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ORIGINAL ARTICLE10-17-2022
Supervision of the professional practice of nursing: case study describing the “on-site inspection” sub-process
Revista Brasileira de Enfermagem. 2022;75(2):e20210823
Abstract
ORIGINAL ARTICLESupervision of the professional practice of nursing: case study describing the “on-site inspection” sub-process
Revista Brasileira de Enfermagem. 2022;75(2):e20210823
DOI 10.1590/0034-7167-2021-0823
Views0See moreABSTRACT
Objectives:
to describe the “On-site inspection” sub-process of the macroprocess “Supervision” conducted at the headquarters unit of the Regional Nursing Council of São Paulo.
Methods:
an exploratory descriptive research, in a single case study modality using data reported by the Headquarters Unit Inspection Management leaders.
Results:
the description of the “On-Site inspection” sub-process, initial and return, showed how the activities/tasks pre-established in the inspection roadmap and inserted in the respective inspection terms need to be accurately and sequentially executed to comply with the current legislation and provided the identification of activities that add value to the inspection process.
Conclusions:
the results obtained give visibility to the activities/tasks developed by the inspectors and will provide the Inspection Management with subsidies for the rational allocation of the required human resources; and, to the technical managers and legal representatives of the inspected institutions, the knowledge of the activities developed during the performance of the sub-process “On-site inspection”.
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REVIEW10-17-2022
Authentic leadership in nurses’ professional practice: an integrative review
- Ellen Daiane Biavatti de Oliviera Algeri
, - Rosemary Silva da Silveira ,
- Jamila Geri Tomaschewski Barlem ,
- Maria Claudia Medeiros Dantas de Rubim Costa ,
- Danubia Andressa da Silva Stigger , [ … ],
- Cristiane de Sá Dan
Abstract
REVIEWAuthentic leadership in nurses’ professional practice: an integrative review
Revista Brasileira de Enfermagem. 2022;75(1):e20210972
DOI 10.1590/0034-7167-2021-0972
- Ellen Daiane Biavatti de Oliviera Algeri ,
- Rosemary Silva da Silveira ,
- Jamila Geri Tomaschewski Barlem ,
- Maria Claudia Medeiros Dantas de Rubim Costa ,
- Danubia Andressa da Silva Stigger ,
- Cristiane de Sá Dan
Views0See moreABSTRACT
Objectives:
to identify the primary constructs concerning authentic leadership and its relevance for nurses’ professional practice.
Methods:
integrative literature review conducted between 2015 and 2020 in LILACS, SciELO, and PubMed databases.
Results:
the United States published most of the 31 studies analyzed, with eight studies (25.8%), followed by Canada with seven studies (22.6%), and Brasil with five (16.1%). Most studies adopted a quantitative approach (77.41%), and 96.8% presented weak evidence. Three categories emerged: Work Engagement/Job Satisfaction and Organizational Commitment; Healthy Work Environment; and Intention to Quit the Job and Mental Exhaustion.
Final Considerations:
authentic leadership positively contributes to management and nursing care practice, promoting healthy work environments, structural empowerment, greater work engagement, and organizational commitment, decreasing absenteeism and mental exhaustion.
- Ellen Daiane Biavatti de Oliviera Algeri
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REVIEW10-07-2022
Strategies for thirst management in postoperative adult patients: a scoping review
- Tâmara Taynah Medeiros da Silva ,
- Joyce Karolayne dos Santos Dantas ,
- Sara Cristina Matias de Araújo ,
- Silmara de Oliveira Silva ,
- Daniele Vieira Dantas , [ … ],
- Rodrigo Assis Neves Dantas
Abstract
REVIEWStrategies for thirst management in postoperative adult patients: a scoping review
Revista Brasileira de Enfermagem. 2022;75(4):e20220154
DOI 10.1590/0034-7167-2022-0154
- Tâmara Taynah Medeiros da Silva ,
- Joyce Karolayne dos Santos Dantas ,
- Sara Cristina Matias de Araújo ,
- Silmara de Oliveira Silva ,
- Daniele Vieira Dantas ,
- Rodrigo Assis Neves Dantas
Views0See moreABSTRACT
Objectives:
to map the strategies for managing thirst in postoperative adult patients.
Methods:
scoping review was conducted in October 2021 in 19 data sources: 14 databases and 5 platforms to search in the grey literature. It was prepared according to the recommendations of the Joanna Briggs Institute and the checklist of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Nine selected articles were part of the final sample.
Results:
there is evidence of strategies to manage postoperative thirst using interventions such as water, ice, mentholated measures, carbohydrate and protein enriched fluid, oral hydrator, flavored gargling, cold gargling, wet gauze, 0.75% citric acid spray, and cold water.
Final Considerations:
the strategies observed may be reduced to cold and menthol use, salivary stimulants, and early introduction of fluids. The outcomes were positive in all the studies reviewed.
- Tâmara Taynah Medeiros da Silva
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ORIGINAL ARTICLE10-07-2022
Perception of men perpetrators of violence about paternity
- Milena Arão da Silva Oliveira ,
- Fernanda Matheus Estrela ,
- Andrey Ferreira da Silva ,
- Júlia Renata Fernandes de Magalhães ,
- Nadirlene Pereira Gomes , [ … ],
- Moniky Araújo da Cruz
Abstract
ORIGINAL ARTICLEPerception of men perpetrators of violence about paternity
Revista Brasileira de Enfermagem. 2022;75(4):e20210890
DOI 10.1590/0034-7167-2021-0890
- Milena Arão da Silva Oliveira ,
- Fernanda Matheus Estrela ,
- Andrey Ferreira da Silva ,
- Júlia Renata Fernandes de Magalhães ,
- Nadirlene Pereira Gomes ,
- Álvaro Pereira ,
- Anderson Reis de Sousa ,
- Moniky Araújo da Cruz
Views0See moreABSTRACT
Objectives:
to learn about the perception of men in the judicial process due to spousal violence about paternity.
Methods:
a descriptive, qualitative study with nine men in the judicial process due to spousal violence. Data were collected through interviews; the men validated the data, which were systematized by the categorical thematic content analysis, and analyzed in light of scientific texts that discuss the subject.
Results:
the study allowed the creation of three categories: the father is the example for the son; the father must provide for the son’s needs; the father corrects the son.
Conclusions:
that context reveals the need to re-signify paternity to influence children’s education positively.
- Milena Arão da Silva Oliveira
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ORIGINAL ARTICLE10-07-2022
Construction and validation of a serial album for companions of patients with stroke
- Cristina da Silva Fernandes ,
- Magda Milleyde de Sousa Lima ,
- Dariane Veríssimo de Araújo ,
- Nelson Miguel Galindo Neto ,
- Joselany Áfio Caetano , [ … ],
- Lívia Moreira Barros
Abstract
ORIGINAL ARTICLEConstruction and validation of a serial album for companions of patients with stroke
Revista Brasileira de Enfermagem. 2022;75(4):e20210843
DOI 10.1590/0034-7167-2021-0843
- Cristina da Silva Fernandes ,
- Magda Milleyde de Sousa Lima ,
- Dariane Veríssimo de Araújo ,
- Nelson Miguel Galindo Neto ,
- Joselany Áfio Caetano ,
- Lívia Moreira Barros
Views0See moreABSTRACT
Objectives:
to construct and validate a serial album, to be used in hospital discharge planning of patients with stroke.
Methods:
a methodological study, with construction of a serial album, validity by 22 judges and assessment by 22 companions. Data were collected from the Health Education Content Validity Instrument, with the companions, from the Suitability Assessment of Materials.
Results:
the serial album has 21 pages. The overall Content Validity Index was equal to 0.87 among expert judges and 1.0 among companions.
Conclusions:
the educational technology constructed was considered valid by the judges and assessed as understandable by the companions so that it presented itself as a viable technological resource for use in the health education of companions of patients with stroke.
- Cristina da Silva Fernandes
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ORIGINAL ARTICLE10-07-2022
Violence against nursing workers: repercussions on patient access and safety
- Grasiele Fatima Busnello ,
- Letícia de Lima Trindade ,
- Daiane Dal Pai ,
- Carmem Lúcia Colomé Beck ,
- Olga Maria Pimenta Lopes Ribeiro , [ … ],
- Maiara Daís Schoeninger
Abstract
ORIGINAL ARTICLEViolence against nursing workers: repercussions on patient access and safety
Revista Brasileira de Enfermagem. 2022;75(4):e20210765
DOI 10.1590/0034-7167-2021-0765
- Grasiele Fatima Busnello ,
- Letícia de Lima Trindade ,
- Daiane Dal Pai ,
- Carmem Lúcia Colomé Beck ,
- Olga Maria Pimenta Lopes Ribeiro ,
- Elisabete Maria das Neves Borges ,
- Maiara Daís Schoeninger
Views1See moreABSTRACT
Objectives:
to analyze the repercussions of violence against nursing professionals, in the access and safety of patients in Family Health Strategy.
Methods:
a mixed study, with 169 nursing professionals. We used a socio-labor questionnaire, Survey Questionnaire Workplace Violence in the Health Sector, a patient safety instrument and interviews.
Results:
verbal aggression was related to support (p=0.048), respect (p=0.021), hours of care (p=0.047) and patient safety behaviors (p=0.033) among professionals. Suffering from bullying was related to fear of questioning when something is wrong (p=0.010) and lack of support from management (p=0.016). Victims of physical violence felt that their mistakes could be used against them. Mixed data converge and confirm that violence affects professional behavior and puts Primary Health Care attributes at risk.
Conclusions:
violence affects workers’ behavior, interferes with the care provided, weakens the access and safety of patients.
- Grasiele Fatima Busnello
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ORIGINAL ARTICLE10-07-2022
Nursing workload associated with neonatal mortality risk: a cross-sectional study
- Raquel Rondina Pupo da Silveira ,
- Clarita Terra Rodrigues Serafim ,
- Meire Cristina Novelli e Castro ,
- Gabrielle Maria Rodrigues ,
- José Eduardo Corrente , [ … ],
- Silvana Andrea Molina Lima
Abstract
ORIGINAL ARTICLENursing workload associated with neonatal mortality risk: a cross-sectional study
Revista Brasileira de Enfermagem. 2022;75(4):e20200965
DOI 10.1590/0034-7167-2020-0965
- Raquel Rondina Pupo da Silveira ,
- Clarita Terra Rodrigues Serafim ,
- Meire Cristina Novelli e Castro ,
- Gabrielle Maria Rodrigues ,
- José Eduardo Corrente ,
- Silvana Andrea Molina Lima
Views0See moreABSTRACT
Objectives:
to analyze the association between nursing workload and neonatal mortality risk in newborns admitted to the Neonatal Intensive Care Unit.
Methods:
this is an observational, cross-sectional study conducted from January 2019 to January 2020.
Results:
the sample consisted of 399 newborns, 55.4% male, Nursing Activities Score mean of 67.5%, and Score for Neonatal Acute Physiology Perinatal Extension mean of 17.7, revealed itself as a predictor of the risk of death, while gestational age, length of hospitalization, and the first-minute Apgar established a protective relationship. The correlation between workload and neonatal mortality was low (r= 0.23, p=0.0009).
Conclusions:
the workload of the nursing team is not associated with the risk of mortality in the Neonatal Intensive Care Unit, as measured by the Nursing Activities Score.
- Raquel Rondina Pupo da Silveira
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REVIEW10-03-2022
Intravenous therapy device labeling in Intensive Care Units: an integrative review
Revista Brasileira de Enfermagem. 2022;75(6):e20220049
Abstract
REVIEWIntravenous therapy device labeling in Intensive Care Units: an integrative review
Revista Brasileira de Enfermagem. 2022;75(6):e20220049
DOI 10.1590/0034-7167-2022-0049
Views0See moreABSTRACT
Objectives:
to synthesize the evidence on intravenous device labeling used to identify medications administered to patients in Intensive Care Units, with a view to preventing medication errors.
Methods:
an integrative review, in the LILACS, IBECS, Embase, MEDLINE, Scopus, Web of Science and CINAHL databases, from November to December 2021, using descriptors and selection criteria. Data were collected in 11 articles and subsequently classified, summarized and aggregated.
Results:
pre-designed labels, with pre-defined colors and information, help to prevent medication identification errors. There is still a lack of standardization in the practice of labeling syringes, intravenous lines, infusion pumps and saline solution bags. There are errors related to the lack of labeling devices or to their performance with incomplete information.
Conclusions:
device labeling is a barrier to defending the medication system safety and should be standardized.
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01-01-2015
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
Views0See moreObjective:
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.
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01-01-2015
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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01-01-2015
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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01-01-2015
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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01-01-2015
Research lines in nursing: phylosophical and epistemological highlights
Revista Brasileira de Enfermagem. 2015;68(4):723-729
Abstract
Research lines in nursing: phylosophical and epistemological highlights
Revista Brasileira de Enfermagem. 2015;68(4):723-729
DOI 10.1590/0034-7167.2015680421p
Views0See moreRESUMEN
Objetivo:
elucidar destaques filosóficos y epistemológicos mediante consideraciones en favor de la casualidad de cuestiones en el interés de la Enfermería.
Método:
es fundamentado en las proposiciones teóricas de Johannes Hessen y de otros autores consagrados.
Resultados:
clareamiento de aspectos sustantivo e implicaciones adjetivas no sólo el interés de la investigación, resaltando los significados esenciales del asunto coincidido con las elaboraciones de disertaciones y tesis (Maestría y Doctorado de Enfermería).
Conclusión:
texto representa una contribución valiosa para esclarecer mejor detalles de la construcción del conocimiento en la temática y problemática del asunto puesto en causa.
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01-01-2015
Linhas de pesquisa em enfermagem: destaques filosóficos e epistemológicos
Revista Brasileira de Enfermagem. 2015;68(4):723-729
Abstract
Linhas de pesquisa em enfermagem: destaques filosóficos e epistemológicos
Revista Brasileira de Enfermagem. 2015;68(4):723-729
DOI 10.1590/0034-7167.2015680421p
Views0See moreRESUMO
Objetivo:
elucidar destaques filosóficos e epistemológicos mediante considerações significativas, essenciais, em favor da causalidade de questões no interesse da Enfermagem.
Método:
abordagem fundamentada nas proposições teóricas de Johannes Hessen, com referência a outros autores expertos no tema.
Resultados:
esclarecimento de aspectos substantivos e implicações adjetivas não só no interesse da investigação, ressaltando os significados essenciais do assunto, condizente com as elaborações de dissertações de mestrado e teses de doutorado de Enfermagem.
Conclusão:
trata-se de uma contribuição valiosa para esclarecer melhor detalhes da construção do conhecimento na temática e problemática do assunto posto em causa, as linhas de pesquisa em enfermagem.
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01-01-2015
Using the theory of meaningful learning in nursing education
Revista Brasileira de Enfermagem. 2015;68(4):713-722
Abstract
Using the theory of meaningful learning in nursing education
Revista Brasileira de Enfermagem. 2015;68(4):713-722
DOI 10.1590/0034-7167.2015680420i
Views0See moreABSTRACT
Objective:
to synthesize the scientific literature about the Theory of Meaningful Learning in the process of teaching and learning in nursing.
Method:
this is an integrative review conducted in the databases MEDLINE, LILACS, SciELO, BDENF and CINAHL with studies addressing the subject or aspects of the theory of meaningful learning of David Ausubel. Ten studies were included, from which six were written in Portuguese and four in English, published from 1998 to 2013.
Results:
five studies used the theory of meaningful learning, four studies cited Ausubel as the author of this theory and only two studies followed the framework for the application of the theory completely. There are only a few studies on this subject and those which explore it are not correlated with Ausubel’s theory.
Conclusion:
it is necessary to break with the dichotomy between theory and practice and promote the articulation of content with action, introducing the student as the author of their own knowledge.
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01-01-2015
Nursing scientific production on health promotion, chronic condition, and aging
Revista Brasileira de Enfermagem. 2015;68(4):705-712
Abstract
Nursing scientific production on health promotion, chronic condition, and aging
Revista Brasileira de Enfermagem. 2015;68(4):705-712
DOI 10.1590/0034-7167.2015680419i
Views1See moreABSTRACT
Objective:
to characterize the scientific production of Postgraduate Programs Nursing in Brazil on health promotion with a focus on elderly people with chronic conditions in the period from 2006 to 2010.
Method:
integrative research developed by searching for dissertations and theses in the database of the Center for Nursing Studies and Research of the Brazilian Nursing Association published in the period from 2006 to 2010 and which focused on health promotion for elderly people with chronic conditions.
Results:
five themes emerged: “Living with the disease”; “Technologies of care”, “Potential for self-care” “Psycho-spiritual dimension”, and “Family caregiver”.
Conclusion:
it was possible to identify nursing care as a key element to promote the health of elderly people and make them more independent in their care so as to live with their limitations or disabilities, even when affected by chronic diseases.
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01-01-2015
Longevity according to life histories of the oldest-old
Revista Brasileira de Enfermagem. 2015;68(4):697-704
Abstract
Longevity according to life histories of the oldest-old
Revista Brasileira de Enfermagem. 2015;68(4):697-704
DOI 10.1590/0034-7167.2015680418i
Views0See moreABSTRACT
Objective:
to interpret life histories of the oldest-old in a community, grounded on the perspective of the Active Aging and Life Course.
Method:
this is a qualitative research. Participants included twenty seniors 80 years and older, users of a Basic Health Unit. Life histories were collected and analyzed according to the proposition of the Autobiographical Narrative Interview.
Results:
during the analytic process, elements found in the elders’ present and past arose, contributing to the development of a theoretical model: “Building longevity along the life course.”
Conclusion:
longevity is rooted in the past, strongly infl uenced by the family culture and life course; assumptions of the Active Aging are more meaningful in the informants’ present trajectory. The content of the narratives pointed to new possibilities of Gerontology Nursing intervention in Primary Care, aiming at health promotion and intervention, specially grounded on the respect to the oldest-elders’ culture.
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01-01-2015
Accuracy in inference of nursing diagnoses in heart failure patients
Revista Brasileira de Enfermagem. 2015;68(4):690-696
Abstract
Accuracy in inference of nursing diagnoses in heart failure patients
Revista Brasileira de Enfermagem. 2015;68(4):690-696
DOI 10.1590/0034-7167.2015680417i
Views0See moreABSTRACT
Objective:
to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients.
Method:
descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating effi cacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected.
Results:
the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identifi ed by the nursing evaluators.
Discussion:
the search for improving diagnostic accuracy reaffi rms the need for continuous and specifi c training to improve the diagnosis capability of nurses.
Conclusion:
the training allowed the exercise of clinical judgment and better accuracy of nurses.
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01-01-2015
Direct cost of development and documentation of the nursing process
Revista Brasileira de Enfermagem. 2015;68(4):683-689
Abstract
Direct cost of development and documentation of the nursing process
Revista Brasileira de Enfermagem. 2015;68(4):683-689
DOI 10.1590/0034-7167.2015680416i
Views0See moreABSTRACT
Objective:
identify the average direct cost (ADC) of the activities performed by nursing professionals in the nursing process development and documentation at the medical clinic of a teaching hospital.
Method:
1040 activities were observed and the ADC was calculated by multiplying the time spent by professionals by the unit cost of direct labor.
Results:
the ADC of patient admission was R$ 55.57 (SD=19.44); among the activities of patient follow-up, the assessment phase documentation had the most significant ADC (R$ 17.70 – SD=14.60); the ADC of descriptive records corresponded to R$ 1.21 (SD=1.21) and the ADC of the nursing team for shift change was R$ 54.23 (SD=28.95).
Conclusion:
the study promotes visibility of the work performed by nursing professionals in the development of the nursing process, providing financial data to ensure consistent arguments for proper resources to its feasibility.
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01-01-2015
Health status and mental health in patients after percutaneous coronary intervention
Revista Brasileira de Enfermagem. 2015;68(4):676-682
Abstract
Health status and mental health in patients after percutaneous coronary intervention
Revista Brasileira de Enfermagem. 2015;68(4):676-682
DOI 10.1590/0034-7167.2015680415i
Views0See moreABSTRACT
Objective:
to assess the association between perceived health status and the mental health of patients submitted to percutaneous coronary intervention after hospital discharge.
Method:
a quantitative and cross-sectional study involving 101 participants. The following instruments were used: a sociodemographic and clinical characterization instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Participants were divided into three groups: no anxiety and no depression (G1); anxiety or depression (G2); and both (G3). The ANOVA test was used for the intergroup comparison of means on the SF-36 domains.
Results:
There was an association between perceived health status and mental health. The participants in G1 presented higher scores in all SF-36 domains in comparison with participants in G2 and G3.
Conclusion:
Participants with no anxiety and depression presented better-perceived health status in comparison with those with anxiety or depression, or both.
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