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ORIGINAL ARTICLE
Construction and validation of an instrument for event-related sterility of processed healthcare products
Revista Brasileira de Enfermagem. 2024;77(4):e20240021
06/09/2024
Resumo
ORIGINAL ARTICLEConstruction and validation of an instrument for event-related sterility of processed healthcare products
Revista Brasileira de Enfermagem. 2024;77(4):e20240021
06/09/2024DOI 10.1590/0034-7167-2024-0021
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Objective:
To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products.
Methods:
This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing.
Results:
Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable.
Conclusion:
The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.
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ORIGINAL ARTICLE
Factors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
06/09/2024
Resumo
ORIGINAL ARTICLEFactors associated with burnout in military police officers in a city in Paraná
Revista Brasileira de Enfermagem. 2024;77(4):e20230510
06/09/2024DOI 10.1590/0034-7167-2023-0510
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Objective:
to analyze the association between burnout and sociodemographic, work factors, lifestyle habits and health conditions of military police officers in a municipality in the state of Paraná, Brazil.
Method:
cross-sectional research with 131 military police officers. Data were analyzed using the Statistical Package for the Social Sciences software and the R program. Chi-square, Fisher’s exact and Poisson Generalized Linear Model tests were used.
Results:
most participants (65.6%) had a high level of burnout. In relation to protective factors, those who carried out leisure activities had a 33.6% chance of not developing burnout. Conjugality was also a protective factor. Not practicing physical activity and leisure activities are factors that can contribute to the occurrence of burnout.
Conclusions:
important factors and high rates of burnout were observed in the police officers investigated. It is necessary to implement public health policies to reduce burnout with attention focused on this professional category.
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ORIGINAL ARTICLE
Reflective practice of nurse residents in the teaching-learning process in teaching hospitals
Revista Brasileira de Enfermagem. 2024;77(4):e20230540
06/09/2024
Resumo
ORIGINAL ARTICLEReflective practice of nurse residents in the teaching-learning process in teaching hospitals
Revista Brasileira de Enfermagem. 2024;77(4):e20230540
06/09/2024DOI 10.1590/0034-7167-2023-0540
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Objective:
To analyze reflective practice in the teaching-learning process of nurses in residency programs in teaching hospitals in Minas Gerais, Brazil.
Methods:
Case study, based on the reflective practice framework, conducted in two teaching hospitals. Observation and interviews were conducted with first and second-year residents, and five participants were included for in-depth analysis, with their data subjected to frequency distribution analysis and Critical Discourse Analysis.
Results:
In 519 observed activities, elements of reflection were identified in 22.2%, especially active listening and expression of doubts. Discourses indicated practice as the best moment for teaching-learning due to its potential to generate reflections. Learning by doing and case discussion were considered potential strategies for reflective learning.
Conclusion:
Know-in-action reflection was evidenced as the predominant formative aspect for residents, with few opportunities for reflection on reflection-in-action.
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ORIGINAL ARTICLE
Development and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
06/09/2024
Resumo
ORIGINAL ARTICLEDevelopment and content validation of a risk classification instrument
Revista Brasileira de Enfermagem. 2024;77(4):e20230502
06/09/2024DOI 10.1590/0034-7167-2023-0502
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Objective:
Develop and validate the content of an instrument for patient risk classification in emergency services of Primary Health Care.
Method:
The study included two stages: item generation and content validity. A literature review and retrospective analysis of medical records were conducted to create the instrument items. The Content Validity Ratio (CVR) was used to assess agreement among judges during content validation.
Results:
In the first and second rounds, 75 and 71 judges validated the risk classification instrument, respectively. The minimum adherence score for the latent variable item based on the final number of judges was 0.22 and 0.18; thus, 52 items, divided into three classification categories (red, orange, and yellow), were retained.
Conclusion:
The instrument was considered valid regarding clarity, relevance, pertinence, and agreement regarding the severity indicated in the item.
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Nursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
06/09/2024
Resumo
Nursing students’ mindfulness and emotional regulation: an integrative review
Revista Brasileira de Enfermagem. 2024;77(4):e20230466
06/09/2024DOI 10.1590/0034-7167-2023-0466
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Objective:
to identify the scientific evidence available in national and international literature on the relationships between nursing students’ mindfulness and emotional regulation.
Methods:
an integrative literature review, in four databases, with a time frame from January 2002 to December 2022. Articles in English, Spanish and Portuguese available in full were included.
Results:
the sample consisted of six original articles, predominantly with a quantitative approach, with cross-sectional designs standing out.
Conclusion:
the synthesis of scientific production revealed that there is a lack of research at national and international level on the subject with experimental and qualitative designs that enable conclusions about cause and effect and/or take into account subjective experiences of the applicability of mindfulness-based practice in nursing students’ emotional regulation.
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ORIGINAL ARTICLE
Meanings attributed to changes experienced by individuals after COVID-19 hospitalization
Revista Brasileira de Enfermagem. 2024;77:e20230122
30/08/2024
Resumo
ORIGINAL ARTICLEMeanings attributed to changes experienced by individuals after COVID-19 hospitalization
Revista Brasileira de Enfermagem. 2024;77:e20230122
30/08/2024DOI 10.1590/0034-7167-2023-0122
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Objectives:
to understand the meanings attributed to the experiences of individuals after hospitalization for COVID-19.
Methods:
qualitative study, with a theoretical framework based on Symbolic Interactionism and a methodological approach grounded in Grounded Theory. Nineteen participants who had moderate and severe forms of COVID-19 after hospitalization were interviewed. Data collection took place between April and November 2021 through online interviews, and the data were analyzed using initial and focused coding in the MAXQDA software.
Results:
the data illustrate new meanings attributed to different aspects of life after hospitalization, including relationships with others, the environment, physical and mental health, finances, identity, and interactions with a new social reality.
Conclusions:
the meanings are intrinsically linked to the value of interpersonal relationships, the perception of their impact, and the consequences after hospitalization. This allows professionals to understand the importance of this information to improve care and prepare for future epidemics.
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ORIGINAL ARTICLE
Fatores determinantes para à hesitação vacinal contra a COVID-19 em brasileiros: estudo utilizando modelagem de equações estruturais
Revista Brasileira de Enfermagem. 2024;77:e20240112
30/08/2024
Resumo
ORIGINAL ARTICLEFatores determinantes para à hesitação vacinal contra a COVID-19 em brasileiros: estudo utilizando modelagem de equações estruturais
Revista Brasileira de Enfermagem. 2024;77:e20240112
30/08/2024DOI 10.1590/0034-7167-2024-0112
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Objetivos:
investigar los factores que influyen en la vacilación ante la vacuna contra la COVID-19 entre los brasileños.
Métodos:
esta investigación empleó un enfoque observacional y analítico, utilizando una encuesta en línea. La recolección de datos se llevó a cabo en 2020 y el análisis de los datos se realizó utilizando el modelado de ecuaciones estructurales.
Resultados:
la prevalencia de la vacilación ante la vacuna fue del 27,5% (1182 individuos). Existe una correlación negativa entre la creencia en teorías de conspiración y la influencia social. Entre las diversas creencias asociadas con las intenciones de vacunación, solo las creencias en conspiraciones mostraron un valor predictivo significativo. Así, los resultados sugieren que las creencias personales impactan significativamente la vacilación ante la vacunación y también indican que la confianza en los órganos gubernamentales está inversamente relacionada con la vacilación.
Conclusiones:
la vacilación ante la vacuna emerge como un fenómeno multifacético influenciado por una amplia gama de factores, incluyendo las creencias personales, la confianza en los órganos gubernamentales y los sistemas de salud.
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ORIGINAL ARTICLE
Risk of smoking cessation treatment dropout: a cohort to help (re)think care
Revista Brasileira de Enfermagem. 2024;77:e20230537
30/08/2024
Resumo
ORIGINAL ARTICLERisk of smoking cessation treatment dropout: a cohort to help (re)think care
Revista Brasileira de Enfermagem. 2024;77:e20230537
30/08/2024DOI 10.1590/0034-7167-2023-0537
Visualizações0ABSTRACT
Objectives:
to evaluate the relative risk of smoking cessation treatment dropout during its intensive phase.
Methods:
a retrospective and quantitative cohort study was developed from the electronic medical records of individuals who started smoking cessation treatment between 2015 and 2019 at a specialty clinic in a city in the interior of São Paulo, Brazil. The relative risk of dropping out of treatment was calculated using the Poisson regression model.
Results:
it was observed that out of the 396 (100.0%) individuals who started the treatment, 109 (27.5%) abandoned it before the end of the intensive phase. For each one-year increase in age, the risk of dropping out of smoking cessation treatment decreased by an average of 2%.
Conclusions:
the risk of dropping out of smoking cessation treatment is higher among younger individuals. It is necessary to rethink the care offered to younger adults to promote the continuity of treatment.
Palavras-chave: Patient DropoutPublic HealthPublic Health NursingTobacco ControlTobacco Use DisorderVer mais
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ORIGINAL ARTICLE
Fatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
16/12/2024
Resumo
ORIGINAL ARTICLEFatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
16/12/2024DOI 10.1590/0034-7167-2023-0304pt
Visualizações1RESUMO
Objetivos:
analisar os fatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais.
Métodos:
estudo transversal, aninhado a uma coorte, realizado com puérperas em um município mineiro. Foi adotada a escala Bem-Estar Materno em Situação de Parto 2. Estimaram-se as prevalências do bem-estar materno em situação de parto. A magnitude da associação entre mal-estar materno e práticas assistenciais foi estimada pela Razão de Prevalência (RP), utilizando-se a regressão de Poisson.
Resultados:
participaram 183 puérperas com idade entre 15 e 46 anos, sendo que 26,2%, 27,9% e 45,9% relataram, respectivamente, ótimo, adequado e mal-estar na assistência ao parto. O mal-estar materno foi mais prevalente entre puérperas que passaram por parto cesárea (RP = 1,60) e que não receberam informações sobre amamentação (RP = 1,59).
Conclusões:
observou-se elevada prevalência de mal-estar no parto, associada à realização de cesáreas e à falta de informações sobre amamentação.
Palavras-chave: Assistência ao PartoBem-Estar MaternoHumanização da AssistênciaParto ObstétricoPeríodo Pós-PartoVer mais -
ORIGINAL ARTICLE
The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
16/12/2024
Resumo
ORIGINAL ARTICLEThe nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
16/12/2024DOI 10.1590/0034-7167-2023-0315
Visualizações1ABSTRACT
Objectives:
to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.
Methods:
a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.
Results:
the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.
Conclusions:
the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.
Palavras-chave: Complexity AnalysisHealth Facility EnvironmentNursingPatient SafetyQuality of Health CareVer mais -
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
16/12/2024
Resumo
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
16/12/2024DOI 10.1590/0034-7167-2024-0086
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Objectives:
to summarize the recommendations of guidelines for promoting mental health in the workplace.
Methods:
an umbrella review, according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses methodological assumptions. Data collection was carried out in January 2021 and updated in July 2023 in the American Psychological Association, Cochrane Library, EMBASE, National Library of Medicine, and Scopus databases. Systematic reviews that assessed guidelines with recommendations for mental health care for workers were included. PROSPERO registration CRD42023461845.
Results:
four systematic reviews published between 2015 and 2018 were identified. The abstracts highlighted actions that facilitate and inhibit the recommendations as well as three categories of intervention: primary prevention – worker protection; secondary prevention – promoting workers’ mental health; and tertiary prevention – supporting, monitoring and rehabilitating workers upon returning to work.
Conclusions:
the interventions are based on prevention, promotion and early recognition, support and rehabilitation of mental health problems.
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Effectiveness of mobile applications in pregnant women’s adherence to prenatal consultations: randomized clinical trial
Revista Brasileira de Enfermagem. 2021;74:e20190599
15/03/2021
Resumo
Effectiveness of mobile applications in pregnant women’s adherence to prenatal consultations: randomized clinical trial
Revista Brasileira de Enfermagem. 2021;74:e20190599
15/03/2021DOI 10.1590/0034-7167-2019-0599
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Objective:
to evaluate the effectiveness of a mobile application for cell phones in the adherence of pregnant women to prenatal consultations.
Method:
a randomized controlled clinical trial, simple-blind with two parallel groups, conducted from January to December 2018. Data collection was carried out through a structured interview at the end of the third trimester of pregnancy. For analysis, Chi-Square and Mann-Whitney tests were used. The sample consisted of 88 pregnant women from 2 Family Health Strategies in Northeast Brazil. Participants were randomized into two groups: intervention (IG), who used the application, and control (CG), who attended prenatal consultations.
Results:
pregnant women who used the application (IG) attended a greater number of consultations when compared to participants in the CG, identifying a statistical difference between the groups (p<0.05).
Conclusion:
the application showed to be an effective health technology to improve adherence to prenatal care. Brazilian Registry of Clinical Trials: RBR-74SNST.
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ORIGINAL ARTICLE
Envelhecimento, sexualidade e cuidados de enfermagem: o olhar da mulher idosa
Revista Brasileira de Enfermagem. 2019;72:71-78
05/12/2019
Resumo
ORIGINAL ARTICLEEnvelhecimento, sexualidade e cuidados de enfermagem: o olhar da mulher idosa
Revista Brasileira de Enfermagem. 2019;72:71-78
05/12/2019DOI 10.1590/0034-7167-2018-0015
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Objetivo:
analisar a percepção da mulher idosa sobre sexualidade e a prática do cuidado de enfermagem nesse contexto.
Método:
estudo qualitativo descritivo. Foram entrevistadas 50 mulheres idosas de Guanambi – Bahia, em 2016. A técnica de coleta de dados foi a entrevista direta com utilização de um roteiro não estruturado. Foi feita a análise de conteúdo semântica descrita, e foram levantadas duas categorias empíricas: o olhar da mulher idosa sobre o cuidado de enfermagem na promoção da saúde sexual e na vivência da sexualidade na terceira idade; o processo do cuidar de enfermagem no contexto do envelhecimento da mulher.
Resultados:
notou-se que as idosas têm receio de falar sobre sexualidade, principalmente com os profissionais da saúde. Pelas próprias influências da sociedade, muitas vezes excluem essa temática do cuidado da saúde da mulher idosa.
Considerações finais:
ressalta-se que mudanças devem ser pensadas sobre a assistência prestada no que cerne à sexualidade.
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ORIGINAL ARTICLE
Construção e validação de cartilha para idoso acerca da higiene do sono
Revista Brasileira de Enfermagem. 2019;72:214-220
05/12/2019
Resumo
ORIGINAL ARTICLEConstrução e validação de cartilha para idoso acerca da higiene do sono
Revista Brasileira de Enfermagem. 2019;72:214-220
05/12/2019DOI 10.1590/0034-7167-2018-0603
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Objetivo:
construir e validar cartilha educativa para idosos, com orientações sobre higiene do sono.
Método:
pesquisa metodológica com construção da cartilha, validação por 22 juízes e avaliação por 22 idosos. O conteúdo foi extraído das orientações da associação brasileira do sono e do manual de saúde do idoso da Secretaria de Direitos Humanos. Foi considerado válido o item com Índice de Validade de Conteúdo (IVC) maior que 0,8 ou cuja proporção de concordância, verificada com o teste binomial, foi estatisticamente igual ou superior a 80%.
Resultados:
a cartilha apresentou 14 orientações para idosos sobre higiene do sono, distribuídas em 25 páginas. Todos os itens foram avaliados como pertinentes e o IVC teve média de 0,95 pelos juízes e 0,95 pelos idosos.
Conclusão:
a cartilha foi construída e validada quanto seu conteúdo e aparência e pode ser utilizada pelos profissionais de saúde nos diversos serviços com o público idoso.
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ORIGINAL ARTICLE
Prenatal follow-up of high-risk pregnancy in the public service
Revista Brasileira de Enfermagem. 2019;72:204-211
13/12/2019
Resumo
ORIGINAL ARTICLEPrenatal follow-up of high-risk pregnancy in the public service
Revista Brasileira de Enfermagem. 2019;72:204-211
13/12/2019DOI 10.1590/0034-7167-2018-0425
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Objective:
to analyze the prenatal follow-up of high-risk pregnancy in the public service.
Method:
an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05).
Results:
the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005).
Conclusion:
the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.
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ORIGINAL ARTICLE
Depression, self-concept, future expectations and hope of people with HIV
Revista Brasileira de Enfermagem. 2019;72(5):1288-1294
16/09/2019
Resumo
ORIGINAL ARTICLEDepression, self-concept, future expectations and hope of people with HIV
Revista Brasileira de Enfermagem. 2019;72(5):1288-1294
16/09/2019DOI 10.1590/0034-7167-2018-0730
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Objective:
To analyze conditions of depression, self-concept, future expectations and hope in people with HIV/AIDS.
Method:
Cross-sectional survey of 108 individuals living with HIV/AIDS, carried out in a reference hospital for the treatment of infectious diseases in Northeast Brazil. The following instruments were employed: sociodemographic data, and questionnaires for ascertaining participants’ emotions, including scales for self-concept, hope, depression (HAMD-D), and future expectations. Descriptive statistics using the following tests were performed: Mann–Whitney, Kruskal–Wallis, chi-square, and t-test—considered significant when p ≤ 0.05.
Results:
31.5% presented mild depression and 21.3% presented moderate depression; 63% reported difficulty in obtaining decent employment; 52.8% considered life a failure; 52.8% felt worthless. Fear, guilt and loneliness influenced self-concept (p ≤ 0.05). Loneliness influenced hope (p ≤ 0.05).
Conclusion:
It is necessary to raise the attention of nursing professionals and healthcare managers to the importance of providing health services that consider the mental health of people with HIV/AIDS, contributing to treatment adherence and well-being.
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ORIGINAL ARTICLE
Spirituality and religiousity in the experience of suffering, guilt, and death of the elderly with cancer
Revista Brasileira de Enfermagem. 2020;73:e20190034
08/07/2020
Resumo
ORIGINAL ARTICLESpirituality and religiousity in the experience of suffering, guilt, and death of the elderly with cancer
Revista Brasileira de Enfermagem. 2020;73:e20190034
08/07/2020DOI 10.1590/0034-7167-2019-0034
Visualizações0Ver maisABSTRACT
Objective:
to understand spirituality and religiosity in the experience of suffering, guilt, and death of the elderly with cancer.
Method:
qualitative research based on Viktor Frankl’s Existential Analysis. Twenty phenomenological interviews were conducted with people over 60 years old undergoing chemotherapy treatment at an oncology unit of a hospital in the city of Salvador, Bahia State, Brazil, between August and October 2018.
Results:
the following categories emerged: Experiences spirituality and religiosity in the face of the tragic triad and existential emptiness; Uses spirituality/religiosity as resilience strategies. After apprehension of ontic aspects, it was possible the ontological understanding of spirituality and religiosity in the face of suffering, guilt, and death experienced in the elderly with cancer’s daily life.
Final considerations:
spirituality and religiosity were understood as coping strategies used in the unstable experience of the elderly with cancer, providing comfort and resilience.
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ORIGINAL ARTICLE
Ansiedade e depressão em cuidadores informais de idosos dependentes: um estudo analítico
Revista Brasileira de Enfermagem. 2020;73:e20190851
21/09/2020
Resumo
ORIGINAL ARTICLEAnsiedade e depressão em cuidadores informais de idosos dependentes: um estudo analítico
Revista Brasileira de Enfermagem. 2020;73:e20190851
21/09/2020DOI 10.1590/0034-7167-2019-0851
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Objetivo:
Analisar os sintomas de ansiedade e depressão em cuidadores informais de idosos dependentes em domicílio.
Métodos:
Estudo analítico, transversal, realizado no município de Teresina (PI), com cuidadores informais de idosos dependentes. A coleta de dados ocorreu no período de novembro de 2017 a fevereiro de 2018, por meio de um formulário de caracterização do idoso dependente e seu cuidador, Inventário de Ansiedade de Beck (BAI) e Inventário de Depressão de Beck (BDI). Utilizou-se o modelo de regressão linear forward para identificação das variáveis preditoras de ansiedade e depressão.
Resultados:
Constatou-se que 18,4% dos cuidadores apresentaram sintomas de depressão; e 14%, ansiedade moderada a severa. Houve correlação entre ansiedade e depressão (p = 0,000).
Conclusão:
Os achados deste estudo possibilitam a avaliação da ansiedade e depressão nos cuidadores de idosos dependentes, sendo possível, mediante tais parâmetros, visualizar o perfil e as demandas de cuidado dessa população.
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ORIGINAL ARTICLE
Estresse e qualidade do sono em alunos de graduação em Enfermagem
Revista Brasileira de Enfermagem. 2020;73:e20180227
15/05/2020
Resumo
ORIGINAL ARTICLEEstresse e qualidade do sono em alunos de graduação em Enfermagem
Revista Brasileira de Enfermagem. 2020;73:e20180227
15/05/2020DOI 10.1590/0034-7167-2018-0227
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Objetivo:
analisar o nível de estresse e a qualidade do sono em estudantes de enfermagem por períodos do curso.
Método:
pesquisa descritiva e transversal desenvolvida em uma instituição de ensino superior do Nordeste brasileiro com 167 estudantes. Utilizaram-se, para coleta de dados, informações sociodemográficas e uma escala de avaliação do estresse e qualidade do sono em estudantes de enfermagem.
Resultados:
identificou-se diferença estatística significante entre os domínios da escala de estresse e os períodos do curso de graduação, e entre a qualidade do sono e os períodos do curso, como no quarto e sexto períodos. Conclusão: os diferentes escores do estresse demonstram que o semestre do estudante que mais o preocupa é o quinto. A qualidade de sono mostrou-se de boa qualidade para o primeiro, terceiro, quinto, sétimo e oitavo períodos; e qualidade ruim de sono para o quarto e sexto períodos.
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