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Piotrkowska R, Mędrzycka-Dąbrowska WA, Tomaszek L. Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries-a cross-sectional study. Front Public Health 2024; 12:1363828. [PMID: 38577292 PMCID: PMC10991680 DOI: 10.3389/fpubh.2024.1363828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Peripheral artery and aorta diseases contribute to complex consequences in various areas, as well as increasing physical and mental discomfort resulting from the progressive limitation or loss of functional capacities, in particular in relation to walking, decreased endurance during physical exercise, a drop in effort tolerance, and pain suffered by patients. Limitations in functional capacities also increase the risk of falls. Most falls take place during the performance of simple activities. The aim of this study was to investigate factors associated with moderate-to-high risk of future falls in patients scheduled for vascular surgeries. Methods This cross-sectional study included patients aged 33-87, scheduled for vascular surgeries. Based on the Timed Up and Go test, patients were categorized as having a moderate-to-high (≥ 10 s) or low risk of falls. Multiple logistic regression was carried out to assess the relationship between fall-risk levels and independent sociodemographic and clinical variables. Results Forty-eight percent of patients were categorized as having a moderate-to-high risk of future falls. Females (OR = 1.67; Cl95%: 1.07-2.60) and patients who suffered from hypertension (OR = 2.54; Cl95%: 1.19-5.40) were associated with a moderate-to-high risk of future falls. The Barthel Index correlated negatively (OR = 0.69; Cl95%: 0.59-0.80), while age correlated positively with fall-risk levels (OR = 1.07; Cl95%: 1.02-1.12). Conclusion Factors that may be associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries include age, female gender, hypertension, and the Barthel Index.
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Affiliation(s)
- Renata Piotrkowska
- Department of Surgical Nursing, Medical University of Gdansk, Gdańsk, Poland
- Clinic of Cardiac and Vascular Surgery, University Clinical Center, Gdańsk, Poland
| | | | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Kraków Academy of Andrzej Frycz Modrzewski, Kraków, Poland
- Institute of Tuberculosis and Lung Diseases, Rabka-Zdrój Branch, Rabka-Zdrój, Poland
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Amput P, Wongphon S, Phrompao P. Evaluating the Balancing Ability of Older Adults with Diabetes Mellitus Using the Multi-directional Reach Test. Curr Aging Sci 2024; 17:113-117. [PMID: 38904153 DOI: 10.2174/0118746098253144231024052312] [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: 03/13/2023] [Revised: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 06/22/2024]
Abstract
BACKGROUND The incidence of elderly people experiencing falls is currently increasing, which results in serious medical issues, such as fear of falling, limited physical activity, disability, and bone fractures, especially hip fractures. This study aimed to investigate balancing ability using a multi-directional reach test (MDRT) in older adults with and without diabetes mellitus. METHODS 72 older adults with and without diabetes mellitus were recruited, and divided into two groups, including older adults without diabetes mellitus (n = 36) and older adults with diabetes mellitus (n = 36). All subjects completed all directions of the MDRT. RESULTS There were no significant differences in MDRT scores in all directions between the two groups (p>0.05). Both groups achieved the highest MDRT scores in the forward direction. In contrast, the two groups had the lowest scores of MDRT in a backward direction. Furthermore, older adults with diabetes mellitus had lower MDRT scores in all directions than older adults without diabetes mellitus. CONCLUSION The current study indicated that MDRT could be used to investigate the ability of balance in individuals with diabetes mellitus.
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Affiliation(s)
- Patchareeya Amput
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitation, University of Phayao, Phayao, Thailand
| | - Sirima Wongphon
- Department of Traditional Chinese Medicine, School of Public Health, University of Phayao, Phayao, Thailand
| | - Patcharin Phrompao
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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Chhetri K, Rinchen U, Lamichaney G, Kinley B, Dorji S. Team approach to fall reduction in paediatric ward of national referral hospital, Thimphu, Bhutan: a quality improvement initiative. BMJ Open Qual 2022; 11:bmjoq-2022-001892. [PMID: 36175035 PMCID: PMC9528595 DOI: 10.1136/bmjoq-2022-001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022] Open
Abstract
Falls are common and preventable adverse events that occur in a hospital setting. Falls can cause pain, damage, increase cost and mistrust in the health system. Inpatient fall is a multifactorial event which can be reduced with multistrategic interventions. In this project, we aimed to reduce the fall rate in paediatric ward of Jigme Dorji Wangchuck National Referral Hospital, Bhutan by 25% from the baseline over a period of 6 months by focusing on fall risk assessment, staff education on fall prevention measures and devoting more attention to patients at high risk of fall. We tested three sets of interventions using the Plan–Do–Study–Act approach. For the first cycle, emphasis was on staff education in terms of proper use of fall risk assessment form, risk categorisation and fall prevention advice. In the second cycle, in addition to the first we introduced the ‘high risk of fall package’ and the third cycle focused on early and easy identification of high-risk patients by continuous fall risk assessment and use of high risk of fall sticker. We observed that at the start of the quality improvement project despite our intervention the fall rate of our ward went up but as we continued adding more ideas focusing on high risk patients, we could achieve a fall reduction of 49.3% from the base line by end of third cycle. Our ward saw fall free days of almost 90 days at the end of project. We conclude that inpatient falls occur due to multiple factors therefore a multi-pronged strategy is needed to prevent it. One of the prime preventive strategy is identifying patients who are at high risk of fall and concentrating attention to those patients.
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Affiliation(s)
- Kalpana Chhetri
- Pediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Rinchen
- Pediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Bhutan Kinley
- Pediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sangay Dorji
- Pediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Oren G, Jolkovsky S, Tal S. Falls in oldest-old adults hospitalized in acute geriatric ward. Eur Geriatr Med 2022; 13:859-866. [PMID: 35776410 DOI: 10.1007/s41999-022-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The study aims to identify risk factors for falling among acutely ill older patients, hospitalized in acute geriatric ward. METHODS A retrospective study of 260 cases of patients who had fallen and 439 controls was conducted in a geriatric ward. We retrieved from the electronic hospital records data including patient demographics, medical diagnoses, and laboratory results, and drugs taken prior to the fall were reviewed. In addition, data on functional and cognitive status were recorded. Admission Morse Falls Scale for every patient was also retrieved. RESULTS The following on-admission diagnoses were associated with a higher incidence of falls during hospitalization: hypertension (84% vs. 38%), congestive heart failure (CHF), 74% vs 16%, dementia (36% vs. 5%), and delirium (36% vs 5%). A higher percentage of fallers compared to controls consumed beta blockers (69% vs. 53%), benzodiazepines (46% vs. 32%), antidepressants (33% vs. 23%), oral diabetes drugs (20% vs. 11%) and opiates (8% vs. 4%). On-admission Morse Falls Scale score was found to be higher in the patients who fell (59 vs.53). The strongest predictors of falling during hospitalization were CHF, hypertension, dementia, delirium, assisted mobility and dependence. CONCLUSION A systematic screening of risk factors for falls and identification of them might contribute to reducing the risk associated with falls during hospitalization.
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Affiliation(s)
- Gal Oren
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel
| | - Svetlana Jolkovsky
- Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel
| | - Sari Tal
- Acute Geriatrics Department at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, 1, Derech Pasternak, st., Rehovot, Israel. .,Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel.
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Usmani S, Saboor A, Haris M, Khan MA, Park H. Latest Research Trends in Fall Detection and Prevention Using Machine Learning: A Systematic Review. SENSORS 2021; 21:s21155134. [PMID: 34372371 PMCID: PMC8347190 DOI: 10.3390/s21155134] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/16/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022]
Abstract
Falls are unusual actions that cause a significant health risk among older people. The growing percentage of people of old age requires urgent development of fall detection and prevention systems. The emerging technology focuses on developing such systems to improve quality of life, especially for the elderly. A fall prevention system tries to predict and reduce the risk of falls. In contrast, a fall detection system observes the fall and generates a help notification to minimize the consequences of falls. A plethora of technical and review papers exist in the literature with a primary focus on fall detection. Similarly, several studies are relatively old, with a focus on wearables only, and use statistical and threshold-based approaches with a high false alarm rate. Therefore, this paper presents the latest research trends in fall detection and prevention systems using Machine Learning (ML) algorithms. It uses recent studies and analyzes datasets, age groups, ML algorithms, sensors, and location. Additionally, it provides a detailed discussion of the current trends of fall detection and prevention systems with possible future directions. This overview can help researchers understand the current systems and propose new methodologies by improving the highlighted issues.
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Affiliation(s)
- Sara Usmani
- School of Electrical Engineering and Computer Science (SEECS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (S.U.); (M.H.)
| | - Abdul Saboor
- Department of Electrical Engineering (ESAT), Katholieke Universiteit (KU) Leuven, 3000 Leuven, Belgium;
| | - Muhammad Haris
- School of Electrical Engineering and Computer Science (SEECS), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (S.U.); (M.H.)
| | - Muneeb A. Khan
- Department of Software, Sangmyung University, Cheonan 31066, Korea;
| | - Heemin Park
- Department of Software, Sangmyung University, Cheonan 31066, Korea;
- Correspondence:
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Hauer K, Dutzi I, Gordt K, Schwenk M. Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5385. [PMID: 32962248 PMCID: PMC7570858 DOI: 10.3390/s20185385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann-Whitney-U tests, and Chi-square tests between patients with ("in-hospital fallers") and without an in-hospital fall ("in-hospital non-fallers"), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.
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Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Katharina Gordt
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany;
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany
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Montejano-Lozoya R, Miguel-Montoya I, Gea-Caballero V, Mármol-López MI, Ruíz-Hontangas A, Ortí-Lucas R. Impact of Nurses' Intervention in the Prevention of Falls in Hospitalized Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176048. [PMID: 32825282 PMCID: PMC7504031 DOI: 10.3390/ijerph17176048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023]
Abstract
Background: Clinical safety is a crucial component of healthcare quality, focused on identifying and avoiding the risks to which patients are exposed. Among the adverse events that occur in a hospital environment, falls have a large impact (1.9–10% of annual income in acute care hospitals); they can cause pain, damage, costs, and mistrust in the health system. Our objective was to assess the effect of an educational intervention aimed at hospital nurses (systematic assessment of the risk of falls) in reducing the incidence of falls. Methods: this was a quasi-experimental study based on a sample of 581 patients in a third level hospital (Comunitat Valenciana, Spain). An educational program was given to the intervention group (n = 303), and a control group was included for comparison (n = 278). In the intervention group, the nurses participated in a training activity on the systematized assessment of the risk of falls. Analysis was undertaken using the Bayesian logistic regression model. Results: a total of 581 patients were studied (50.6% male, 49.4% female), with an average age of 68.3 (DT = 9) years. The overall incidence of falls was 1.2% (0.3% in the intervention group and 2.2% in the control group). Most of the falls occurred in people ≥65 years old (85.7%). The intervention group had a lower probability of falling than the control group (OR: 0.127; IC95%: 0.013–0.821). Neither the length of hospital stay, nor the age of the participants, had any relevant effect. Conclusions: the systematic assessment of the risk of a patient falling during hospital processes is an effective intervention to reduce the incidence of falls.
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Affiliation(s)
- Raimunda Montejano-Lozoya
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Isabel Miguel-Montoya
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Vicente Gea-Caballero
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
- Correspondence:
| | - María Isabel Mármol-López
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Antonio Ruíz-Hontangas
- Escuela Enfermería La Fe, Valencia (Spain), adscript center of Universitat de Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain; (R.M.-L.); (I.M.-M.); (M.I.M.-L.); (A.R.-H.)
| | - Rafael Ortí-Lucas
- Public Health Department, Catholic University of Valencia, 46001 Valencia, Spain;
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Aguiar JR, Barbosa ADO, Galindo Neto NM, Ribeiro MA, Caetano JÁ, Barros LM. Fatores de risco associados à queda em pacientes internados na clínica médica-cirúrgica. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar os fatores de risco associados à quedas em pacientes internados na clínica médica-cirúrgica. Métodos Estudo analítico e descritivo com abordagem quantitativa realizado de junho a setembro de 2017 em hospital público de grande porte da região norte do estado do Ceará-Brasil. A amostra foi de 155 pacientes e a coleta ocorreu por meio de instrumento estruturado dividido em cinco partes: a) Dados Clínico-Epidemiológicos; b) Aplicação do Mini-mental; c) Aplicação da Escala de queda de Morse; d) Aplicação do índice de Katz; e) Diagnóstico de Enfermagem “Risco de Quedas”. Para análise estatística, foi considerado erro amostral de 5%. Resultados Dos 155 pacientes, 41,2% (64) possuíam diagnóstico clínico e 58,8% (91) eram pacientes traumatológicos. Foi identificado correlação estatisticamente para ocorrência de quedas entre dias de internamento (p=0,07), Mini exame mental (p=0,048) e Katz (p=0,017) para os pacientes clínicos enquanto que os pacientes traumatológicos apresentam associação positiva para ocorrência de quedas nas variáveis idade (p=0,028) e Katz (p=0,037). Conclusão Os principais fatores de risco identificados foram: uso de dispositivos auxiliares, história de quedas, estar em pós-operatório, dificuldade na marcha, força diminuída nas extremidades, equilíbrio prejudicado, mobilidade física prejudicada, cenário pouco conhecido e material antiderrapante insuficiente no banheiro.
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Severo IM, Kuchenbecker RDS, Vieira DFVB, Lucena ADF, Almeida MDA. Risk factors for fall occurrence in hospitalized adult patients: a case-control study. Rev Lat Am Enfermagem 2018; 26:e3016. [PMID: 30110094 PMCID: PMC6091377 DOI: 10.1590/1518-8345.2460.3016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/11/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to identify risk factors for falls in hospitalized adult patients. METHODS a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. RESULTS risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. CONCLUSION risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.
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Affiliation(s)
- Isis Marques Severo
- PhD, RN, Serviço de Terapia Intensiva, Hospital de Clínicas de Porto
Alegre, Porto Alegre, RS, Brazil
| | | | | | - Amália de Fátima Lucena
- PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal
do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Miriam de Abreu Almeida
- PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal
do Rio Grande do Sul, Porto Alegre, RS, Brazil
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