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ORIGINAL ARTICLE05-13-2024
Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health
- Marta Cossetin Costa
, - Maria de Fátima Mantovani ,
- Fernanda Moura D’Almeida Miranda ,
- Ivonete Teresinha Schülter Buss Heidemann ,
- Aida Maris Peres
Abstract
ORIGINAL ARTICLEGeneralized Resistance Deficits in inmates with hypertension: missing resources that limit health
Revista Brasileira de Enfermagem. 2024;77(2):e20230246
DOI 10.1590/0034-7167-2023-0246
- Marta Cossetin Costa ,
- Maria de Fátima Mantovani ,
- Fernanda Moura D’Almeida Miranda ,
- Ivonete Teresinha Schülter Buss Heidemann ,
- Aida Maris Peres
Views0See moreABSTRACT
Objective:
to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit.
Method:
qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison.
Results:
13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole.
Final considerations:
knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.
- Marta Cossetin Costa
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REVIEW05-13-2024
Lean methodology: contributions to improving work processes in health and nursing
- Fernanda Novaes Moreno Brancalion ,
- Lara Gonçalves de Souza ,
- Simone Berger ,
- Antônio Fernandes Costa Lima
Abstract
REVIEWLean methodology: contributions to improving work processes in health and nursing
Revista Brasileira de Enfermagem. 2024;77(2):e20230322
DOI 10.1590/0034-7167-2023-0322
- Fernanda Novaes Moreno Brancalion ,
- Lara Gonçalves de Souza ,
- Simone Berger ,
- Antônio Fernandes Costa Lima
Views0See moreABSTRACT
Objective:
to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects.
Method:
an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively.
Results:
the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod.
Conclusion:
three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.
- Fernanda Novaes Moreno Brancalion
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REVIEW05-13-2024
Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
Abstract
REVIEWStunting predictors among children aged 0-24 months in Southeast Asia: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
DOI 10.1590/0034-7167-2022-0625
Views0See moreABSTRACT
Objective:
To identify predictors of stunting among children 0-24 months in Southeast Asia.
Methods:
This scoping review focused on articles with observational study design in English published from 2012 to 2023 from five international databases. The primary keyword used were: “stunting” OR “growth disorder” AND “newborn” AND “predict” AND “Southeast Asia”.
Results:
Of the 27 articles selected for the final analysis there are thirteen predictors of stunting in seven Southeast Asia countries. The thirteen predictors include the child, mother, home, inadequate complementary feeding, inadequate breastfeeding, inadequate care, poor quality foods, food and water safety, infection, political economy, health and healthcare, water, sanitation, and environment, and social culture factor.
Conclusion:
All these predictors can lead to stunting in Southeast Asia. To prevent it, health service providers and other related sectors need to carry out health promotion and health prevention according to the predictors found.
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05-13-2024
A influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
A influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreRESUMEN
Objetivos:
describir el perfil de los ancianos que acceden a internet para buscar información de salud e identificar los factores que pueden influir en las decisiones de los ancianos sobre su salud a partir de la información recopilada en línea.
Métodos:
391 ancianos respondieron a un cuestionario online sobre hábitos y satisfacción con la información de salud recogida en internet. El procesamiento de datos implicó regresión logística.
Resultados:
la educación superior reduce en un 44% la probabilidad de que un anciano siga las recomendaciones de salud en los sitios web. Sin embargo, las actividades sociales y la salud autopercibida aumentan la posibilidad de seguir las recomendaciones en un 83% y un 71%, respectivamente. La creencia de que internet promueve hábitos saludables aumenta 29,2 veces la probabilidad de que un anciano siga un consejo.
Consideraciones Finales:
conocer el perfil de los ancianos que utilizan internet puede ayudar a los profesionales a formular políticas públicas y construir buenas plataformas de información sobre salud y bienestar.
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ORIGINAL ARTICLE05-13-2024
The influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
ORIGINAL ARTICLEThe influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreABSTRACT
Objectives:
to describe the profile of older adults who access the internet to search for health information and identify the factors that can influence older adults’ decisions about their health based on information collected online.
Methods:
391 older adults answered an online questionnaire regarding habits and satisfaction with information about health collected on the internet. Data processing involved Logistic Regression.
Results:
higher education reduces by 44% the likelihood of an older adult following the health recommendations on internet sites. However, social activities and self-perceived health increase the possibility of following the recommendations by 83% and 71%, respectively. The belief that the internet promotes healthy habits increases by 29.2 times the probability of an older adult following the advice.
Final Considerations:
knowing the profile of older adults who use the Internet can help professionals formulate public policies and build good information platforms on health and well-being.
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REVIEW05-13-2024
Technologies used in the treatment of burn victims in intensive care: a scope review
- Kyohana Matos de Freitas Clementino ,
- Gabriela Duarte Bezerra ,
- Gleice Adriana Araujo Gonçalves ,
- Maria Corina Amaral Viana ,
- Luis Rafael Leite Sampaio , [ … ],
- Woneska Rodrigues Pinheiro
Abstract
REVIEWTechnologies used in the treatment of burn victims in intensive care: a scope review
Revista Brasileira de Enfermagem. 2024;77(1):e20220738
DOI 10.1590/0034-7167-2022-0738
- Kyohana Matos de Freitas Clementino ,
- Gabriela Duarte Bezerra ,
- Gleice Adriana Araujo Gonçalves ,
- Maria Corina Amaral Viana ,
- Luis Rafael Leite Sampaio ,
- Woneska Rodrigues Pinheiro
Views0See moreABSTRACT
Objectives:
to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care.
Methods:
this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions.
Results:
the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control.
Final Considerations:
the study identified essential technologies in burn care, emphasizing the need for further research on “soft” technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.
- Kyohana Matos de Freitas Clementino
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ORIGINAL ARTICLE05-03-2024
What is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians?
- Danielle Samara Tavares de Oliveira-Figueiredo ,
- Matteus Pio Gianotti Pereira Cruz Silva ,
- Paula Yhasmym de Oliveira Feitosa ,
- Bruna Cardoso Leite ,
- Fabiana Lucena Rocha , [ … ],
- Luciana Dantas Farias de Andrade
Abstract
ORIGINAL ARTICLEWhat is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians?
Revista Brasileira de Enfermagem. 2024;77(1):e20220809
DOI 10.1590/0034-7167-2022-0809
- Danielle Samara Tavares de Oliveira-Figueiredo ,
- Matteus Pio Gianotti Pereira Cruz Silva ,
- Paula Yhasmym de Oliveira Feitosa ,
- Bruna Cardoso Leite ,
- Fabiana Lucena Rocha ,
- Luciana Dantas Farias de Andrade
Views0See moreABSTRACT
Objective:
To estimate the prevalence of multimorbidity in elderly people and its association with sociodemographic characteristics, lifestyle, and anthropometry.
Methods:
This was a cross-sectional study using data from the National Health Survey, 2019. A total of 22,728 elderly individuals from all 27 Brazilian states were randomly selected. Poisson regression models with robust variance were employed, and a significance level of 5% was adopted.
Results:
The prevalence of multimorbidity was 51.6% (95% CI: 50.4-52.7), with the highest estimates observed in the South and Southeast. Multimorbidity was associated with being female (aPR = 1.33; 95% CI: 1.27-1.39), being 80 years old or older (aPR = 1.12; 95% CI: 1.05-1.19), having low education (aPR = 1.16; 95% CI: 1.07-1.25), past cigarette use (aPR = 1.16; 95% CI: 1.11-1.21), insufficient physical activity (aPR = 1.13; 95% CI: 1.06-1.21), and screen use for 3 hours or more per day (aPR = 1.13; 95% CI: 1.08-1.18).
Conclusion:
Multimorbidity affects more than half of the elderly population in Brazil and is associated with social, demographic, and behavioral factors.
- Danielle Samara Tavares de Oliveira-Figueiredo
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ORIGINAL ARTICLE05-03-2024
Cancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25
Revista Brasileira de Enfermagem. 2024;77(1):e20230358
Abstract
ORIGINAL ARTICLECancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25
Revista Brasileira de Enfermagem. 2024;77(1):e20230358
DOI 10.1590/0034-7167-2023-0358
Views0See moreABSTRACT
Objectives:
to psychometrically validate the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-INFO25 instrument and identify the domains that influence patients’ perception of the information received.
Methods:
a cross-sectional methodology with cancer patients in a Brazilian philanthropic hospital institution. Sociodemographic and clinical instruments, EORTC QLQ-C30, EORTC QLQ-INFO25 and Supportive Care Needs Survey – Short Form 34 were used. Analysis occurred using Cronbach’s alpha coefficients, intraclass correlation, test-retest and exploratory factor analysis.
Results:
128 respondents participated. Cronbach’s alpha coefficient was 0.85. The test-retest obtained p-value=0.21. In the factor analysis, one item was excluded. Satisfaction with the information received was 74%, with three areas with averages below 70%. In open-ended questions, there was a greater desire for information.
Conclusions:
validity evidence was obtained with instrument reliability, consistency and stability. Respondents expressed satisfaction with the information received.
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REVIEW07-10-2020
Acute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review
- Matheus Santos Moitinho ,
- Angélica Gonçalves da Silva Belasco ,
- Dulce Aparecida Barbosa ,
- Cassiane Dezoti da Fonseca
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
- Matheus Santos Moitinho ,
- Angélica Gonçalves da Silva Belasco ,
- Dulce Aparecida Barbosa ,
- Cassiane Dezoti da Fonseca
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.
- Matheus Santos Moitinho
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ORIGINAL ARTICLE03-24-2021
Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists
- Angélica Olivetto de Almeida ,
- Sônia Regina Pérez Evangelista Dantas ,
- Maria Angela Boccara de Paula ,
- Juliany Lino Gomes Silva ,
- Ednalda Maria Franck , [ … ],
- Ana Railka de Souza Oliveira-Kumakura
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
- Angélica Olivetto de Almeida ,
- Sônia Regina Pérez Evangelista Dantas ,
- Maria Angela Boccara de Paula ,
- Juliany Lino Gomes Silva ,
- Ednalda Maria Franck ,
- Ana Railka de Souza Oliveira-Kumakura
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.
- Angélica Olivetto de Almeida
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ORIGINAL ARTICLE07-15-2020
Cultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil
- Fernanda Garcia Bezerra Góes ,
- Beatriz Cabral Ledo ,
- Andressa Silva Torres dos Santos ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Aline Cerqueira Santos Santana da Silva , [ … ],
- Marialda Moreira Christoffel
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
- Fernanda Garcia Bezerra Góes ,
- Beatriz Cabral Ledo ,
- Andressa Silva Torres dos Santos ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Aline Cerqueira Santos Santana da Silva ,
- Marialda Moreira Christoffel
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.
- Fernanda Garcia Bezerra Góes
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ORIGINAL ARTICLE03-30-2020
Parental care for infants with feeding tube: psychosocial repercussions
- Fábio Luiz Banhara ,
- Francely Tineli Farinha ,
- Gesiane Cristina Bom ,
- Ana Paula Ribeiro Razera ,
- Maria de Lourdes Merighi Tabaquim , [ … ],
- Armando dos Santos Trettene
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
- Fábio Luiz Banhara ,
- Francely Tineli Farinha ,
- Gesiane Cristina Bom ,
- Ana Paula Ribeiro Razera ,
- Maria de Lourdes Merighi Tabaquim ,
- Armando dos Santos Trettene
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.
- Fábio Luiz Banhara
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ORIGINAL ARTICLE03-30-2020
Stomized children care practices: narratives of relatives
- Manuela Costa Melo ,
- Bárbara Natália Ferreira Vilas-Boas ,
- Brenda Limeira Martins ,
- Allan Willis Albernáz Vasconcellos ,
- Ivone Kamada
Abstract
ORIGINAL ARTICLEStomized children care practices: narratives of relatives
Revista Brasileira de Enfermagem. 2020;73(2):e20180370
DOI 10.1590/0034-7167-2018-0370
- Manuela Costa Melo ,
- Bárbara Natália Ferreira Vilas-Boas ,
- Brenda Limeira Martins ,
- Allan Willis Albernáz Vasconcellos ,
- Ivone Kamada
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.
- Manuela Costa Melo
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ORIGINAL ARTICLE06-16-2021
Family interview for organ and tissue donation: good practice assumptions
- Neide da Silva Knhis ,
- Sabrina Regina Martins ,
- Aline Lima Pestana Magalhães ,
- Saulo Fábio Ramos ,
- Camila Telemberg Sell , [ … ],
- Laura Calvacanti de Farias Brehmer
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
- Neide da Silva Knhis ,
- Sabrina Regina Martins ,
- Aline Lima Pestana Magalhães ,
- Saulo Fábio Ramos ,
- Camila Telemberg Sell ,
- Clarice Koerich ,
- Laura Calvacanti de Farias Brehmer
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.
- Neide da Silva Knhis
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ORIGINAL ARTICLE12-13-2019
Perception of women with breast cancer undergoing chemotherapy: a comprehensive analysis
- Marlise Barros de Medeiros ,
- Rose Mary Costa Rosa Andrade Silva ,
- Eliane Ramos Pereira ,
- Sérgio Henrique da Silva Melo ,
- Fabiana Lopes Joaquim , [ … ],
- Ticiane Roberta Pinto Goés
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
- Marlise Barros de Medeiros ,
- Rose Mary Costa Rosa Andrade Silva ,
- Eliane Ramos Pereira ,
- Sérgio Henrique da Silva Melo ,
- Fabiana Lopes Joaquim ,
- Bianca Marques dos Santos ,
- Ticiane Roberta Pinto Goés
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.
- Marlise Barros de Medeiros
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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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