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ORIGINAL ARTICLE07-19-2024
Understanding intimate self-care among riverine women: qualitative research through the lens of the Sunrise Model
- Camila Evelyn de Sousa Brito
, - Bruna Larissa Fernandes Coelho ,
- Talita Lima dos Santos ,
- Thais Cristina Flexa Souza Marcelino ,
- Lucas Geovane dos Santos Rodrigues , [ … ],
- Adriana de Sá Pinheiro
Abstract
ORIGINAL ARTICLEUnderstanding intimate self-care among riverine women: qualitative research through the lens of the Sunrise Model
Revista Brasileira de Enfermagem. 2024;77(2):e20230364
DOI 10.1590/0034-7167-2023-0364
- Camila Evelyn de Sousa Brito ,
- Bruna Larissa Fernandes Coelho ,
- Talita Lima dos Santos ,
- Thais Cristina Flexa Souza Marcelino ,
- Lucas Geovane dos Santos Rodrigues ,
- Mary Elizabeth de Santana ,
- Antonio Jorge Silva Correa Júnior ,
- Adriana de Sá Pinheiro
Views0ABSTRACT
Objectives:
to contribute to the change in understandings and knowledge of the popular system among riverine women about female intimate self-care before and after the application of an educational dynamic.
Methods:
a qualitative-participative study based on the Sunrise Model. Twenty women registered at a Basic Health Unit on the Combu island, state of Pará, Brazil, participated in the second half of 2022. Semi-structured interviews were conducted before and after the educational dynamic; followed by reflective inductive analysis.
Results:
these are pointed out: a female mechanism of generational education; the cultural act of bathing as synonymous with intimate self care and disease prevention; intimate care with medicinal herbs; lack of professional system approach to the topic; fear of using “muddy water”; and lack of financial resources to purchase specific products for genitourinary care.
Final Considerations:
companionship and social factors drive intimate self-care; however, riverine women experience taboos, ignorance, and poverty.
Keywords:Health EducationPrimary Health CareSocial Determinants of HealthTranscultural NursingWomen's HealthSee more
- Camila Evelyn de Sousa Brito
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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for assessing leprosy care in children and adolescents
- Gutembergue Santos de Sousa ,
- Isael Marcos Silva Mendonça ,
- Lia Hanna Martins Morita ,
- Denise da Costa Boamorte Cortela ,
- Pãmela Rodrigues de Souza Silva , [ … ],
- Silvana Margarida Benevides Ferreira
Abstract
ORIGINAL ARTICLEValidation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
DOI 10.1590/0034-7167-2023-0344
- Gutembergue Santos de Sousa ,
- Isael Marcos Silva Mendonça ,
- Lia Hanna Martins Morita ,
- Denise da Costa Boamorte Cortela ,
- Pãmela Rodrigues de Souza Silva ,
- Silvana Margarida Benevides Ferreira
Views0See moreABSTRACT
Objectives:
to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care.
Methods:
methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach’s Alpha were calculated.
Results:
a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach’s Alpha of the instrument, the assigned value was 0.717.
Conclusions:
the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.
- Gutembergue Santos de Sousa
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ORIGINAL ARTICLE07-19-2024
Validation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
Abstract
ORIGINAL ARTICLEValidation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
DOI 10.1590/0034-7167-2023-0211
Views0See moreABSTRACT
Objectives:
to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles.
Methods:
this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach’s alpha test, and z-test for proportion comparison were used.
Results:
the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership.
Conclusions:
the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.
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REVIEW07-19-2024
Nursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
- Esther Mourão Nicoli ,
- Frances Valéria Costa e Silva ,
- Luciana Guimarães Assad ,
- Camila Castanho Cardinelli ,
- Raquel Azevedo Alves , [ … ],
- Samara Gonçalves de Oliveira
Abstract
REVIEWNursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230180
DOI 10.1590/0034-7167-2023-0180
- Esther Mourão Nicoli ,
- Frances Valéria Costa e Silva ,
- Luciana Guimarães Assad ,
- Camila Castanho Cardinelli ,
- Raquel Azevedo Alves ,
- Samara Gonçalves de Oliveira
Views0See moreABSTRACT
Objectives:
to map the constituent elements of the safe mobility concept present in hospital care for older adults.
Methods:
a scoping review of 35 articles searched in databases and gray literature – BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established.
Results:
none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family).
Final Considerations:
the constituent elements of safe mobility express hospital units’ capacity to guarantee care and protection from fall accidents for hospitalized older adults.
- Esther Mourão Nicoli
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REVIEW07-19-2024
Drug-resistant tuberculosis: integrative review of nursing care in primary health care
- Sibele Naiara Ferreira Germano ,
- Alacoque Lorenzini Erdmann ,
- Camila Freire Albuquerque ,
- Lúcia Nazareth Amante ,
- Darlisom Sousa Ferreira , [ … ],
- Marlucia da Silva Garrido
Abstract
REVIEWDrug-resistant tuberculosis: integrative review of nursing care in primary health care
Revista Brasileira de Enfermagem. 2024;77(2):e20230097
DOI 10.1590/0034-7167-2023-0097
- Sibele Naiara Ferreira Germano ,
- Alacoque Lorenzini Erdmann ,
- Camila Freire Albuquerque ,
- Lúcia Nazareth Amante ,
- Darlisom Sousa Ferreira ,
- Marlucia da Silva Garrido
Views0See moreABSTRACT
Objectives:
to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care.
Methods:
integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases.
Results:
six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services.
Final Considerations:
the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.
- Sibele Naiara Ferreira Germano
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ORIGINAL ARTICLE07-19-2024
Translation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
Abstract
ORIGINAL ARTICLETranslation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
DOI 10.1590/0034-7167-2023-0060
Views0See moreABSTRACT
Objectives:
to translate and cross-culturally adapt the MISSCARE Survey-Ped for use in Brazil.
Methods:
a methodological study proposed by translation, synthesis of translations, back-translation, assessment by a committee of experts and pre-testing with the target population.
Results:
two direct translations of the instrument were carried out, followed by a consensual version between them. This synthetic version was back-translated and analyzed by a committee of five experts in pediatric nursing and patient safety, obtaining a Content Validity Index (CVI) of 0.95 and Cronbach’s alpha of 0.804. The final version was sent for pre-testing with 254 Brazilian pediatric nurses, with 44 (17.3%) analyzing the instrument for understanding (CVI 0.866; Content Validity Ratio (CVR) 0.773), relevance (CVI 0.931; CVR 0.864) and relevance (CVI 0.977; CVR 0.955).
Conclusions:
the MISSCARE Survey-Ped Brasil was considered suitable for application in pediatric nurses’ clinical practice in the country.
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Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301pt
Views0Na concepção comum, o trabalho é comumente associado a uma atividade remunerada em uma sociedade mercantil e de direito, refletindo a visão moderna que o limita ao tempo trocado por salário. Essa perspectiva, influenciada pelos princípios da Revolução Industrial, estabelece uma dicotomia entre o trabalho e o tempo fora dele, segmentando a vida em esferas […]See more -
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301
Views0In the common conception, work is commonly associated with a paid activity in a commercial and legal society, reflecting the modern view that limits it to time exchanged for wage. This perspective, influenced by Industrial Revolution principles, establishes a dichotomy between work and time outside of work, segmenting life into professional and private spheres. However, […]See more
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Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
Abstract
Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
DOI 10.1590/0034-7167.2015680104i
Views0Objective:
the objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU.
Method:
this was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity – short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire.
Results:
it was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046).
Conclusion:
physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.
Keywords:Burnout ProfessionalHumanization of Hospital ServicesIntensive Care UnitPhisycal ActivityQuality of LifeSedentary LifestyleSee more
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Learning needs of Nursing students in technical vocational education
Revista Brasileira de Enfermagem. 2015;68(1):20-25
Abstract
Learning needs of Nursing students in technical vocational education
Revista Brasileira de Enfermagem. 2015;68(1):20-25
DOI 10.1590/0034-7167.2015680103i
Views0See moreObjective:
identify learning needs of students of Technical Vocational Education (TVE) in Nursing. Qualitative study conducted in a city of São Paulo state.
Method:
the subjects were students, teachers and coordinators of TVE and students of the bachelor degree who have had contact with TVE. Data collection was performed by questionnaire socioeconomic and cultural circles about the learning needs. For data analysis we used the content analysis.
Results:
it was found that students have difficulties contents not related to nursing as portuguese and mathematics, as well as introductory courses in the course of TVE which possibly may interfere negatively in learning specific content of nursing and the quality of health care.
Conclusion:
it is necessary to rethink the content taught and ways to teach from basic education, as well as the training of teachers who now works in the TVE.
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Serious game e-Baby: nursing students’ perception on learning about preterm newborn clinical assessment
Revista Brasileira de Enfermagem. 2015;68(1):13-19
Abstract
Serious game e-Baby: nursing students’ perception on learning about preterm newborn clinical assessment
Revista Brasileira de Enfermagem. 2015;68(1):13-19
DOI 10.1590/0034-7167.2015680102i
Views0See moreObjective:
to evaluate students opinion regarding e-Baby educational technology.
Methodology:
exploratory descriptive study in which participated a sample composed of 14 nursing Portuguese students that used e-Baby digital educational technology in an extracurricular course. To achieve the aim of the study, the data collection was realized through an opinion instrument in Likert scale including the possibility of commentaries by students. Is was also collected data of participants’ characterization.
Results:
students made very satisfactory evaluations regarding the game e-Baby, varying since usability acceptation through suggestions of expansion of the game to other nursing themes.
Conclusion:
serious game e-Baby can be considered a didactic innovation and motivator tool of learning. Besides, it demonstrates have adequate interface in design and educative function aspects, evocating intense interaction between user and computational tool.
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Challenges beyond the scientific knowledge production
Revista Brasileira de Enfermagem. 2015;68(1):7-8
Abstract
Challenges beyond the scientific knowledge production
Revista Brasileira de Enfermagem. 2015;68(1):7-8
DOI 10.1590/0034-7167.2015680101p
Views0For several decades, innumerous appeals and reflections on how to build the nursing science and achieve visibility in the scientific world led researchers to make efforts to produce knowledge that contributed to the well-being of people, improving their quality of life, relieving their suffering and transforming the reality in which we live. In addition to […]See more
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Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices
Revista Brasileira de Enfermagem. 2017;70(6):1206-1211
Abstract
Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices
Revista Brasileira de Enfermagem. 2017;70(6):1206-1211
DOI 10.1590/0034-7167-2016-0432
Views0See moreABSTRACT
Objective:
To characterize the sound alarms of the Intra-Aortic Balloon Pump (IABP) during aortic counterpulsation therapy; to measure the stimulus-response time of the team to these; and to discuss the implications of increasing this time for patient safety from the alarm fatigue perspective.
Method:
This is an observational and descriptive study with quantitative and qualitative approach, case study type, carried out in a Cardiac Surgical Intensive Care Unit.
Results:
The most audible IABP alarm was the one of high priority increased-reduced diastolic blood pressure. The stimulus-response time was 33.9 seconds on average.
Conclusion:
Managing the alarms of these equipment is essential to minimize the occurrence of the alarm fatigue phenomenon and to offer a safer assistance to patients who rely on this technology.
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Possibilities of care for serodiscordant couples for HIV who got pregnant
Revista Brasileira de Enfermagem. 2017;70(6):1199-1205
Abstract
Possibilities of care for serodiscordant couples for HIV who got pregnant
Revista Brasileira de Enfermagem. 2017;70(6):1199-1205
DOI 10.1590/0034-7167-2016-0344
Views0See moreABSTRACT
Objective:
Understanding the meaning of pregnancy for heterosexual couples facing serodiscordant situation for HIV, aiming at construction of care possibilities based on subjectivity.
Method:
Phenomenological research, theoretical-philosophical-methodological framework by Martin Heidegger. Research was conducted in a University Hospital in the countryside of Southern Brazil, from September 2013 to May 2014 through a phenomenological interview, with participation of eleven couples.
Results:
For the couples, pregnancy is part of life when they wish to have a child, even when one or both of them already have children from previous relationships. In addition, it is part of life when they consider the risks and do not want to have children in such circumstances anymore, but it happened unexpectedly.
Conclusion:
Understanding reproductive needs and demands of these couples is an aid for qualification and improvement of care as a contribution to nursing care planning towards reproductive health of these couples.
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Interactive Theory of Breastfeeding: creation and application of a middle-range theory
Revista Brasileira de Enfermagem. 2017;70(6):1191-1198
Abstract
Interactive Theory of Breastfeeding: creation and application of a middle-range theory
Revista Brasileira de Enfermagem. 2017;70(6):1191-1198
DOI 10.1590/0034-7167-2016-0523
Views0See moreABSTRACT
Objective:
To describe a breastfeeding theory based on King’s Conceptual System.
Method:
Theoretical study that used analysis of concept, assertion synthesis, and derivation of theory for the creation of a new theory.
Results:
King’s system components were associated with elements of the breastfeeding process and a middle-range theory was created, which describes, explains, predicts, and prescribes breastfeeding by analyzing factors that precede and affect it, as well as their consequences on the breastfeeding process.
Conclusion:
The Breastfeeding Interactive Model is abstract enough to be applied in different social, cultural, political, and economic contexts, because it conceptualizes breastfeeding in systemic, dynamic, and procedural aspects. Based on a conceptual model of nursing, it contributes to the scientific construction of the subject; however it can also potentially be applied by other professionals involved in breastfeeding assistance.
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Family resilience and chemical dependency: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(6):1184-1190
Abstract
Family resilience and chemical dependency: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(6):1184-1190
DOI 10.1590/0034-7167-2016-0476
Views0See moreABSTRACT
Objective:
To learn the perception of health professionals from the Psychosocial Attention Center for Alcohol and Other Drugs regarding the resilience attributes that are critical to family members of psychoactive substance dependents.
Method:
A qualitative descriptive study conducted from February to May 2016, using a focus group technique for data collection. In total, 15 professionals participated in the study: 13 health professionals and two administrative professionals. The statements were recorded and transcribed, and these data were analyzed using the technique of thematic content analysis.
Results:
Health professionals recognize the family resilience attributes needed for efficient and assertive communication, as well as organizational patterns and facilitating family strengths, factors that contribute to improved family relationship and family functionality.
Final considerations:
This study contributed to a perspective of clinical intervention with family members that is not limited to the negative aspects of family relationship and life, such as fragility and family dysfunction.
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Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods
Revista Brasileira de Enfermagem. 2017;70(6):1176-1183
Abstract
Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods
Revista Brasileira de Enfermagem. 2017;70(6):1176-1183
DOI 10.1590/0034-7167-2016-0608
Views0ABSTRACT
Objective:
to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.
Method:
a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay.
Results:
720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.
Conclusion:
the methods did not present a good correlation, neither quantitative nor qualitatively.
Keywords:Equipment ContaminationHealth Facility EnvironmentHousekeepingInfectious Disease TransmissionNursing AuditSee more
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Cultural adaptation of The End-Stage Renal Disease Adherence Questionnaire for hemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(6):1169-1175
Abstract
Cultural adaptation of The End-Stage Renal Disease Adherence Questionnaire for hemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(6):1169-1175
DOI 10.1590/0034-7167-2016-0519
Views0ABSTRACT
Objective:
To describe the stages in the cultural adaptation of “The End-Stage Renal Disease Adherence Questionnaire” for use in Brazil.
Method:
A descriptive, transversal study with a quantitative approach. The cultural adaptation followed the steps of translation, professional committee, back translation, panel of patients and pretest.
Results:
the translation stage created a version in Portuguese that was analyzed by specialists, who suggested alterations in the title, seven sentences in the questions and three sets of answers. In the panel of patients phase, two questions were altered. The back translation considered the original characteristics of the instrument were maintained, likewise there were no modifications in the pretest phase. The third version written in Portuguese was considered to be the final version of the questionnaire.
Conclusion:
this instrument should facilitate nursing care management in hemodialysis, enabling the monitoring of adherence among these patients and also contribute to improving the indicators of morbidity and mortality.
Keywords:Adherence to MedicationChronic Renal InsufficiencyHemodialysisNephrology NursingPatient CooperationSee more
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Revalidation of game for teaching blood pressure auscultatory measurement: a pilot study
Revista Brasileira de Enfermagem. 2017;70(6):1159-1168
Abstract
Revalidation of game for teaching blood pressure auscultatory measurement: a pilot study
Revista Brasileira de Enfermagem. 2017;70(6):1159-1168
DOI 10.1590/0034-7167-2016-0578
Views0ABSTRACT
Objective:
To adapt a pre-existing educational game, making it specific to the teaching of blood pressure auscultatory measurement, and to apply this game in a pilot study.
Method:
The original game cards were altered by the authors and submitted to content validation by six experts in the field. After redesigns, the game was applied to 30 subjects, who answered a questionnaire (pre-test and post-test) on auscultatory measurement. Data were analyzed descriptively and by the paired Student’s t-test and paired Wilcoxon test.
Results:
Throughout the content validation process, 17 of the 28 original cards were modified. Of these 17 cards, 13 obtained 80% agreement, and the rest were modified according to the judges’ suggestions. The obtained grades significantly increased between pre- and the post-test.
Conclusion:
It was concluded that the reformulated game presented satisfactory evidence of content validity. Its use as a teaching-learning method was effective for this sample.
Keywords:Determination of Blood PressureEducation in NursingEducational TechnologyExperimental GamesGames and ToysSee more
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Validation of Family Management Measure for the Brazilian culture
Revista Brasileira de Enfermagem. 2017;70(6):1151-1158
Abstract
Validation of Family Management Measure for the Brazilian culture
Revista Brasileira de Enfermagem. 2017;70(6):1151-1158
DOI 10.1590/0034-7167-2016-0326
Views0See moreABSTRACT
Etjective:
To validate the Family Management Measure (FaMM) for Brazilian culture.
Method:
Quantitative research excerpt, following the recommendations for validation studies. The data presented refer to the last stage of the process.
Results:
The internal consistency of the items was analyzed through Cronbach’s alpha of the six domains: Child’s Daily Life (0.78); Condition Management Effort (0.51); Condition Management Ability (0.55); Family Life Difficulty (0.86); View of Condition Impact (0.56); and Parental Mutuality (0.80). Exploratory factorial analysis of the instrument was carried out, obtaining an acceptable adjustment, according to validation standards.
Conclusion:
The FaMM presents evidence of validation and can be used in the Brazilian culture under the name of Instrumento de Medida de Manejo Familiar, which was adjusted in eight domains, providing varied aspects of family management and a good evaluation of the fundamental aspects of family life in the context of childhood chronic conditions.
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