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01-01-2016
Prevalence and factors associated with traffic accidents involving motorcycle taxis
Revista Brasileira de Enfermagem. 2016;69(2):382-388
Abstract
Prevalence and factors associated with traffic accidents involving motorcycle taxis
Revista Brasileira de Enfermagem. 2016;69(2):382-388
DOI 10.1590/0034-7167.2016690223i
Views0See moreABSTRACT
Objective:
to determine the prevalence of motorcycle accidents involving motorcycle taxi drivers and associated factors.
Method:
this is a cross-sectional and exploratory study, with application of questionnaires to motorcycle taxi drivers of 32 regions of Caicó, Rio Grande do Norte, Brazil (N=420).
Results:
motorcycle taxi drivers have a high level of daily working hours (12 hours on average), and it was found that 63.6% were involved in at least one motorcycling accident. The occurence of motorcycling accidents was significantly associated only to level of education (p<0.001), with no significant association with the other variables, such as age (p=0.132), time of service (p=0.744) and working hours (p=0.830).
Conclusion:
it is necessary to implement preventive and educational actions with motorcycle taxi drivers and users of this service concerning accidents and emergency measures, due to constant exposure to accidents during work routine.
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01-01-2016
Characterization of undergraduate nursing courses according to the National Student Performance Exam
Revista Brasileira de Enfermagem. 2016;69(2):375-381
Abstract
Characterization of undergraduate nursing courses according to the National Student Performance Exam
Revista Brasileira de Enfermagem. 2016;69(2):375-381
DOI 10.1590/0034-7167.2016690222i
Views0See moreABSTRACT
Objective:
to characterize undergraduate nursing courses according to Enade (National Student Performance Exam) in 2010 and 2013.
Method:
a quantitative documental study was performed and descriptive statistics was used for data organization and analysis.
Results:
Enade report analysis enabled the identification of a reduction in the total number of institutions providing undergraduate nursing courses that passed the evaluation process. The Southeastern, Northeastern and Southern regions of Brazil included the highest numbers of courses assessed and showed the best results in the two evaluation cycles. Additionally, the courses characterized as “without a ranking” were mainly held at private institutions.
Conclusion:
the results of these evaluation cycles are important to support investigative and intervention processes about and with undergraduate nursing courses.
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01-01-2016
Teaching airway management with laryngeal mask: randomized controlled trial
Revista Brasileira de Enfermagem. 2016;69(2):368-374
Abstract
Teaching airway management with laryngeal mask: randomized controlled trial
Revista Brasileira de Enfermagem. 2016;69(2):368-374
DOI 10.1590/0034-7167.2016690221i
Views0See moreABSTRACT
Objective:
to teach airway management with laryngeal mask to nursing students through dialogic lectures along with laboratory activities or exclusively through simulation class.
Method:
randomized controlled trial. Population: eighth semester bachelor’s degree students. Sample: 17 students randomized in the intervention group (IG: simulation class) or control group (CG: dialogic lecture along with laboratory activities). Elaborated and validated instruments: written test, simulation scenario, objective structured clinical examination (checklist). Data collected from workshop. Structured clinical examination in simulation scenario filmed and evaluated by 3 experts, and written tests were applied.
Results:
24.4±4.2 years old. Right answers percentage: CG: pre-test 66±10%; post-test 84±8%. IG: pre-test 65±5%; post-test 86±11%. Scenario: CG 78±5.2%; IG 84±8.9%.
Conclusion:
strategies allowed the development of knowledge, skills and decision-making, which are essential to achieve the scenario objectives. Knowledge was incorporated in airway management with laryngeal mask, shown by the increase in the scenario and written tests scores.
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01-01-2016
Influence of the São Paulo State innovative models on Brazil’s mental health policy
Revista Brasileira de Enfermagem. 2016;69(2):360-367
Abstract
Influence of the São Paulo State innovative models on Brazil’s mental health policy
Revista Brasileira de Enfermagem. 2016;69(2):360-367
DOI 10.1590/0034-7167.2016690220i
Views0See moreABSTRACT
Objective:
to analyze the influence of two São Paulo State experiences in the choice of psychosocial care centers as guiding service providers for the national mental health policy.
Method:
qualitative, exploratory, and descriptive study using oral history as a methodology and theoretical reference.
Results:
eight professionals involved in the deployment of the mental health policy in the cities of Santos and São Paulo between the years 1989 and 1992 were interviewed. Data were analyzed after treating the narratives and grouping the most significant content. Two central themes emerged: development of the local-regional model, and the model’s influence on the choice of the psychosocial care center.
Conclusion:
due to greater insertion of the Santos experience group in the spheres of the federal government, its influence on the choice of the substitute model was higher in ideological terms, whereas the São Paulo model had its influence restricted for political reasons.
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01-01-2016
Stress and cardiovascular risk: multi-professional intervention in health education
Revista Brasileira de Enfermagem. 2016;69(2):351-359
Abstract
Stress and cardiovascular risk: multi-professional intervention in health education
Revista Brasileira de Enfermagem. 2016;69(2):351-359
DOI 10.1590/0034-7167.2016690219i
Views0See moreABSTRACT
Objective:
to identify cardiovascular risk in educators (administrators and teachers) from the South region of Brazil, evaluated before and after intervention with stress management activities and health education.
Method:
longitudinal study of the before and after type. The sample consisted of 49 participants. Variables studied were socio-demographic, morbidity antecedents and lifestyle habits. Measured risk factors for cardiovascular disease were arterial blood pressure, body mass index, ratio of waist to hip size, lipid profile and capillary blood glucose. Stress levels were evaluated using the Lipp Stress Symptoms Inventory (LSSI). The study ran for four months, with weekly meetings of a multidisciplinary team.
Results:
after intervention, the study observed a statistically significant reduction of the investigated variables, except for blood glucose levels in the administrators group.
Conclusion:
stress management activities are potential tools in the identification and control of the risk factors studied, particularly in those involving multi- and trans-disciplinary focus.
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01-01-2016
Social representations of nursing students about hospital assistance and primary health care
Revista Brasileira de Enfermagem. 2016;69(2):343-350
Abstract
Social representations of nursing students about hospital assistance and primary health care
Revista Brasileira de Enfermagem. 2016;69(2):343-350
DOI 10.1590/0034-7167.2016690218i
Views0See moreABSTRACT
Objective:
To analyze how social representations of hospital and community care are structured in two groups of nursing students – 1st and 4th years.
Method:
Qualitative research oriented by the Theory of Social Representations. We used a questionnaire with Free Association of Words. Data were analyzed in the Software IRaMuTeQ 0.6 alpha 3.
Results:
We applied the method of Descending Hierarchical Classification and obtained four classes. Class 4 has the largest social representation (30.41%) within the corpus. The two organizational axes are nurse and disease/patient in the central core. On the periphery are the care and help related to the nurse and the treatment and prevention associated with the disease.
Conclusion:
Social representations focus on disease/patient and on the role of nurses in the treatment, prevention, and care. Health promotion and the social determinants of health are absent from the social representations of students.
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01-01-2016
Prevalence of medication therapy adherence in the elderly and related factors
Revista Brasileira de Enfermagem. 2016;69(2):335-342
Abstract
Prevalence of medication therapy adherence in the elderly and related factors
Revista Brasileira de Enfermagem. 2016;69(2):335-342
DOI 10.1590/0034-7167.2016690217i
Views0See moreABSTRACT
Objective:
to determine the prevalence of adherence to medication therapy in elderly outpatients; to verify whether there is an association between medication therapy adherence and demographic and socioeconomic factors, health conditions.
Method:
a quantitative, exploratory, descriptive, cross-sectional study, performed in outpatient clinics of a university hospital in Rio Grande do Sul, Brazil. Three data collection instruments were answered by a convenience sample of 107 elders. A descriptive and inferential statistical analysis was conducted.
Results:
the prevalence of adherence was 86.9%. A statistically significant association was identified between the adherence variable and receiving medical guidelines on how to take medications, and having adverse reactions. Conclusion: Nurses must know the prevalence of medication adherence and related factors in order to plan interventions that promote therapeutic success.
Conclusion:
Nurses must know the prevalence of medication adherence and related factors in order to plan interventions that promote therapeutic success.
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01-01-2016
Family farming and human and environmental health conservation
Revista Brasileira de Enfermagem. 2016;69(2):326-334
Abstract
Family farming and human and environmental health conservation
Revista Brasileira de Enfermagem. 2016;69(2):326-334
DOI 10.1590/0034-7167.2016690216i
Views0See moreABSTRACT
Objective:
understand how farmers identify positive and negative impacts of family farming work on the environment and conserve the environmental health.
Method:
a qualitative study with 129 farmers from Ilha dos Marinheiros, Rio Grande, Brazil. Secondary data and recorded interviews were used in this study, with subsequent analysis performed by Bardin and NVivo10, both based on Enrique Leff’s cultural rationality.
Results:
the positive impacts included food production with responsibility, work appreciation, and the correct, minimum or inexistent insertion of agrochemicals. The negative aspects included excessive and incorrect use of agrochemicals and absent farming knowledge.
Conclusion:
environmental conservation consisted in reducing impacts that could have a negative effect on health, while performing work activities.
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12-04-2023
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301pt
Views0A relação entre cronicidade e trabalho tem sido uma preocupação crescente na sociedade contemporânea. À medida que o número de doenças crônicas aumenta em todo o mundo, é fundamental compreender como essas condições impactam a saúde dos trabalhadores(). Neste editorial, exploraremos os impactos da cronicidade na saúde do trabalhador, destacando dados da Carga Global de […]See more -
12-04-2023
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301
Views0The relationship between chronicity and work has been a growing concern in contemporary society. As the number of chronic illnesses increases around the world, it is critical to understand how these conditions impact workers’ health(). In this editorial, we will explore the impacts of chronicity on workers’ health, highlighting data from the Global Burden of […]See more -
12-04-2023
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
Abstract
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
DOI 10.1590/0034-7167-2023-0126
Views0See moreABSTRACT
Objectives:
to reflect on the impacts of the General Personal Data Protection Law on Nursing practice.
Methods:
reflection article, through the intentional collection of materials relating to the topic.
Results:
legislation regulates confidentiality, processing and data sharing, requiring institutional protection measures. The nursing team is responsible for acting preventively, both in care and in the management role, in order to avoid the misuse of the patient’s personal data. The law allows academic research to be carried out as long as the purpose is clear, data collection occurs with an explicit purpose and data is anonymized.
Final Considerations:
although the General Personal Data Protection Law requires greater care in relation to data processing, it is established on precepts of good faith and respect for the rights of the individual, concepts aligned with the nursing code of ethics.
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REVIEW12-04-2023
Supervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
Abstract
REVIEWSupervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
DOI 10.1590/0034-7167-2023-0077
Views0See moreABSTRACT
Objectives:
to map studies that analyze the audit process of nursing councils.
Methods:
this is a scoping review, anchored in the JBI framework, with the guiding question: what is the evidence of the audit process of legal practice of nursing by class councils (COFEN/COREN system)? The searches were carried out in October and November 2022 without limitation of language and year.
Results:
of the 9 selected studies, all are Brazilian and published from 2014 onwards. Among the topics addressed are the role, challenges, costs and difficulties in nurse auditors’ daily work process, in addition to the contribution of the audit sector in Brazil.
Conclusions:
the studies gathered discuss aspects related to costs, challenges and difficulties, but there is no focus on corrective, disciplinary and educational activities as well as little is said about the audit process, its reporting, referral and outcomes.
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ORIGINAL ARTICLE12-04-2023
Overview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
Abstract
ORIGINAL ARTICLEOverview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
DOI 10.1590/0034-7167-2022-0808
Views0See moreABSTRACT
Objectives:
to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions.
Methods:
descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil.
Results:
153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women’s, Children’s, Adolescent’s, Adult’s and Older People’s Health, and Mental Health.
Final Considerations:
the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.
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12-04-2023
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
Abstract
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
DOI 10.1590/0034-7167-2022-0797es
Views0See moreRESUMEN
Objetivos:
debatir sobre aspectos éticos en la atención de enfermería a personas transgénero.
Métodos:
estudio reflexivo fundamentado sobre los dilemas que se plantean en los cuidados de enfermería a personas transgénero. El relato se ha estructurado en torno a los cuatro principios bioéticos.
Resultados:
la atención sanitaria a las personas trans es compleja, transversal a muchos dispositivos y especialidades y longitudinal en el tiempo por lo que precisa de la actuación coordinada. Existe un marco ético en el que se encuadran los cuidados de enfermería que se precisan en la atención a este colectivo.
Consideraciones Finales:
la enfermera como agente de salud puede asumir diversas líneas generales en la atención a pacientes transgénero. Para ello, se debe brindar formación adicional no solo a los profesionales, también a los estudiantes de enfermería y de las demás ciencias de la salud.
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12-04-2023
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
Abstract
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
DOI 10.1590/0034-7167-2022-0759
Views0See moreABSTRACT
Objectives:
to reflect on the ethical dilemmas involved in the care of patients at the end of their lives.
Methods:
this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari.
Results:
discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient’s autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care.
Final Considerations:
issues related to being, stemming from one’s reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.
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08-19-2024
Abuso sexual, aborto e saúde pública no brasil: quando o julgamento moral acentua as iniquidades
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
Abstract
Abuso sexual, aborto e saúde pública no brasil: quando o julgamento moral acentua as iniquidades
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
DOI 10.1590/0034-7167.202477suppl0401pt
Views0Eis aqui um editorial acadêmico-político que tem como objetivo convocar o campo científico a refletir sobre os perigos das decisões relativas ao direito ao aborto sob réguas morais, uma vez que não há evidências de que tal perspectiva se traduza em práticas de cuidado, proteção à infância e equidade de gênero – elementos tão urgentes […]See more -
ORIGINAL ARTICLE08-19-2024
The use of individual tracking programs in public health: a bioethics dilemma
Revista Brasileira de Enfermagem. 2024;77:e20230041
Abstract
ORIGINAL ARTICLEThe use of individual tracking programs in public health: a bioethics dilemma
Revista Brasileira de Enfermagem. 2024;77:e20230041
DOI 10.1590/0034-7167-2023-0041
Views0See moreABSTRACT
Objective:
to understand the bioethical perspectives on mobile tracking device use.
Methods:
theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee.
Results:
from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods.
Final considerations:
the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals’ private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.
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ORIGINAL ARTICLE08-19-2024
Bioethical issues in the family health strategy: Considerations for nursing care management
Revista Brasileira de Enfermagem. 2024;77:e20220818
Abstract
ORIGINAL ARTICLEBioethical issues in the family health strategy: Considerations for nursing care management
Revista Brasileira de Enfermagem. 2024;77:e20220818
DOI 10.1590/0034-7167-2022-0818
Views0See moreABSTRACT
Objective:
To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy.
Method:
A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map.
Results:
Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified.
Final considerations:
Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.
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REVIEW07-29-2024
Telenursing in the postoperative period: a scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20240066
Abstract
REVIEWTelenursing in the postoperative period: a scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20240066
DOI 10.1590/0034-7167-2024-0066
Views0See moreABSTRACT
Objectives:
to map available evidence on telenursing use in the postoperative period and its impact on patient outcomes.
Methods:
a scoping review, conducted according to the JBI model and the PRISMA-ScR checklist. The search was carried out in the CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus and Cochrane Library databases.
Results:
twelve studies were included, published between 2011 and 2023, 66.6% of which were in developed countries. Of the positive outcomes, we highlight improved levels of disability, autonomy and quality of life, lower rates of post-operative complications, pain and reduced costs. Telephone monitoring was the most widely used modality, but there were few studies in the pediatric context and in Brazil.
Conclusions:
of the studies, 11 (91.6%) identified at least one positive outcome in telenursing use and none showed negative aspects in the postoperative period. The role of nurses in digital health needs further study.
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ORIGINAL ARTICLE07-29-2024
Men’s perception of paternal parenthood and the promotion of child development
Revista Brasileira de Enfermagem. 2024;77(3):e20230514
Abstract
ORIGINAL ARTICLEMen’s perception of paternal parenthood and the promotion of child development
Revista Brasileira de Enfermagem. 2024;77(3):e20230514
DOI 10.1590/0034-7167-2023-0514
Views0See moreABSTRACT
Objectives:
to comprehend men’s perception of paternal parenthood while caring for infants to promote child development.
Methods:
this qualitative study adopts an exploratory approach and was conducted with undergraduate and graduate students, faculty, and staff who are fathers of infants up to 6 months old from a higher education institution, excluding fathers from mononuclear families. Data collection occurred through semi-structured interviews and was analyzed using thematic categorical analysis.
Results:
fifteen men participated in the study. From the analysis, two empirical categories emerged: “Perception of being a father: challenges and novelties” and “Promotion of child development: actions carried out by fathers”. Fathers revealed feeling unprepared, the need for emotional support, and recognized activities aimed at their children’s development.
Final Considerations:
the relevance of the paternal figure for child development is highlighted, as well as the need for public policies to encourage paternal parenthood.
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ORIGINAL ARTICLE07-29-2024
Contribution of informal caregivers to self-care in individuals with heart failure
Revista Brasileira de Enfermagem. 2024;77(3):e20230492
Abstract
ORIGINAL ARTICLEContribution of informal caregivers to self-care in individuals with heart failure
Revista Brasileira de Enfermagem. 2024;77(3):e20230492
DOI 10.1590/0034-7167-2023-0492
Views0See moreABSTRACT
Objectives:
to evaluate the contribution of informal caregivers to the self-care of individuals with heart failure.
Methods:
a cross-sectional study was conducted with 87 caregivers from March to October 2022 in the city of João Pessoa/PB. The caregivers’ contribution was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index instrument. Scores ≥ 70 points indicate adequate contribution. Data were analyzed using descriptive statistics and Spearman’s correlation.
Results:
the sample consisted of 81.6% female caregivers. Median scores obtained for the self-care contribution scales were: 63.3 for maintenance; 55.5 for management; and 66.6 for confidence. Caregivers never or rarely recommended monitoring body weight, regular physical exercise, extra use of diuretics, and fluid restriction.
Conclusions:
informal caregivers showed inadequate contribution in the areas of maintenance, management, and confidence in self-care of individuals with heart failure.
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07-29-2024
Reflections on theoretical framework use in nursing research
Revista Brasileira de Enfermagem. 2024;77(3):e20230486
Abstract
Reflections on theoretical framework use in nursing research
Revista Brasileira de Enfermagem. 2024;77(3):e20230486
DOI 10.1590/0034-7167-2024-0486
Views0See moreABSTRACT
Objectives:
to reflect on theoretical framework use in nursing research.
Methods:
a theoretical-reflexive study, based on concepts and constructs pertinent to using nursing theories and other sciences, considering issues of epistemology or philosophy of science.
Results:
we presented what it is and why to do nursing research and what a theoretical framework is and why to use it, in addition to some considerations regarding theoretical framework use in nursing research, essential for constructing disciplinary knowledge, which enables the materialization of researchers’ work and the presentation of propositions resulting from investigations in and for nursing as a discipline and science.
Final Considerations:
based on a reflection based on epistemological conceptions, it is possible to affirm that a theoretical framework is the core of researchers’ thinking, delimiting a problem to be investigated and, based on it, outlining methodological strategies to be followed, supporting nursing action and thinking as discipline and science.
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REVIEW07-29-2024
Nursing diagnoses for people hospitalized with heart failure: an integrative review
Revista Brasileira de Enfermagem. 2024;77(3):e20230471
Abstract
REVIEWNursing diagnoses for people hospitalized with heart failure: an integrative review
Revista Brasileira de Enfermagem. 2024;77(3):e20230471
DOI 10.1590/0034-7167-2023-0471
Views0See moreABSTRACT
Objectives:
to identify in the literature the main nursing diagnoses according to the NANDA-I diagnostic classification for people hospitalized with heart failure.
Methods:
an integrative literature review, carried out in February 2019 and updated in July 2023, in the MEDLINE via PubMed, LILACS, SciELO and CINAHL databases. Given the use of acronym PEO, studies without a time cut in Portuguese, English and Spanish were included. Descriptive analysis was carried out to present the identified information.
Results:
analysis of 27 articles identified 24 nursing diagnoses, with emphasis on Decreased Cardiac Output, Excessive Fluid Volume, Decreased Activity Tolerance and Fatigue.
Final Considerations:
evidence can contribute to better diagnostic decisions centered on people with heart failure in search of more assertive health results and have the potential to support future studies on a possible syndromic pattern in this population.
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