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ORIGINAL ARTICLE12-04-2023
Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?
- Tita Rohita
, - Nursalam Nursalam ,
- Muhammad Hadi ,
- Iqbal Pramukti ,
- Dedeng Nurkholik , [ … ],
- Ika Adelia Susanti
Abstract
ORIGINAL ARTICLEWork-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?
Revista Brasileira de Enfermagem. 2023;76:e20220586
DOI 10.1590/0034-7167-2022-0586
- Tita Rohita ,
- Nursalam Nursalam ,
- Muhammad Hadi ,
- Iqbal Pramukti ,
- Dedeng Nurkholik ,
- Arifah Septiane ,
- Idyatul Hasanah ,
- Ika Adelia Susanti
Views0See moreABSTRACT
Objective:
To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic.
Methods:
A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression.
Results:
More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively.
Conclusion:
The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.
- Tita Rohita
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ORIGINAL ARTICLE12-04-2023
Incidence and risk factors of pressure injuries in critically ill patients with COVID-19
- Aline de Oliveira Ramalho ,
- Rodrigo Augusto Gonçalves Fonseca ,
- Eliane Mazócoli ,
- Alessandra Marin ,
- Paula Cristina Nogueira
Abstract
ORIGINAL ARTICLEIncidence and risk factors of pressure injuries in critically ill patients with COVID-19
Revista Brasileira de Enfermagem. 2023;76:e20220553
DOI 10.1590/0034-7167-2022-0553
- Aline de Oliveira Ramalho ,
- Rodrigo Augusto Gonçalves Fonseca ,
- Eliane Mazócoli ,
- Alessandra Marin ,
- Paula Cristina Nogueira
Views0See moreABSTRACT
Objective:
to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs.
Method:
a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI.
Results:
PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001).
Conclusion:
PI incidence in critically ill patients with COVID-19 was high.
- Aline de Oliveira Ramalho
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12-04-2023
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
Abstract
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
DOI 10.1590/0034-7167-2022-0797es
Views0See moreRESUMEN
Objetivos:
debatir sobre aspectos éticos en la atención de enfermería a personas transgénero.
Métodos:
estudio reflexivo fundamentado sobre los dilemas que se plantean en los cuidados de enfermería a personas transgénero. El relato se ha estructurado en torno a los cuatro principios bioéticos.
Resultados:
la atención sanitaria a las personas trans es compleja, transversal a muchos dispositivos y especialidades y longitudinal en el tiempo por lo que precisa de la actuación coordinada. Existe un marco ético en el que se encuadran los cuidados de enfermería que se precisan en la atención a este colectivo.
Consideraciones Finales:
la enfermera como agente de salud puede asumir diversas líneas generales en la atención a pacientes transgénero. Para ello, se debe brindar formación adicional no solo a los profesionales, también a los estudiantes de enfermería y de las demás ciencias de la salud.
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ORIGINAL ARTICLE12-04-2023
Working conditions in nursing in the face of Covid-19 from the perspective of precariousness
- Ana Paula Nogueira de Magalhães ,
- Diego de Oliveira Souza ,
- Fernanda Pereira de Macêdo ,
- Sabrina Ângela França da Silva Cruz ,
- Camila Pereira-Abagaro , [ … ],
- Roselia Arminda Rosales-Flores
Abstract
ORIGINAL ARTICLEWorking conditions in nursing in the face of Covid-19 from the perspective of precariousness
Revista Brasileira de Enfermagem. 2023;76:e20220679
DOI 10.1590/0034-7167-2022-0679
- Ana Paula Nogueira de Magalhães ,
- Diego de Oliveira Souza ,
- Fernanda Pereira de Macêdo ,
- Sabrina Ângela França da Silva Cruz ,
- Camila Pereira-Abagaro ,
- Roselia Arminda Rosales-Flores
Views0See moreABSTRACT
Objective:
To investigate working conditions in nursing when facing the Covid-19 pandemic, in light of aspects of precarious work.
Methods:
Cross-sectional study, with 131 nursing workers who worked against Covid-19 in hospitals in Alagoas State, Northeast Brazil. Data were collected online, using a workers’ health assessment questionnaire. The Chi -Square or Fisher’s Exact test and logistic regression were used.
Results:
among nursing workers, 71% had precarious contracts, 33.6% reported extended working hours and 23.7% were union members. In the multivariable analysis, having little hospital experience was a predictor for poor employment (OR= 2.408; 95%CI= 1.051-5.518). The predictor variables for lengthening the working day were being a nurse (OR= 3.824; 95%CI= 1.274-11.483); overtime (OR= 3.668; 95%CI= 1.009-13.333) and inadequate number of workers (OR= 10.872; 95%CI= 3.409-34.675). Being a nursing technician was a predictor of being a union member (OR= 8.967; 95%CI=2.560-31.410).
Conclusions:
The pandemic has accentuated the precariousness of working conditions in nursing professionals, especially among nurses.
- Ana Paula Nogueira de Magalhães
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12-04-2023
Estresse laboral entre enfermeiros na pandemia de COVID-19: Quais são os fatores contribuintes?
- Tita Rohita ,
- Nursalam Nursalam ,
- Muhammad Hadi ,
- Iqbal Pramukti ,
- Dedeng Nurkholik , [ … ],
- Ika Adelia Susanti
Abstract
Estresse laboral entre enfermeiros na pandemia de COVID-19: Quais são os fatores contribuintes?
Revista Brasileira de Enfermagem. 2023;76:e20220586
DOI 10.1590/0034-7167-2022-0586
- Tita Rohita ,
- Nursalam Nursalam ,
- Muhammad Hadi ,
- Iqbal Pramukti ,
- Dedeng Nurkholik ,
- Arifah Septiane ,
- Idyatul Hasanah ,
- Ika Adelia Susanti
Views0See moreRESUMEN
Objetivo:
Analizar los factores contribuyentes del estrés laboral entre enfermeros en la pandemia de COVID-19.
Métodos:
Estudio transversal realizado con 101 enfermeros de dos hospitales de Java Occidental, Indonesia. Se distribuyó un cuestionario en línea para evaluar el estrés laboral y los datos se analizaron mediante regresión logística ordinal.
Resultados:
Más de la mitad de los enfermeros experimentaron un estrés laboral moderado. El estudio reveló que los enfermeros mayores de 35 años tenían una menor probabilidad de experimentar estrés laboral (AOR: 0.173; IC95%: 0.038-0.782) y los enfermeros casados tenían una mayor probabilidad (AOR: 7.156; IC95%: 1.456-35.163). Los enfermeros con cargas de trabajo bajas y moderadas tenían una probabilidad menor, (AOR: 0.003; IC95%: 0.000-0.051) y (AOR: 0.025; IC95%: 0.005-0.116), respectivamente.
Conclusión:
Es fundamental considerar la edad, el estado civil y la carga de trabajo para un abordaje eficaz del estrés laboral entre los enfermeros.
- Tita Rohita
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12-04-2023
Fatores que afetam a atitude da comunidade em relação à vacinação contra a COVID-19: estudo transversal
- Chintia Gracelia Amalo ,
- Ezra Amarya Ekaristy ,
- Maretty Wattileo ,
- Martina Pakpahan ,
- Ester Silitonga
Abstract
Fatores que afetam a atitude da comunidade em relação à vacinação contra a COVID-19: estudo transversal
Revista Brasileira de Enfermagem. 2023;76:e20220597
DOI 10.1590/0034-7167-2022-0597
- Chintia Gracelia Amalo ,
- Ezra Amarya Ekaristy ,
- Maretty Wattileo ,
- Martina Pakpahan ,
- Ester Silitonga
Views0See moreRESUMEN
Objetivo:
El objetivo de este estudio fue analizar los factores que afectan la actitud de la comunidad hacia la vacunación contra el COVID-19 en el distrito de Tangerang.
Métodos:
Estudio transversal en el que se utilizó un muestreo por conveniencia para seleccionar a 400 encuestados. Los criterios de inclusión fueron vivir en el distrito de Tangerang, edad 18-55 años y trabajar. Se utilizó un cuestionario en línea, el cual pasó pruebas de validez y confiabilidad. Este estudio recibió aprobación ética.
Resultados:
La mayoría de los encuestados tenía un alto nivel de educación (48,50%), bajos ingresos (72,50%), alto conocimiento (78%) y una actitud positiva (76,50%) respecto a la vacunación contra el COVID-19. La prueba chi-cuadrado reveló una correlación entre el conocimiento y las actitudes hacia la vacunación contra el COVID-19 (p=0,001) y los niveles educativos (p=0,001). No hubo correlación entre los ingresos y las actitudes (p=0,094).
Conclusiones:
Los profesionales de la salud deben realizar una amplia socialización y visitas cara a cara con personas con acceso limitado a la información para promover una actitud positiva y ampliar el alcance de la vacunación contra el COVID-19.
- Chintia Gracelia Amalo
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ORIGINAL ARTICLE11-28-2023
Factors associated with psychopathological symptoms among nurses at a university hospital
- Sheila Janaína Oliveira Araújo Lima ,
- Danielle Christine Moura dos Santos ,
- Maria de Fátima de Souza Santos ,
- Felicialle Pereira da Silva ,
- Darine Marie Rodrigues da Silva , [ … ],
- Jael Maria de Aquino
Abstract
ORIGINAL ARTICLEFactors associated with psychopathological symptoms among nurses at a university hospital
Revista Brasileira de Enfermagem. 2023;76(1):e20220075
DOI 10.1590/0034-7167-2022-0075
- Sheila Janaína Oliveira Araújo Lima ,
- Danielle Christine Moura dos Santos ,
- Maria de Fátima de Souza Santos ,
- Felicialle Pereira da Silva ,
- Darine Marie Rodrigues da Silva ,
- Jael Maria de Aquino
Views0See moreABSTRACT
Objectives:
to analyze the factors associated with psychopathological symptoms among nurses at a university hospital.
Methods:
a cross-sectional study developed at a university hospital in Pernambuco, in which 90 nurses participated. A questionnaire with social and professional characteristics and the Symptom Assessment Scale were used.
Results:
an association was found between the variable changing profession and the presence of characteristic symptoms of psychoticism, somatization and anxiety among nurses.
Conclusions:
the emergence of psychopathological symptoms has influenced nurses’ desire to search for another profession. This evidence reinforces the need for greater investments in better working conditions and welcoming actions in the work environment, in order to provide a better quality of professional life and promote the health of these workers.
- Sheila Janaína Oliveira Araújo Lima
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11-28-2023
O diagnóstico e o tratamento da tuberculose latente por enfermeiros no Brasil: estratégia necessária
Revista Brasileira de Enfermagem. 2023;76(1):e760101
Abstract
O diagnóstico e o tratamento da tuberculose latente por enfermeiros no Brasil: estratégia necessária
Revista Brasileira de Enfermagem. 2023;76(1):e760101
DOI 10.1590/0034-7167.2023760101pt
Views0A prevenção da tuberculose (TB), de impedir a progressão da infecção para a TB ativa, é a principal estratégia para reduzir a sua incidência e para o alcance das metas definidas pela Organização Mundial da Saúde, conforme a estratégia End TB().O Brasil, que ocupa a 19ª posição quanto ao número de casos, assumiu seu compromisso […]See more
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06-11-2021
Resilience in elderly people: factors associated with sociodemographic and health conditions
Revista Brasileira de Enfermagem. 2021;74:e20200171
Abstract
Resilience in elderly people: factors associated with sociodemographic and health conditions
Revista Brasileira de Enfermagem. 2021;74:e20200171
DOI 10.1590/0034-7167-2020-0171
Views0See moreABSTRACT
Objective:
to describe the sociodemographic and health characteristics of elderly people, measure the score of total resilience and by sex and verify the association of sociodemographic and health variables with total resilience and by sex.
Methods:
this is a household survey with 808 elderly people, assessed by validated instruments. Student’s t test and multiple linear regression (p<0.05).
Results:
most were female, 60|-|79 years old. The total resilience score was 78.06, for men 81.53 and for women, 76.32. Total resilience was associated with males; positive self-perceived health; greater participation in Advanced Activities of Daily Living; fewer morbidities; absence of depressive symptoms. Among men and women, resilience was associated with greater participation in Advanced Activities of Daily Living and absence of depressive symptoms and, specifically, among women, positive self-perceived health.
Conclusion:
these results contribute to nursing care, aiming to encourage resilience.
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REFLECTION03-05-2021
Reflections on patient safety incident reporting systems
- Maria de Jesus Castro Sousa Harada ,
- Ana Elisa Bauer de Camargo Silva ,
- Liliane Bauer Feldman ,
- Sheilla Siedler Tavares ,
- Luiza Maria Gerhardt , [ … ],
- Adriane Cristina Bernat Kolankiewicz
Abstract
REFLECTIONReflections on patient safety incident reporting systems
Revista Brasileira de Enfermagem. 2021;74:e20200307
DOI 10.1590/0034-7167-2020-0307
- Maria de Jesus Castro Sousa Harada ,
- Ana Elisa Bauer de Camargo Silva ,
- Liliane Bauer Feldman ,
- Sheilla Siedler Tavares ,
- Luiza Maria Gerhardt ,
- Antônio José de Lima Júnior ,
- Adriane Cristina Bernat Kolankiewicz
Views0See moreABSTRACT
Objective:
To reflect on the main characteristics and recommendations of Incident Reporting Systems, discuss the population’s participation in reporting, and point out challenges in the Brazilian system.
Method:
Reflection study, based on Ordinance No. 529/13, which instituted the National Patient Safety Program, under Collegiate Board Resolution (CBR) No. 36/13; reflections by experts were added.
Results:
Reporting systems are a source for learning and monitoring, allow early detection of incidents, investigations and, mainly, the generation of recommendations prior to recurrences, in addition to raising information for patients and relatives. There is little participation of the population in the reporting, regardless of the type of system and characteristics such as confidentiality, anonymity, and mandatory nature.
Final Considerations:
In Brazil, although reporting is mandatory, there is an urgency to advance the involvement and participation of the population, professionals, and institutions. To simplify data entry by improving the interface and importing data from the reporting system is an objective to be achieved.
- Maria de Jesus Castro Sousa Harada
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ORIGINAL ARTICLE09-16-2019
Validation of Brazilian educational technology for disseminating knowledge on leprosy to adolescents
Revista Brasileira de Enfermagem. 2019;72(5):1333-1340
Abstract
ORIGINAL ARTICLEValidation of Brazilian educational technology for disseminating knowledge on leprosy to adolescents
Revista Brasileira de Enfermagem. 2019;72(5):1333-1340
DOI 10.1590/0034-7167-2018-0610
Views0See moreABSTRACT
Objective:
Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma.
Method:
First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers’ experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test.
Results:
After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents.
Conclusions:
There was an increase in knowledge about leprosy.
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ORIGINAL ARTICLE09-16-2019
Development and evaluation of an application for syphilis control
- Rafaela Oliveira de Sales ,
- Lucas Michael Dilts ,
- Raimunda Magalhães da Silva ,
- Christina Cesar Praça Brasil ,
- José Eurico de Vasconcelos Filho
Abstract
ORIGINAL ARTICLEDevelopment and evaluation of an application for syphilis control
Revista Brasileira de Enfermagem. 2019;72(5):1326-1332
DOI 10.1590/0034-7167-2018-0877
- Rafaela Oliveira de Sales ,
- Lucas Michael Dilts ,
- Raimunda Magalhães da Silva ,
- Christina Cesar Praça Brasil ,
- José Eurico de Vasconcelos Filho
Views0See moreABSTRACT
Objective:
to develop and evaluate an application for syphilis control in pregnant women.
Method:
methodological research developed between March and November of 2016 in two phases: bibliographic survey of the years 2012 to 2016 in the databases PubMed, CAPES and Scopus and application development. Eight users participated in the usability test and five doctors and five nurses working in prenatal care participated in the evaluation.
Results:
the application contains informative video, information about the disease, map of health clinics, agenda function and anonymous notification. The evaluation of the objective, function and relevance was considered adequate with value higher than 0.80 in all items of the Content Validity Index.
Final considerations:
the application makes easier the routine of health services in the context of health promotion, in the convocation and treatment of pregnant women and their partners.
- Rafaela Oliveira de Sales
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ORIGINAL ARTICLE03-30-2022
Nursing consultation in the Family Health Strategy and the nurse’s perception: Grounded Theory
- Stella Godoy Silva e Lima ,
- Regina Stella Spagnuolo ,
- Carmen Maria Casquel Monti Juliani ,
- Rosana Maria Barreto Colichi
Abstract
ORIGINAL ARTICLENursing consultation in the Family Health Strategy and the nurse’s perception: Grounded Theory
Revista Brasileira de Enfermagem. 2022;75(4):e20201105
DOI 10.1590/0034-7167-2020-1105
- Stella Godoy Silva e Lima ,
- Regina Stella Spagnuolo ,
- Carmen Maria Casquel Monti Juliani ,
- Rosana Maria Barreto Colichi
Views0See moreABSTRACT
Objectives:
to understand the experience of nurses with nursing consultations in the context of the Family Health Strategy and propose a representative model.
Methods:
qualitative research using Grounded Theory, with 14 nurses working through non-directive interviews. For data analysis, three stages were used: open, axial and selective coding, which originated phenomena, themes, categories and subcategories, which supported the construction of the central category and, consequently, the theoretical model.
Results:
the interrelation of phenomena emerged from the essence of the nurse’s experience, revealing the central category: From nursing education to the practice of Nursing Consultation, unveiling learning, challenges and autonomy as intervening components. Final Considerations: the nurse’s experience is positive and, despite numerous challenges in daily life, the nurse has been performing it based on comprehensive care. New studies may add new understandings that enable the expansion of working conditions, valuing the nursing consultation.
- Stella Godoy Silva e Lima
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ORIGINAL ARTICLE02-10-2020
Resources, objectives and guidelines in a Psychosocial Care Network structure
- Maria do Perpétuo Socorro de Sousa Nóbrega ,
- Gabriela dos Santos Mantovani ,
- Alessandra Matheus Domingos
Abstract
ORIGINAL ARTICLEResources, objectives and guidelines in a Psychosocial Care Network structure
Revista Brasileira de Enfermagem. 2020;73(1):e20170864
DOI 10.1590/0034-7167-2017-0864
- Maria do Perpétuo Socorro de Sousa Nóbrega ,
- Gabriela dos Santos Mantovani ,
- Alessandra Matheus Domingos
Views0See moreABSTRACT
Objective:
to analyze a Psychosocial Care Network structure, based on the compromise of its resources and meeting objectives and guidelines recommended in Ordinance 3,088/2011.
Method:
an empirical, quantitative study with 123 primary care professionals, psychosocial and emergency care, who work at Western Network of the city of São Paulo. Questionnaires and statistical analysis were applied through the Exact Fisher’s test with 5% significance considering p= <0.05.
Results:
there is compromise of physical resources in the absence of mental health beds in a general hospital (p=0.047); of technological resources in the lack of discussion forums (p=0.036); of human resources in number of teams (p=0.258); and of financial resources (p=0.159). Psychosocial care is the one that most meets the objectives and guidelines.
Conclusion:
there are insufficient physical, technological, human, and financial resources for the work articulated in the three care modalities that are heterogeneous in terms of meeting the objectives and guidelines.
- Maria do Perpétuo Socorro de Sousa Nóbrega
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ORIGINAL ARTICLE02-25-2022
Assessment of the attributes of Primary Health Care with women of reproductive age
- Débora Cristina Martins ,
- Giordana Maronezzi da Silva ,
- Giovanna Brichi Pesce ,
- Carlos Alexandre Molena Fernandes
Abstract
ORIGINAL ARTICLEAssessment of the attributes of Primary Health Care with women of reproductive age
Revista Brasileira de Enfermagem. 2022;75(3):e20210015
DOI 10.1590/0034-7167-2021-0015
- Débora Cristina Martins ,
- Giordana Maronezzi da Silva ,
- Giovanna Brichi Pesce ,
- Carlos Alexandre Molena Fernandes
Views0See moreABSTRACT
Objectives:
to evaluate the quality of Primary Health Care attributes according to the characterization and perspective of women of reproductive age.
Methods:
descriptive, quantitative, cross-sectional study, with 397 women of reproductive age from six municipalities in the 16th Health Region of the state of Paraná, with variables for sociodemographic characterization and the Primary Care Assessment Tool (PCATool).
Results:
mean age, 30.43 years old, most were married, 70.2% worked outside the home and 55.5% had completed high school. The highest average score of the eight domains evaluated was “Family Guidance” and “Coordination – Integration of Care”, with averages of 5.86 and 4.89. Domains “Integrality – Services Provided” and “Community Orientation” had lower averages (3.32 and 3.76).
Conclusions:
the study allowed tracing the characterization of the participants and identifying that the attributes of Primary Care are unsatisfactory, making it necessary to expand access to the services offered and to qualify the comprehensive care for women’s health.
- Débora Cristina Martins
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ORIGINAL ARTICLE09-23-2022
Social entrepreneurship in the professional training in Nursing
- Dirce Stein Backes ,
- Juliana Silveira Colomé ,
- Giovana Batistella de Mello ,
- Regina Celia de Castro Gomes ,
- Maria de Lurdes Lopes de Freitas Lomba , [ … ],
- Carla Lizandra de Lima Ferreira
Abstract
ORIGINAL ARTICLESocial entrepreneurship in the professional training in Nursing
Revista Brasileira de Enfermagem. 2022;75(3):e20220391
DOI 10.1590/0034-7167-2021-0391
- Dirce Stein Backes ,
- Juliana Silveira Colomé ,
- Giovana Batistella de Mello ,
- Regina Celia de Castro Gomes ,
- Maria de Lurdes Lopes de Freitas Lomba ,
- Carla Lizandra de Lima Ferreira
Views0See moreABSTRACT
Objectives:
to assess the knowledge and practices that stimulate social entrepreneurship in the professional training of Nursing students.
Methods:
qualitative exploratory-descriptive study carried out with 44 Nursing students from a University in the South Region of Brazil. Data were collected between May and August 2021, through individual online interviews. The participants were students of nursing course in the 6th semester or above, who had previously participated in teaching, research, or university outreach activities on entrepreneurship.
Results:
the data was organized and analyzed according to the thematic analysis technique and resulted in three thematic categories: Meanings of social entrepreneurship, Factors that sparked social entrepreneurship, and Recognizing oneself as an entrepreneurial nurse.
Final Considerations:
the knowledge and practices that stimulate social entrepreneurship in the professional training of Nursing students are associated with teaching, research and university outreach activities that allow concrete experiences in the living and dynamic world of communities.
- Dirce Stein Backes
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