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Older adults abuse in three Brazilian cities
Revista Brasileira de Enfermagem. 2017;70(4):783-791
Abstract
Older adults abuse in three Brazilian cities
Revista Brasileira de Enfermagem. 2017;70(4):783-791
DOI 10.1590/0034-7167-2017-0114
Views0See moreABSTRACT
Objective:
To analyze the police reports filed by older adults who suffered abuse in order to identify the socio-demographic characteristics of victims and aggressors, type of violence, location, as well as to compare rates in three Brazilian cities in the period from 2009 to 2013.
Method:
Ecological study, in which 2,612 police reports registered in Police Stations were analyzed. An instrument was used to obtain data from the victim, the aggressor and the type of violence.
Results:
Psychological abuse predominated and most cases occurred in the older adults own home. In the cities of Ribeirão Preto and João Pessoa, the older adults presented similar rates for both gender. Regarding the standardized rates, in João Pessoa, there was a rise of this type of abuse in the two first years, and later there was a certain stability. In the city of Teresina, there was an increase, also observed in the city of Ribeirão Preto in the three first years, followed by a decrease.
Conclusion:
Older adults abuse is a cultural phenomenon difficult to be reported by them, since it occurs in the family context.
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Validation of educational booklet for HIV/Aids prevention in older adults
Revista Brasileira de Enfermagem. 2017;70(4):775-782
Abstract
Validation of educational booklet for HIV/Aids prevention in older adults
Revista Brasileira de Enfermagem. 2017;70(4):775-782
DOI 10.1590/0034-7167-2017-0145
Views0See moreABSTRACT
Objective:
To describe the process of manufacturing and validation of an educational booklet for HIV/Aids prevention in older adults
Methods:
Methodological study developed in two phases – manufacturing of the booklet and validation of the educational material by judges. The manufacturing process involved a situational diagnosis with older adults, and its result indicated gaps in the knowledge with respect to HIV/Aids. The validation process was performed by nine judges, selected by convenience. It was considered an agreement index of at least 0.80, analyzed through the content validity index.
Results:
We opted for a dialogue between two older adults divided into three categories: myths and taboos; ignorance; and prevention and importance of diagnosis. The average of the items was 0.90. The suggestions made by the judges were observed and modified for the final version.
Conclusion:
The material had relevant content for the judges, in addition to being able to be used by health professionals in the education and clarification of issues on the subject.
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Association between filial responsibility when caring for parents and the caregivers overload
Revista Brasileira de Enfermagem. 2017;70(4):767-774
Abstract
Association between filial responsibility when caring for parents and the caregivers overload
Revista Brasileira de Enfermagem. 2017;70(4):767-774
DOI 10.1590/0034-7167-2017-0133
Views0See moreABSTRACT
Objective:
To analyze the association between filial responsibility and the overload of the children when caring for their older parents.
Method:
Cross-sectional study with 100 caregiver children of older adults. Filial liability was assessed by the attitudes of the responsible child (scale of expectation and filial duty) and by care behaviors (assistance in activities of daily living, emotional and financial support, and keeping company). The overload was assessed by the Caregiver Burden Inventory. To assess the associations, the correlation coefficients of Pearson and Spearman, Kruskal-Wallis Test, and Mann-Whitney were employed. Variables that presented p-value<0.20 in the bivariate analysis were inserted in a multivariate linear regression model.
Results:
The factors associated with overload were: formal employment (p=0.002), feelings regarding family life (p<0.001), financial support (p=0.027), and assistance with Activities of Daily Living (ADLs) (p<0.001).
Conclusion:
Children who were more involved with the ADLs and provided financial support showed higher levels of overload.
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Religiosity and spirituality as resilience strategies among long-living older adults in their daily lives
Revista Brasileira de Enfermagem. 2017;70(4):761-766
Abstract
Religiosity and spirituality as resilience strategies among long-living older adults in their daily lives
Revista Brasileira de Enfermagem. 2017;70(4):761-766
DOI 10.1590/0034-7167-2016-0630
Views0See moreABSTRACT
Objective:
to investigate religiosity and spirituality as a resilience strategy for the long-living older adults in their daily lives.
Method:
Qualitative research of phenomenological approach based on Martin Heidegger thoughts. Interviews were conducted with 14 older adults registered at a family health unit in the city of Jequié, BA, Brazil. The data were analyzed in the light of Being and Time.
Results:
The results revealed that God occupies a central position in their lives, and the reading of the bible, praying the rosary and prayers are resilience strategies used for coping with unfavorable situations, recovery and/or maintenance of health, personal and family protection, and, above all, the experience of a satisfactory aging.
Final considerations:
Religiosity and spirituality were presented as an important resilience strategy in the existence of older adults, showing that through them it is possible to achieve well-being and cope with health and social problems.
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Family of older adults with mental disorder: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(4):753-760
Abstract
Family of older adults with mental disorder: perception of mental health professionals
Revista Brasileira de Enfermagem. 2017;70(4):753-760
DOI 10.1590/0034-7167-2016-0646
Views0ABSTRACT
Objective:
to understand the perceptions of healthcare professionals of the Psychosocial Care Centers regarding the family of older adults with mental disorders.
Method:
study of a Qualitative Case conducted with 12 healthcare professionals from a Psychosocial Care Center, with a convenient and exhaustive sample. Conducting semi-structured interviews to collect data, which were analyzed with the Content Analysis technique.
Results:
the following categories stood out: “Family exhaustion and deterioration in the perception of the healthcare professional” and “The abandonment of older adults by family members and their distancing in the perception of the healthcare professional.”
Final considerations:
culpability of older adults and penalization of the family were verified by healthcare professionals. To bring awareness about the difficulties faced in the attempt to bring the family closer to the healthcare service, it is necessary to analyze the care given to the older adult and to overcome challenges in the effective construction of the bond between family, healthcare user and mental health service.
Keywords:Community PsychiatryFrail Older AdultsGeriatric PsychiatryOlder adultsProfessional-Family RelationshipSee more -
Frailty in the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2017;70(4):747-752
Abstract
Frailty in the elderly: prevalence and associated factors
Revista Brasileira de Enfermagem. 2017;70(4):747-752
DOI 10.1590/0034-7167-2016-0633
Views0See moreABSTRACT
Objective:
to know the prevalence and factors associated with frailty in elderly assisted by the Centro Mais Vida de Referência em Assistência à Saúde do Idoso (Mais Vida Health Reference Center for the Elderly) in the North of Minas Gerais, Brazil.
Method:
cross-sectional study, with sampling by convenience. Data collection occurred in 2015. Demographic and socioeconomic variables, morbidities, use of health services and the score of the Edmonton Frail Scale were analyzed. The adjusted prevalence ratios were obtained by multiple analysis of Poisson regression with robust variance.
Results:
360 elderly aged 65 or older were evaluated. Frailty prevalence was 47.2%. The variables associated with frailty were the following: advanced age elderly, who live without a partner, have a caregiver, present depressive symptoms, osteoarticular disease, as well as history of hospitalization and falls in the last twelve months.
Conclusion:
knowledge of factors associated with frailty allows development of health actions aimed at the elderly.
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Falls in long-term care institutions for elderly people: protocol validation
Revista Brasileira de Enfermagem. 2017;70(4):740-746
Abstract
Falls in long-term care institutions for elderly people: protocol validation
Revista Brasileira de Enfermagem. 2017;70(4):740-746
DOI 10.1590/0034-7167-2017-0109
Views1See moreABSTRACT
Objectives:
To validate the content of a fall management risk protocol in long-term institutions for elderly people.
Methods:
Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria.
Results:
The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item.
Conclusion:
The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people.
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Deaths among the elderly with ICU infections
Revista Brasileira de Enfermagem. 2017;70(4):733-739
Abstract
Deaths among the elderly with ICU infections
Revista Brasileira de Enfermagem. 2017;70(4):733-739
DOI 10.1590/0034-7167-2016-0611
Views0See moreABSTRACT
Objective:
to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the findings with sociodemographic and clinical variables.
Method:
descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed.
Results:
a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on.
Conclusion:
the clinical outcome of the elderly who acquire infection in the intensive care unit is influenced by sociodemographic and clinical variables that increase mortality rates.
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ORIGINAL ARTICLE11-22-2024
Safe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
Abstract
ORIGINAL ARTICLESafe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
DOI 10.1590/0034-7167-2024-0172
Views0ABSTRACT
Objectives:
to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals.
Methods:
this methodological study was developed according to Falkembach’s theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution.
Results:
content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic.
Conclusions:
the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.
Keywords:Antineoplastic AgentsEducational TechnologyExtravasation of Diagnostic and Therapeutic MaterialsInstructional Film and VideoNursingSee more -
REVIEW11-22-2024
Telenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
Abstract
REVIEWTelenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
DOI 10.1590/0034-7167-2024-0093
Views1See moreABSTRACT
Objective:
to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic.
Methods:
an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out.
Results:
the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario.
Final considerations:
through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary.
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Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
Abstract
Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
Views0RESUMEN
Objetivos:
analizar las experiencias de personas con discapacidad física adquirida en cuanto a accesibilidad y condiciones sociales; identificar intervenciones de rehabilitación dirigidas por enfermeras para la accesibilidad y condiciones sociales; determinar indicadores sensibles a la enfermería para mejorar la accesibilidad y condiciones sociales.
Métodos:
estudio cualitativo descriptivo-exploratorio utilizó entrevistas semiestructuradas con personas con discapacidad física adquirida mediante muestreo intencionado en bola de nieve para cumplir con todos los objetivos. El análisis de datos siguió los principios del análisis de contenido de Bardin. Los objetivos 2 y 3 se lograron mediante un enfoque teórico reflexivo.
Resultados:
los 27 participantes informaron desafíos de accesibilidad, que impactan las actividades de la vida diaria y las condiciones sociales. Esto influye en la enfermería de rehabilitación, dando lugar a tres campos de intervención: Evaluar la capacidad para realizar actividades diarias y los factores que influyen; Desarrollar e implementar capacitación para la realización de actividades diarias; Promover la movilidad, la accesibilidad y la participación social.
Consideraciones Finales:
a partir de las experiencias de los participantes, identificamos intervenciones de rehabilitación dirigidas por enfermeras para promover la accesibilidad y condiciones sociales.
Keywords:Acessibilidade ArquitetónicaCondições SociaisEnfermagem em ReabilitaçãoObjetivos de Desenvolvimento SustentávelPessoas com DeficiênciaSee more -
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0RESUMEN
Objetivo:
Analizar la configuración de las relaciones de poder entre el equipo multiprofesional en el proceso de rondas de cabecera en el hospital.
Método:
Investigación cualitativa con datos analizados a través del análisis del discurso, basado en el marco teórico de Michel Foucault. De septiembre a diciembre de 2022, realizamos entrevistas y observaciones de campo con el equipo multiprofesional de un hospital de Belo Horizonte, Minas Gerais, Brasil, así como entrevistas cualitativas semiestructuradas con 37 profesionales.
Resultados:
Los participantes señalaron que las experiencias de los profesionales involucrados en las rondas de cabecera dependen de cómo el médico conduce el proceso, y el proceso centrado en el médico dificulta la participación de otros profesionales del equipo.
Consideraciones finales:
La forma en que los hospitales organizan las rondas de cabecera no promueve la articulación del conocimiento de sus profesionales. Además, dificulta la circulación del poder y perjudica el trabajo interdisciplinario en un proceso que mantiene al médico como actor principal de las decisiones clínicas.
Keywords:Conhecimentos, Atitudes e Prática em SaúdeEquipe de Assistência MultidisciplinarHospitaisPrática ProfissionalRelações InterprofissionaisSee more -
ORIGINAL ARTICLE11-22-2024
Bedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLEBedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0ABSTRACT
Objective:
To analyze the configuration of power relations among the multiprofessional team in the bedside round process in the hospital.
Methods:
Qualitative research with data analyzed through discourse analysis, based on Michel Foucault’s theoretical framework. From September to December 2022, we conducted interviews and field observations with the multiprofessional team at a hospital in Belo Horizonte, Minas Gerais, Brazil, as well as qualitative, semi-structured interviews with 37 professionals.
Results:
The participants pointed out that the experiences of the professionals involved in bedside rounds depend on how the physician conducts the process, and the physician-centered process makes it difficult for other professionals in the team to participate.
Final considerations:
The way hospitals organize bedside rounds does not promote knowledge articulation for their professionals. It hinders the circulation of power and harms interdisciplinary work in a process that maintains the physician as the main actor in clinical decisions.
Keywords:Health Knowledge, Attitudes, PracticeHospitalsInterprofessional RelationsPatient Care TeamProfessional PracticeSee more -
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
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
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.
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Nursing instrument to attend mothers who recently gave birth in primary health care
Revista Brasileira de Enfermagem. 2016;69(2):316-325
Abstract
Nursing instrument to attend mothers who recently gave birth in primary health care
Revista Brasileira de Enfermagem. 2016;69(2):316-325
DOI 10.1590/0034-7167.2016690215I
Views0See moreABSTRACT
Objective:
To build a nursing instrument to attend mothers who have recently given birth in primary health care.
Method:
This is a methodological research developed in five stages: identification of empirical indicators associated with mothers who have recently given birth by reviewing integrative literature; evaluation of empirical indicators by focal group; instrument structuring by categorizing indicators; instrument validation using the Delphi technique; and application and development of diagnostic statements and nursing interventions.
Results:
The instrument comprises identification data on mothers who have given birth recently, on the assessment of their human needs, and on nursing Care items. In the final version, we selected 73 diagnoses and 155 nursing interventions.
Conclusion:
With the completion of this study, nurses will have an instrument for Nursing Care Systematization to attend mothers who have given birth recently in primary health care. Besides, this study will also work as a tool in research and teaching of Obstetric Nursing.
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Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy
Revista Brasileira de Enfermagem. 2016;69(2):307-315
Abstract
Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy
Revista Brasileira de Enfermagem. 2016;69(2):307-315
DOI 10.1590/0034-7167.2016690214i
Views0See moreABSTRACT
Objective:
to identify nursing diagnoses in intensive care unit (ICU) patients by means of a cross-mapping of terms contained in nursing records with the NANDA-I taxonomy.
Method:
an exploratory, descriptive study with a retrospective analysis of nursing records in 256 medical records of patients that were hospitalized in the general ICU of a hospital in the western border of the state of Rio Grande do Sul. Terms indicating conditions demanding nursing interventions were collected from the records; cross-mapping of these terms with the NANDA-I taxonomy diagnoses was performed and confirmed in a nursing focus group. Data were analyzed through descriptive statistics.
Results:
a total of 832 terms and expressions referring to 52 different diagnoses in 9 of the 13 domains of the NANDA-I taxonomy were identified.
Conclusion:
the present study enabled the identification of nursing diagnoses in patients hospitalized in ICUs, affecting care management, the training process of experts in the area, and information systems.
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Direct cost of dressings for pressure ulcers in hospitalized patients
Revista Brasileira de Enfermagem. 2016;69(2):290-297
Abstract
Direct cost of dressings for pressure ulcers in hospitalized patients
Revista Brasileira de Enfermagem. 2016;69(2):290-297
DOI 10.1590/0034-7167.2016690212i
Views0ABSTRACT
Objective:
to identify the average direct cost (ADC) on the direct labor (DL) for nurses and the consumption of materials and solutions used in performing dressings for pressure ulcers (PU) in hospitalized patients.
Methods:
case study, exploratory and descriptive case conducted in a teaching hospital. For six months, 228 dressings were performed for the treatment of PU patients. We calculated the cost by multiplying the time spent by nurses by the DL unit cost, adding to the cost of materials and solutions consumed.
Results:
the dressings ADC of PU corresponds to US$ 19.18 (PUs-category I); US$ 6.50 (PUs-category II); US$ 12.34 (PUs-category III); US$ 5.84 (PUs-category IV); US$ 9.52 (PUs-unclassifiable) and US$ 3.76 (PU suspected deep tissue injury).
Conclusion:
the methodology used can be reproduced in different hospital settings for the development of other studies to expand and complement the knowledge gained.
Keywords:Costs and Cost AnalysisNursing Administration ResearchNursing CareNursing Service, HospitalPressure UlcerSee more -
Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples
Revista Brasileira de Enfermagem. 2016;69(2):275-281
Abstract
Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples
Revista Brasileira de Enfermagem. 2016;69(2):275-281
DOI 10.1590/0034-7167.2016690210i
Views0ABSTRACT
Objective:
to unveil the existential movement of a couple when performing vertical HIV transmission prophylaxis.
Method:
qualitative research, using Martin Heidegger’s phenomenological approach. A phenomenological interview was conducted with 14 participants between December/2011 and February/2012 in the outpatient facilities of an university hospital, Brazil. A comprehensive and interpretative heideggerian analysis was developed.
Results:
the couple understands that they have followed the guidance of the health professionals as indicated. By not being able to breastfeed, the woman did not fail to be a mother, but it was also not a complete experience. The senses of the occupation of the couple-being unfolded to the prophylactic treatment and facticity due to the fact of not breastfeeding.
Conclusion:
we indicate the need to rethink care, proposing a working relationship that transcends the impersonal that dictates about what the couple must deal with, enabling their active participation in care decisions and actions.
Keywords:Child HealthNursingPrenatal CareQualitative ResearchVertical Transmission of Infectious DiseaseSee more -
Attitudes and pleasure/suffering in mental health work
Revista Brasileira de Enfermagem. 2016;69(2):266-274
Abstract
Attitudes and pleasure/suffering in mental health work
Revista Brasileira de Enfermagem. 2016;69(2):266-274
DOI 10.1590/0034-7167.2016690209i
Views0See moreABSTRACT
Objective:
to investigate the existence of a relationship between attitudinal profiles and the pleasure/suffering dynamic in workers of Mental Health Services.
Method:
a quantitative, descriptive-analytical, correlational and cross-sectional study conducted in 2014. We used three instruments: characterization questionnaire, Opinions on Mental Illness Scale and Pleasure and Suffering Indicators at Work Scale, answered by 80 workers of the Network for Psychosocial Care of Alfenas, state of Minas Gerais, Brazil.
Results:
Authoritarianism proved to be the predominant profile. As for the pleasure/suffering at work, Gratification was considered adequate, and indicators such as Freedom, Wear and Insecurity were considered moderate critical. There were positive correlations between the most favorable attitudes and pleasure indicators at work. The values of both scales showed a relationship with socio-demographic and professional variables.
Conclusion:
the less favorable attitudes are prevalent and, in spite of suffering being present, these professionals feel gratified about their work.
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Overweight in young adult students: the vulnerability of a distorted self-perception of body image
Revista Brasileira de Enfermagem. 2016;69(2):258-265
Abstract
Overweight in young adult students: the vulnerability of a distorted self-perception of body image
Revista Brasileira de Enfermagem. 2016;69(2):258-265
DOI 10.1590/0034-7167.2016690208i
Views0See moreABSTRACT
Objective:
To analyze overweight in young adult students from the individual dimension of vulnerability, especially its interpersonal and subjective markers.
Method:
An analytical quantitative study was performed with 560 young adults from 26 schools in a capital city in Northeastern Brazil. After obtaining data to administer specific questionnaires, logistic regression was used to identify markers of individual vulnerability.
Results:
In the bivariate analysis, overweight showed a statistically significant association with self-perception of health, satisfaction with body image and self-perception of overweight, the latter remaining in the final regression model.
Conclusion:
It can be mainly concluded that self-perception of overweight is distorted when compared to one’s actual body weight and, for this reason, young adults are vulnerable to dysfunctional health states. However, it was confirmed that this health condition must be understood in an individual and contextual perspective.
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