-
ORIGINAL ARTICLE12-08-2024
Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations
Revista Brasileira de Enfermagem. 2024;77(1):e20220773
Abstract
ORIGINAL ARTICLEInitial nipple damages in breastfeeding women: analysis of photographic images and clinical associations
Revista Brasileira de Enfermagem. 2024;77(1):e20220773
DOI 10.1590/0034-7167-2022-0773
Views0See moreABSTRACT
Objective:
to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women.
Methods:
a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied.
Results:
115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area.
Conclusions:
assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
-
ORIGINAL ARTICLE12-08-2024
Safe practices for bed bathing in the intensive care unit: validation of a checklist
- Juliana Cristina Silva
, - Márcia Marques dos Santos Felix ,
- Rosa Helena Aparecida Gonçalves ,
- Isadora Braga Calegari ,
- Maria Beatriz Guimarães Raponi , [ … ],
- Maria Helena Barbosa
Abstract
ORIGINAL ARTICLESafe practices for bed bathing in the intensive care unit: validation of a checklist
Revista Brasileira de Enfermagem. 2024;77(1):e20230135
DOI 10.1590/0034-7167-2023-0135
- Juliana Cristina Silva ,
- Márcia Marques dos Santos Felix ,
- Rosa Helena Aparecida Gonçalves ,
- Isadora Braga Calegari ,
- Maria Beatriz Guimarães Raponi ,
- Maria Helena Barbosa
Views0See moreABSTRACT
Objective:
To validate a checklist for safe bathing in critically ill patients.
Methods:
This is a methodological and quantitative study. Researchers developed a checklist for safe bathing in critically ill patients consisting of 41 items, which were submitted to the apparent and content validation process, evaluated by eleven judges, and interobserver reliability. For reliability analysis, the instrument was applied in 54 bed bath procedures in the ICU; Kappa and CHF tests were used.
Results:
In the apparent and content validation, adjustments were made according to the judges’ suggestions. Kappa values ranged from moderate to almost perfect (0.462 to 0.962), and, in some items, there was 100% agreement; the reliability of the instrument was excellent (ICC = 0.962).
Conclusion:
The instrument proved to be dependable and easy to apply. Its use will contribute to safe bed bathing and subsidize interventions aimed at increasing the quality of care.
- Juliana Cristina Silva
-
REVIEW11-29-2024
Assessment of knowledge in oncology about care for transgender people: a scoping review
- Fernanda Fachetti Xavier de Almeida ,
- Cremilson de Paula Silva ,
- Ricardo Souza Evangelista Sant’Ana ,
- Ruan Nilton Rodrigues Melo
Abstract
REVIEWAssessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
DOI 10.1590/0034-7167-2023-0532
- Fernanda Fachetti Xavier de Almeida ,
- Cremilson de Paula Silva ,
- Ricardo Souza Evangelista Sant’Ana ,
- Ruan Nilton Rodrigues Melo
Views0See moreABSTRACT
Objective:
to identify evidence available in the literature on instruments and methodologies used to assess healthcare professionals’ knowledge about cancer care for the transgender population.
Methods:
a scoping review was conducted in seven databases, including studies that answered the question: what is the healthcare professionals’ level of knowledge about cancer care for the transgender population?
Results:
forty-one articles were selected that dealt specifically with healthcare professionals’knowledge in relation to care for the LGBTQIAPN+ population, especially the transgender population. Eighteen studies assessed patients’ perceptions of professionals’knowledge, whereas other studies used their own assessment tools, considering the global context of LGBTQIAPN+ health.
Conclusions:
there is no tested and validated instrument that assesses the knowledge about the transgender population’s oncological health, highlighting the need to construct and validate an instrument focused on this population’s needs.
- Fernanda Fachetti Xavier de Almeida
-
ORIGINAL ARTICLE11-29-2024
Sleep quality of vulnerable elderly people: associated factors
- Ariene Angelini dos Santos-Orlandi ,
- Ana Carolina Ottaviani ,
- Elén dos Santos Alves ,
- Tábatta Renata Pereira de Brito ,
- Keika Inouye
Abstract
ORIGINAL ARTICLESleep quality of vulnerable elderly people: associated factors
Revista Brasileira de Enfermagem. 2024;77:e20230283
DOI 10.1590/0034-7167-2023-0283
- Ariene Angelini dos Santos-Orlandi ,
- Ana Carolina Ottaviani ,
- Elén dos Santos Alves ,
- Tábatta Renata Pereira de Brito ,
- Keika Inouye
Views0See moreABSTRACT
Objective:
To identify factors associated with poor sleep quality in elderly dependent individuals in social vulnerability.
Method:
Cross-sectional study with 59 elderly dependent individuals assisted by Family Health Units in São Carlos/SP. The following tools were used: Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, Addenbrooke’s Cognitive Examination Revised, Fried’s Frailty Phenotype, Geriatric Depression Scale (15 items), Perceived Stress Scale, Family APGAR, Social Support Scale from the Medical Outcomes Study, and World Health Organization Quality of Life, abbreviated and “old” versions.
Results:
The majority of participants were women (52.5%), aged 60-74 years (71.1%), and had poor sleep quality (76.2%). Stress (OR=1.12; 95%CI=1.02-1.22) and polypharmacy (OR=7.39; 95%CI=1.22-44.73) increased the chances of poor sleep quality, while physical activity decreased these chances (OR=0.15; 95%CI=0.02-0.79).
Conclusion:
Stress and polypharmacy are associated with poor sleep quality in elderly dependent individuals.
- Ariene Angelini dos Santos-Orlandi
-
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
- Maria Isabel Ventura Araújo ,
- Alberto Carlos Marques Duarte ,
- Maria Henriqueta de Jesus Silva Figueiredo ,
- Carmen Maria da Silva Maciel Andrade
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
- Maria Isabel Ventura Araújo ,
- Alberto Carlos Marques Duarte ,
- Maria Henriqueta de Jesus Silva Figueiredo ,
- Carmen Maria da Silva Maciel Andrade
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
- Maria Isabel Ventura Araújo
-
11-22-2024
Social Technology in the Prevention of Adolescent Violence: documentary production
- Daiane de Paulo Paltanin Silva ,
- Laura Christina Macedo ,
- Rafaela Gessner Lourenço ,
- Thammy Novakovski dos Santos
Abstract
Social Technology in the Prevention of Adolescent Violence: documentary production
Revista Brasileira de Enfermagem. 2024;77(5):e20230298
DOI 10.1590/0034-7167-2023-0298
- Daiane de Paulo Paltanin Silva ,
- Laura Christina Macedo ,
- Rafaela Gessner Lourenço ,
- Thammy Novakovski dos Santos
Views0See moreABSTRACT
Objective:
To report the development of a technological innovation in the form of a documentary, aimed at disseminating actions for preventing violence against adolescents within the context of Primary Health Care.
Methods:
The documentary was developed through action research and interventions with adolescents in the territory of a Health Unit, conducted between 2020 and 2022, using Social Technology as both an action strategy and a conceptual reference.
Results:
The Social Technology proposal, created through workshops and seminars, resulted in a documentary focusing on violence prevention, involving 48 adolescents. The documentary’s script, collectively developed, portrays a soccer match between teams symbolizing peace and violence, with peace ultimately prevailing. The documentary is six minutes long.
Final Considerations:
The documentary has proven to be an effective Social Technology tool among adolescents, as it fosters critical thinking, is accessible, has potential for digital dissemination, and appeals to the target audience.
- Daiane de Paulo Paltanin Silva
-
ORIGINAL ARTICLE11-22-2024
Prevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
- Juan Ignacio Calcagno ,
- Sarah Iribarren ,
- Cristiane Flora Villarreal ,
- Patricia Santos de Oliveira ,
- Amado Nizarala de Ávila
Abstract
ORIGINAL ARTICLEPrevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
DOI 10.1590/0034-7167-2023-0327
- Juan Ignacio Calcagno ,
- Sarah Iribarren ,
- Cristiane Flora Villarreal ,
- Patricia Santos de Oliveira ,
- Amado Nizarala de Ávila
Views0See moreABSTRACT
Objectives:
to assess pain management during labor.
Methods:
a cross-sectional study was carried out by reviewing medical records and conducting postpartum interviews. Prevalence and effectiveness of analgesia were assessed.
Results:
the prevalence of non-pharmacological analgesia was 61.86% of 215 women in labor in Obstetric Center and 82.51% of 62 in midwife-led unit. Prevalence of severe pain, on the Visual Analogue Scale, before and after non-pharmacological analgesia, was from 92.16% to 64.04% (p=0.00) in Obstetric Center and from 85.96% to 52.63% (p=0.01) in midwife-led unit. Prevalence of pharmacological analgesia in Obstetric Centers was 15.81%, with no variation in severe pain (p=0.57). Patients’ request for analgesia was associated with education (p=0.00) and pain intensity (p=0.02).
Conclusions:
non-pharmacological analgesia improved pain intensity. Prevalence of pharmacological analgesic prescription was lower than that identified in developed countries. Pain management needs to consider the preferences and needs of women in labor.
- Juan Ignacio Calcagno
-
ORIGINAL ARTICLE11-22-2024
Perceptions from people with physical disabilities about accessibility and social conditions: interventions for rehabilitation nursing
- Rute Salomé da Silva Pereira ,
- Salomé Sobral Sousa ,
- Maria Manuela Martins ,
- Wiliam César Alves Machado ,
- Soraia Dornelles Schoeller
Abstract
ORIGINAL ARTICLEPerceptions from people with physical disabilities about accessibility and social conditions: interventions for rehabilitation nursing
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
- Rute Salomé da Silva Pereira ,
- Salomé Sobral Sousa ,
- Maria Manuela Martins ,
- Wiliam César Alves Machado ,
- Soraia Dornelles Schoeller
Views0ABSTRACT
Objectives:
to analyze the experiences of people with acquired physical disabilities regarding accessibility and social conditions; to identify nurse-led rehabilitation interventions for accessibility and social conditions; to determine nursing-sensitive indicators to improve accessibility and social conditions.
Methods:
a descriptive-exploratory qualitative study employed semi-structured interviews with people with acquired physical disabilities through purposive snowball sampling to address all objectives. Data analysis followed Bardin’s content analysis principles. Furthermore, objectives 2 and 3 were achieved through a reflective theoretical approach.
Results:
the 27 participants reported accessibility challenges, impacting activities of living and social conditions. This influences rehabilitation nursing, leading to three intervention fields: Assess the ability to perform activities of living and influencing factors; Develop and implement training to perform activities of living; Promote mobility, accessibility, and social participation.
Final Considerations:
based on participants experiences, we identified nurse-led rehabilitation interventions to promote accessibility and social conditions.
Keywords:Architectural AccessibilityPeople with DisabilitiesRehabilitation NursingSocial ConditionsSustainable Development GoalsSee more
- Rute Salomé da Silva Pereira
-
09-16-2019
Socioeconomic factors related to leprosy: an integrative literature review
- Heloisy Alves de Medeiros Leano ,
- Kleane Maria da Fonseca Azevedo Araújo ,
- Isabela de Caux Bueno ,
- Eyleen Nabyla Alvarenga Niitsuma ,
- Francisco Carlos Félix Lana
Abstract
Socioeconomic factors related to leprosy: an integrative literature review
Revista Brasileira de Enfermagem. 2019;72(5):1405-1415
DOI 10.1590/0034-7167-2017-0651
- Heloisy Alves de Medeiros Leano ,
- Kleane Maria da Fonseca Azevedo Araújo ,
- Isabela de Caux Bueno ,
- Eyleen Nabyla Alvarenga Niitsuma ,
- Francisco Carlos Félix Lana
Views0See moreABSTRACT
Objective:
To investigate in the literature the relation of socioeconomic factors in the incidence of the disease and other outcomes related to leprosy.
Method:
Integrative review conducted in Lilacs, Medline, Scopus databases and SciELO online library with studies from 2000 to 2016.
Results:
32 studies were included. Only studies that analyzed statistical associations of socioeconomic factors and outcomes related to leprosy were selected.
Conclusion:
Leprosy is greatly affected by the social context in which the patient is inserted, the chances of exposure to illness are the result of a set of not only individual aspects, but also of contexts or collective conditions. It is imperative for Nursing, as an essential part of the multiprofessional team entrusted with the care and surveillance of the disease, to recognize these factors to predict unfavorable outcomes and to develop new practices capable of reducing inequities.
- Heloisy Alves de Medeiros Leano
-
ORIGINAL ARTICLE06-27-2019
Literacy in health and self-care in people with type 2 diabetes mellitus
- Nádya dos Santos Moura ,
- Bárbara Brandão Lopes ,
- João Joadson Duarte Teixeira ,
- Mônica Oliveira Batista Oriá ,
- Neiva Francenely Cunha Vieira , [ … ],
- Maria Vilani Cavalcante Guedes
Abstract
ORIGINAL ARTICLELiteracy in health and self-care in people with type 2 diabetes mellitus
Revista Brasileira de Enfermagem. 2019;72(3):700-706
DOI 10.1590/0034-7167-2018-0291
- Nádya dos Santos Moura ,
- Bárbara Brandão Lopes ,
- João Joadson Duarte Teixeira ,
- Mônica Oliveira Batista Oriá ,
- Neiva Francenely Cunha Vieira ,
- Maria Vilani Cavalcante Guedes
Views0See moreABSTRACT
Objective:
To evaluate the effect of educational intervention in the adherence to self-care activities and functional health literacy and numeracy in people with type 2 diabetes mellitus.
Methods:
This was a quasi-experimental study conducted in two units of the Brazilian Family Health Strategy, involving people with diabetes. Educational interventions occurred in three meetings, weekly, lasting 60 minutes on average. Data were collected using the Questionário de Autocuidado com o Diabetes, before and after the interventions.
Results:
55 people participated in the study. After the interventions, the greatest difference for a better adherence to self-care was the item “inspecting the inside of the shoes before putting them on”, with 3.29 days in the week delta at analytical level. The worst was “taking insulin shots as recommended”, with 0.00 days a week delta at basic level.
Conclusion:
Educational interventions had a positive effect on adherence to self-care and functional literacy in health.
- Nádya dos Santos Moura
-
08-19-2019
Qualitative research in health: a reflective approach
- Ellen Synthia Fernandes de Oliveira ,
- Cristina Lavareda Baixinho ,
- Maria Helena Carvalho Valente Presado
Abstract
Qualitative research in health: a reflective approach
Revista Brasileira de Enfermagem. 2019;72(4):830-831
DOI 10.1590/0034-7167.2019-720401
- Ellen Synthia Fernandes de Oliveira ,
- Cristina Lavareda Baixinho ,
- Maria Helena Carvalho Valente Presado
Views0Qualitative research makes possible the development of health knowledge, because it works with complex phenomena whose totality, besides depth, depends on the intensity. For Minayo, the objective of the qualitative research is to make explicit data, indicators, verified trends and/or construct theoretical models applicable to practice. Therefore, its purpose is to study history, representations, relationships, […]See more - Ellen Synthia Fernandes de Oliveira
-
ORIGINAL ARTICLE12-05-2019
Occurrence of violence in the elderly and its associated factors
- Paulo Henrique Silva Maia ,
- Efigênia Ferreira e Ferreira ,
- Elza Machado de Melo ,
- Andréa Maria Duarte Vargas
Abstract
ORIGINAL ARTICLEOccurrence of violence in the elderly and its associated factors
Revista Brasileira de Enfermagem. 2019;72:64-70
DOI 10.1590/0034-7167-2018-0014
- Paulo Henrique Silva Maia ,
- Efigênia Ferreira e Ferreira ,
- Elza Machado de Melo ,
- Andréa Maria Duarte Vargas
Views0See moreABSTRACT
Objective:
to analyze the occurrence of violence in the elderly and its associated factors in the city of Betim, Minas Gerais.
Method:
cross-sectional study constituted by a population survey conducted through structured interviews. The sample was stratified by clusters and included 178 elderly people at the end. Data were analyzed by the chi-square test and was performed a Correspondence Analysis.
Results:
The most prevalent forms of violence were: lack of access to social rights (31%), verbal violence (22%), moral/psychological (19%), lack of care (16%), physical violence (6%), sexual (3%) and discrimination (3%). Women suffered more abuse than men and violence had greater association with the degree of depressive symptoms.
Conclusion:
our research has direct implication for the sectors interested in coping with violence in the elderly, especially for nurses, because it shows violence is part of a cycle with characteristic associated factors that conforms a model nested mainly in the family relationship.
- Paulo Henrique Silva Maia
-
REFLECTION07-01-2020
How to translate scientific knowledge into practice? Concepts, models and application
Revista Brasileira de Enfermagem. 2020;73(5):e20190179
Abstract
REFLECTIONHow to translate scientific knowledge into practice? Concepts, models and application
Revista Brasileira de Enfermagem. 2020;73(5):e20190179
DOI 10.1590/0034-7167-2019-0179
Views0See moreABSTRACT
Objectives:
to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle.
Results:
we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination.
Conclusions:
in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders.
-
REVIEW04-22-2020
Polycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers
- Helenize Ferreira Lima Leachi ,
- Maria Helena Palucci Marziale ,
- Júlia Trevisan Martins ,
- Patricia Aroni ,
- Maria José Quina Galdino , [ … ],
- Renata Perfeito Ribeiro
Abstract
REVIEWPolycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers
Revista Brasileira de Enfermagem. 2020;73(3):e20180965
DOI 10.1590/0034-7167-2018-0965
- Helenize Ferreira Lima Leachi ,
- Maria Helena Palucci Marziale ,
- Júlia Trevisan Martins ,
- Patricia Aroni ,
- Maria José Quina Galdino ,
- Renata Perfeito Ribeiro
Views0See moreABSTRACT
Objectives:
to identify the scientific evidence on the development of cardiovascular and respiratory diseases due to workplace contamination by polycyclic aromatic hydrocarbons.
Methods:
integrative literature review. The search for primary articles was held in October 2017 in the Medical Literature Analysis and Retrieval System Online (through Pubmed), Web of Science and Latin American and Caribbean Literature in Health Sciences (LILACS).
Results:
the 16 studies analyzed showed that exposure to polycyclic aromatic hydrocarbons was associated with cardiovascular diseases, such as increased blood pressure, heart rate variation, and ischemic heart disease; and respiratory disorders, such as decreased lung function, chronic obstructive pulmonary disease, asthma, wheeze, coughing, pulmonary wheezing, chest tightness, effort dyspnea, and sore throat.
Conclusions:
polycyclic aromatic hydrocarbons cause deleterious effects on the cardiovascular and respiratory systems through mutations and cellular inflammation, being a risk to exposed individuals.
- Helenize Ferreira Lima Leachi
-
ORIGINAL ARTICLE02-17-2020
Occupational stress in nursing professionals of a university hospital
Revista Brasileira de Enfermagem. 2020;73(2):e20180997
Abstract
ORIGINAL ARTICLEOccupational stress in nursing professionals of a university hospital
Revista Brasileira de Enfermagem. 2020;73(2):e20180997
DOI 10.1590/0034-7167-2018-0997
Views0See moreABSTRACT
Objectives:
To identify the presence of occupational stress in nursing professionals of a university hospital in the inlands of the state of Minas Gerais and examine influence of sociodemographic and occupational characteristics in this disease.
Methods:
Cross-sectional, exploratory and quantitative study with 124 professional nurses from a university hospital in the inlands of the state of Minas Gerais. The adapted and validated Portuguese version of the Job Stress Scale (JSS) was used for the performance of the study.
Results:
Most professionals were women (87.9%) with a mean age of 40.2 years, 80.6% were nursing technicians and 71.8% of the sample had some degree of exposure to occupational stress.
Conclusions:
The occupational stress index was higher than that observed in previous studies. Data obtained in the study point to the need to implement institutional measures for the prevention of occupational stress, especially by strengthening social support at work.
-
ORIGINAL ARTICLE07-08-2020
Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke
- Naiana Oliveira dos Santos ,
- Mariane Lurdes Predebon ,
- Carla Cristiane Becker Kottwitz Bierhals ,
- Carolina Baltar Day ,
- Diani de Oliveira Machado , [ … ],
- Lisiane Manganelli Girardi Paskulin
Abstract
ORIGINAL ARTICLEDevelopment and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke
Revista Brasileira de Enfermagem. 2020;73:e20180894
DOI 10.1590/0034-7167-2018-0894
- Naiana Oliveira dos Santos ,
- Mariane Lurdes Predebon ,
- Carla Cristiane Becker Kottwitz Bierhals ,
- Carolina Baltar Day ,
- Diani de Oliveira Machado ,
- Lisiane Manganelli Girardi Paskulin
Views0See moreABSTRACT
Objective:
development and validation the content of a nursing care protocol with educational interventions for family caregivers of elderly people after stroke.
Methods:
a methodological study conducted in three stages: (1) protocol development through literature review; (2) pretest with multidisciplinary team, analyzed with literature articulation; (3) protocol validation by the Delphi Technique.
Results:
the protocol was structured in the following areas: Disease Guidelines; Emotional Support; Using the Health Care Network; Diet; Airways; Medications; Hygiene; Skin Care; Disposal; Dressing/Undressing; Positioning and Transfer; Fall Prevention. In the pretest, eight experts assessed protocol clarity and content. In validation, there were two rounds by the Delphi Technique. The validated protocol consisted of 12 domains, containing 42 items and 240 care guidelines.
Conclusion:
the protocol qualifies the transition of care after hospital discharge assisting nurses in home care practice.
- Naiana Oliveira dos Santos
Search
Search in:
Nuvem de Tags
Adolescente (85) Atenção Primária à Saúde (239) COVID-19 (91) Criança (91) Cuidados de Enfermagem (269) Educação em Enfermagem (151) Educação em Saúde (139) Enfermagem (930) Enfermagem Pediátrica (86) Estudantes de Enfermagem (77) Estudos de Validação (131) Família (87) Idoso (208) Promoção da Saúde (99) Qualidade de Vida (104) Saúde do Trabalhador (86) Saúde Mental (145) Saúde Pública (82) Segurança do Paciente (150) Tecnologia Educacional (100)