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RESEARCH01-01-2017
Assessing the adequacy of workload measurement tools using a quality-based methodology
Revista Brasileira de Enfermagem. 2017;70(1):39-46
Abstract
RESEARCHAssessing the adequacy of workload measurement tools using a quality-based methodology
Revista Brasileira de Enfermagem. 2017;70(1):39-46
DOI 10.1590/0034-7167-2016-0246
Views0See moreABSTRACT
Objective:
determine which tool (NEMS and NAS) is most suitable for use in intensive care units using a quality-based methodology.
Method:
after identifying the opportunity for improvement “Inadequacy of the NEMS for determining nursing workload in the intensive care unit (ICU)”, we assessed the NEMS and the NAS, as a proposed improvement to the NEMS, using quality improvement cycles methodology based on the following criteria: measurement of daily nursing workload on a daily and shift basis; the tool encompasses all nursing activities undertaken in the ICU; and workload assessed per patient and unit.
Results:
there was no significant difference in level of compliance for the NEMS (67%). The comparison NEMS-NAS showed that there was a statistically significant improvement for all criteria except criterion 1. The NEMS only assesses criterion 1 (64.22%); while the NAS assessed all four criteria, obtaining a compliance rate of 64.74% for criteria 1, 2, and 4, and 100% for criterion 3.
Conclusion:
the NAS is more suitable for measuring nursing workload in UCIs.
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Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis
Revista Brasileira de Enfermagem. 2017;70(1):31-38
Abstract
Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis
Revista Brasileira de Enfermagem. 2017;70(1):31-38
DOI 10.1590/0034-7167-2016-0015
Views0See moreABSTRACT
Objective:
to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis.
Method:
quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention.
Results:
the mean age of participants was 58±13.1 years, with a treatment time of 51.1±44.7 months. A reduction in serum phosphorus values of 7.06 ± 1.43 to 5.80 ± 1.53 (p <0.001) and the intensity of itching after the intervention was observed.
Conclusion:
the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.
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Filial care and the relationship with the elderly in families of different nationalities
Revista Brasileira de Enfermagem. 2017;70(1):22-30
Abstract
Filial care and the relationship with the elderly in families of different nationalities
Revista Brasileira de Enfermagem. 2017;70(1):22-30
DOI 10.1590/0034-7167-2015-0050
Views0See moreABSTRACT
Objective:
identify how filial care and the relationship with the elderly occur in families of different nationalities.
Method:
qualitative study carried out in a town on the triple frontier of Paraná, comprising 33 elderly people of five different nationalities, adopting the Symbolic Interactionism and the Grounded Theory as theoretical-methodological strategy.
Results:
among Lebanese people, the Muslim religion teaches children to obey and respect parents; among French, distant family relationships and institutions for the elderly stand out. Paraguayans hold close family relationships; Chinese people consider filial care as a tacit obligation; Brazilians, in turn, tend to embrace and take care of their parents in old age.
Conclusion:
family care prevailed, but the traditions of each society lead the actions of that care, demanding health professionals’ capacity of recognizing in which context the elderly is inserted.
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RESEARCH01-01-2017
Excesso de volume de líquidos: análise clínica e sociodemográfica em pacientes de hemodiálise
Revista Brasileira de Enfermagem. 2017;70(1):15-21
Abstract
RESEARCHExcesso de volume de líquidos: análise clínica e sociodemográfica em pacientes de hemodiálise
Revista Brasileira de Enfermagem. 2017;70(1):15-21
DOI 10.1590/0034-7167-2015-0138
Views0See moreRESUMEN
Objetivo:
analizar las características definitorias y los factores relacionados con el diagnóstico enfermero de exceso de volumen líquido y su relación con variables sociodemográficas y clínicas en pacientes de hemodiálisis.
Método:
estudio transversal, realizado mediante un formulario y examen físico, con una muestra de 100 pacientes, entre diciembre de 2012 y abril de 2013 en un hospital universitario y una clínica de diálisis.
Resultados:
se encontraron 10 asociaciones estadísticamente significativas entre las características definitorias, factores relacionados de volumen de exceso de líquido y las variables sociodemográficas y clínicas.
Conclusión:
las características definitorias y los factores relacionados de exceso de volumen líquido podrían estar influenciados por variables sociodemográficas y clínicas en clientes de hemodiálisis.
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Excess fluid volume: sociodemographic and clinical analysis in haemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(1):15-21
Abstract
Excess fluid volume: sociodemographic and clinical analysis in haemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(1):15-21
DOI 10.1590/0034-7167-2015-0138
Views0See moreABSTRACT
Objective:
To analyse the defining characteristics and related factors in the nursing diagnosis Excess fluid volume and its relationship to sociodemographic and clinical variables in haemodialysis patients.
Method:
Cross-sectional study, conducted using a form and physical examination, with a sample of 100 patients, between December 2012 and April 2013 at a university hospital and a dialysis clinic.
Results:
It was found 10 significant statistical associations between the defining characteristics/ related factors of Excess fluid volume and the sociodemographic and clinical variables.
Conclusion:
The defining characteristics and related factors of Excess fluid volume could be influenced by sociodemographic and clinical variables in haemodialysis clientele.
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Facing challenges in times of adversity
Revista Brasileira de Enfermagem. 2017;70(1):1-2
Abstract
Facing challenges in times of adversity
Revista Brasileira de Enfermagem. 2017;70(1):1-2
DOI 10.1590/0034-7167.2017700101
Views0At the confluence of tradition, respect for history and a critical approach to the issues inherent to the development of the nursing profession, the Brazilian Nursing Association (ABEn) has been consolidating an exemplary trajectory in Brazilian society. Throughout its history, the reflections, discussions and decisions on pertinent and urgent subjects of the profession have made […]See more -
Enfrentando desafios em tempos de adversidades
Revista Brasileira de Enfermagem. 2017;70(1):1-2
Abstract
Enfrentando desafios em tempos de adversidades
Revista Brasileira de Enfermagem. 2017;70(1):1-2
DOI 10.1590/0034-7167.2017700101
Views0Na confluência da tradição, do respeito pela história e da abordagem crítica das questões inerentes ao desenvolvimento da profissão de enfermagem, a Associação Brasileira de Enfermagem (ABEn) vem consolidando uma trajetória exemplar na sociedade brasileira. Ao longo da sua história, as reflexões, discussões e decisões sobre assuntos pertinentes e prementes da profissão têm possibilitado intervenções […]See more -
Epistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
Abstract
Epistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
DOI 10.1590/0034-7167-2016-0331
Views0See moreABSTRACT
Objective:
to reflect on nursing care and its epistemology from its historical, theoretical, philosophical, spiritual dimensions and as a social practice.
Method:
discussions originated in the discipline “Epistemology of caring”, from the graduate nursing program of the School of Nursing, Federal University of Minas Gerais, and in critical analysis of nursing literature together with the professional practice of the authors.
Results:
we identified the necessity of developing a critical conscience on health care provision, research, and teaching, as well as on challenges in maintaining high standards of working interpersonal relationships, which has a profound impact on population health.
Conclusion:
we suggest the rescue of integrality, humanization, unity, and spirituality in researches and practices of individual, familiar, and community care, as an advance in incorporating epistemology of caring in nursing.
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Women’s temporality after cardiac surgery: contributions to nursing care
Revista Brasileira de Enfermagem. 2015;68(6):1056-1062
Abstract
Women’s temporality after cardiac surgery: contributions to nursing care
Revista Brasileira de Enfermagem. 2015;68(6):1056-1062
DOI 10.1590/0034-7167.2015680609i
Views0See moreABSTRACT
Objective:
to unveil women’s existential movement after cardiac surgery.
Method:
qualitative phenomenological study. The research setting was a hospital in Minas Gerais, in which ten women were interviewed between December 2011 and January 2012.
Results:
after hospital discharge, the women experienced physical, social and emotional impairments, and expressed the desire to go back to the time before their diagnosis, because they felt as though they still had heart disease. This vague and average understanding led to three units of meaning that, from a Heideggerian hermeneutic point of view, revealed the phenomenon of cardiac surgery as a present circumstance that limited the participants’ daily lives.
Conclusion:
nurses supporting women patients after cardiac surgery should promote health considering existential facets that are expressed during care. The bases for comprehensive care are revealed in singular and whole meetings of subjectivity.
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Compliance of hand hygiene in maintaining the catheter for hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1050-1055
Abstract
Compliance of hand hygiene in maintaining the catheter for hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1050-1055
DOI 10.1590/0034-7167.2015680608i
Views0See moreABSTRACT
Objective:
to assess the compliance of the practice of hand hygiene in maintaining the temporary double-lumen catheter for hemodialysis, through the use of process indicator at the University Hospital of the University of São Paulo.
Method:
a quantitative, exploratory, descriptive, observational study. Sample consists of 155 observations of patients with catheter from March to November 2011, using the Maintenance Indicator Temporary Dual Lumen Catheter for Hemodialysis.
Results:
the overall compliance rate was 65.8%. Of the 13 specific components evaluated, 9 (69.2%) had 100% compliance. Hand hygiene by health professionals presented one of the worst rates (83.9%).
Conclusion:
it is necessary to implement strategies to reduce the rates of non-compliance, improve quality of care and safety of patients with catheter, and explore factors that affect the process, such as structural issues, and behavioral materials.
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Replication of the training program in nonverbal communication in gerontology
Revista Brasileira de Enfermagem. 2015;68(6):1042-1049
Abstract
Replication of the training program in nonverbal communication in gerontology
Revista Brasileira de Enfermagem. 2015;68(6):1042-1049
DOI 10.1590/0034-7167.2015680607i
Views0See moreABSTRACT
Objective:
to measure the rate of assimilation of applied content at immediate and subsequent moments after a nonverbal communication in gerontology training program.
Method:
descriptive and exploratory fi eld study developed in three state administered hospitals, which attend Brazilian National Health Service (SUS) clients. The duration of the training was twelve hours, applied with 102 healthcare professionals.
Results:
the results revealed that the rate of assimilation of the content immediately after the program was satisfactory, as well as being satisfactory in the aspects concept of aging; strategies to foster the independence and autonomy of the elderly person; communication interferences linked to the elderly and the professional; recognition of non-verbal functions and dimensions. The exception was the professional perception faced with aspects that influence the success of communication.
Conclusion:
it was concluded that the replication of this program was relevant and current for the hospital context, remaining effi cient for healthcare professionals.
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Physical and psychological violence against the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2015;68(6):1035-1041
Abstract
Physical and psychological violence against the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2015;68(6):1035-1041
DOI 10.1590/0034-7167.2015680606i
Views0See moreABSTRACT
Objective:
to verify the prevalence and associated factors to physical and psychological violence against elderlies and trace the sociodemographic and clinical indicators of this population.
Method:
household survey conducted in 729 elderlies Uberaba – MG. Data were analyzed by Chi-square test and logistic regression (p < 0,05).
Results:
the prevalence of elderly on violence was 20.9%, and 5.9% to 20.9% for physical and psychological. Among them prevailed women; with 60├80 years; no education; with income, with their partner as the primary aggressor; negative self-perception of health, hospitalization in the last year and presence of multimorbidities. The violence has been associated with have 60├80 years, living with your partner and dependence for instrumental activities of daily living.
Conclusion:
reinforces the need for early identification of domestic violence and invest in both the old protective actions and in maintaining functional capacity and social inclusion.
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First civil service examination for nurses at the Administrative Department of Public Service
Revista Brasileira de Enfermagem. 2015;68(6):1027-1034
Abstract
First civil service examination for nurses at the Administrative Department of Public Service
Revista Brasileira de Enfermagem. 2015;68(6):1027-1034
DOI 10.1590/0034-7167.2015680605i
Views0See moreABSTRACT
Objective:
to describe the results of the first national public service examination for nurses conducted by the Administrative Department of Public Service between 1941 and 1942.
Method:
historical-documentary research with a quantitative approach.
Results:
155 candidates registered, aged between 21 and 35 years old, 141 (91%) of whom were female. A total of 120 candidates passed the practical exam. Of these, 116 took the written qualification exam. In the end, 107 were approved, 74 (69.1%) of whom were temporary public nurses, 59 (55.1%) Anna Nery Nursing School alumni, and 10 among the first 20 twenty became involved with the Brazilian Association of Nursing later.
Conclusion:
although the exam legitimized the meritbased culture in the staff selection in the area of Brazilian nursing, egalitarian criteria were mitigated, especially regarding the grades applied to different kinds of exams. This resulted in a significant number of temporary nurses approved.
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Children and adolescents with chronic kidney disease in haemodialysis: perception of professionals
Revista Brasileira de Enfermagem. 2015;68(6):1020-1026
Abstract
Children and adolescents with chronic kidney disease in haemodialysis: perception of professionals
Revista Brasileira de Enfermagem. 2015;68(6):1020-1026
DOI 10.1590/0034-7167.2015680604i
Views0See moreABSTRACT
Objective:
to identify aspects impacting on quality of life for children and adolescents with chronic kidney disease on hemodialysis, from the perspective of health professionals, as an essential step for the construction of a specific module of the DISABKIDS® instrument.
Method:
methodological study. Data was collected between May and June 2012, through personal interviews with 12 participants, in two dialysis centers. The empirical material was analyzed according to the thematic content analysis, using the program MAXQDA – Qualitative Data Analysis Software.
Results:
we identifi ed seven themes: self-care, family support, impact of diagnosis, expectation of kidney transplant, truancy, socialization and stigma, grouped into three domains.
Conclusion:
the results showed aspects that impact the quality of life of these customers and, therefore, will be considered in the development of specifi c DISABKIDS® module. In addition, these aspects are relevant to the preparation and planning of actions directed towards children and adolescents with chronic kidney disease.
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From frustration to coping with caring for death by nurse technicians
Revista Brasileira de Enfermagem. 2015;68(6):1013-1019
Abstract
From frustration to coping with caring for death by nurse technicians
Revista Brasileira de Enfermagem. 2015;68(6):1013-1019
DOI 10.1590/0034-7167.2015680603i
Views0See moreABSTRACT
Objective:
to understand nurse technicians’ experience with caring for the death of terminal patients in ICUs and to configure a theoretical model.
Method:
qualitative study with theoretical saturation when analyzing the 10th non-directive interview, having as reference Grounded Theory, Symbolic Interactionism and Bioethics.
Results:
the core category – from frustration to coping with dignified nursing care for finitude: the acceptance of death as a therapeutic and intervenient component – emerged from the comparison of the sub-processes: when the nurse does not feel prepared for caring for death, accepting death as a therapeutic phenomenon and developing coping strategies.
Conclusion:
according to Symbolic Interactionism, a novice professional’s frustration in caring for an individual for death is related to his/her interaction and interpretation of the situation as he/she feels prepared only to care for individuals for life.
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Sedentary lifestyle in individuals with hypertension
Revista Brasileira de Enfermagem. 2015;68(6):1005-1012
Abstract
Sedentary lifestyle in individuals with hypertension
Revista Brasileira de Enfermagem. 2015;68(6):1005-1012
DOI 10.1590/0034-7167.2015680602i
Views0See moreABSTRACT
Objective:
to identify the prevalence of nursing diagnosis Sedentary lifestyle (SL) and to analyze its association with clinical indicators (CI) and related factors (RF) in patients with hypertension.
Method:
cross-sectional study with 285 patients with hypertension at a reference center for outpatient care in Northeastern Brazil. To collect data it was used an instrument based on operational defi nitions of the CI and RF previously validated. Four nurses rated SL as present or absent. To evaluate the association between CI and RF with the presence of SL it was applied the chi-square test. The prevalence ratio and confi dence interval was calculated to verify the magnitude of the effect between RF and SL. Results: SL was identifi ed in 55.8% of the sample. Five IC and six RF showed a signifi cant association with SL.
Conclusion:
the study identifi es main indicators for inference of SL as well as their possible causal factors among people with hypertension.
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A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201pt
Views0A prática profissional da navegação de pacientes é algo incipiente no Brasil e, sendo assim, é indispensável uma ampla discussão com vários setores da sociedade, sendo essa a principal propositura deste editorial. Comecemos pela história.A navegação de pacientes foi definida em 1989 como uma intervenção de prestação de serviços baseada na comunidade, com o objetivo […]See more -
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more -
ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
DOI 10.1590/0034-7167.20247701e02
Views0In the article “Active teaching model to promote critical thinking”, with DOI number: , published in Revista Brasileira de Enfermagem, 2019;72(1):293-8, on page 297:Include before REFERENCES:[…]See more -
REVIEW02-26-2024
Practice of immersion in hot water to relieve pain in neonatology: an integrative review
- Danton Matheus de Souza
, - Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça , [ … ],
- Lisabelle Mariano Rossato
Abstract
REVIEWPractice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
DOI 10.1590/0034-7167-2023-0260
- Danton Matheus de Souza ,
- Maria Eduarda Pires Yamamoto ,
- Joese Aparecida Carvalho ,
- Vanderlei Amadeu da Rocha ,
- Vanessa Dias Fogaça ,
- Lisabelle Mariano Rossato
Views0See moreABSTRACT
Objectives:
to identify immersion use in hot water to relieve pain in newborns.
Methods:
an integrative literature review, carried out in the PubMed, VHL, EMBASE, Scopus, CINAHL, Cochrane and SciELO databases, with investigations in English, Spanish, French or Portuguese, published between 2002 and 2022. The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used to answer the following question: what are the uses of hot water immersion in relieving pain in newborns?
Results:
nine studies were included, mainly Brazilian, experimental, with a predominance of strong and moderate levels of evidence. Hydrotherapy and bath use (immersion and bandaging) was observed, promising interventions in reducing pain scores, assessed using scales, physiological and endocrine parameters.
Conclusions:
hot water proved to be a promising non-pharmacological intervention in relieving pain in infants in different contexts.
- Danton Matheus de Souza
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ORIGINAL ARTICLE02-26-2024
Artificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
Abstract
ORIGINAL ARTICLEArtificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
DOI 10.1590/0034-7167-2023-0201
Views0See moreABSTRACT
Objectives:
to assess the predictive performance of different artificial intelligence algorithms to estimate bed bath execution time in critically ill patients.
Methods:
a methodological study, which used artificial intelligence algorithms to predict bed bath time in critically ill patients. The results of multiple regression models, multilayer perceptron neural networks and radial basis function, decision tree and random forest were analyzed.
Results:
among the models assessed, the neural network model with a radial basis function, containing 13 neurons in the hidden layer, presented the best predictive performance to estimate the bed bath execution time. In data validation, the squared correlation between the predicted values and the original values was 62.3%.
Conclusions:
the neural network model with radial basis function showed better predictive performance to estimate bed bath execution time in critically ill patients.
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REVIEW02-26-2024
Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas , [ … ],
- Indiara Sartori Dalmolin
Abstract
REVIEWEvidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
DOI 10.1590/0034-7167-2023-0134
- Lays Souza de Oliveira ,
- Patrícia Madalena Vieira Hermida ,
- Elizimara Ferreira Siqueira ,
- Juliana Cipriano Braga Silva de Arma ,
- Larissa Scheeren Thomas ,
- Indiara Sartori Dalmolin
Views0ABSTRACT
Objectives:
to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.
Methods:
an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.
Results:
141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses’ competency to insert an intrauterine device; and Women’s access to intrauterine devices.
Conclusions:
nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.
Keywords:Advanced Practice NursingIntrauterine DevicesLong-Acting Reversible ContraceptionNursesPrimary Health CareSee more
- Lays Souza de Oliveira
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