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de Oliveira Serra MAA, da Silva RAA, Monari FF, Silva JOE, de Sá Junior JX, Silva RDAE, Fontoura IG, Neto MS, de Araújo MFM. Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study. Trans R Soc Trop Med Hyg 2023; 117:852-858. [PMID: 37615659 DOI: 10.1093/trstmh/trad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.
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Affiliation(s)
| | | | - Flavia Ferreira Monari
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
- Faculdade de Imperatriz (FACIMP-Wyden), Imperatriz, Maranhão 65.910.140, Brazil
| | | | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
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Moraes PCD, Eidt LM, Koehler A, Ransan LG, Scrofeneker ML. Epidemiological characteristics of leprosy from 2000 to 2019 in a state with low endemicity in southern Brazil. An Bras Dermatol 2023; 98:602-610. [PMID: 37120406 PMCID: PMC10404493 DOI: 10.1016/j.abd.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Leprosy is an infectious and contagious disease caused by Mycobacterium leprae and is mainly characterized by lesions in the skin and peripheral nerves. In Brazil, it is a public health problem due to its high endemicity. However, the state of Rio Grande do Sul presents low endemicity of this disease. OBJECTIVE To characterize the epidemiological profile of leprosy in the state of Rio Grande do Sul from 2000 to 2019. METHODS This was a retrospective observational study. Epidemiological data were collected from the Notifiable Diseases Information System (SINAN, Sistema de Informação de Agravos de Notificação). RESULTS Among the 497 municipalities in the state, 357 (71.8%) registered cases of leprosy in the assessed period, with an average of 212 (81.5%) new cases per year. The average detection rate was 1.61 new cases per 100,000 inhabitants. The male sex was predominant (51.9%) and the mean age was 50.4 years. Regarding the epidemiological clinical profile; 79.0% of the patients were multibacillary; 37.5% presented the borderline clinical form; 16% had grade 2 physical disability at diagnosis and bacilloscopy was positive in 35.4% of cases. As for treatment, 73.8% of the cases were treated with the standard multibacillary therapeutic regimen. STUDY LIMITATIONS There were missing/inconsistent data in the database available. CONCLUSIONS The findings observed in this study indicate that the state presents a low endemicity profile of the disease and these results can support adequate health policies relevant to the reality of Rio Grande do Sul, inserted in a national scenario of highly endemic leprosy.
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Affiliation(s)
- Paulo Cezar de Moraes
- Department of Sanitary Dermatology, Sanitary Dermatology Outpatient Clinic, State Health Secretariat of Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia Maria Eidt
- Department of Sanitary Dermatology, Sanitary Dermatology Outpatient Clinic, State Health Secretariat of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alessandra Koehler
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leonardo Girardi Ransan
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Lúcia Scrofeneker
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Assad DBN, Cara J, Ortega-Mier M. Comparing Short-Term Univariate and Multivariate Time-Series Forecasting Models in Infectious Disease Outbreak. Bull Math Biol 2023; 85:9. [PMID: 36565344 PMCID: PMC9789525 DOI: 10.1007/s11538-022-01112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022]
Abstract
Predicting infectious disease outbreak impacts on population, healthcare resources and economics and has received a special academic focus during coronavirus (COVID-19) pandemic. Focus on human disease outbreak prediction techniques in current literature, Marques et al. (Predictive models for decision support in the COVID-19 crisis. Springer, Switzerland, 2021) state that there are four main methods to address forecasting problem: compartmental models, classic statistical models, space-state models and machine learning models. We adopt their framework to compare our research with previous works. Besides being divided by methods, forecasting problems can also be divided by the number of variables that are considered to make predictions. Considering this number of variables, forecasting problems can be classified as univariate, causal and multivariate models. Multivariate approaches have been applied in less than 10% of research found. This research is the first attempt to evaluate, over real time-series data of 3 different countries with univariate and multivariate methods to provide a short-term prediction. In literature we found no research with that scope and aim. A comparison of univariate and multivariate methods has been conducted and we concluded that besides the strong potential of multivariate methods, in our research univariate models presented best results in almost all regions' predictions.
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Affiliation(s)
- Daniel Bouzon Nagem Assad
- Universidad Politécnica de Madrid, Department of Organization Engineering, Business Administration and Statistics, Escuela Técnica Superior de Ingenieros Industriales, José Gutiérrez Abascal, 2, 28006 Madrid, Spain ,Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524, Maracanã, 20550-900 Rio de Janeiro, Brazil
| | - Javier Cara
- Universidad Politécnica de Madrid, Department of Organization Engineering, Business Administration and Statistics, Escuela Técnica Superior de Ingenieros Industriales, José Gutiérrez Abascal, 2, 28006 Madrid, Spain
| | - Miguel Ortega-Mier
- Universidad Politécnica de Madrid, Department of Organization Engineering, Business Administration and Statistics, Escuela Técnica Superior de Ingenieros Industriales, José Gutiérrez Abascal, 2, 28006 Madrid, Spain
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Matos DP, Torres MD, da Silva LSR, Dos Santos CAAS, de Oliveira FJF, de Araújo MFM, de Oliveira Serra MAA. Hansenapp: development of a mobile application to assist primary healthcare providers to control leprosy. Trop Med Int Health 2022; 27:719-726. [PMID: 35761478 DOI: 10.1111/tmi.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. METHOD A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development, and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics, and expert validation. Five experts individually analyzed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. RESULTS The mobile app's content, navigation methods, and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p = 0.007), 0.99 (p > 0.0001), and 0.93 (p = 0.01) were obtained. CONCLUSION The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment, and follow-up, in addition to leprosy control actions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Mateus Dantas Torres
- Federal University of Maranhão, Brazil.,Federal University of Maranhão Postgraduate Program in Health and Technology, Brazil
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Serum Levels of Ficolin-3 and Mannose-Binding Lectin in Patients with Leprosy and Their Family Contacts in a Hyperendemic Region in Northeastern Brazil. Trop Med Infect Dis 2022; 7:tropicalmed7050071. [PMID: 35622698 PMCID: PMC9145322 DOI: 10.3390/tropicalmed7050071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
The present study aimed at analyzing the serum levels of mannose-binding lectin (MBL) and ficolin-3 (FCN3) in leprosy patients and their healthy family contacts in a hyperendemic region in northeastern Brazil. A cross-sectional study was carried out with 90 patients who had been diagnosed with leprosy and 79 healthy family contacts. Serum levels of the MBL and FCN3 proteins were measured using the immunofluorometric assay (ELISA). Clinical information was determined from the patients’ charts. It was observed that the leprosy patients were more likely to be male (OR = 2.17; p = 0.01) and younger than fifteen years of age (OR = 2.01; p = 0.03) when compared to the family contacts. Those under 15 years of age had higher levels of MBL (4455 ng/mL) than those over 15 years of age (2342 ng/mL; p = 0.018). Higher FCN3 levels were identified in patients with indeterminate leprosy (41.9 µg/mL) compared to those with the lepromatous form (34.3 µg/mL; p = 0.033) and in those with no physical disabilities (38.1 µg/mL) compared to those with some disability (p = 0.031). Higher FCN3 levels were also observed in the group of patients without leprosy reactions (37.4 µg/mL) compared to those with type 1 (33.7 µg/mL) and type 2 (36.1 µg/mL) reactions. The MBL levels were higher in children under 15 years of age than they were in adults. It was evidenced that higher FCN3 serum levels were associated with early and transient clinical forms and lower expression in severe forms of leprosy.
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Martoreli Júnior JF, Ramos ACV, Alves JD, Crispim JDA, Alves LS, Berra TZ, Barbosa TP, da Costa FBP, Alves YM, dos Santos MS, Gomes D, Yamamura M, Pinto IC, Fuentealba-Torres MA, Nunes C, Pieri FM, Arcoverde MAM, dos Santos FL, Arcêncio RA. Inequality of gender, age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil. PLoS Negl Trop Dis 2021; 15:e0009941. [PMID: 34784350 PMCID: PMC8631739 DOI: 10.1371/journal.pntd.0009941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/30/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to investigate the epidemiological situation of leprosy
(Hansen’s Disease), in a hyperendemic metropolis in the Central-West region of
Brazil. We studied trends over eleven years, both in the detection of the
disease and in disabilities, analyzing disparities and/or differences regarding
gender and age. This is an ecological time series study conducted in Cuiabá,
capital of the state of Mato Grosso. The population consisted of patients
diagnosed with leprosy between the years 2008 and 2018. The time series of
leprosy cases was used, stratifying it according to gender (male and female),
disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar
adjustment technique was applied. For modeling the trends, the Seasonal-Trend
decomposition procedure based on Loess (STL) was used. We identified 9.739
diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59
years. Regarding detection according to gender, there was a decrease among women
and an increase in men. The study shows an increasing trend in disabilities in
both genders, which may be related to the delay in diagnosis. There was also an
increasing number of cases that were not assessed for disability at the time of
diagnosis, which denotes the quality of the services. In the 2019 report, Brazil had a detection rate of 13.23 per 100.000 inhabitants
far from the goal of less than 1 leprosy (Hansen’s Disease) case per 10,000
inhabitants describe by the World Health Organization. The present study aimed
to investigate the epidemiological situation of leprosy and its trend between
2008 and 2018 in a hyperendemic metropolis in the Central-West region of Brazil.
A total of 9.739 leprosy cases were reported between 2008 and 2018. The majority
of cases were male (58.37%), with a predominant age of 15 to 59 years (87.55%).
The predominant level of education was incomplete elementary school (43.96%).
The disability grade at diagnosis showed that 40.19% had G0D and for the G2D was
8,.06%.There was a predominance in operational classification of multibacillary
cases (72.85%). While detection rate trends in females and the majority of the
age groups are decreasing, increases are seen in the detection of male patients
and patients already suffering from disabilities. Although declining trends were
presented, the metropolis is still not close to elimination showing the need
prioritize leprosy actions and to improve care for this disease.
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Affiliation(s)
- José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
- * E-mail:
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Josilene Dalia Alves
- Departament of Epidemiology, Federal University of Mato Grosso, Cuiába,
Mato Grosso, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Tatiana Pestana Barbosa
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Márcio Souza dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Dulce Gomes
- Department of Mathematics, University of Évora, Évora,
Portugal
| | - Mellina Yamamura
- Departament of Nursing, Federal University of São Carlos, São Carlos, São
Paulo, Brazil
| | - Ione Carvalho Pinto
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | | | - Carla Nunes
- Department of Public Health, New University of Lisbon, Lisbon,
Portugal
| | | | - Marcos Augusto Moraes Arcoverde
- Center for Education, Letters and Health, Western Paraná State
University, Campus Foz do Iguaçu, Foz do Iguaçu, Paraná,
Brazil
| | - Felipe Lima dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
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Ramos ACV, Alonso JB, Berra TZ, Alves LS, Martoreli Júnior JF, Santos FLD, Alves YM, Andrade HLPD, Costa FBPD, Crispim JDA, Yamamura M, Alves JD, Santos Neto M, Fuentealba-Torres M, Pinto IC, Arcêncio RA. Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study. Acta Trop 2021; 218:105884. [PMID: 33676938 DOI: 10.1016/j.actatropica.2021.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Jonas Bodini Alonso
- Research Support Center at the University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Hamilton Leandro Pinto de Andrade
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Avenida da Universidade, S/N, Bom Jesus, Imperatriz, Maranhão, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Nursing Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, São Paulo, Brazil
| | - Josilene Dália Alves
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Campus Barra do Garças, Avenida Valdon Varjão, 6390, Barra do Garças, Mato Grosso, Brazil
| | - Marcelino Santos Neto
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Avenida da Universidade, S/N, Bom Jesus, Imperatriz, Maranhão, Brazil
| | - Miguel Fuentealba-Torres
- Faculty of Nursing and Obstetrics of the Universidad de los Andes, Chile, Avenida Monseñor Álvaro del Portillo, 12455, Las Condes, Santiago, Chile
| | - Ione Carvalho Pinto
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
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