framework and the principles of Patient-Centered Care. The prototype guides patients through a body diagram and directs them to an evaluation using specific instruments that address the multidimensional aspects of chronic pain.
Results:
the GerenciaDOR* project enables navigation through the Web App screens, providing access to pain assessment features up to the presentation of results.
Final Considerations:
the study describes a systematic approach to pain assessment and expands nurses’ knowledge in pain management. Additionally, it can promote the development of other digital technologies for chronic pain assessment and contribute to a multidisciplinary, patient centered treatment.
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ORIGINAL ARTICLE12-16-2024
Psychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
- Frederico Marques Andrade ,
- Lanuza Borges Oliveira ,
- Igor Monteiro Lima Martins ,
- Maria Eduarda Borges Rodrigues ,
- Carla Silvana de Oliveira e Silva
Abstract
ORIGINAL ARTICLEPsychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
Revista Brasileira de Enfermagem. 2024;77(6):e20240085
DOI 10.1590/0034-7167-2024-0085
- Frederico Marques Andrade ,
- Lanuza Borges Oliveira ,
- Igor Monteiro Lima Martins ,
- Maria Eduarda Borges Rodrigues ,
- Carla Silvana de Oliveira e Silva
Views0See moreABSTRACT
Objectives:
to analyze the psychometric properties of the ProQOL-BR instrument in hospital nursing professionals.
Methods:
a methodological study to validate the ProQOL-BR. Confirmatory factor analysis, assessment of local and global adjustment quality, Pearson hypothesis testing and Cronbach’s alpha internal consistency analysis were used.
Results:
a total of 490 professionals participated. The model presents adequate quality due to factor weights (λ≥ 0.40), acceptable overall fit quality and adequate chi-square ratio and degrees of freedom (χ2/g.1=2.51) for the parameters of CFI (0.923), GFI (0.902), TLI (0.914) and RMSEA (0.042). In terms of validity, it was shown to be adequate with CC=0.89. The internal consistency obtained by standardized Cronbach’s alpha was 0.761. Criterion validity was shown to be favorable with significant correlations (0.001).
Conclusions:
the instrument was validated regarding content, criteria and reliability. Three questions were removed from the original instrument, ProQOL-BR, leaving the final instrument with 25 questions.
- Frederico Marques Andrade
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REVIEW12-16-2024
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
- Evelin Daiane Gabriel Pinhatti ,
- Amanda Salles Margatho do Nascimento ,
- Regina Celia Bueno Rezende Machado ,
- Rosangela Aparecida Pimenta ,
- André Estevam Jaques , [ … ],
- Maria do Carmo Fernandez Lourenço Haddad
Abstract
REVIEWRecommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
DOI 10.1590/0034-7167-2024-0086
- Evelin Daiane Gabriel Pinhatti ,
- Amanda Salles Margatho do Nascimento ,
- Regina Celia Bueno Rezende Machado ,
- Rosangela Aparecida Pimenta ,
- André Estevam Jaques ,
- Maria do Carmo Fernandez Lourenço Haddad
Views1See moreABSTRACT
Objectives:
to summarize the recommendations of guidelines for promoting mental health in the workplace.
Methods:
an umbrella review, according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses methodological assumptions. Data collection was carried out in January 2021 and updated in July 2023 in the American Psychological Association, Cochrane Library, EMBASE, National Library of Medicine, and Scopus databases. Systematic reviews that assessed guidelines with recommendations for mental health care for workers were included. PROSPERO registration CRD42023461845.
Results:
four systematic reviews published between 2015 and 2018 were identified. The abstracts highlighted actions that facilitate and inhibit the recommendations as well as three categories of intervention: primary prevention – worker protection; secondary prevention – promoting workers’ mental health; and tertiary prevention – supporting, monitoring and rehabilitating workers upon returning to work.
Conclusions:
the interventions are based on prevention, promotion and early recognition, support and rehabilitation of mental health problems.
- Evelin Daiane Gabriel Pinhatti
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ORIGINAL ARTICLE12-16-2024
Analysis of omission of antimicrobial doses in Intensive Care Units
- Isabelle Ribeiro Machado ,
- Danielle de Mendonça Henrique ,
- Flávia Giron Camerini ,
- Vanessa Galdino de Paula ,
- Cintia Silva Fassarella , [ … ],
- Lucas Rodrigo Garcia de Mello
Abstract
ORIGINAL ARTICLEAnalysis of omission of antimicrobial doses in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(6):e20240102
DOI 10.1590/0034-7167-2024-0102
- Isabelle Ribeiro Machado ,
- Danielle de Mendonça Henrique ,
- Flávia Giron Camerini ,
- Vanessa Galdino de Paula ,
- Cintia Silva Fassarella ,
- Lucas Rodrigo Garcia de Mello
Views0See moreABSTRACT
Objectives:
to analyze the rate of antimicrobial dose omission in intensive care units.
Methods:
cross-sectional study carried out between March 1 and September 30, 2023, in intensive care units of a University Hospital in Rio de Janeiro.
Results:
the sample consisted of 452 prescriptions and 1467 antimicrobial doses. The dose omission rate was 4.29%. Each antimicrobial prescribed increased the chance of omission by 51%. The strategy of double-checking prescriptions helped prevent 30% of antimicrobial dose omissions (p=0.0001).
Conclusions:
monitoring the omission of antimicrobial doses can guide nursing actions to improve quality and patient safety, contributing to the prevention of medication errors, antimicrobial stewardship and the fight against antimicrobial resistance.
- Isabelle Ribeiro Machado
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ORIGINAL ARTICLE12-16-2024
Health literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
Abstract
ORIGINAL ARTICLEHealth literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
DOI 10.1590/0034-7167-2024-0154
Views0See moreABSTRACT
Objectives:
to identify the process of health literacy development among primary care patients, relating it to their self-care practices.
Methods:
qualitative, prospective research with 22 patients from two Family Health Strategy units. Data were obtained through individual semi-structured interviews, examined through descriptive statistics and thematic content analysis.
Results:
the results discuss how participants learn about health and how this resonates in their behaviors, culminating in two thematic categories: “Health knowledge construction”; and “Dialogue between health knowledge construction and patient care actions”.
Final Considerations:
health knowledge is developed mainly through interpersonal relationships, mediated by health professionals through bonding and communication. Community educational actions and training of health professionals in communication can promote health literacy and self-care among patients.
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ORIGINAL ARTICLE12-16-2024
Bladder ultrasound: evidence of content validity of a checklist for training nurses
- Filipe Utuari de Andrade Coelho ,
- Sabrina Martins Reigota ,
- Flávia Manfredi Cavalcanti ,
- Dejanira Aparecida Regagnin ,
- Beatriz Murata Murakami , [ … ],
- Vinícius Batista Santos
Abstract
ORIGINAL ARTICLEBladder ultrasound: evidence of content validity of a checklist for training nurses
Revista Brasileira de Enfermagem. 2024;77(6):e20230183
DOI 10.1590/0034-7167-2023-0183
- Filipe Utuari de Andrade Coelho ,
- Sabrina Martins Reigota ,
- Flávia Manfredi Cavalcanti ,
- Dejanira Aparecida Regagnin ,
- Beatriz Murata Murakami ,
- Vinícius Batista Santos
Views0See moreABSTRACT
Objectives:
to develop and analyze evidence of content validity of a checklist for training nurses in measuring bladder volume through ultrasound.
Methods:
a methodological study, consisting of three stages: literature review; instrument item preparation; and analysis of evidence of content validity. The Content Validity Index (CVI) and Gwet’s AC2 were used for content validity analyses.
Results:
the checklist consisted of 23 items. The CVIs for clarity, relevance and dimensionality were 0.99, 0.99 and 0.98 respectively, and the CVIs for Gwet’s AC2 with coefficients for clarity, relevance and dimensionality were 0.89, 0.97 and 0.95, respectively, with p<0.001.
Conclusions:
the checklist developed for training nurses in measuring bladder volume through ultrasound achieved adequate evidence of content validity, and can be used to train nurses in clinical practice and future research.
- Filipe Utuari de Andrade Coelho
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12-16-2024
A relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
- Amelia Margaretha Simbolon ,
- Jesika Sari Munthe ,
- Mikar Syah Idaman Daeli ,
- Ineke Patrisia ,
- Chriska Roully Adeline Sinaga
Abstract
A relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
Revista Brasileira de Enfermagem. 2024;77(6):e20220615
DOI 10.1590/0034-7167-2022-0615
- Amelia Margaretha Simbolon ,
- Jesika Sari Munthe ,
- Mikar Syah Idaman Daeli ,
- Ineke Patrisia ,
- Chriska Roully Adeline Sinaga
Views1See moreRESUMEN
Objetivos:
identificar las variables asociadas a la práctica clínica relacionadas con la ansiedad de los estudiantes de enfermería.
Métodos:
se utilizó un diseño descriptivo, cuantitativo, correlacional con las recomendaciones STROBE, EQUATOR. La población fue de 233 estudiantes de enfermería con una muestra de 135 personas. Los datos se recopilaron de marzo a abril de 2022 utilizando instrumentos validados.
Resultados:
la prueba de chi-cuadrado y razón de verosimilitud significativa para género, formación académica y entorno de aprendizaje son superiores a 0.05, por lo que no existe una relación significativa entre las variables y la ansiedad de los estudiantes.
Conclusiones:
los estudiantes necesitan prepararse nuevamente antes de ingresar al campo de la práctica. Investigaciones cualitativas también son necesarias.
- Amelia Margaretha Simbolon
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REVIEW12-21-2020
Strategies and competences of nurses in men’s health care: an integrative review
- Josias Alves de Oliveira ,
- Isabella Félix Meira Araújo ,
- Gilberto Tadeu Reis da Silva ,
- Anderson Reis de Sousa ,
- Álvaro Pereira
Abstract
REVIEWStrategies and competences of nurses in men’s health care: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190546
DOI 10.1590/0034-7167-2019-0546
- Josias Alves de Oliveira ,
- Isabella Félix Meira Araújo ,
- Gilberto Tadeu Reis da Silva ,
- Anderson Reis de Sousa ,
- Álvaro Pereira
Views0See moreABSTRACT
Objectives:
to synthesize scientific evidence on nurses’ strategies and competencies in men’s health care.
Methods:
an integrative review carried out in seven databases, with a time frame from 2009 to 2019, using the descriptors “men’s health”, “professional competence”, “nursing”, “nursing care” and “male” in Portuguese and in English.
Results:
ten articles were selected, in which it was demonstrated that nursing professionals develop their professional practices with regard to men’s health care, in convergence with the general skills of the profession. The most used are health care; decision-making; Communication; administration; management; continuing education and leadership, consecutively.
Final Considerations:
professionals’ efforts to strengthen health actions, aimed at male needs, in accordance with the general skills of the profession and the principles and guidelines of the Brazilian National Policy for Comprehensive Care to Men’s Health.
- Josias Alves de Oliveira
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ORIGINAL ARTICLE09-16-2019
Social representations of HIV/AIDS by older people and the interface with prevention
Revista Brasileira de Enfermagem. 2019;72(5):1129-1136
Abstract
ORIGINAL ARTICLESocial representations of HIV/AIDS by older people and the interface with prevention
Revista Brasileira de Enfermagem. 2019;72(5):1129-1136
DOI 10.1590/0034-7167-2017-0748
Views0See moreABSTRACT
Objective:
To apprehend the social representations elaborated by older people about HIV/AIDS and to understand how they relate to the prevention of HIV infection.
Method:
Descriptive and qualitative research based on the Theory of Social Representations with 42 older people assisted at primary care. Data were produced through in-depth interviews with a semi-structured instrument, processed in the IRaMuTeQ software, and analyzed by means of the descending hierarchical classification.
Results:
Five classes emerged: “HIV/AIDS: a problem of young people”; “Quality of life improvement for people living with HIV/AIDS”; “Vulnerability to HIV/AIDS among heterosexual women in a stable union”; “HIV/AIDS Information Network: process of creation and transformation of social representations” and “Prevention versus stigma”.
Final considerations:
The social representations that older people have about HIV/AIDS influence the adoption of preventive measures negatively because stigma is present and HIV/AIDS is attributed to young men, and to men who have sex with other men.
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ORIGINAL ARTICLE09-21-2020
Autonomy in the reproductive health of quilombolas women and associated factors
- Elionara Teixeira Boa Sorte Fernandes ,
- Sílvia Lúcia Ferreira ,
- Cláudia Suely Barreto Ferreira ,
- Eliene Almeida Santos
Abstract
ORIGINAL ARTICLEAutonomy in the reproductive health of quilombolas women and associated factors
Revista Brasileira de Enfermagem. 2020;73:e20190786
DOI 10.1590/0034-7167-2019-0786
- Elionara Teixeira Boa Sorte Fernandes ,
- Sílvia Lúcia Ferreira ,
- Cláudia Suely Barreto Ferreira ,
- Eliene Almeida Santos
Views0See moreABSTRACT
Objective:
Identify the level of reproductive autonomy of quilombola women and associate it with sociodemographic characteristics and aspects of sexual and reproductive health.
Methods:
Cross-sectional census study carried out in quilombola communities in a municipality in Bahia. Data was collected through questionnaires from the National Health Survey and the Reproductive Autonomy Scale, applied to quilombola women who agreed to participate. Descriptive statistics procedures were used and associations were made between reproductive autonomy scores and sociodemographic and reproductive characteristics.
Results:
The average total score for reproductive autonomy was 2.06. An association was found between the “decision-making” score and marital status. The score for “total reproductive autonomy” was associated with the use of contraceptive method.
Conclusion:
The reality of the study participants converges with the literature regarding the interference of sociodemographic and reproductive factors in the reproductive autonomy of black women.
- Elionara Teixeira Boa Sorte Fernandes
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ORIGINAL ARTICLE08-19-2019
Psychosocial risks related to the nurse in the psychiatric hospital and management strategies
- Maria Carolina Santos Scozzafave ,
- Laura Andrian Leal ,
- Mirelle Inácio Soares ,
- Silvia Helena Henriques
Abstract
ORIGINAL ARTICLEPsychosocial risks related to the nurse in the psychiatric hospital and management strategies
Revista Brasileira de Enfermagem. 2019;72(4):834-840
DOI 10.1590/0034-7167-2017-0311
- Maria Carolina Santos Scozzafave ,
- Laura Andrian Leal ,
- Mirelle Inácio Soares ,
- Silvia Helena Henriques
Views0See moreABSTRACT
Objective:
To characterize the presence of psychosocial risks related to the work of the nurse in a psychiatric hospital and the strategies for managing these risks.
Methods:
Qualitative, in which 25 nurses from a psychiatric hospital participated using semi-structured interviews from November 2014 to January 2015. Data analysis was performed using the thematic method.
Results:
The results showed psychosocial risks related to the work of psychiatric nurses, such as: insufficient academic training; lack of preparation and maintenance of equipment; poor relationship with colleagues; shortage of human resources and lack of capacity building; conflict between the demands of the home and work, as well as strategies for managing psychosocial risks such as family, cinema, music, reading, among others.
Final considerations:
This study should provoke the reflection of managers and future nurses regarding the working conditions in a psychiatric hospital and possible psychosocial risks to which they are exposed.
- Maria Carolina Santos Scozzafave
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EXPERIENCE REPORT07-01-2020
Generating meaningful conversation: World Café in strategic interprofessional planning in Continuing Education
- Jennifer Bazilio ,
- Jessica de Aquino Pereira ,
- Maura Cristiane e Silva Figueira ,
- Eliete Maria Silva
Abstract
EXPERIENCE REPORTGenerating meaningful conversation: World Café in strategic interprofessional planning in Continuing Education
Revista Brasileira de Enfermagem. 2020;73(5):e20190279
DOI 10.1590/0034-7167-2019-0279
- Jennifer Bazilio ,
- Jessica de Aquino Pereira ,
- Maura Cristiane e Silva Figueira ,
- Eliete Maria Silva
Views0See moreABSTRACT
Objectives:
to present the particularities of the World Café, identifying the main aspects that characterize a planning strategy for a constructive, interactive, and participative dialogue of the individuals, aiming at collaborative and innovative learning.
Methods:
a World Café method workshop with 24 professionals from the teams that work in basic health units.
Results:
we obtained three analysis categories: Individual Needs, Group Needs, and Institutional Needs, which resulted in the Municipal Plan of Actions on Continuing Health Education.
Conclusions:
we found that the World Café was adequate and relevant for the discussion of key themes, for the practices of teams in Primary Care and the production and organization of data in a collective space.
Final Considerations:
the method can contribute to the construction of knowledge and proximity to the daily reality of interdisciplinary teams, as well as serving as a tool in the preparation of planning in Permanent Education.
- Jennifer Bazilio
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06-28-2021
Trends in fertility rates, proportion of antenatal consultations and caesarean sections among Brazilian adolescents
- Milena Laryssa Costa Bicalho ,
- Fernanda Gontijo Araújo ,
- Gisele Nepomuceno de Andrade ,
- Eunice Francisca Martins ,
- Mariana Santos Felisbino-Mendes
Abstract
Trends in fertility rates, proportion of antenatal consultations and caesarean sections among Brazilian adolescents
Revista Brasileira de Enfermagem. 2021;74:e20200884
DOI 10.1590/0034-7167-2020-0884
- Milena Laryssa Costa Bicalho ,
- Fernanda Gontijo Araújo ,
- Gisele Nepomuceno de Andrade ,
- Eunice Francisca Martins ,
- Mariana Santos Felisbino-Mendes
Views1See moreABSTRACT
Objective:
To analyze the temporal trends in the fertility rate, proportion of antenatal consultations and caesarean sections in Brazilian adolescents aged 15 to 19, between 2000 and 2015. Methods: The fertility rate, proportion of prenatal consultations and proportion of routes of birth were calculated using data from DATASUS. The trend analysis was performed using the Prais-Winsten regression model and the annual percentage change.
Results:
There was a trend of reduction of 3.5% per year in the fertility rate among adolescents (p<0.05), in addition to an increasing trend of 6% per year in the proportion of more than six antenatal consultations (p <0.0001) and an increasing trend of 6.8% per year in the proportion of caesarean sections (p<0.0001).
Conclusion:
Despite the decreasing trend in fertility rates among Brazilian adolescents, they remain high. Also noteworthy is the growing trend for caesarean sections, even with improved access to antenatal care.
- Milena Laryssa Costa Bicalho
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ORIGINAL ARTICLE03-30-2020
Implication of the training ad continuing education process for the interprofessional performance
- Carine Vendruscolo ,
- Letícia de Lima Trindade ,
- André Lucas Maffissoni ,
- Jussara Gue Martini ,
- Cláudio Claudino da Silva Filho , [ … ],
- Juliana Vieira de Araujo Sandri
Abstract
ORIGINAL ARTICLEImplication of the training ad continuing education process for the interprofessional performance
Revista Brasileira de Enfermagem. 2020;73(2):e20180359
DOI 10.1590/0034-7167-2018-0359
- Carine Vendruscolo ,
- Letícia de Lima Trindade ,
- André Lucas Maffissoni ,
- Jussara Gue Martini ,
- Cláudio Claudino da Silva Filho ,
- Juliana Vieira de Araujo Sandri
Views0See moreABSTRACT
Objetives:
to analyze the implication of the training/continuing education process of professionals of the Expanded Nucleus of Family Health and Basic Care (Portuguese acronym: Nasf-AB) for their interprofessional performance.
Methods:
a qualitative case study performed with Nasf-AB teams representative of four macro-regions of health of the state of Santa Catarina. Participation of 43 professionals, who answered collective interviews. The results were later submitted to thematic analysis.
Results:
the training is strongly influenced by the Biomedical Model, which acts as an obstacle to interprofessional performance, given the challenges in the daily routine of Nasf-AB professionals. Continuing education emerges as a potential for the successful collaborative work among teams, and between the teams and Family Health professionals.
Final considerations:
there are important limits in the training of professionals. However, the constant interprofessional development promoted by strategies of continuing education contributes to broaden the support and collaborative practices that qualify services and strengthen Basic Care.
- Carine Vendruscolo
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ORIGINAL ARTICLE05-28-2021
Authentic leadership, nurse satisfaction at work and hospital accreditation: study in a private hospital network
- Sonia Aparecida Batista ,
- Paula Vitali Miclos ,
- Fernanda Amendola ,
- Andrea Bernardes ,
- Andréa Gomes da Costa Mohallem
Abstract
ORIGINAL ARTICLEAuthentic leadership, nurse satisfaction at work and hospital accreditation: study in a private hospital network
Revista Brasileira de Enfermagem. 2021;74(2):e20200227
DOI 10.1590/0034-7167-2020-0227
- Sonia Aparecida Batista ,
- Paula Vitali Miclos ,
- Fernanda Amendola ,
- Andrea Bernardes ,
- Andréa Gomes da Costa Mohallem
Views0See moreABSTRACT
Objectives:
to identify the dominant dimensions of the authentic leadership of nurses in a private hospital network and to verify the association with job satisfaction and accreditation.
Methods:
cross-sectional, analytical study carried out in 11 hospitals with 282 nurses, of which 94 were leaders and 188 were led. Participants answered the Authentic Leardership Questionnaire and the Job Satisfaction Survey.
Results:
there was a significant difference between the assessment of leaders and followers in all dimensions of the Authentic Leardership Questionnaire. Regarding the association of authentic leadership and job satisfaction, a significant positive moderate correlation was found among the employees. In hospitals accredited by the Joint Commission International, leaders were perceived as more transparent by their subordinates.
Conclusions:
there was correlation between authentic leadership and job satisfaction and authentic leadership and the accreditation model among the subordinates.
- Sonia Aparecida Batista
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