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ORIGINAL ARTICLE02-03-2023
Quality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study
- Caroline de Castro Moura
, - Bárbara Guimarães Lourenço ,
- Bruna de Oliveira Alves ,
- Bianca Bacelar de Assis ,
- Luana Vieira Toledo , [ … ],
- Tânia Couto Machado Chianca
Abstract
ORIGINAL ARTICLEQuality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study
Revista Brasileira de Enfermagem. 2023;76:e20220522
DOI 10.1590/0034-7167-2022-0522
- Caroline de Castro Moura ,
- Bárbara Guimarães Lourenço ,
- Bruna de Oliveira Alves ,
- Bianca Bacelar de Assis ,
- Luana Vieira Toledo ,
- Ludmila de Oliveira Ruela ,
- Tânia Couto Machado Chianca
Views0See moreABSTRACT
Objectives:
to evaluate the quality of life before and after the application of auriculotherapy and the satisfaction of university students with the treatment during the covid-19 pandemic.
Methods:
quasi-experimental study conducted with 44 students in a University Health Center. The intervention consisted of ten sessions of auriculotherapy focusing on emotional changes with quality of life assessment before and after treatment. The study also investigated the satisfaction concerning the intervention.
Results:
predominated among the students: women, from health courses, in use of psychotropic drugs and complaining of emotional changes. There was a statistically significant increase in all domains of quality of life, and students were satisfied with the treatment.
Conclusions:
auriculotherapy improved the quality of life of university students during the covid-19 pandemic, and the level of satisfaction with the treatment was high.
- Caroline de Castro Moura
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ORIGINAL ARTICLE02-03-2023
Factors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic
- Tatiana Aparecida Rodrigues ,
- Fabrícia Moreira Amorim Amaral ,
- Marília Alves Hoffmann ,
- Cissa Azevedo ,
- Helen Cristiny Teodoro Couto Ribeiro , [ … ],
- Luciana Regina Ferreira da Mata
Abstract
ORIGINAL ARTICLEFactors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220280
DOI 10.1590/0034-7167-2022-0280
- Tatiana Aparecida Rodrigues ,
- Fabrícia Moreira Amorim Amaral ,
- Marília Alves Hoffmann ,
- Cissa Azevedo ,
- Helen Cristiny Teodoro Couto Ribeiro ,
- Luciana Regina Ferreira da Mata
Views0See moreABSTRACT
Objectives:
to assess the factors associated with the safety culture of patients under dialysis in the context of the COVID-19 pandemic.
Methods:
a cross-sectional and analytical study, carried out in Minas Gerais, with 134 professionals from three dialysis services. The Hospital Survey on Patient Safety Culture, adapted for Brazil, was used.
Results:
only variable type of management was associated with the highest percentage of positive response in public and private services. Patient safety was rated as good by 55.7% of respondents. In dimension assessment, the public service presented one strength and five weaknesses, the private service did not present weak areas, and the philanthropic service presented a weakness. The priority areas for improvement actions are represented by dimensions “Nonpunitive response to error” and “Staffing”.
Conclusions:
interventions should consider the type of service management, as it is a factor associated with safety culture.
- Tatiana Aparecida Rodrigues
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ORIGINAL ARTICLE02-03-2023
Remote teaching during the COVID-19 pandemic: repercussions from professors’ perspective
- Joanara Rozane da Fontoura Winters ,
- Débora Rinaldi Nogueira ,
- Ivonete Terezinha Schülter Buss Heidemann ,
- Michelle Kuntz Durand ,
- Adriana Bitencourt Magagnin , [ … ],
- Aline Megumi Arakawa-Belaunde
Abstract
ORIGINAL ARTICLERemote teaching during the COVID-19 pandemic: repercussions from professors’ perspective
Revista Brasileira de Enfermagem. 2023;76:e20220172
DOI 10.1590/0034-7167-2022-0172
- Joanara Rozane da Fontoura Winters ,
- Débora Rinaldi Nogueira ,
- Ivonete Terezinha Schülter Buss Heidemann ,
- Michelle Kuntz Durand ,
- Adriana Bitencourt Magagnin ,
- Aline Megumi Arakawa-Belaunde
Views0See moreABSTRACT
Objectives:
to understand the repercussions of teaching work in remote teaching during the COVID-19 pandemic in Higher Education Institutions in northern Santa Catarina.
Methods:
a qualitative participatory action research, based on Paulo Freire’s theoretical-methodological precepts. Seventeen health professors participated in two Virtual Culture Circles held in the first half of 2021.
Results:
six generating themes emerged for discussion, which aroused in participants’ feelings and perspectives regarding the remote teaching process in the pandemic context, with an emphasis on the connectivity theme, which generated dialogue through reports of personal experiences.
Final Considerations:
the pandemic has had repercussions in sectors such as health and education. Professors talked about their experience in creating, recreating and adapting to remote teaching and the challenges facing the teaching-learning process, listing the worsening of mental health and the need to learn new digital technologies.
- Joanara Rozane da Fontoura Winters
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ORIGINAL ARTICLE01-30-2023
Pressure injury prevention in older people: construction and validation of an instrument for caregivers
- Suellen Duarte de Oliveira Matos ,
- Ana Paula Marques de Andrade Souza ,
- Margarida da Silva Neves de Abreu ,
- Anne Carolinne Marie dos Santos Gomes ,
- Jacira dos Santos Oliveira , [ … ],
- Simone Helena dos Santos Oliveira
Abstract
ORIGINAL ARTICLEPressure injury prevention in older people: construction and validation of an instrument for caregivers
Revista Brasileira de Enfermagem. 2023;76(1):e20210930
DOI 10.1590/0034-7167-2021-0930
- Suellen Duarte de Oliveira Matos ,
- Ana Paula Marques de Andrade Souza ,
- Margarida da Silva Neves de Abreu ,
- Anne Carolinne Marie dos Santos Gomes ,
- Jacira dos Santos Oliveira ,
- Mirian Alves da Silva ,
- Maria Júlia Guimarães Oliveira Soares ,
- Simone Helena dos Santos Oliveira
Views0See moreABSTRACT
Objectives:
to construct and validate an instrument to assess the knowledge, attitudes, and practices related to pressure injury prevention among caregivers of institutionalized older people.
Methods:
this is a three-stage methodological study that consisted of instrument construction, analysis by experts, and semantic and appearance analysis, with 78 participants, observing the validation process steps for psychometric instruments in the criteria of clarity and relevance.
Results:
in the Delphi I round, the validity index of the general content in the clarity criterion was 0.66, in relevance 0.85, and the Kappa value was >0.76. In Delphi II, clarity was 0.95, relevance 1.00, and the Kappa value was >0.97.
Conclusions:
this is a valid instrument in terms of content and appearance, which allows further analysis of its reliability for the measurement of the constructs for which it is intended. Therefore, it can be considered a tool for care management in pressure injury prevention.
- Suellen Duarte de Oliveira Matos
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ORIGINAL ARTICLE01-30-2023
Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients
- Juliane Rangel Dantas ,
- Anna Thays Dias Almeida ,
- Karolayne Cabral Matias ,
- Maria Isabel da Conceição Dias Fernandes ,
- Jéssica Dantas de Sá Tinôco , [ … ],
- Ana Luísa Brandão de Carvalho Lira
Abstract
ORIGINAL ARTICLEAccuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients
Revista Brasileira de Enfermagem. 2023;76(1):e20220174
DOI 10.1590/0034-7167-2022-0174
- Juliane Rangel Dantas ,
- Anna Thays Dias Almeida ,
- Karolayne Cabral Matias ,
- Maria Isabel da Conceição Dias Fernandes ,
- Jéssica Dantas de Sá Tinôco ,
- Marcos Venícios de Oliveira Lopes ,
- Ana Luísa Brandão de Carvalho Lira
Views0See moreABSTRACT
Objectives:
to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients.
Methods:
diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019.
Results:
the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999).
Conclusions:
six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.
- Juliane Rangel Dantas
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ORIGINAL ARTICLE01-30-2023
Adverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
- Rafaela Moreira da Silva Canille ,
- Maria Helena Pinto ,
- Katia Jaira Galisteu ,
- Rildo César Czorny ,
- Luana Gaino Bertolazzi , [ … ],
- Tamara Veiga Faria
Abstract
ORIGINAL ARTICLEAdverse dermatoneurological events and impacts on daily activities of patients with gastrointestinal neoplasms undergoing chemotherapy
Revista Brasileira de Enfermagem. 2023;76(1):e20220161
DOI 10.1590/0034-7167-2022-0161
- Rafaela Moreira da Silva Canille ,
- Maria Helena Pinto ,
- Katia Jaira Galisteu ,
- Rildo César Czorny ,
- Luana Gaino Bertolazzi ,
- Tamara Veiga Faria
Views0See moreABSTRACT
Objective:
to associate the presence and grading of adverse dermatoneurological events (peripheral neuropathy and hand-foot syndrome) and the interference in the activities of daily living of patients with gastrointestinal neoplasms undergoing systemic antineoplastic treatment.
Method:
this is a longitudinal, prospective study, using instruments to assess hand-foot syndrome and peripheral neuropathy.
Results:
there were 36 patients: 66.7% diagnosed with colon cancer and 83.2% on combination therapy. From cycle 5 onwards, all of them had hand-foot syndrome, with a majority of grade 1, unrelated to interference in activities of daily living. Regarding peripheral neuropathy, there was a moderate to strong correlation from cycle 1 of treatment.
Conclusion:
peripheral neuropathy negatively affects activities of daily living. The monitoring of dermatoneurological events by oncology nurses contributes to the clinical practice of nursing and subsidizes the development of advanced practice in the country.
- Rafaela Moreira da Silva Canille
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ORIGINAL ARTICLE01-30-2023
Educational material production and validity: educational instrument for home care for premature newborns
- Isabela Lorencini Santos ,
- Luciana de Cássia Nunes Nascimento ,
- Marta Pereira Coelho ,
- Paula de Souza Silva Freitas ,
- Adriana Nunes Moraes-Partelli
Abstract
ORIGINAL ARTICLEEducational material production and validity: educational instrument for home care for premature newborns
Revista Brasileira de Enfermagem. 2023;76(1):e20210648
DOI 10.1590/0034-7167-2021-0648
- Isabela Lorencini Santos ,
- Luciana de Cássia Nunes Nascimento ,
- Marta Pereira Coelho ,
- Paula de Souza Silva Freitas ,
- Adriana Nunes Moraes-Partelli
Views0See moreABSTRACT
Objective:
to produce and validate a booklet, based on Jean Watson’s Theory, on home care for premature newborns, based on caregivers’ experiences.
Method:
a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts.
Results:
the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet “Booklet for Premature Newborns: Demystifying Home Care”. The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity.
Final considerations:
the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers’ autonomy in providing home care to newborns.
- Isabela Lorencini Santos
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ORIGINAL ARTICLE01-30-2023
Development and validation of an instrument for the evaluation of HIV care in Primary Health Care
- Clarissa Mourão Pinho ,
- Morgana Cristina Leôncio de Lima ,
- Mônica Alice Santos Silva ,
- Cynthia Angélica Ramos de Oliveira Dourado ,
- Regina Célia de Oliveira , [ … ],
- Maria Sandra Andrade
Abstract
ORIGINAL ARTICLEDevelopment and validation of an instrument for the evaluation of HIV care in Primary Health Care
Revista Brasileira de Enfermagem. 2023;76(1):e20220247
DOI 10.1590/0034-7167-2022-0247
- Clarissa Mourão Pinho ,
- Morgana Cristina Leôncio de Lima ,
- Mônica Alice Santos Silva ,
- Cynthia Angélica Ramos de Oliveira Dourado ,
- Regina Célia de Oliveira ,
- Jael Maria de Aquino ,
- Erika Simone Galvão Pinto ,
- Maria Sandra Andrade
Views0See moreABSTRACT
Objective:
To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care.
Method:
Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis.
Results:
The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered “totally agree” for the items presented.
Conclusion:
The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.
- Clarissa Mourão Pinho
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REVIEW08-05-2020
Communication of bad news in pediatrics: integrative review
- Bruna Pase Zanon ,
- Luiza Cremonese ,
- Aline Cammarano Ribeiro ,
- Stela Maris de Mello Padoin ,
- Cristiane Cardoso de Paula
Abstract
REVIEWCommunication of bad news in pediatrics: integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190059
DOI 10.1590/0034-7167-2019-0059
- Bruna Pase Zanon ,
- Luiza Cremonese ,
- Aline Cammarano Ribeiro ,
- Stela Maris de Mello Padoin ,
- Cristiane Cardoso de Paula
Views1See moreABSTRACT
Objectives:
to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics.
Methods:
integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included.
Results:
the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information).
Conclusions:
there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child’s right to know their condition.
- Bruna Pase Zanon
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03-15-2021
Advanced Practice Nursing in Latin America and the Caribbean: seeking its implementation
Revista Brasileira de Enfermagem. 2021;74:e74suppl601
Abstract
Advanced Practice Nursing in Latin America and the Caribbean: seeking its implementation
Revista Brasileira de Enfermagem. 2021;74:e74suppl601
DOI 10.1590/0034-7167.202174suppl601
Views1Healthcare organizations are increasingly complex and specialized, seeking to optimize their quality and safety standards, and be able to meet the growing needs of their users. To face this reality, health professionals need to adapt to respond in time to the demands of the health context. In turn, the World Health Organization (WHO), through the […]See more -
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 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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REFLECTION09-29-2022
Health care of deaf persons during coronavirus pandemics
Revista Brasileira de Enfermagem. 2022;75:e20201036
Abstract
REFLECTIONHealth care of deaf persons during coronavirus pandemics
Revista Brasileira de Enfermagem. 2022;75:e20201036
DOI 10.1590/0034-7167-2020-1036
Views0See moreABSTRACT
Objective:
To reflect about the barriers experienced by the deaf population during the COVID-19 pandemic, the proposals to overcome communication barriers in health care and the role of public policies in effecting the social inclusion of deaf people.
Methods:
Reflection based on studies on health care for deaf people, the COVID-19 pandemic and public accessibility policies.
Results:
The global crisis of COVID-19 has deepened pre-existing inequalities in the world, in addition to highlighting the vulnerability of people with disabilities, including deaf. Government, institutional and social initiatives to mitigate difficulties in communicating to deaf people have been made, but they are still insufficient to guarantee protection for them in this pandemic and full inclusion in health care.
Final considerations:
Social inclusion, supported by law, and the linguistic accessibility of deaf people still need to generate broad and concrete actions so that deaf people can enjoy their rights as citizens.
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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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ORIGINAL ARTICLE09-16-2019
Knowledge of nursing student on the prevention of sexually transmitted infections
Revista Brasileira de Enfermagem. 2019;72(5):1145-1152
Abstract
ORIGINAL ARTICLEKnowledge of nursing student on the prevention of sexually transmitted infections
Revista Brasileira de Enfermagem. 2019;72(5):1145-1152
DOI 10.1590/0034-7167-2017-0801
Views0See moreABSTRACT
Objective:
To identify the knowledge and self-care actions taken by nursing undergraduate students of a Federal University of the South of Brazil, against Sexually Transmitted Infections.
Method:
Exploratory qualitative study, conducted 40 interviews with undergraduate students at the beginning and end of the course. The analysis was thematic, resulting in three categories.
Results:
Knowledge about the subject is a decisive factor for self-care, and the more knowledge, the greater the prevention. The dissemination of knowledge of students at the end of the course not only influences self-care but also health promotion in the social sphere.
Final considerations:
Knowledge is important in self-care and caring for others. The dissemination of knowledge becomes evident according to the complexity of the course. Stable relationships may interfere with the use or disuse of condoms in sexual relationships, a misnomer present in today’s society.
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ORIGINAL ARTICLE04-22-2020
Men’s health care: construction and validation of a tool for nursing consultation
- Kelly Caroline dos Santos ,
- Deborah Franscielle da Fonseca ,
- Patrícia Peres de Oliveira ,
- Anna Gabryela Sousa Duarte ,
- João Marcos Alves Melo , [ … ],
- Raíssa Silva Souza
Abstract
ORIGINAL ARTICLEMen’s health care: construction and validation of a tool for nursing consultation
Revista Brasileira de Enfermagem. 2020;73(3):e20190013
DOI 10.1590/0034-7167-2019-0013
- Kelly Caroline dos Santos ,
- Deborah Franscielle da Fonseca ,
- Patrícia Peres de Oliveira ,
- Anna Gabryela Sousa Duarte ,
- João Marcos Alves Melo ,
- Raíssa Silva Souza
Views0See moreABSTRACT
Objectives:
to elaborate and validate a data collection tool for nursing consultation with men in the context of Primary Health Care.
Method:
a methodological study developed in four stages. The first one consisted in tool elaboration, using databases and the Dorothea Orem’s theoretical model. In the second and third stages, content validation and tool appearance by 23 nurse judges took place. The Concordance Index was used for assessment. In the fourth stage, a pilot test was carried out with 20 men using Primary Health Care.
Results:
of the 145 indicators prepared, organized and submitted to validation process, items with the Concordance Index <0.80 were excluded. The final tool consisted of 156 items. An overall 0.88 Concordance Index calculation was obtained.
Conclusions:
the final tool presented content validity for data collection with men in Primary Health Care.
- Kelly Caroline dos Santos
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