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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program
Revista Brasileira de Enfermagem. 2015;68(1):84-92
Abstract
Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program
Revista Brasileira de Enfermagem. 2015;68(1):84-92
DOI 10.1590/0034-7167.2015680112p
Views0See moreObjective:
to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs.
Method:
we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0.
Results:
among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune.
Conclusion:
it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns.
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The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
Abstract
The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
DOI 10.1590/0034-7167.2015680111p
Views0See moreObjective:
To identify the mental disorders carriers’ perception, the smokers ones, about the decreasing number of cigarettes during psychiatric hospitalization.
Method:
Exploratory study with 96 hospitalized carriers of mental disorders who are smokers: G1 (34 subjects hospitalized when was allowed one cigarette by hour) and G2 (62 subjects hospitalized when it was reduced to eight cigarette by day). Semi-structured questionnaire. Thematic content analysis.
Results:
The G1 admitted satisfaction with the restriction – smoking during hospitalization as entitlement. The G2 resists the restriction change occurred without dialogue or support. In spite of the difficulties, some attitude changes about the cigarette were noticed such as increase of the responsibility, discovery of the ability to reduce smoking and the meaning of its role.
Conclusion:
Some subjects understand the smoking health policy change as punishment, while others as opportunity to think about the role of cigarette in their life.
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Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
Abstract
Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
DOI 10.1590/0034-7167.2015680110p
Views0See moreObjective:
the aim of this study was to identify factors associated with family functionality of non-institutionalized long-lived subjects, who were residents in Goiânia (GO), Brazil.
Method:
this was a population-based epidemiological study with cross-sectional outline. Evaluation scales of the functional and cognitive capacities were used. Family dynamics was measured using the Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) instrument by making home interviews with 131 long-lived individuals.
Results:
there was prevalence of the female gender, average of age of 83.87 years old, widowhood condition, and residence in a big family, primary schooling, and self-perception of regular health. A great amount showed independence for self-care and partial dependence for daily life instrumental activities. Family functionality prevailed with score average of 9.06 points.
Conclusion:
in conclusion, family functionality in long-lived subjects is associated with self-perception of poor/bad health, osteoporosis, and fall. Results allowed characterizing long-lived subjects’ family functionality with the aim of valuing and prioritizing family as a caregiver.
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Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
Abstract
Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
DOI 10.1590/0034-7167.2015680109i
Views0See moreObjective:
the aim of the study was to determine the prevalence of non-adherence to antihypertensive drug treatment and its association with factors bio-socio-economic and welfare.
Method:
it was a descriptive, cross-sectional study, performed with 422 hypertensive individuals. Data were collected through home interviews, conducted between December 2011 and March 2012.
Results:
the results showed that the respondents were mostly female, married, elderly, low income and little time of diagnosis. Were considered non adherent to medication 42.65% of participants. Non-Caucasian hypertensive patients, with fewer than eight years of schooling, who did not regularly attend doctor’s appointments, took more than two anti-hypertensive medications and did not have private health insurance, showed higher likelihood of not complying with the drug treatment.
Conclusion:
these findings suggest that hypertensive patients with unfavorable socioeconomic characteristics and difficulty of access to the service require different interventions in order to encourage them to adhere to medication treatment.
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Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
Abstract
Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
DOI 10.1590/0034-7167.2015680108i
Views0See moreObjective:
this study aimed to assess adherence and knowledge of manicures/pedicures on the use of Personal Protective Equipment (PPE).
Methods:
it was a survey with 235 manicures/pedicures in salons, Belo Horizonte/Brazil. Data were analyzed with the software Statistical package for the social sciences (17.0), using descriptive statistics, chi-square and logistic regression.
Results:
the adherence and the knowledge of the professional were evaluated using the median of the results, obtaining 52% and 63% respectively. The professionals younger than 31 were more likely (2.54 times) to adhere to PPE and those who claimed to have done biosafety course and to use uniform during work, had better chance of understanding (2.86 and 3.12 times, respectively). The majority (83.4 %) stated that the use of PPE should occur for all procedures, meanwhile 71.5 % cited not use them.
Conclusions:
the results indicate the poor adherence to PPE, strengthen occupational biological risk and need for training of these professionals.
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Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
Abstract
Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
DOI 10.1590/0034-7167.2015680107i
Views0See moreObjective:
to analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients.
Methods:
prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted.
Results:
patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority.
Conclusions:
STM proved a good predictor of clinical outcomes.
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Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
Abstract
Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
DOI 10.1590/0034-7167.2015680106i
Views0See moreObjective:
the present study aimed to identify and characterize nursing companies managed by entrepreneur nurses registered at the Commercial Registry of São Paulo by 2011.
Method:
it’s a descriptive, exploratory study, whose data collection, made throughout January 2012, was carried out on the Commercial Registry of Sao Paulo website. This non-governmental body has the function of registering the opening of companies and supervising their trade situation.
Results and conclusion:
this study allowed us to identify that the entrepreneur nurse is a growing reality through the identification of 196 companies opened by these professionals. Afterwards, it was analyzed their time of functioning, the main economic activity of the company, capital value, percentage of nurse partners and the distribution of companies by region of Sao Paulo State.
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Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
Abstract
Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
DOI 10.1590/0034-7167.2015680105i
Views0See moreObjective:
the study aims at discussing the significations apprehended by the non-blood donators, considering the context and the consequences of the acting of the nurse in hemotherapy.
Method:
it is a qualitative approach, with theoretical frame of Symbolic Interactionism and Grounded Theory method. The data production was carried out by intensive interview with subjects of three sample groups of a University Hospital of Rio de Janeiro City.
Results:
the phenomenon originated two analysis categories: “Perceiving the blood matter” and “Reflecting about the blood donation campaigns”. It was observed that the environment of the donor is not composed by contact with the other and the information that it can achieve, including the media.
Conclusion:
these were the main basis for the knowledge of blood donation according to their beliefs, culture and values. Therefore, all these aspects must be considered by the nurse acting on donors capture.
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TECHNOLOGICAL INNOVATION10-21-2022
Cancer symptom clusters: from the lab bench to clinical practice
Revista Brasileira de Enfermagem. 2022;75(5):e2022v75n5inov
Abstract
TECHNOLOGICAL INNOVATIONCancer symptom clusters: from the lab bench to clinical practice
Revista Brasileira de Enfermagem. 2022;75(5):e2022v75n5inov
DOI 10.1590/0034-7167-2022v75n5inov
Views0See moreABSTRACT
Objective:
to present and discuss the advancement of science in symptom management through research involving oncological symptom clusters (OSC).
Method:
a reflective study, supported by the scientific literature on OSC.
Results:
five key points are crucial to advancing the science of symptom management through research involving OSC: definition of OSC characteristics; underlying mechanisms and priority symptom clusters; OSC measurement; targeted and personalized interventions; new analytical strategies.
Final considerations:
a better understanding of the complex connections between different systems and biobehavioral aspects in patients, especially in the field of oncology nursing, is urgent. The study of these interactions has become increasingly promising and emerging for oncology nursing, since therapeutic interventions, whose target is the neuroimmunoendocrine axis, are relevant for personalized care, translating into greater scientific and nurse autonomy to care for patients.
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ORIGINAL ARTICLE10-21-2022
Technology for nursing consultation with transsexual women in the light of Leininger’s transcultural theory
Revista Brasileira de Enfermagem. 2022;75(5):e20210769
Abstract
ORIGINAL ARTICLETechnology for nursing consultation with transsexual women in the light of Leininger’s transcultural theory
Revista Brasileira de Enfermagem. 2022;75(5):e20210769
DOI 10.1590/0034-7167-2021-0769
Views0ABSTRACT
Objective:
to describe the construction and validation of a nursing consultation technology for transgender women.
Methods:
a methodological study developed in three stages with construction based on the Leininger’s Cross-Cultural Theory, content validation performed by experts in transgender sexual health and evaluation by nurses of care for transgender women. Items with a minimum agreement of 80% were considered validated, according to the Content Validity Index and binomial test.
Results:
the technology contains 59 items in three blocks: the first, for identification of the transsexual woman; the second, with the Clinical Data; and the third, regarding the Propaedeutics of Care. All items reached agreement higher than 0.8 and an overall Validity Index of 80%.
Conclusions:
the technology was content-validated and evaluated by nurses and can be applicable in clinical and outpatient practice as well as in academia to promote quality care for transgender women.
Keywords:Culturally Competent Health CareNursing ConsultationTechnologyTransgender PeopleValidation StudySee more -
ORIGINAL ARTICLE10-21-2022
“EMPODEREENF”: construction of an application for nurses’ continuing education on psychological violence against women
Revista Brasileira de Enfermagem. 2022;75(5):e20200391
Abstract
ORIGINAL ARTICLE“EMPODEREENF”: construction of an application for nurses’ continuing education on psychological violence against women
Revista Brasileira de Enfermagem. 2022;75(5):e20200391
DOI 10.1590/0034-7167-2020-0391
Views0ABSTRACT
Objective:
to construct a prototype of a mobile application on psychological violence against women to facilitate nurses’ continuing education.
Method:
an applied methodological research of technological development, based on the Contextualized Instructional Design method.
Results:
the prototype content was based on the learning objectives developed through a narrative review, which guided an integrative review to compile the information. The prototype is called “EmpodereEnf”, and is composed of an initial screen, bringing nurses as a target audience, and, soon after, offering nine general moblets for access to information such as: concepts, causes, manifestations and consequences of psychological violence; means for identification and approach in nursing consultation and health education; compulsory notification and referral; examples of cases of psychological violence and references.
Final considerations:
the prototype is a possibility for future coping interventions and a work tool for nurses in the face of psychological violence against women.
Keywords:ContinuingDomestic ViolenceEducationEducational TechnologyNursingPrimary Care NursingWomen's HealthSee more -
ORIGINAL ARTICLE10-21-2022
Management in the Family Health Strategy: workloads and structured institutional violence
Revista Brasileira de Enfermagem. 2022;75(3):e20220071
Abstract
ORIGINAL ARTICLEManagement in the Family Health Strategy: workloads and structured institutional violence
Revista Brasileira de Enfermagem. 2022;75(3):e20220071
DOI 10.1590/0034-7167-2022-0071
Views0See moreABSTRACT
Objectives:
to understand the relationship between workloads and institutional violence in Family Health Strategy managers’ practice.
Methods:
qualitative research using theoretical triangulation and data from semi-structured interviews. Participants were 35 managers of Basic Health Units in the five Regions of Brazil, who worked in the Family Health Strategy. We used thematic analysis and ATLAS.ti for data analysis.
Results:
workloads were analyzed, showing relationships with institutional violence. Thematic categories emerged: “related to the management work itself”; “related to other instances of health system management”; “related to users and community”. There was an interrelationship between increased managers’ workloads and institutional violence.
Final Considerations:
the Family Health Strategy is relevant for universal access to health and requires favorable institutional conditions for its effectiveness. Adverse scenarios lead to increased workloads, approaching institutional violence.
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ORIGINAL ARTICLE10-17-2022
Cross-cultural adaptation of the University Student Depression Inventory for Brazil
Revista Brasileira de Enfermagem. 2022;75:e20220004
Abstract
ORIGINAL ARTICLECross-cultural adaptation of the University Student Depression Inventory for Brazil
Revista Brasileira de Enfermagem. 2022;75:e20220004
DOI 10.1590/0034-7167-2022-0004
Views0See moreABSTRACT
Objectives:
to adapt the University Student Depression Inventory for Brazil.
Methods:
we used 6 methodological stages: initial translation, translation synthesis, back-translation, expert committee, pre-final version testing and document submission to the scale authors for assessing the adaptation process. The judges were 2 methodologists, 1 health professional and 2 translators. For the pre-test, 30 undergraduate and graduate students participated.
Results:
the data were analyzed by Excel®, resulting in satisfactory content validity, a scale composed of 30 items, 3 domains and a total CVC of 0.91. Language clarity and practical relevance had a CVC of 0.91 and theoretical relevance of 0.90.
Conclusions:
the USDI-BR was cross-culturally adapted for Brazil, showing evidence of satisfactory content validity. After an analysis of reliability and convergent validity to be tested in future studies, multidisciplinary teams will be able to apply this scale to Brazilian students.
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ORIGINAL ARTICLE10-17-2022
Factors associated with psychoactive substance use among professional truck drivers
Revista Brasileira de Enfermagem. 2022;75:e20210187
Abstract
ORIGINAL ARTICLEFactors associated with psychoactive substance use among professional truck drivers
Revista Brasileira de Enfermagem. 2022;75:e20210187
DOI 10.1590/0034-7167-2021-0187
Views0ABSTRACT
Objectives:
to identify factors associated with the use of psychoactive substances among professional truck drivers.
Methods:
cross-sectional study that investigated the use of at least one psychoactive substance and its association with sociodemographic, occupational, and health characteristics in 354 professional truck drivers. Researchers collected data through face-to-face interviews using forms. Multiple regression analyzes estimated prevalence ratios (PR) and respective 95% confidence intervals (95%CI).
Results:
lower family income (PR: 2.03; 95%CI: 1.08-3.83), symptoms of insomnia (PR: 2.18, 95%CI: 1.46-3.26), and long working hours (PR: 1.95, 95%CI: 1.30-2.92) independently associated with the use of at least one psychoactive substance.
Conclusions:
a set of sociodemographic, occupational, and health variables acts at distinct levels and is independently associated with the use of psychoactive substances among professional truck drivers.
Keywords:Cross-Sectional StudiesIllicit DrugsMotor VehiclesOccupational HealthOccupational Health NursingSee more -
ORIGINAL ARTICLE10-17-2022
Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
Revista Brasileira de Enfermagem. 2022;75:e20210960
Abstract
ORIGINAL ARTICLEEthics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
Revista Brasileira de Enfermagem. 2022;75:e20210960
DOI 10.1590/0034-7167-2021-0960
Views1See moreABSTRACT
Objectives:
to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic.
Methods:
a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used.
Results:
we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class’s representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims.
Final Considerations:
the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.
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ORIGINAL ARTICLE10-17-2022
Coping with the health condition from the perspective of people with HIV who abandoned treatment
Revista Brasileira de Enfermagem. 2022;75:e20210958
Abstract
ORIGINAL ARTICLECoping with the health condition from the perspective of people with HIV who abandoned treatment
Revista Brasileira de Enfermagem. 2022;75:e20210958
DOI 10.1590/0034-7167-2021-0958
Views0See moreABSTRACT
Objectives:
to understand how people living with HIV who have abandoned treatment face their health condition.
Methods:
a qualitative study, based on the Chronic Care Model theoretical precepts. Data were collected between April and August 2021, through interviews with 24 people registered in a specialized service in the Brazilian Midwest.
Results:
coping with the health condition included good and bad moments and is influenced by individual behaviors and the way in which the network was organized. Treatment abandonment was motivated by the absence of signs and symptoms, the way care is provided and medication side effects.
Final Considerations:
care actions focusing on behavior change and maintenance become necessary in order to favor continuity of treatment. Furthermore, the gaps identified in the way health services are organized are subject to intervention.
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