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ORIGINAL ARTICLE10-09-2023
Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
Abstract
ORIGINAL ARTICLEIndependent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
DOI 10.1590/0034-7167-2022-0780
Views0See moreABSTRACT
Objective:
To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.
Methods:
Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.
Results:
Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.
Conclusion:
Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.
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ORIGINAL ARTICLE10-09-2023
Health care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
- Eduarda Aguiar da Silva
, - Paula Hino ,
- Hugo Fernandes ,
- Maria Rita Bertolozi ,
- Aline Aparecida Monroe , [ … ],
- Lucimara Fabiana Fornari
Abstract
ORIGINAL ARTICLEHealth care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
Revista Brasileira de Enfermagem. 2023;76(4):e20220733
DOI 10.1590/0034-7167-2022-0733
- Eduarda Aguiar da Silva ,
- Paula Hino ,
- Hugo Fernandes ,
- Maria Rita Bertolozi ,
- Aline Aparecida Monroe ,
- Lucimara Fabiana Fornari
Views0See moreABSTRACT
Objective:
to know the multidisciplinary team’s perspective about the health care of people with tuberculosis and human immunodeficiency virus co-infection in relation to treatment.
Methods:
this is a descriptive-exploratory study, with a qualitative approach, carried out in a health care service in São Paulo, from May to June 2019. Semi-structured interviews were conducted with nine professionals from the multidisciplinary team. Data were processed through discourse analysis with the support of webQDA.
Results:
Two empirical categories emerged: Health care interfaces for people with tuberculosis and human immunodeficiency virus co-infection; Barriers and facilitators for health care for people with co-infection.
Final considerations:
the health-disease process in co-infection is mediated by conditions that positively or negatively interfere with treatment compliance. People’s health care goes beyond exclusively clinical assistance and requires the recognition of needs in a broad perspective.
- Eduarda Aguiar da Silva
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ORIGINAL ARTICLE10-09-2023
Translation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho , [ … ],
- Bernardo de Mattos Viana
Abstract
ORIGINAL ARTICLETranslation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho ,
- Bernardo de Mattos Viana
Views0See moreABSTRACT
Objective:
to translate, culturally adapt and validate the Multidimensional Individual and Interpersonal Resilience Measure to Brazilian Portuguese.
Method:
after initial translation, the pre-final version underwent rigorous cultural adaptation procedures. As a result, the final adapted version was submitted to a validity study.
Results:
adaptation procedures provided equivalence between the pre-final and the original versions in semantic, idiomatic, experiential and conceptual terms. A total of 187 older adults were included in the validity study. Exploratory factorial analysis (EFA) generated a model of five factors ((RMSEA = 0.030; TLI = 0.959; X = 151.590 p> 0.05). Final version showed adequate consistency (Cronbach’s α = 0.705) and test-retest reliability (ICC=0.835). No statistically significant correlation was found between resilience and sociodemographic and epidemiological variables assessed in this study.
Conclusion:
EMRII-BR is a valid and reliable instrument for measuring resilience in Brazilian older adults.
- Jéssica Diniz Rodrigues Ferreira
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10-09-2023
Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
- Elaine Aparecida da Cunha Lima ,
- Renata Oliveira Caetano ,
- Marisa Dibbern Lopes Correia ,
- Luana Vieira Toledo ,
- Thais Bitencourt Faria , [ … ],
- Luciene Muniz Braga Daskaleas
Abstract
Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
Revista Brasileira de Enfermagem. 2023;76(4):e20220692
DOI 10.1590/0034-7167-2022-0692
- Elaine Aparecida da Cunha Lima ,
- Renata Oliveira Caetano ,
- Marisa Dibbern Lopes Correia ,
- Luana Vieira Toledo ,
- Thais Bitencourt Faria ,
- Daniela de Almeida Pereira ,
- Luciene Muniz Braga Daskaleas
Views0See moreABSTRACT
Objective:
to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy.
Methods:
a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges’ answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated.
Results:
twenty-five nurses participated in validity, identifying judges’ opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0.
Conclusions:
the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.
- Elaine Aparecida da Cunha Lima
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ORIGINAL ARTICLE10-09-2023
Clinical supervision strategies, learning, and critical thinking of nursing students
- Angélica Oliveira Veríssimo da Silva ,
- António Luís Rodrigues Faria de Carvalho ,
- Rui Marques Vieira ,
- Cristina Maria Correia Barroso Pinto
Abstract
ORIGINAL ARTICLEClinical supervision strategies, learning, and critical thinking of nursing students
Revista Brasileira de Enfermagem. 2023;76(4):e20220691
DOI 10.1590/0034-7167-2022-0691
- Angélica Oliveira Veríssimo da Silva ,
- António Luís Rodrigues Faria de Carvalho ,
- Rui Marques Vieira ,
- Cristina Maria Correia Barroso Pinto
Views0See moreABSTRACT
Objective:
To identify the supervisory strategies that Nursing students consider facilitators of the development of critical thinking skills in clinical teaching.
Methods:
This is a qualitative study, within the interpretative paradigm, using the focus group methodology. Eight undergraduate nursing students participated in the study.
Results:
Participants recognized the indispensability of critical thinking for professional responsibility and quality of care and highlighted the importance of using supervisory strategies adapted to their needs, learning objectives, and the context of clinical practice.
Final considerations:
This study highlights the urgent need to establish, within the Nursing curricula, clinical supervision strategies that promote critical thinking and favor the development of skills for good clinical judgment, problem solving, and safe, effective, and ethical decision-making.
- Angélica Oliveira Veríssimo da Silva
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EXPERIENCE REPORT10-09-2023
Focus group in the development of concepts for a Nursing model: experience report
Revista Brasileira de Enfermagem. 2023;76(4):e20220689
Abstract
EXPERIENCE REPORTFocus group in the development of concepts for a Nursing model: experience report
Revista Brasileira de Enfermagem. 2023;76(4):e20220689
DOI 10.1590/0034-7167-2022-0689
Views0See moreABSTRACT
Objective:
To communicate the experience of developing concepts for the construction of a care model through focus groups.
Methods:
An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil.
Results:
Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question.
Final considerations:
Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.
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10-09-2023
Autocompaixão entre estudantes de enfermagem de uma Universidade Estadual da Indonésia durante a pandemia de COVID-19
Revista Brasileira de Enfermagem. 2023;76(4):e20220585
Abstract
Autocompaixão entre estudantes de enfermagem de uma Universidade Estadual da Indonésia durante a pandemia de COVID-19
Revista Brasileira de Enfermagem. 2023;76(4):e20220585
DOI 10.1590/0034-7167-2022-0585
Views0See moreRESUMEN
Objetivo:
Determinar el nivel de autocompasión e investigar las relaciones entre las variables sociodemográficas y la autocompasión entre estudiantes de pregrado de enfermería en una universidad estatal de Indonesia durante la pandemia de COVID-19
Métodos:
Este estudio utilizó un diseño transversal. Las muestras se seleccionaron mediante una técnica de muestreo aleatorio estratificado proporcional (n=260). Los datos se recopilaron utilizando una versión indonesia de la Escala de Autocompasión, que consta de 6 subescalas: bondad propia, autocrítica, humanidad común, aislamiento, atención plena y sobre identificación. Los datos se analizaron mediante análisis univariado y bivariado.
Resultados:
El 60% de los estudiantes tenían autocompasión moderada. Los estudiantes puntuaron más alto en amabilidad consigo mismos (3,93±1,02) y sobre identificación (3,58±0,94), lo que indica que a menudo intentaban amarse a sí mismos cuando sentían dolor emocional y a menudo se dejaban llevar cuando sucedió algo perturbador. Posteriormente, se encontró una correlación significativa entre la edad y la autocompasión (p<0,05).
Conclusión:
La autocompasión entre los estudiantes de enfermería debe mejorarse por medio de intervenciones como la alfabetización de la compasión, el entrenamiento en atención plena y las técnicas experienciales basadas en la compasión.
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10-09-2023
Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho , [ … ],
- Bernardo de Mattos Viana
Abstract
Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho ,
- Bernardo de Mattos Viana
Views0See moreRESUMEN
Objetivo:
traducir, adaptar culturalmente y validar el Multidimensional Individual and Interpersonal Resilience Measure para el portugués brasileño.
Método:
después de la traducción inicial, la versión pre-final pasó por rigurosos procedimientos de adaptación cultural. Como resultado, la versión final adaptada fue sometida a un estudio de validez.
Resultados:
los procedimientos de adaptación proporcionaron equivalencia entre las versiones pre-final y original en términos semánticos, idiomáticos, experienciales y conceptuales. Un total de 187 ancianos fueron incluidos en el estudio de validez. El análisis factorial exploratorio (AFE) generó un modelo de cinco factores ((RMSEA = 0,030; TLI = 0,959; X = 151,590 p> 0,05). La versión final mostró adecuada consistencia (α de Cronbach = 0,705) y confiabilidad prueba-reprueba (ICC=0,835). No se encontró correlación estadísticamente significativa entre la resiliencia y las variables sociodemográficas y epidemiológicas evaluadas en este estudio.
Conclusión:
EMRII-BR es un instrumento válido y confiable para medir la resiliencia en ancianos brasileños.
- Jéssica Diniz Rodrigues Ferreira
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ORIGINAL ARTICLE10-21-2019
Child and adolescent violence: oral story of women who attempted suicide
- Cíntia Mesquita Correia ,
- Nadirlene Pereira Gomes ,
- Normélia Maria Freire Diniz ,
- Isabela Carolyne Sena de Andrade ,
- Cátia Maria Costa Romano , [ … ],
- Gilmara Ribeiro Santos Rodrigues
Abstract
ORIGINAL ARTICLEChild and adolescent violence: oral story of women who attempted suicide
Revista Brasileira de Enfermagem. 2019;72(6):1450-1456
DOI 10.1590/0034-7167-2017-0814
- Cíntia Mesquita Correia ,
- Nadirlene Pereira Gomes ,
- Normélia Maria Freire Diniz ,
- Isabela Carolyne Sena de Andrade ,
- Cátia Maria Costa Romano ,
- Gilmara Ribeiro Santos Rodrigues
Views0See moreABSTRACT
Objective:
To unveil expressions of intrafamily violence experienced in childhood and/or adolescence by women who attempted suicide.
Method:
This is a study with a qualitative approach based on Oral Story. Participants were ten women with a history of suicide attempt, who experienced intrafamily violence in childhood and/or adolescence. The research was carried out at the Center for the Study and Prevention of Suicide, linked to a Toxicological Information Center in the city of Salvador, Bahia, Brazil.
Results:
From the orality of women, the study allowed the emergence of the following representative categories of intrafamily abuse experienced in childhood and/or adolescence: psychological violence, rejection, neglect, physical violence and sexual violence.
Final considerations:
The study alerts to intrafamily violence as an aggravation related to suicidal behavior, offering elements that help in the identification of their expressions, which will raise awareness to suicidal behavior and consequently suicide prevention.
- Cíntia Mesquita Correia
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ORIGINAL ARTICLE07-08-2020
Cognition and quality of life relationship among the elderly community: a cross-sectional study
- Barbara Maria Lopes da Silva Brandão ,
- Alice Maria Barbosa da Silva ,
- Rafaella Queiroga Souto ,
- Fabia Alexandra Pottes Alves ,
- Gleicy Karine Nascimento de Araújo , [ … ],
- Hulda Vale de Araújo
Abstract
ORIGINAL ARTICLECognition and quality of life relationship among the elderly community: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73:e20190030
DOI 10.1590/0034-7167-2019-0030
- Barbara Maria Lopes da Silva Brandão ,
- Alice Maria Barbosa da Silva ,
- Rafaella Queiroga Souto ,
- Fabia Alexandra Pottes Alves ,
- Gleicy Karine Nascimento de Araújo ,
- Viviane Cristina Fonseca da Silva Jardim ,
- Hulda Vale de Araújo
Views0See moreABSTRACT
Objective:
to assess cognitive functions and their association with quality of life among elderly people enrolled in a Family Health Unit (FHU) of Primary Health Care in Recife-PE.
Methods:
a quantitative, descriptive, cross-sectional study in which elderly aged 60 years and over were studied.
Results:
76.7% of the elderly were women and the age group was less than or equal to 70 years. 68.6% had cognitive impairment, and in the quality of life assessment it was found that the social participation facet had the highest mean score among the elderly (14.25), while the lowest was observed in the sensory functioning facet (9.10). There was an association between cognitive decline and quality of life.
Conclusion:
most of the elderly had good quality of life rates, but low cognitive level. Using screening tools allows early detection of health problems, guiding the nursing staff in the construction of preventive measures.
- Barbara Maria Lopes da Silva Brandão
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ORIGINAL ARTICLE03-30-2020
Meanings assigned by families about children’s chronic disease diagnosis
Revista Brasileira de Enfermagem. 2020;73(2):e20180742
Abstract
ORIGINAL ARTICLEMeanings assigned by families about children’s chronic disease diagnosis
Revista Brasileira de Enfermagem. 2020;73(2):e20180742
DOI 10.1590/0034-7167-2018-0742
Views0See moreABSTRACT
Objectives:
to understand the meanings assigned by family caregivers about children’s chronic disease diagnosis.
Methods:
qualitative study, which used as theoretical framework the Symbolic Interactionism, and methodological, the Grounded Theory. It was held in a pediatric unit in Southern Brazil, in 2016, through interviews submitted to open and axial analysis, with the participation of 20 family caregivers of hospitalized children.
Results:
relatives, interacting with the nursing/health staff, perceive children’s disease at birth. They are diagnosed with chronic disease by the physician and deny it. Subsequently, they accept and seek information on care.
Conclusions:
the results pointed out the stages that relatives experience by assigning meanings to about children’s chronic disease diagnosis. These meanings provide subsidies for nurses’ actions, which need to be aware of children’s and family’s needs in order to offer comprehensive and humanized care.
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ORIGINAL ARTICLE04-03-2020
Nurse as an integrator in healthcare management of children with chronic condition
- Deborah Dinorah de Sá Mororó ,
- Rejane Maria Paiva de Menezes ,
- Ana Angélica Rêgo de Queiroz ,
- Carlos Jordão de Assis Silva ,
- Wanesca Caroline Pereira
Abstract
ORIGINAL ARTICLENurse as an integrator in healthcare management of children with chronic condition
Revista Brasileira de Enfermagem. 2020;73(3):e20180453
DOI 10.1590/0034-7167-2018-0453
- Deborah Dinorah de Sá Mororó ,
- Rejane Maria Paiva de Menezes ,
- Ana Angélica Rêgo de Queiroz ,
- Carlos Jordão de Assis Silva ,
- Wanesca Caroline Pereira
Views0See moreABSTRACT
Objectives:
to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting.
Methods:
analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin’s Content Analysis with interface of the Atlas.ti software.
Results:
categories of analysis were “Nurse as mediator of healthcare management”; “Nursing process as a mechanism of healthcare management”.
Final
considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.
- Deborah Dinorah de Sá Mororó
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ORIGINAL ARTICLE09-18-2020
Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes
- Rosimere Ferreira Santana ,
- Marcos Barragan da Silva ,
- Daniela Aparecida da Silva Rebouças Marcos ,
- Cristiane dos Santos Rosa ,
- Willi Wetzel Junior , [ … ],
- Romulo Delvalle
Abstract
ORIGINAL ARTICLENursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes
Revista Brasileira de Enfermagem. 2020;73:e20200260
DOI 10.1590/0034-7167-2020-0260
- Rosimere Ferreira Santana ,
- Marcos Barragan da Silva ,
- Daniela Aparecida da Silva Rebouças Marcos ,
- Cristiane dos Santos Rosa ,
- Willi Wetzel Junior ,
- Romulo Delvalle
Views0See moreABSTRACT
Objective:
to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes.
Method:
a study of experts’ recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem)
Results:
the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions.
Final considerations:
the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.
- Rosimere Ferreira Santana
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REVIEW12-21-2020
Skill acquisition of safe medication administration through realistic simulation: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190880
Abstract
REVIEWSkill acquisition of safe medication administration through realistic simulation: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190880
DOI 10.1590/0034-7167-2019-0880
Views0See moreABSTRACT
Objective:
to investigate evidence that indicates the contribution of realistic high, medium or low fidelity simulation to acquire knowledge, skills and attitudes in safe medication administration by nursing students.
Methods:
an integrative review of experimental studies from MEDLINE, LILACS, Web of Science, Scopus and Science Direct. The descriptors “nursing students”, “simulation”, “high fidelity simulation training”, “medication errors” and “pharmacology” were used to identify 14 studies that answered the research question, and were assessed for accuracy methodological level and level of evidence.
Results:
there was a sample of quasi-experimental studies, (level 3 of evidence; 78.6%) and randomized clinical trials (level 2 of evidence; 21.4%), whose expressive majority showed superiority of the simulation strategy over the traditional methodology (71.4%).
Conclusion:
using low and high fidelity simulators, standardized patients and virtual simulation can promote acquisition of essential skills for patient safety.
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ORIGINAL ARTICLE12-07-2020
Sarcopenia screening in elderly in primary health care: nurse knowledge and practices
- Rutielle Ferreira Silva ,
- Maria do Livramento Fortes Figueiredo ,
- Juan José Tirado Darder ,
- Ana Maria Ribeiro dos Santos ,
- Maria Antonieta Rubio Tyrrell
Abstract
ORIGINAL ARTICLESarcopenia screening in elderly in primary health care: nurse knowledge and practices
Revista Brasileira de Enfermagem. 2020;73:e20200421
DOI 10.1590/0034-7167-2020-0421
- Rutielle Ferreira Silva ,
- Maria do Livramento Fortes Figueiredo ,
- Juan José Tirado Darder ,
- Ana Maria Ribeiro dos Santos ,
- Maria Antonieta Rubio Tyrrell
Views0See moreABSTRACT
Objective:
Describe the knowledge and practices of the Primary Health Care nurse on sarcopenia screening in the elderly.
Methods:
Qualitative study conducted with 24 Primary Health Care nurses. The data was collected through semi-structured interviews, recorded and later transcribed. The speeches were grouped in thematic categories, later analyzed, supported by Paulo Freire’s reference.
Results:
The findings showed that the primary care nurses’ knowledge of sarcopenia screening in the elderly was incipient and fragile. This reality is reflected in a gap in practice, although some instruments already require the registration of characteristics indicative of sarcopenia, such as the evaluation of the calf circumference.
Final Considerations:
The need to train nurses to perform sarcopenia screening and to implement a promotional and preventive care plan, which will result in improving the quality of life of the elderly assisted in Primary Care, was highlighted.
- Rutielle Ferreira Silva
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ORIGINAL ARTICLE10-21-2019
Inclusion of mental health in primary health care: care strategy in the territory
Revista Brasileira de Enfermagem. 2019;72(6):1677-1682
Abstract
ORIGINAL ARTICLEInclusion of mental health in primary health care: care strategy in the territory
Revista Brasileira de Enfermagem. 2019;72(6):1677-1682
DOI 10.1590/0034-7167-2018-0806
Views0See moreABSTRACT
Objective:
To analyze the strategies, challenges and possibilities of the articulation between mental health and primary health care from the perspective of health managers.
Method:
Exploratory, qualitative research carried out with 28 managers of mental health and primary care. The data were collected through semi-structured interviews between July and November 2013 and submitted to thematic content analysis.
Results:
The inclusion of mental health actions in primary care made it possible, in the view of managers, to increase users’ access to the care they need. This care strategy allows the extension of care practices in the territory, with matrix support as the main tool for the implementation of this care strategy.
Final considerations:
The articulation between primary care and mental health is a powerful device for psychosocial care, but it demands a new conformation of the Psychosocial Care Centers (Caps) and primary care services.
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