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RESEARCH01-01-2018
Nursing diagnoses from ICNP® for people with metabolic syndrome
Revista Brasileira de Enfermagem. 2018;71:467-474
Abstract
RESEARCHNursing diagnoses from ICNP® for people with metabolic syndrome
Revista Brasileira de Enfermagem. 2018;71:467-474
DOI 10.1590/0034-7167-2017-0125
Views0See moreABSTRACT
Objective:
To construct nursing diagnosis statements based on the International Classification for Nursing Practice (ICNP®) for people with metabolic syndrome, settled on the theoretical framework of Basic Human Needs.
Method:
Descriptive study developed in four stages: 1) Identification and validation of terms relevant to care with health priority; 2) Cross-mapping of the terms identified with ICNP® terms; 3) Construction of the nursing diagnosis statements; and 4) Cross-mapping of constructed statements with the ones in ICNP®.
Results:
Regarding terms extracted, 370 were validated based on the consensus (100%) among specialists, subsidizing the elaboration of 52 nursing diagnosis statements from ICNP® version 2015, distributed among the Basic Human Needs proposed by theoretical framework.
Conclusion:
It was possible to construct nursing diagnoses for people with metabolic syndrome based on the terms extracted from the literature, with a predominance of the need for “Health education and learning”.
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01-01-2018
Street Clinic as good practice in Collective Health
Revista Brasileira de Enfermagem. 2018;71:465-466
Abstract
Street Clinic as good practice in Collective Health
Revista Brasileira de Enfermagem. 2018;71:465-466
DOI 10.1590/0034-7167-201871sup102
Views0“Freely translated as “How can I face this world? Life is ungrateful itself; but it brings hope even from the midst of the bitterness of despair”().Life on the streets has presented itself as a reality for an increasing number of people, especially in the big cities of Brazil and the world. This harsh social reality […]See more -
01-01-2018
Consultório na Rua como boa prática em Saúde Coletiva
Revista Brasileira de Enfermagem. 2018;71:465-466
Abstract
Consultório na Rua como boa prática em Saúde Coletiva
Revista Brasileira de Enfermagem. 2018;71:465-466
DOI 10.1590/0034-7167-201871sup102
Views0“Como é que posso com este mundo? A vida é ingrata no macio de si; mas transtraz a esperança mesmo do meio do fel do desespero”().A vida nas ruas tem se apresentado como uma realidade para um número cada vez maior de pessoas, sobretudo nas grandes cidades do Brasil e do mundo. Essa dura realidade […]See more -
01-01-2018
30 years of Nursing in Collective Health
Revista Brasileira de Enfermagem. 2018;71:463-464
Abstract
30 years of Nursing in Collective Health
Revista Brasileira de Enfermagem. 2018;71:463-464
DOI 10.1590/0034-7167-201871sup101
Views1It is celebrated 30 years of the official launch, in Brazil, of the Nursing in Collective Health, a field of theories and practices supported by the historical and dialectical materialism. Nothing is more instigating than bringing to readers the special edition of REBEn called “Contributions of Public Health to nursing practice”. In this editorial, it […]See more -
01-01-2018
30 anos de Enfermagem em Saúde Coletiva
Revista Brasileira de Enfermagem. 2018;71:463-464
Abstract
30 anos de Enfermagem em Saúde Coletiva
Revista Brasileira de Enfermagem. 2018;71:463-464
DOI 10.1590/0034-7167-201871sup101
Views1Comemora-se os 30 anos do lançamento oficial, no Brasil, da Enfermagem em Saúde Coletiva, um campo de teorias e práticas sustentadas pelo materialismo histórico e dialético. Nada mais instigante do que trazer aos leitores o número especial da REBEn intitulado “Contribuições e desafios das práticas de Enfermagem em Saúde Coletiva”. Neste editorial, indaga-se: teremos sido […]See more -
RESEARCH01-24-2017
Nurses in the labor market: professional insertion, competencies and skills
Revista Brasileira de Enfermagem. 2017;70(6):1220-1226
Abstract
RESEARCHNurses in the labor market: professional insertion, competencies and skills
Revista Brasileira de Enfermagem. 2017;70(6):1220-1226
DOI 10.1590/0034-7167-2016-0061
Views0See moreABSTRACT
Objective:
to characterize nurses graduated from the School of Nursing of the University of São Paulo, from 2006 to 2012; verify their entry, facilitating factors and difficulties of these graduates in the labor market and to consider their skills and competences in the world of work.
Method:
an exploratory, descriptive study with a qualitative approach.
Results:
out of 505 graduates, 172 (34.1%) participated in the research. Entry into the labor market was mainly via public hospital institutions, in the SE of Brazil, in the caregiving sectors. The greater part remained from one to two years in their first job. Most agreed that they were prepared to meet the health needs of the population. Furthermore, they had been encouraged to seek systematic and continuous improvement in a critical, reflexive and creative way, while combining technical-scientific knowledge and personal skills.
Conclusion:
the results show that the University of São Paulo has been preparing nurses for work in the labor market, in accordance with the provisions of the National Curricular Guidelines.
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ERRATUM01-01-2017
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1348-1348
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1348-1348
DOI 10.1590/0034-7167.20177006e02
Views0Article “Nursing appointment and cardiometabolic control of diabetics: a randomized clinical trial”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, v70(3):468-7, on page 468:Where it read:[…]See more -
ERRATUM01-01-2017
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1347-1347
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1347-1347
DOI 10.1590/0034-7167.20177006e01
Views0Article “Physical and psychological violence against the elderly: prevalence and associated factors”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, v68(6):727-33, on page 732, it is added:“FUNDING[…]See more
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ORIGINAL ARTICLE08-06-2021
Hope in a depression therapeutic group: a qualitative case study
Revista Brasileira de Enfermagem. 2021;74(4):e20201309
Abstract
ORIGINAL ARTICLEHope in a depression therapeutic group: a qualitative case study
Revista Brasileira de Enfermagem. 2021;74(4):e20201309
DOI 10.1590/0034-7167-2020-1309
Views1See moreABSTRACT
Objective:
to understand the perceptions of hope for people with depression in the context of a therapy group.
Methods:
using a qualitative case study approach, a semi-structured in-depth interview and a self-report questionnaire were conducted with seven women with depression integrated in a therapy group at a Portuguese day-care psychiatric unit. Data collection and analysis used triangulation of sources.
Results:
the participants evidenced hope founded on the positive experiences of the past with a strong affiliation component. Hope management is done fundamentally through the interpersonal relationships established between the members of the group, based on communicational patterns that are established on a regular basis, mediated by the group therapist.
Conclusion:
the therapy group functioned towards the reinforcement of hope in people who experience depression, and it works as a motivation to manage the implications of illness in the participants’ life and health project.
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REVIEW08-16-2021
Fatigue due to compassion in health professionals and coping strategies: a scoping review
Revista Brasileira de Enfermagem. 2021;74(5):e20190628
Abstract
REVIEWFatigue due to compassion in health professionals and coping strategies: a scoping review
Revista Brasileira de Enfermagem. 2021;74(5):e20190628
DOI 10.1590/0034-7167-2019-0628
Views0See moreABSTRACT
Objectives:
to identify the current state of knowledge on compassion fatigue in the work context of healthcare professionals; and how coping strategies are established in this scenario.
Method:
a scoping review with search applied to the databases: MEDLINE, LILACS, CINAHL, Scopus. Temporal limit: 2009 to 2019. The data was analyzed and synthesized in narrative form
Results:
thirty articles were selected, synthesized into two categories: a) Health work and compassion fatigue: conceptual analysis, context, and manifestations; b) Coping strategies for compassion fatigue.
Conclusions:
this study presented: a descriptive and general panorama about compassion fatigue in healthcare professionals, identifying a greater consolidation of the concept between 2015 and 2018; and some coping strategies. The association between health and spirituality is highlighted as one of the strategies in this scenario, enabling new research to be conducted in view of the importance of the theme in life, health work.
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ORIGINAL ARTICLE07-23-2021
Disabilities in leprosy: construction and validation of instrument on knowledge and attitude of professionals
Revista Brasileira de Enfermagem. 2021;74(5):e20200862
Abstract
ORIGINAL ARTICLEDisabilities in leprosy: construction and validation of instrument on knowledge and attitude of professionals
Revista Brasileira de Enfermagem. 2021;74(5):e20200862
DOI 10.1590/0034-7167-2020-0862
Views0See moreABSTRACT
Objective:
To develop and test the content validity of the “Knowledge and Attitudes on Assessing Degrees of Physical Disability in Leprosy” instrument.
Methods:
Methodological study carried out between January and May 2019 in three stages: item generation, analysis of aggregated redundancy to the composition, and content validation, using the Delphi technique.
Results:
In the first evaluation, a relevance of ≥ 0.80 stood out for all items, except for 2.8, which was excluded. To make the instrument clearer, the sequence was renumbered from one to 32; 2.6, 3.1, and 15 were reformulated, and the others underwent modifications, except for ten and 13. After the second evaluation, all items obtained Content Validity Index > 0.90 and Kappa = 1.00.
Conclusion:
The instrument has an excellent content validity; it is inferred that it is adequate to measure the knowledge and attitudes of professionals in the assessment of physical disabilities in leprosy.
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ORIGINAL ARTICLE08-30-2021
Mental health in adolescence: Elaboration and validation of an educational technology for health promotion
Revista Brasileira de Enfermagem. 2021;74(5):e20201023
Abstract
ORIGINAL ARTICLEMental health in adolescence: Elaboration and validation of an educational technology for health promotion
Revista Brasileira de Enfermagem. 2021;74(5):e20201023
DOI 10.1590/0034-7167-2020-1023
Views1See moreABSTRACT
Objective:
to build and validate the appearance of a digital educational technology to promote the mental health of school adolescents.
Methods:
methodological study, which included the elaboration and validation of the “Conect@dos com a S@ude” online course based on the Galvis-Panqueva methodological framework. The elaboration was based on a literature review and followed the Theory of Meaningful Learning. The validation was performed by a total of 21 adolescent students, using an instrument adapted for the study. A quantitative analysis was performed from the Content Validity Index and descriptive of the suggestions pointed out by the target audience.
Results:
the analysis of the Content Validity index ranged from 0.8 to 1 in all evaluated items. The adolescents presented some suggestions for improvement for the course, most of them were accepted.
Conclusion:
the course was validated by the target audience.
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ORIGINAL ARTICLE08-30-2021
Family functionality and burden of family caregivers of users with mental disorders
Revista Brasileira de Enfermagem. 2021;74(5):e20201061
Abstract
ORIGINAL ARTICLEFamily functionality and burden of family caregivers of users with mental disorders
Revista Brasileira de Enfermagem. 2021;74(5):e20201061
DOI 10.1590/0034-7167-2020-1061
Views0See moreABSTRACT
Objective:
to verify the difference of mean or median in the scores of family functionality and burden of family caregivers of people with mental disorders.
Methods:
cross-sectional study carried out in a Psychosocial Care Center with 61 family caregivers. Instruments were used for sociodemographic characterization, care process, Family Apgar Index and Family Burden Interview Schedule. Mean/median difference tests were adopted.
Results:
women with mental disorders and the presence of children in the home decreased the median of the family Apgar score. Difficulty in the relationship between caregiver/user, nervousness/tension, physical aggression and agitation of patients increased the global average of subjective burden.
Conclusions:
nursing interventions to reduce burden and promote family functionality should prioritize caregivers of women with mental disorders, assist them in managing troublesome behaviors and raising awareness of family nucleus to co-responsibility for caring for sick people, especially in families with children who demand daily care.
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ORIGINAL ARTICLE07-23-2021
The role of grandparents of children with cancer in the hospital
Revista Brasileira de Enfermagem. 2021;74(5):e20201143
Abstract
ORIGINAL ARTICLEThe role of grandparents of children with cancer in the hospital
Revista Brasileira de Enfermagem. 2021;74(5):e20201143
DOI 10.1590/0034-7167-2020-1143
Views0See moreABSTRACT
Objective:
To understand the role of grandparents of hospitalized children with cancer.
Methods:
In a qualitative study, we interviewed eleven grandparents of children with cancer hospitalized at a referral center for pediatric oncology in São Paulo. The data were analyzed using the Hybrid Framework of Thematic Analysis.
Results:
Six themes were found to describe the role of grandparents in this context: Being the family’s support, Sharing love to my child and my grandchild, Being there for my child and my grandchild, Offering spiritual support to my child and my grandchild, Making an effort to be able to manage my own feelings and Balancing the demands of hospitalization with available resources.
Final considerations:
The findings show the significance of the grandparents’ role in this experience and emphasize the value of being considered, by health professionals, as part of the family and care.
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ORIGINAL ARTICLE07-30-2021
Perspective of nursing students about active learning and insertion in the job market
Revista Brasileira de Enfermagem. 2021;74(6):e20190168
Abstract
ORIGINAL ARTICLEPerspective of nursing students about active learning and insertion in the job market
Revista Brasileira de Enfermagem. 2021;74(6):e20190168
DOI 10.1590/0034-7167-2019-0168
Views0See moreABSTRACT
Objective:
to understand the perception of alumni from a nursing course which uses active learning methods about their insertion in the job market.
Methods:
descriptive and exploratory study with a qualitative approach, carried out through 17 interviews with alumni from 2012 and 2014. The analysis took place using Dialectic Hermeneutics, as subsidized by the theoretical framework of the Theory of Complexity.
Results:
the statements of the alumni showed aspects related to safety to act in the job market, to stimulating proactivity and initiative for learning as proposed by the active method, to difficulties in teamwork, and to the lack of experience in certain specialized fields.
Final Considerations:
there are advances and challenges marked by contradictions in the way the alumni act and think as they enter the job market, which is an inherent condition to processes of change, from the perspective of complex thinking.
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ORIGINAL ARTICLE08-20-2021
Resilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
Abstract
ORIGINAL ARTICLEResilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
DOI 10.1590/0034-7167-2019-0388
Views0See moreABSTRACT
Objectives:
analyze the level of resilience of family caregivers of children and adolescents hospitalized for cancer treatment and associated factors.
Methods:
cross-sectional study, carried out in 2018, with 62 family caregivers in a university hospital in the state of Rio Grande do Sul, Brazil. The instruments CDRisc-10-Br, SRQ20, PSS-14 and WHOQOL-Bref were used to measure resilience, minor psychological disorders, stress, and quality of life, respectively. Inferential statistics were used.
Results:
female caregivers, married, with one child and who practice some predominated religion. They were classified as having a moderate level of resilience (48.4%); with suspicion for minor psychological disorders (45%) and high level of stress (41%). In terms of quality of life, they were satisfied in the Physical, Psychological and Social Relations domains; and dissatisfied in the Environment domain.
Conclusions:
there were direct weak to moderate correlations between the level of resilience and quality of life and inversely with stress and minor psychological disorders.
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REVIEW07-10-2020
Acute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20200354
Abstract
REVIEWAcute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20200354
DOI 10.1590/0034-7167-2020-0354
Views0See moreABSTRACT
Objective:
to assess scientific evidence on SARS-CoV-2 Acute Kidney Injury in patients with COVID-19.
Methods:
an integrative review, with adoption of PICO strategy and classification of the level of evidence, carried out on April 10, 2020 in the PubMed database, of articles available between December 2019 and April 2020.
Results:
the sample consisted of six original, five observational and one experimental articles. Observational studies addressed the clinical findings of patients with COVID-19 and association between kidney damage, infection, and morbidity-mortality.
Conclusion:
the studies addressed the mechanism of intracellular infection of SARS-CoV-2, its cytopathic effects on kidney cells and incidence of acute kidney injury in patients infected with SARS-CoV-2. Acute kidney injury is associated with increased mortality and morbidity in these patients. This review realizes the need for new research that can mention kidney care to patients with COVID-19.
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ORIGINAL ARTICLE03-24-2021
Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists
Revista Brasileira de Enfermagem. 2021;74(1):e20200360
Abstract
ORIGINAL ARTICLEDevelopment, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists
Revista Brasileira de Enfermagem. 2021;74(1):e20200360
DOI 10.1590/0034-7167-2020-0360
Views0See moreABSTRACT
Objectives:
to build and validate three clinical simulation scenarios and report the application with candidates for the specialist’s degree in stomatherapy.
Methods:
methodological study, building three scenarios and evaluation checklists; content validation with judges, using content validity index and Modified Kappa Coefficient; pre-test and application.
Results:
scenarios built based on nursing care for: 1. insufficiency and venous ulcer; 2. demarcation of intestinal stomia; and 3. Clean intermittent catheterization. In the content validation of the 24 items appreciated, 83%, 80%, and 92% were validated without change. In the pre-test, the objectives and checklists were adjusted. In the application, to standardize the evaluation, actors and evaluators were trained previously, and each candidate passed the three stations.
Conclusions:
scenarios built and with validated content, based on evidence and covering the three areas of stomatherapy. The pre-test allowed for adjustments in the scenarios, and the candidates achieved the expected objectives.
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ORIGINAL ARTICLE07-15-2020
Cultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil
Revista Brasileira de Enfermagem. 2020;73:e20190103
Abstract
ORIGINAL ARTICLECultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil
Revista Brasileira de Enfermagem. 2020;73:e20190103
DOI 10.1590/0034-7167-2019-0103
Views0See moreABSTRACT
Objectives:
to translate and culturally adapt the Infant Feeding Intentions Scale for pregnant women in Brazil.
Methods:
methodological study that included stages of translation, synthesis, face and content validation, back translation and semantic assessment. In the face and content and semantic validation stages, we used the Content Validity Index for individual items and for the overall scale for clarity and representativeness.
Results:
nine (100.0%) experts participated in face and content validation, and the average index obtained was 85.0% for representativeness. In the semantic assessment, performed with 31 (100.0%) pregnant women, the tool was considered clear, obtaining an average index of 91.0%.
Conclusions:
the Brazilian version of the scale was considered representative and clear. After assessing psychometric properties, the scale is expected to be valid and reliable to assess maternal intention to breastfeed exclusively until the infant’s six months of life in different Brazilian settings.
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ORIGINAL ARTICLE03-30-2020
Parental care for infants with feeding tube: psychosocial repercussions
Revista Brasileira de Enfermagem. 2020;73(2):e20180360
Abstract
ORIGINAL ARTICLEParental care for infants with feeding tube: psychosocial repercussions
Revista Brasileira de Enfermagem. 2020;73(2):e20180360
DOI 10.1590/0034-7167-2018-0360
Views0See moreABSTRACT
Objectives:
to understand the psychosocial repercussions experienced by caregiving parents, resulting from care for the child with dysphagic cleft lip and palate.
Methods:
qualitative study, developed in a tertiary hospital in September 2016. The sample defined by theoretical saturation consisted of seven mothers. Data collection was performed by unstructured interview, being audio-recorded and fully transcribed. Symbolic Interactionism was used as theoretical framework, and Thematic Content Analysis as methodological framework.
Results:
the following themes emerged: diagnosisimpact and coping; coping with overload and stress; interaction between caregivers as an acceptance and coping strategy; impact on family and social life of caregivers; and curiosity coping, and family and community prejudice.
Final considerations:
despite the physical and emotional overload, the mother figure plays the main and determining role in care, reflecting the complexity of care.
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ORIGINAL ARTICLE03-30-2020
Stomized children care practices: narratives of relatives
Revista Brasileira de Enfermagem. 2020;73(2):e20180370
Abstract
ORIGINAL ARTICLEStomized children care practices: narratives of relatives
Revista Brasileira de Enfermagem. 2020;73(2):e20180370
DOI 10.1590/0034-7167-2018-0370
Views0See moreABSTRACT
Objectives:
to understand the practices adopted by relatives regarding ostomized children care.
Methods:
qualitative approach, conducted with 11 relatives of ostomized children. Methodological framework was used as narrative technique; NVivo® software for data categorization and information analysis; content analysis technique.
Results:
participants revealed unpreparedness in dealing with children, lack of knowledge about handling materials and equipment inherent to ostomy and challenges faced in the daily life of children in school. They are unanimous in telling they feel encouraged and strengthened by receiving support from nurses in child care. They suggested the development of strategies to guide ostomized children care, such as educational material use.
Conclusions:
to understand family members’ experience made it possible to support training and qualification of nursing professionals, and to establish priorities in care. Evidence found may contribute to reflections that aid health promotion and prevention of complications in ostomized children care.
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ORIGINAL ARTICLE06-16-2021
Family interview for organ and tissue donation: good practice assumptions
Revista Brasileira de Enfermagem. 2021;74(2):e20190206
Abstract
ORIGINAL ARTICLEFamily interview for organ and tissue donation: good practice assumptions
Revista Brasileira de Enfermagem. 2021;74(2):e20190206
DOI 10.1590/0034-7167-2019-0206
Views0See moreABSTRACT
Objectives:
to identify information that can support creating good practice assumptions to develop family interview for organ and tissue donation.
Methods:
this scoping study, conducted in two Brazilian hospitals in the southern, between April and December 2017, included integrative review and consultation with 15 families who experienced interview for organ donation. For data analysis, thematic content analysis was used.
Results:
three categories emerged: communication of death, which shows the need to know the history of hospitalization of patients; emotional support, the team must have mastery of the stages of mourning; information about donation, professionals need to know the stages of the donation process and respect families’ time.
Final Considerations:
good practice assumptions point to the need for team training, respect for family time and the use of simple language.
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ORIGINAL ARTICLE12-13-2019
Perception of women with breast cancer undergoing chemotherapy: a comprehensive analysis
Revista Brasileira de Enfermagem. 2019;72:103-110
Abstract
ORIGINAL ARTICLEPerception of women with breast cancer undergoing chemotherapy: a comprehensive analysis
Revista Brasileira de Enfermagem. 2019;72:103-110
DOI 10.1590/0034-7167-2018-0165
Views0See moreABSTRACT
Objective:
To comprehensively analyze the perception of women with breast cancer on the experience of undergoing chemotherapy.
Method:
This was a qualitative, descriptive, phenomenological study, supported by the Merleau-Ponty philosophy. It was conducted in a chemotherapy outpatient clinic with 20 participants who completed a phenomenological interview.
Results:
The phenomenological data analysis demonstrated that the perception of women about the experience of chemotherapy is about change, not only of the physical body, but of their identity, and that it considers existential aspects. Three categories emerged from the experience of alopecia, fatigue, and spirituality, respectively: the body itself, the current and habitual body, and transcendence.
Final considerations:
Bodily changes, and the existential implications perceived by the women in this study, analyzed from the Merleau-Ponty perspective, makes it possible to consider body concept, and provides support for humanized care based on singularity and the socio-cultural context.
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REVIEW07-14-2021
Symptom management theory applied to nursing care: scoping review
Revista Brasileira de Enfermagem. 2021;74(3):e20201004
Abstract
REVIEWSymptom management theory applied to nursing care: scoping review
Revista Brasileira de Enfermagem. 2021;74(3):e20201004
DOI 10.1590/0034-7167-2020-1004
Views0See moreABSTRACT
Objectives:
to identify publications about the applicability of the Symptom Management Theory in nursing care to pediatric, adolescent, adult and elderly patients.
Methods:
scoping review following the steps: definition of the objective, research question and inclusion criteria; search, selection and analysis of publications; synthesis of results. The search occurred in the VHL, SciELO, CAPES and PubMed Journals Portal bases, contemplating publications between 1994 and July 2020.
Results:
out of 3,286 studies, ten were selected, published between 2008 and 2019. They described the relationships between the participants and the domains (person, environment, health and disease), components (symptom experience, management strategies, results) and presented strategies for symptom management.
Conclusions:
the Symptom Management Theory was considered applicable to the participants of the studies and to nursing care. It was concluded that understanding the interaction of these elements is essential to plan actions aimed at controlling symptoms effectively.
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