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Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis
- Mariana Torreglosa Ruiz
, - Nayara Freitas Azevedo ,
- Cynthya Viana de Resende ,
- Wellington Francisco Rodrigues ,
- Joilson Meneguci , [ … ],
- Carlo José Freire de Oliveira
12-04-2023
Abstract
Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230070
12-04-2023DOI 10.1590/0034-7167-2023-0070
- Mariana Torreglosa Ruiz ,
- Nayara Freitas Azevedo ,
- Cynthya Viana de Resende ,
- Wellington Francisco Rodrigues ,
- Joilson Meneguci ,
- Divanice Contim ,
- Monika Wernet ,
- Carlo José Freire de Oliveira
Views0See moreABSTRACT
Objective:
to compare the effectiveness of different diagnostic methods to estimate postpartum blood volume loss.
Methods:
a systematic review of effectiveness according to PRISMA and JBI Protocol. Searches in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science and CINAHL, with descriptor “Postpartum Hemorrhage” associated with keyword “Quantification of Blood Loss”. Tabulated extracted data, presented in metasynthesis and meta-analysis was applied to quantitative data. To assess risk of bias, JBI Appraisal Tools were applied.
Results:
fourteen studies were included, published between 2006 and 2021. Quantification of loss by any method was superior to visual estimation and is highly recommended, however the studies’ high heterogeneity did not allow estimating this association.
Conclusion:
the studies’ high heterogeneity, with a probable margin of error given the uncontrolled factors, indicates the need for further studies, however quantification proved to be effective in relation to visual estimate. PROSPERO registration CRD 42021234486.
- Mariana Torreglosa Ruiz
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ORIGINAL ARTICLE
Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial
- Andréia Barcellos Teixeira Macedo ,
- Edwing Alberto Urrea Vega ,
- Liliana Antoniolli ,
- Jessica Morgana Gediel Pinheiro ,
- Juliana Petri Tavares , [ … ],
- Sônia Beatriz Cócaro de Souza
12-04-2023
Abstract
ORIGINAL ARTICLEEffect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial
Revista Brasileira de Enfermagem. 2023;76(6):e20230069
12-04-2023DOI 10.1590/0034-7167-2023-0069
- Andréia Barcellos Teixeira Macedo ,
- Edwing Alberto Urrea Vega ,
- Liliana Antoniolli ,
- Jessica Morgana Gediel Pinheiro ,
- Juliana Petri Tavares ,
- Sônia Beatriz Cócaro de Souza
Views0See moreABSTRACT
Objective:
to assess the effect of cardiovascular biofeedback on nursing staff stress when compared to an activity without self-monitoring.
Method:
a randomized controlled clinical trial, carried out with nursing professionals from a university hospital. The intervention group (n=58) performed cardiovascular biofeedback, and the control (n=57) performed an online puzzle without self-monitoring, totaling nine meetings over three weeks. The outcome was assessed using the Stress Symptoms and Work-Related Stress scales, and the biological marker heart rate variability. The generalized estimating equations method was used.
Results:
the intervention had no effect on self-reported instruments (p>0.050). However, there was an effect of time (p<0.050) on all heart rate variability indicators, demonstrating changes over the sessions.
Conclusion:
cardiovascular biofeedback showed promising results in the biological marker, suggesting that it can be used in nursing staff as a complementary therapy by promoting better autonomic nervous system regulation.
- Andréia Barcellos Teixeira Macedo
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Transition of Care for Individuals with Mental Disorders in Brazil: A Contextual Analysis
- Larissa Arielly Cunha da Silva ,
- Renilly de Melo Paiva ,
- Sarah Lyandra Furtado Faustino ,
- Emanuela Juliana Bezerra Miranda ,
- Viviane Euzébia Pereira Santos
12-04-2023
Abstract
Transition of Care for Individuals with Mental Disorders in Brazil: A Contextual Analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230063
12-04-2023DOI 10.1590/0034-7167-2023-0063
- Larissa Arielly Cunha da Silva ,
- Renilly de Melo Paiva ,
- Sarah Lyandra Furtado Faustino ,
- Emanuela Juliana Bezerra Miranda ,
- Viviane Euzébia Pereira Santos
Views0See moreABSTRACT
Objective:
To describe the contexts of care transition for individuals with mental disorders in the Brazilian setting.
Methods:
A contextual analysis was conducted through a scoping review. The search for studies was conducted in databases and thesis and dissertation portals, and the analysis was based on immediate, specific, general, and meta-contexts.
Results:
The sample, consisting of eight studies, indicated that the following factors are present in the contexts where care transition occurs: Peculiarities of care transition for individuals with mental disorders; Perspectives that can strengthen or weaken this transition; Approaches proposed in the past for the development of care transition; and Elements related to Brazilian legislation.
Final Considerations:
It is observed that the transition of care for individuals with mental disorders in Brazil takes place in various contexts of care levels. These variations present significant potentials and barriers in the care scenarios.
- Larissa Arielly Cunha da Silva
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ORIGINAL ARTICLE
Sexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
- Laércio Deleon de Melo ,
- Thelma Spindola ,
- Cristina Arreguy-Sena ,
- Paula Krempser ,
- Juliana de Lima Brandão , [ … ],
- Paulo Ferreira Pinto
12-04-2023
Abstract
ORIGINAL ARTICLESexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
Revista Brasileira de Enfermagem. 2023;76(6):e20220786
12-04-2023DOI 10.1590/0034-7167-2022-0786
- Laércio Deleon de Melo ,
- Thelma Spindola ,
- Cristina Arreguy-Sena ,
- Paula Krempser ,
- Juliana de Lima Brandão ,
- Cristiane Maria Amorim Costa ,
- Felipe Eduardo Taroco ,
- Paulo Ferreira Pinto
Views0ABSTRACT
Objective:
to discuss undergraduate students’ sexual behavior from the perspective of social markers and cross-cultural care proposed by Madeleine Leininger.
Methods:
descriptive-exploratory qualitative research, with a theoretical-philosophical foundation in the Transcultural Theory. Convenience sample was composed of 57 young people from two universities in Rio de Janeiro. The focus groups’ content were analyzed lexically using the IRAMUTEQ software.
Results:
four classes emerged: Young people’s sexual scripts: between the fear of an unplanned pregnancy and the risk of exposure to sexually transmitted infections; Affective relationships: trust in steady sexual partners, apparent sense of security and disuse of condoms; Sexual practices, gender and cultural determinants: distinction in men’s and women’s role; Sexual partnerships, negotiation of condom use and vulnerability to sexually transmitted infections.
Final considerations:
challenges are perceived for the attention to undergraduate students’ sexual health, who verbalized risky sexual behaviors due to sociocultural vulnerabilities.
Keywords:Cross-Cultural NursingIntersectional FramingSexual BehaviorSexually Transmitted InfectionsYoung AdultSee more
- Laércio Deleon de Melo
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Sleep quality of nurses who worked in coping with COVID-19: an integrative review
- Ítalo Arão Pereira Ribeiro ,
- Ana Lívia Castelo Branco de Oliveira ,
- Carla Danielle Araújo Feitosa ,
- Sandra Cristina Pillon ,
- Maria Helena Palucci Marziale , [ … ],
- Márcia Astrês Fernandes
12-04-2023
Abstract
Sleep quality of nurses who worked in coping with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230007
12-04-2023DOI 10.1590/0034-7167-2023-0007
- Ítalo Arão Pereira Ribeiro ,
- Ana Lívia Castelo Branco de Oliveira ,
- Carla Danielle Araújo Feitosa ,
- Sandra Cristina Pillon ,
- Maria Helena Palucci Marziale ,
- Márcia Astrês Fernandes
Views0See moreABSTRACT
Objective:
to analyze sleep quality of nurses who worked coping with COVID-19 in scientific evidence.
Methods:
an integrative review, carried out in seven databases, including studies between December 2021 and June 2022, without language restrictions. The sample consisted of 15 primary studies.
Results:
nurses working in hospital, intensive care, outpatient care and teaching institutions constitute a vulnerable group for sleep disorders: latency, duration, efficiency and quality. The disorders identified involved insomnia at varying levels of severity: daytime dysfunction and morning sleepiness. Night work and low capacity for self-care were determinants of impaired sleep patterns.
Final considerations:
the COVID-19 pandemic contributed to greater vulnerability of nurses to changes in sleep, requiring strategies for risk management and well-being promotion.
- Ítalo Arão Pereira Ribeiro
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ORIGINAL ARTICLE
Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
- Darci Francisco dos Santos Junior ,
- Marina Nolli Bittencourt ,
- Priscila Maria Marcheti ,
- José Luís da Cunha Pena ,
- Suellen Cristina da Silva Chaves , [ … ],
- Maria do Perpétuo do Socorro de Sousa Nóbrega
12-04-2023
Abstract
ORIGINAL ARTICLEWork and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220792
12-04-2023DOI 10.1590/0034-7167-2022-0792
- Darci Francisco dos Santos Junior ,
- Marina Nolli Bittencourt ,
- Priscila Maria Marcheti ,
- José Luís da Cunha Pena ,
- Suellen Cristina da Silva Chaves ,
- Angélica Martins de Souza Gonçalves ,
- Alessandra Matheus Domingos ,
- Maria do Perpétuo do Socorro de Sousa Nóbrega
Views0See moreABSTRACT
Objective:
To assess the relationship between psychopathological symptoms and the social, clinical, and occupational profile of nurses in the Amazon region of Brazil during the COVID-19 pandemic.
Methods:
A descriptive cross-sectional online study was conducted in 2020 with 261 nurses. The Symptom Assessment Scale-40 was utilized.
Results:
The presence of pre-existing conditions before the pandemic was associated with psychotism (p=0.044). Experiencing constraints and/or violence at work during the pandemic was associated with somatization (p=0.025), and working hours were associated with anxiety (p=0.025). Nurses predominantly exhibited symptoms related to fear (33.7%), tension (34.5%), and a sense that something is wrong in the mind (22.6%).
Conclusions:
A significant association was observed between working hours and anxiety symptoms, the experience of constraints and/or violence at work during the COVID-19 pandemic and somatization symptoms, as well as between pre-existing conditions and psychotism symptoms related to COVID-19.
- Darci Francisco dos Santos Junior
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Simulation training of caregivers at hospital discharge of patients with chronic diseases: an integrative review
- Luciana Aparecida da Cunha Borges ,
- Rodrigo Guimarães dos Santos Almeida ,
- Elton Santo Barboza ,
- Guilherme Oliveira de Arruda
12-04-2023
Abstract
Simulation training of caregivers at hospital discharge of patients with chronic diseases: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230043
12-04-2023DOI 10.1590/0034-7167-2023-0043
- Luciana Aparecida da Cunha Borges ,
- Rodrigo Guimarães dos Santos Almeida ,
- Elton Santo Barboza ,
- Guilherme Oliveira de Arruda
Views0See moreABSTRACT
Objective:
to identify evidence about the use and effects of clinical simulation for preparing caregivers for discharging patients with chronic conditions.
Methods:
an integrative peer review in the Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Virtual Health Library databases, from July to September 2022.
Results:
3,218 studies were identified, with a final sample consisting of four national and two international articles. Using simulation as an educational technology contributed to caregiver preparation in home care. In most studies, using clinical simulation included using other strategies to complement training: expository dialogued class, conversation circle and audiovisual resources.
Final considerations:
simulation proved to be efficient for training caregivers, with the active participation of family members and nurses in health education actions.
- Luciana Aparecida da Cunha Borges
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ORIGINAL ARTICLE
Feelings about birth by a group of high-risk pregnant women
- Juliana de Sousa de Almeida ,
- Emily Marques Alves ,
- Thelma Malagutti Sodré ,
- Keli Regiane Tomeleri da Fonseca Pinto ,
- Fabiana Fontana Medeiros , [ … ],
- Catia Campaner Ferrari Bernardy
12-04-2023
Abstract
ORIGINAL ARTICLEFeelings about birth by a group of high-risk pregnant women
Revista Brasileira de Enfermagem. 2023;76(6):e20230059
12-04-2023DOI 10.1590/0034-7167-2023-0059
- Juliana de Sousa de Almeida ,
- Emily Marques Alves ,
- Thelma Malagutti Sodré ,
- Keli Regiane Tomeleri da Fonseca Pinto ,
- Fabiana Fontana Medeiros ,
- Catia Campaner Ferrari Bernardy
Views0See moreABSTRACT
Objective:
to understand feelings about birth among a group of high-risk pregnant women.
Method:
a descriptive and qualitative study, using Alfred Schütz’s social phenomenology as a philosophical theoretical framework. The study included 25 pregnant women undergoing high-risk prenatal care. The interview had the following guiding questions: tell me about your feelings regarding the moment of birth/childbirth; How do you deal with the high-risk diagnosis? What are your expectations for birth/childbirth?
Results:
five categories emerged: Fear of obstetric care; Fear of complications with the baby; Fear of cesarean section; Resilience in the face of high-risk pregnancy; and Expectations for birth.
Considerations:
high-risk pregnant women are afraid of the care they will receive, the risks and concern about the baby’s vitality at birth. The importance of care is emphasized, with a welcoming environment, bonding and communication between health team and pregnant woman.
- Juliana de Sousa de Almeida
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REVIEW
Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review
- Rodrigo Lima Rodrigues ,
- Franciane Schneider ,
- Luciana Puchalski Kalinke ,
- Silvana Silveira Kempfer ,
- Vânia Marli Schubert Backes
04-16-2021
Abstract
REVIEWClinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review
Revista Brasileira de Enfermagem. 2021;74(2):e20190804
04-16-2021DOI 10.1590/0034-7167-2019-0804
- Rodrigo Lima Rodrigues ,
- Franciane Schneider ,
- Luciana Puchalski Kalinke ,
- Silvana Silveira Kempfer ,
- Vânia Marli Schubert Backes
Views0ABSTRACT
Objective:
to evidence the clinical outcomes of navigation performed by nurses in cancer patients.
Methods:
this is an integrative literature review with collection in MEDLINE via PUBMED, LILACS, Web of Science, Scopus, and CINAHL databases. The final sample consisted of seven studies. The data were analyzed and presented descriptively. Data related to clinical outcomes were compiled and described in full. The Agency for Healthcare Research and Quality categorization was used to assess the level of evidence.
Results:
the clinical outcomes demonstrated were decreased distress, anxiety and depression, improved control and management of symptoms, improved physical conditioning, improved quality and continuity of care, improved quality of life, reduced time to start treatment.
Final considerations:
there is research that shows better clinical outcomes in cancer patients through navigation by nurses across the continuum of health care.
Keywords:Evidence-based NursingOncology NursingOutcome Assessment (Health Care)Patient NavigationTreatment OutcomeSee more
- Rodrigo Lima Rodrigues
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ORIGINAL ARTICLE
Perceptions and expectations of pregnant women about the type of birth
- Roberta Marielle Arik ,
- Cristina Maria Garcia de Lima Parada ,
- Vera Lúcia Pamplona Tonete ,
- Fernanda Cristina Manzini Sleutjes
12-13-2019
Abstract
ORIGINAL ARTICLEPerceptions and expectations of pregnant women about the type of birth
Revista Brasileira de Enfermagem. 2019;72:41-49
12-13-2019DOI 10.1590/0034-7167-2017-0731
- Roberta Marielle Arik ,
- Cristina Maria Garcia de Lima Parada ,
- Vera Lúcia Pamplona Tonete ,
- Fernanda Cristina Manzini Sleutjes
Views0See moreABSTRACT
Objective:
to understand the perceptions and expectations of pregnant women about the type of birth.
Method:
this is a qualitative research, based on the assumptions of the Humanization of Obstetric Care. 15 pregnant women were interviewed twice at the beginning and the end of gestation between October 2015 and May 2016. Data were analyzed according to the method of the Discourse of the Collective Subject.
Results:
the discourses were associated with four themes: Advantages of vaginal birth over cesarean section; Fear and unpredictability of vaginal birth; Importance of the doctor in the definition of the type of birth; and Influence of family and friends in choosing the type of birth.
Final considerations:
according to pregnant women, vaginal birth has more benefit compared to cesarean section. However, during gestation and birth, fear of pain and the unexpected, and medical opinions of friends and family against vaginal birth strongly influence the choice of cesarean section.
- Roberta Marielle Arik
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REVIEW
Nursing practice environment in Primary Health Care: a scoping review
Revista Brasileira de Enfermagem. 2020;73(6):e20190479
08-14-2020
Abstract
REVIEWNursing practice environment in Primary Health Care: a scoping review
Revista Brasileira de Enfermagem. 2020;73(6):e20190479
08-14-2020DOI 10.1590/0034-7167-2019-0479
Views0INTRODUCTIONKnowledge and scientific evidence about nursing practice environments (NPE) in the context of Primary Health Care (PHC) is scarce.Policy makers, health and professional organizations have proposed to redesign the health system in PHC with the aim of increasing citizens’ accessibility, improving customer outcomes and maximizing efficiency. […]See more
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REVIEW
Telenursing in care, education and management in Latin America and the Caribbean: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190317
09-30-2020
Abstract
REVIEWTelenursing in care, education and management in Latin America and the Caribbean: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190317
09-30-2020DOI 10.1590/0034-7167-2019-0317
Views0See moreABSTRACT
Objective:
Analyze the knowledge generated about telenursing related to the roles of nurses (care, education and management) in Latin America and the Caribbean, based on scientific evidence.
Methods:
Integrative review, for the years 2009 to 2019, in scientific databases from Latin America and the Caribbean. Twelve articles were selected.
Results:
Nine studies focused on care and three on education. The information and communication technology used in the studies was telephony directed toward non-communicable diseases. There were concerns about the remote communication process. With respect to education, two focused on educating health teams and one on educating patients.
Conclusion:
It is necessary to conduct studies on telenursing that generate changes in care practices, explore information and communication technology resources and provide communication training focused on this new care model.
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ORIGINAL ARTICLE
High-risk areas of leprosy in Brazil between 2001-2015
- Rayssa Nogueira Rodrigues ,
- Heloisy Alves de Medeiros Leano ,
- Isabela de Caux Bueno ,
- Kleane Maria da Fonseca Azevedo Araújo ,
- Francisco Carlos Félix Lana
04-09-2020
Abstract
ORIGINAL ARTICLEHigh-risk areas of leprosy in Brazil between 2001-2015
Revista Brasileira de Enfermagem. 2020;73(3):e20180583
04-09-2020DOI 10.1590/0034-7167-2018-0583
- Rayssa Nogueira Rodrigues ,
- Heloisy Alves de Medeiros Leano ,
- Isabela de Caux Bueno ,
- Kleane Maria da Fonseca Azevedo Araújo ,
- Francisco Carlos Félix Lana
Views0See moreABSTRACT
Objectives:
to identify high-risk areas of leprosy in Brazil from 2001 to 2015.
Methods:
this is an ecological study of spatial analysis based on Brazilian municipalities. Spatial scan statistics were used to identify spatial clustering and measure the relative risk from the annual detection rate of new cases of leprosy. By criterion based on the Gini index, only secondary clusters were considered.
Results:
spatial scan statistics detected 26 clusters, in which the detection rate was 59.19 cases per 100 thousand inhabitants, while in the remainder of the country it was 11.76. Large part of the cluster area is located in the Legal Amazon. These groups included only 21.34% of the total population, but 60.40% of the new cases of the disease.
Conclusions:
Leprosy remains concentrated in some areas, showing the need for control programs to intensify actions in these municipalities.
- Rayssa Nogueira Rodrigues
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ORIGINAL ARTICLE
Personal Protective Equipment in the coronavirus pandemic: training with Rapid Cycle Deliberate Practice
Revista Brasileira de Enfermagem. 2020;73:e20200303
06-29-2020
Abstract
ORIGINAL ARTICLEPersonal Protective Equipment in the coronavirus pandemic: training with Rapid Cycle Deliberate Practice
Revista Brasileira de Enfermagem. 2020;73:e20200303
06-29-2020DOI 10.1590/0034-7167-2020-0303
Views0See moreABSTRACT
Objective:
to discuss the application of Rapid Cycle Deliberate Practice for attire and unattire training in the context of COVID-19 and structure a practical guide to the application at this juncture.
Methods:
this methodological study described theoretical and practical aspects of the application of a simulation strategy as a technological training tool. An application guide was constructed from the search for evidence from the main health authority bodies in Brazil.
Results:
maximizing time in Deliberate Practice, feedback with evidence and psychological security are the principles of this strategy. The dynamic involves repetition and feedback. The application guide presents the sequence of actions for attire and unattire.
Final considerations:
coping with this pandemic requires appropriate use of personal protective equipment. The authors suggest the Rapid Cycle Deliberate Practice as a technological educational tool for attire/unattire, since it encourages mastery performance.
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ORIGINAL ARTICLE
Interruptions and nursing workload during medication administration process
Revista Brasileira de Enfermagem. 2019;72(4):1001-1006
08-19-2019
Abstract
ORIGINAL ARTICLEInterruptions and nursing workload during medication administration process
Revista Brasileira de Enfermagem. 2019;72(4):1001-1006
08-19-2019DOI 10.1590/0034-7167-2018-0680
Views0See moreABSTRACT
Objective:
To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team’s workload.
Métodos:
This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo.
Resultados:
63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff – 48 (37.8%) − and self-interruptions – 29 (22.8%). The main causes were: information exchanges – 54 (42.5%) − and parallel conversations – 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) – p≤0.05.
Conclusão:
Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.
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ORIGINAL ARTICLE
Depression among nursing students and its association with academic life
- Adriano Machado Facioli ,
- Ângela Ferreira Barros ,
- Manuela Costa Melo ,
- Ivone Crispim Moura Ogliari ,
- Renan Joseph de Moraes Custódio
02-10-2020
Abstract
ORIGINAL ARTICLEDepression among nursing students and its association with academic life
Revista Brasileira de Enfermagem. 2020;73(1):e20180173
02-10-2020DOI 10.1590/0034-7167-2018-0173
- Adriano Machado Facioli ,
- Ângela Ferreira Barros ,
- Manuela Costa Melo ,
- Ivone Crispim Moura Ogliari ,
- Renan Joseph de Moraes Custódio
Views0See moreABSTRACT
Objective:
To measure the levels of depression among Nursing students from a public institution of higher education and the association with aspects of academic life.
Method:
Analytical and quantitative study with 203 students from a higher education institution that uses active methodologies. We used Beck’s Depression Inventory and the Likert type scale of academic factors.
Results:
We verified that 19.2% had moderate or severe levels of depression. Higher levels of depression were associated with female gender (p=0.003), working more than 40 hours per week (p=0.047), spending more than 90 minutes to reach academic activities (p=0.043) and with 12 academic factors specific to routines of the studied institution.
Conclusion:
The results contribute to managers’ and professors’ reflection and analysis concerning nursing students’ mental health, in addition to indicating in which aspects there is a need to provide greater support to these students.
- Adriano Machado Facioli
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