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Community therapy as a strategy for promoting the mental health of professors in the COVID-19 pandemic

La terapia comunitaria como estrategia de promoción de la salud mental del profesorado en la pandemia de COVID-19

ABSTRACT

Objective:

To understand the perception of university professors about Integrative Community Therapy as a mental health promotion strategy.

Methods:

Qualitative, phenomenological and interventional research, conducted with professors of the Nursing course at the Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil. The experiential descriptions were produced through phenomenological interviews, whose resulting material was analyzed based on the Ambiguity Analytical technique.

Results:

The professors expressed a lack of interaction between them, a fact that has become a reality in everyday academic life and that has worsened in the emergence of the COVID-19 pandemic. In this context, the Community Therapy circles in a virtual environment proved to be effective in sharing psychosocial and physical demands, as well as in the collective discussion of problem situations and the search for joint solutions.

Conclusion:

The study highlights the potential of Community Therapy as an integrative and complementary practice to the Brazilian public health care model.

Keywords:
Faculty; Mental health; Health promotion; Complementary therapies; Coronavirus infections

RESUMEN

Objetivo:

Comprender la percepción de los profesores universitarios sobre la Terapia Integrativa Comunitaria como estrategia para promover la salud mental.

Métodos:

Investigación cualitativa, fenomenológica e intervencionista, realizada con profesores del curso de Enfermería de la Universidad Estatal del Sudoeste de Bahía, Jequié, Bahía, Brasil. Las descripciones vivenciales se produjeron a través de entrevistas fenomenológicas, cuyo material resultante fue analizado con base en la técnica Analítica de la Ambigüedad.

Resultados:

Los docentes manifestaron una falta de interacción entre ellos, hecho que se ha hecho realidad en la vida académica cotidiana y que se ha agravado con el surgimiento de la pandemia de COVID-19. En este contexto, las ruedas de Terapia Comunitaria en un entorno virtual demostraron ser efectivas para compartir demandas psicosociales y físicas, así como en la discusión colectiva de situaciones problemáticas y la búsqueda de soluciones conjuntas.

Conclusión:

El estudio destaca el potencial de la Terapia Comunitaria como práctica integradora y complementaria al modelo de salud pública brasileño.

Palabras clave:
Docentes; Salud mental; Promoción de la salud; Terapias complementarias; Infecciones por Coronavírus

RESUMO

Objetivo:

Compreender a percepção de docentes universitários sobre a Terapia Comunitária Integrativa como estratégia de promoção da saúde mental.

Métodos:

Pesquisa qualitativa, fenomenológica e interventiva, realizada com docentes do curso de Enfermagem da Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brasil. As descrições vivenciais foram produzidas mediante entrevista fenomenológica, cujo material resultante foi analisado com base na técnica Analítica da Ambiguidade.

Resultados:

As Docentes expressaram carência de interação entre elas, fato que tem se constituído uma realidade no cotidiano da vida acadêmica e que se agravou na emergência da pandemia da COVID-19. Nesse contexto, as rodas de Terapia Comunitária em ambiente virtual se mostraram eficazes ao compartilhamento de demandas psicossociais e físicas, bem como à discussão coletiva de situações-problema e a busca de soluções conjuntas.

Conclusão:

O Estudo evidencia o potencial da Terapia Comunitária como prática integrativa e complementar ao modelo de atenção à saúde pública brasileiro.

Palavras-chave:
Docentes; Saúde mental; Promoção da saúde; Terapias complementares; Infecções por Coronavirus

INTRODUCTION

Common Mental Disorders (CMD) have been prevalent in worldwide population, and interfere in the personal, social, and work scope. Some studies show that higher education professors are among the groups most affected by these disorders, standing out as the ones with the highest level of stress and anxiety when compared to other professionals11. Baptista MN, Soares TFP, Raad AJ, Santos LM. Burnout, estresse, depressão e suporte laboral em professores universitários. Rev Psicol Organ Trab. 2019;19(1):564-70. doi: https://doi.org/10.17652/rpot/2019.1.15417
https://doi.org/10.17652/rpot/2019.1.154...
,22. Neme GGS, Limongi JE. Prevalência e fatores relacionados a transtornos mentais comuns entre professores universitários de uma universidade federal brasileira. Hygeia. 2019;15(32):112-20. doi: https://doi.org/10.14393/Hygeia153249863
https://doi.org/10.14393/Hygeia153249863...
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Double work shifts, along with the great institutional demands, having to engage in teaching, research and extension activities, as well as always being looking for new improvements, experiencing the precariousness of working conditions, inadequate institutional structures and salary flattening, lead the teaching category to emotional exhaustion and the emergence of some symptoms indicating the possibility of emergence of a mental disorder33. Santos DAS, Azevedo CA, Araújo TM, Soares JFS. Reflexões sobre a saúde docente no contexto de mercantilização do ensino superior. Rev Docência Ens Sup. 2016;6(1):159-86. doi: https://doi.org/0000-0001-6695-3638
https://doi.org/0000-0001-6695-3638...
,44. Campos T, Véras RM, Araújo TM. Trabalho docente em universidades públicas brasileiras e adoecimento mental: uma revisão bibliográfica. Rev Docência Ens Sup. 2020;10:e015193. doi: https://doi.org/10.35699/2237-5864.2020.15193
https://doi.org/10.35699/2237-5864.2020....
. Among the main symptoms stand out, “nervousness, stress, mental fatigue, forgetfulness and insomnia22. Neme GGS, Limongi JE. Prevalência e fatores relacionados a transtornos mentais comuns entre professores universitários de uma universidade federal brasileira. Hygeia. 2019;15(32):112-20. doi: https://doi.org/10.14393/Hygeia153249863
https://doi.org/10.14393/Hygeia153249863...
) ”.

In public universities, this situation becomes even worse, since there is a constant stop on investments, cuts in expenses, a reduction in the number of employees and a reduction in wages44. Campos T, Véras RM, Araújo TM. Trabalho docente em universidades públicas brasileiras e adoecimento mental: uma revisão bibliográfica. Rev Docência Ens Sup. 2020;10:e015193. doi: https://doi.org/10.35699/2237-5864.2020.15193
https://doi.org/10.35699/2237-5864.2020....
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The World Health Organization (WHO) declared, on January 30, 2020, the outbreak of the new coronavirus as a Public Health emergency of international concern and with the Organization’s highest level of alert, as provided for in the International Health Regulations; being the COVID-19 (Coronavirus Disease 2019), an infectious disease caused by the virus called SARS-CoV-2, considered a threat to global public health, which can lead to unpredictable impacts on the mental health of individuals, families, communities and nations, was characterized by WHO as a pandemic on March 11, 202055. World Health Organization [Internet]. Coronavírus disease (COVID-19) out break situation. Geneva: WHO; 2020 [cited 2021 Feb 01]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases...
-77. Ministério da Educação (BR). Gabinete do Ministro. Portaria nº 343, de 17 de novembro de 2020. Dispõe sobre a substituição das aulas presenciais por aulas em meios digitais enquanto durar a situação de pandemia do Novo Coronavírus - COVID-19. Diário Oficial União. 2020 mar 18 [cited 2021 Feb 01];158(53 Seção 1):39. Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=18/03/2020&jornal=515&pagina=39
https://pesquisa.in.gov.br/imprensa/jsp/...
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Regarding the repercussions of the pandemic for education in Brazil, the Ministry of Education, through Ordinance No. 343, published on March 17, 2020, suspended in-person classes because the situation, leading to a new work routine in education with classes and several activities remotely. A fact that implied readjustment of university institutions throughout Brazil and the way in which professors began to develop their work process, in an attempt to maintain teaching-learning practices at graduation88. Silva TF, Ramos TCS. Graduation in the area of health in times of pandemic from COVID-19: teaching the discipline of health promotion practice and disease prevention. Res Soc Dev. 2020;9(9):e782997974. doi: https://doi.org/10.33448/rsd-v9i9.7974
https://doi.org/10.33448/rsd-v9i9.7974...
,99. Palú J, Schutz JA, Mayer L, organizadores. Desafios da educação em tempos de pandemia. Cruz Alta: Ilustração; 2020..

Thus, the COVID-19 pandemic unveiled major challenges in all professional areas, which our generation has never experienced before. In teaching in particular, the challenges in this time of pandemic are numerous, since reaching and welcoming the student in a virtual and relevant way, with the teacher adapting to this new online routine in a context that requires innovative forms of approximation to share knowledge without direct contact, are some challenges to be pointed out and, we can say, bring a certain restlessness and anxiety88. Silva TF, Ramos TCS. Graduation in the area of health in times of pandemic from COVID-19: teaching the discipline of health promotion practice and disease prevention. Res Soc Dev. 2020;9(9):e782997974. doi: https://doi.org/10.33448/rsd-v9i9.7974
https://doi.org/10.33448/rsd-v9i9.7974...
,99. Palú J, Schutz JA, Mayer L, organizadores. Desafios da educação em tempos de pandemia. Cruz Alta: Ilustração; 2020.. Therefore, such aspects lead us to reflect not only on the teaching-learning process in times of social isolation, but on how professors have been feeling in this scenario internationally recognized as the “new normal”.

This context has increasingly demanded strategies to promote the mental health of university professors. In this regard, we believe in the potential of Integrative Community Therapy (ICT), as it constitutes a therapeutic care technology that allows both the identification of situations of psychic suffering and the construction of possibilities for coping and overcoming, and can be used in the re-dimensioning of conflicts, suffering and emotions1010. Castro R, Freitas CA, Rodrigues EP, Silva MB. Terapia comunitária sistêmica e integrativa como instrumento de avaliação e diagnóstico da saúde de servidores da secretaria de educação de Uberaba-MG. Temas em Educação e Saúde. 2016;12(1):85-96 doi: https://doi.org/10.26673/tes.v12i0.9814
https://doi.org/10.26673/tes.v12i0.9814...
,1111. Lemes AG, Rocha EM, Nascimento VF, Volpato RJ, Almeida MASO, Franco SEJ et al. Benefits of integrative community therapy revealed by psychoactive drug users. Acta Paul Enferm. 2020;33:e-APE20190122. doi: https://doi.org/10.37689/acta-ape/2020ao0122
https://doi.org/10.37689/acta-ape/2020ao...
.

ICT was included in the list of Integrative and Complementary Practices (ICP) recommended by the Ministry of Health through Ordinance No. 849, of March 27, 2017. It is a therapeutic practice developed through open and community circles, based on a horizontal perspective, fostering the construction of strategies that help to cope with psychic distress1212. Ministério da Saúde (BR). Gabinete do Ministro. Portaria nº 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Naturopatia, Osteopatia, Quiropraxia, Reflexoterapia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares. Diário Oficial União. 2017 mar 28 [cited 2019 Apr 28];154(60 Seção 1):68-9. Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=28/03/2017&jornal=1&pagina=68&totalArquivos=132
https://pesquisa.in.gov.br/imprensa/jsp/...
.

Realizing that the university, the locus of this study, did not have devices to promote the mental health of professors, despite experiencing increased pressures and frustrations related to the various functions performed, which imply work overload, among other factors that generate stress constant, as occurs in this new pandemic scenario, we were mobilized to implement the ICT, open to any professor who was interested.

Thus, the initiative to conduct the study with an interventional character, by conducting ICT circles with university professors, started from the concern of professors, of an undergraduate nursing course, for the development of strategies to promote mental health in the university setting, for perceiving the intertwining of the context of working life with mental illness, especially in this context of a pandemic that oversized the challenges and conflicts of the world of work in teaching.

Such reflections led us to define the following research question: what is the perception of university professors about Integrative Community Therapy as a strategy for promoting mental health?

To answer the question, we defined the objective: to understand the perception of university professors about Integrative Community Therapy as a strategy for promoting mental health.

METHOD

Qualitative, phenomenological and interventional study, based on the theoretical-philosophical categories of Maurice Merleau-Ponty, about the dimensions of perception as one’s own body, considering that the body is always shown as a draft of what it will be and what makes it its own are the infinite possibilities of becoming another1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.. This article allowed us to understand the intertwining of the five dimensions of one’s own body described by Merleau-Ponty, namely: habitual body, perceptive body, speaking body, sexed body and body of the other1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015..

The habitual body refers to the horizon of the past that fills all intuitive acts and that emerges spontaneously in our actions regardless of personal deliberation. The perceptive body is equivalent to the action itself, which, although it is unreflective, is mobilized by habit. The speaking body consists of the potentiality of speech to generate other speeches, as occurs in dialogue, in intersubjectivity. The sexed body means the human capacity to feel pleasure in what one does; corresponds to what motivates us to live and produce. And the body of the other, also known as the experience of the other, consists of the experience of transcendence, the power of becoming another through temporality1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.,1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015..

The interventional character of the research occurred through the development of ICT circles, which constitute an open community space for sharing life experiences and knowledge, horizontally and in circles, allowing people to be therapists of themselves, through listening of life stories reported in the circles1515. Oliveira DST, Ferreira Filha MO. Contribuição dos recursos culturais para a Terapia Comunitária Integrativa na visão do terapeuta. Rev Gaúcha Enferm. 2011;32(3):524-30. doi: https://doi.org/10.1590/S1983-14472011000300013
https://doi.org/10.1590/S1983-1447201100...
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ICT is based on five theoretical axes: systemic thinking, communication theory, cultural anthropology, Paulo Freire’s pedagogy and resilience. The operationalization of therapy involves the following steps: welcoming, choosing the theme, contextualization, problematization, rituals of aggregation and positive connotation, and evaluation1515. Oliveira DST, Ferreira Filha MO. Contribuição dos recursos culturais para a Terapia Comunitária Integrativa na visão do terapeuta. Rev Gaúcha Enferm. 2011;32(3):524-30. doi: https://doi.org/10.1590/S1983-14472011000300013
https://doi.org/10.1590/S1983-1447201100...
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The themes of each ICT meeting emerged from the daily experiences of the participants themselves during choosing the theme stage, in which each professor had the opportunity both to express their concerns and to vote for the situation in which they most identified and wanted to discuss at the moment1616. Barreto AP. Terapia comunitária passo a passo. 4. ed. Fortaleza: Gráfica LCR; 2010.. Thus, the participants chose the topics discussed in each meeting, such as feeling of overload and dissatisfaction with work, insecurity about the future, experiencing family conflicts, experience of distancing and social isolation, daily repercussions of remote work, conflicting interpersonal relationships, among others.

The study was conducted at the Universidade Estadual do Sudoeste da Bahia (UESB), no campus de Jequié, Bahia, Brazil. The intervention phase started in person with the implementation and development of three ICT circles integrating professors from the institution, every fortnight, in one of the classrooms, in the second semester of 2019. However, due to social distancing as a protective measure against COVID-19, and to contain the spread of the new coronavirus (SARS-CoV-2), in-person academic activities at UESB were suspended, and it was necessary to adapt the ICT circles to an online format.

Thus, from May 2020, 12 circles were developed, weekly, through the Zoom and Google Meet platforms, always by two UESB professors, trained in ICT, in the roles of co-therapist and therapist. Furthermore, there was a student from the UESB nursing course, a scholarship holder of the Institutional Scientific Initiation Scholarship Program (Programa Institucional de Bolsa de Iniciação Científica - PIBIC) of the Regional Council for Scientific and Technological Development (Conselho Regional de Desenvolvimento Científico e Tecnológico - CNPq), who was responsible for publicizing the circles on social networks of the research group (Instagram and Whatsapp), individual invitation to professors who showed interest in participating, scheduling and conducting interviews, according to the guidance and/or monitoring of the professors responsible for the research.

The invitation to participate in the ICT circles was made by email to all professors at UESB, Jequié-BA campus, however, twelve professors of the nursing course were willing to participate. For the research phase, eight of them agreed to participate in the interviews. The inclusion criteria were: having participated in at least six ICT sessions; and not having been away from work during the intervention phase (ICT circles). For the exclusion criteria: having been away from work for vacation and/or leave of any kind, during the interventional phase and not having participated in at least 6 circles of therapy.

To better signal the place of speech of the study participants, we chose to present aspects of their sociodemographic profile. All participants were aged between 45 and 60 years old, four declared themselves married and four single; four claimed to be Catholic, three evangelicals and one did not profess a religious creed; all had been teaching for over twenty years; and, resided in the municipality where they taught.

The experience descriptions (information) were produced through phenomenological individual interviews1717. Santos DAS, Moura MES, Paes ARM, Portela NLC, Vilanova AKL. Vivência da entrevista fenomenológica com adolescentes grávidas: relato de experiência. Rev Augustus. 2019;19(38):29-35. doi: https://doi.org/10.15202/10.15202.2014v19n38p29
https://doi.org/10.15202/10.15202.2014v1...
, in view of the potential of this technique to mobilize the dialogical and intersubjective relationship between researcher and participants, which allows to retake aspects of temporality and the comprehensive process of descriptions. In this type of interview, there is no right or wrong to declare. The participants’ speech and their perception of the world are valued. Thus, the phenomenological interviews favored the construction of intersubjectivity, empathy and meetings that contributed to the unveiling of information1717. Santos DAS, Moura MES, Paes ARM, Portela NLC, Vilanova AKL. Vivência da entrevista fenomenológica com adolescentes grávidas: relato de experiência. Rev Augustus. 2019;19(38):29-35. doi: https://doi.org/10.15202/10.15202.2014v19n38p29
https://doi.org/10.15202/10.15202.2014v1...
,1818. Paula CC, Padoin SMM, Terra MG, Souza IEO, Cabral IE. Modos de condução da entrevista em pesquisa fenomenológica: relato de experiência. Rev Bras Enferm. 2014;67(3):468-72. doi: https://doi.org/10.5935/0034-7167.20140063
https://doi.org/10.5935/0034-7167.201400...
.

The interviews were scheduled previously with the participants, after they had participated in at least six ICT circles. They were held between June and August 2020, online, due to the COVID-19 pandemic context. To conduct the interviews, we used the following trigger question: Talk about the experience of participating in ICT circles during the pandemic. Each interview lasted between 30 and 60 minutes and was recorded using a multimedia resource, with the consent of the participants; then transcribed in full, constituting the experience descriptions of the research (empirical data). It should be noted that the information produced in the ICT circles was not analyzed, despite having mobilized dialogue in some moments of the interviews.

The analysis of the information unveiled in the interviews was based on the Ambiguity Analytical technique1919. De Jesus IS, Oliveira MAF, Santos VTC, Carvalho PAL, Andrade LM, Pereira LC, et al. Perception of basic education students about drugs: a look at the light of Merleau-Ponty. Rev Gaúcha Enferm. 2017;38(4):e65013. doi: https://doi.org/10.1590/1983-1447.2017.04.65013
https://doi.org/10.1590/1983-1447.2017.0...
,2020. Sena ELS, Araújo ML, Ribeiro BS, Santos VTC, Malhado SCB, Soares CJ, et al. Ambiguity of care in the experience of drug consumers. Rev Gaúcha Enferm. 2017;38(2):e64345. doi: http://doi.org/10.1590/1983-1447.2017.02.64345
http://doi.org/10.1590/1983-1447.2017.02...
, whose operability includes: a thorough reading of the experiences descriptions (empirical data); identification of naturalized speeches (theses); perception of ambiguities regarding the dimensions of sensitive (feelings) and reflective (rationalization, thinking) human nature unveiled in intercorporeality with the study participants2121. Silva MZ, Barreto AP, Ruiz JEL, Camboim SP, Lazarte R, Ferreira Filha MO. O cenário da terapia comunitária integrativa no Brasil: história, panorama e perspectivas. Temas Educ Saúde. 2020;16(esp 1):341-59. doi: https://doi.org/10.26673/tes.v16iesp.1.14316
https://doi.org/10.26673/tes.v16iesp.1.1...
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The research complied with the ethical precepts of Resolution 466/2012 of the National Health Council regarding research with human beings. Therefore, the project was submitted to the Research Ethics Committee (REC) of the Universidade Estadual do Sudoeste da Bahia and obtained a favorable opinion of No. 333.535 and CAAE: 58163316,7,1001,005. All participants signed the Free and Informed Consent Form (FICF) with explanations on the research purpose, relevance and stages of the study. To ensure the anonymity of the participants they were identified with fictitious names.

RESULTS

Below are the experiential descriptions of the study participants, which highlight the construction process of the following category:

From pandemic uncertainties to intersubjective hope: reflection of Integrative Community Therapy on the mental health of university professors.

The results of this study revealed the potential of the ICT circle to make intersubjective feelings more encouraging and gratifying, even in moments marked by sadness, uncertainty, fear and hopelessness, as occurred in the COVID 19 pandemic. At the same time, the circles constitute a comprehensive care technology, showing that this dialogic experience can be used in the university context for promoting the mental health of professors.

The participants of this study expressed feelings of satisfaction and well-being for having participated in the ICT circles, while they showed how the identification with the suffering of the other person allows the occurrence of feelings with greater potential to promote hope, as observed in the speeches below:

We usually come in a little sad, even hopeless, sad with the reality we are experiencing and, the moment we leave the circle, we leave with hope. (Julieta)

Everyone arrives with a problem, something that bothers them: uncertainty, fear of what might happen in this moment that we are living, the COVID pandemic [...], but the experiences of sharing in the circles help us to have hope. (Maria)

The experience of the circle favors this exchange, improves the quality of mental health of professors, the moments when we leave the circle were notorious. Without a doubt, they were magical experiences that worked a lot on our emotions, our minds, our whole being. (Amanda)

For the professors who participated in the study, at the same time that it mobilizes the recognition that all people experience problems, ICT allows identification with more encouraging feelings, which increase the sense of satisfaction and contribute to the improvement of work relationships, as evidenced by the statements:

When we have family problems, without being able to eat and sleep properly, or worried about finances [...] this affects performance at university, in work relationships, whether we like it or not, no matter how hard we try not to take these worries to work, it ends up taking them. And when the circles happen, these feelings are softened, because the circle is a place to unload the emotions of everyday life [...] it brings good feelings, hope, joy, reflection [...] favoring the work environment. (Fernanda)

It improves our way of working, of developing our work with the help of a colleague who often deals with us. (Maria)

The potential of ICT to mobilize the expression of feelings such as fear, anguish, sadness, resulting from the pandemic was evidenced by the participants when revealed that they also need care, as below:

With COVID 19 we are not afraid of losing our jobs, but we are experiencing other types of fear that put us in a situation of sharing this feeling that is not only ours but belongs to humanity. [...] some are afraid of unemployment, but we are afraid of other things, afraid of illness and death, worried about tomorrow. (Maria)

In the circle we had the opportunity to experience many feelings, initially of impotence, of anguish with the pandemic, I think these were the strongest feelings at the beginning of the circle, when we put the problem to be discussed there, after that I think that conversation and speech generated feelings of relief and comfort. (Amanda)

The notion of ICT as a space for sharing and dialogue highlights the search of professors who participated in the study for listening and help to re-signify of the difficulties faced, through the expression of the desire to replace them with the strength unveiled by other participants, as revealed by the statements below:

ICT has a very intelligent flow, it moves us, since it is relational; it also makes us able to express emotions that we wouldn't express if the flow wasn't like this, if it didn't have those steps. So, the steps that are provided [...] I leave and I take, I leave my difficulties and take my strengths; this exchange, this dialogue is fabulous, it is fascinating. (Joaquina)

ICT is an opportunity you must share your experiences with other people and, from that listening, people can help you. (Julieta)

Therapy came at an opportune time. I had the desire to participate in-person, but the time did not match, [...] in the pandemic I was able to participate online, which helped me a lot. There were moments when I was not good, with not so positive feelings because of the pandemic, anguished and worried. Participating in the circle, listening to other situations, sometimes helped to improve self-esteem; I also came across situations where the person was going through a much more difficult time than mine, and I was able to signify that moment I was going through. (Marta)

ICT circles favor the transcendence of a sense of joy, pleasure, satisfaction and happiness amidst of meeting with co-workers, even in a remote environment, allowing keeping affective relationships and the strengthening of friendship bonds, as the statements show:

For me, it was a moment of receiving help from the group, but anyway, we end up helping each other when we are willing to listen, which is rewarding. Having people who want to listen, sing, entertain, meet, especially now at the time of the pandemic, meeting time, because this is our new normality, where we can meet friends and talk, even by distance meetings. (Julieta)

Happiness of meeting each week, [...] each one has something that hurts, and expressing that is very good, having someone who listens to us. This thing of having someone listening to you talk, who cares about what you're feeling, that's pleasurable. (Carmem)

You stay in that expectation of the meeting, that's also very good; It's really good to feel like we are not alone. [...] the affections, interaction with people, (the ICT) values these issues much more. (Julieta)

The statements of professors showed the power of dialogue, of sharing experiences, to reduce the sense of hopelessness and produce openness to life and relationships:

We also learn to listen to the other and find solutions trying to draw out our potential, also not to fall into despair [...]. (Julieta)

Sharing with others, learning from others, and envisioning a different future. (Carmem)

You leave with experience, with reflections, you start to reflect on some things. (Fernanda)

For the professors the dialogical relationship provided by the ICT circles favors the experience of spirituality, mobilizes the construction of friendships and solidarity, besides to produce a feeling of lightness, relief, improvement, and comfort, even in times of pandemic, since it is focused on growth of the community, as shown in the statements:

This relational technology (ICT) improves anguish, relieves the heart, soul, spirit a lot, it moves us in terms of emotion and spirit, both things are very present, it gives relief, and that's very good! [...] if I managed to win this far, it is because I have a strong God who sustains me! If we have faith, we will overcome all pandemics. (Joaquina)

We can help in somehow, not financially, but somehow, with our faith, with a word of comfort, I find that interesting. (Antônia)

The professors highlighted the potential of ICT circles to make others more hopeful by transforming perspectives for the future, living it with more optimism, relief and joy. Through discussion about life, the strength of a professor can influence her peers, in the sense of perceiving herself as a strong person and, therefore, capable of overcoming adversities, as shown in the statements:

Everyone feels relieved and leaves more hopeful, because they put a situation and it is discussed with optimism, that there is the possibility of hope for something better. (Maria)

I didn't know I was so strong [...]. The experience in the circles supported us, because sometimes we lose to ourselves, this is the worst loss, it generates great frustration. So, therapy makes us win, face our own fears, the darkest, the most intimate, because we overcome the rest, overcoming our uncertainties and our limit is the true victory. (Joaquina)

The circles have provided a lot of growth, they have strengthened us [...], my life is going to change on a horizon up ahead. (Carmem)

DISCUSSION

The theoretical-philosophical support of the study in the light of Maurice Merleau-Ponty’s framework imposes the denial of any naturalistic attempt to interpret the empirical descriptions produced with the participants in the research. That is, therefore, a dialogical relationship that is characterized by the interweaving of our view, as researchers, with the theoretical categories of the philosopher and the empirical data of the research.

Therefore, the discussion presented here consisted of understanding the results of the study concerning the experiences of university professors regarding their participation in ICT circles and their perceptions about the meaning of the experience in promoting mental health. The philosophical approach proposed by Merleau-Ponty is centered on the experience of perception as an occurrence in the phenomenal field. Thus, in the intersubjectivity of the dialogical experience, the perception is unveiled in profiles, which constitute what the philosopher called his own body1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.,1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015..

Upon the statements of the study participants, we noticed that in the space of simultaneous speech and listening, characteristic of ICT circles, they had the opportunity to experience the phenomenon of the usual body, since they were able to express feelings spontaneously and without worrying about censorship or social judgment, regardless of the guidelines that therapists usually make at the beginning of each ICT circle, for example, the emphasis that in this space one should not make judgments.

In Merleau-Ponty’s terms, the habitual body essentially refers to our primal bond with the environment that surrounds us, it corresponds to an experience that, although experienced by all of us human beings, we will never be able to know it fully, or that is, it always escapes us1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.,1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015..

Thus, the descriptions of university professors who participated in this study reinforced the importance of the usual body in promoting mental health, as it is from this profile of one’s own body that manifestations of both mental distress and satisfaction with life emerge2020. Sena ELS, Araújo ML, Ribeiro BS, Santos VTC, Malhado SCB, Soares CJ, et al. Ambiguity of care in the experience of drug consumers. Rev Gaúcha Enferm. 2017;38(2):e64345. doi: http://doi.org/10.1590/1983-1447.2017.02.64345
http://doi.org/10.1590/1983-1447.2017.02...
.

Thus, the results of the study confirmed that the promotion of mental health takes place in a complex set of relationships and intersubjectivities2020. Sena ELS, Araújo ML, Ribeiro BS, Santos VTC, Malhado SCB, Soares CJ, et al. Ambiguity of care in the experience of drug consumers. Rev Gaúcha Enferm. 2017;38(2):e64345. doi: http://doi.org/10.1590/1983-1447.2017.02.64345
http://doi.org/10.1590/1983-1447.2017.02...
,2121. Silva MZ, Barreto AP, Ruiz JEL, Camboim SP, Lazarte R, Ferreira Filha MO. O cenário da terapia comunitária integrativa no Brasil: história, panorama e perspectivas. Temas Educ Saúde. 2020;16(esp 1):341-59. doi: https://doi.org/10.26673/tes.v16iesp.1.14316
https://doi.org/10.26673/tes.v16iesp.1.1...
, what Merleau-Ponty understood as an experience of interweaving or chiasm, which takes place in a phenomenal field, that is, as a person speaks it mobilizes the production of a series of other speeches and articulations of thoughts1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.. Thus, ICT proved to be effective in promoting the mental health of the professors participating in the study, as corroborated by their experience descriptions.

Following the comprehensive process, in light of the theory of one’s own body, the dynamics of speech articulation and production of reflections that took place in the ICT circles, as showed by the statements produced during the interviews, corresponded to what Merleau-Ponty called the speaking body and, in some of his works, illustrated him with the aesthetic experience of art, with what happens in literature, music, painting, sculpture, cinema. They are speeches that generated speeches and, thus, in the descriptions of the professors we observe that in the ICT circles what essentially configured therapy for them was the experience of speech, of sharing, of intersubjectivity, of the experiential encounter.

The professors’ descriptions revealed that participation in ICT circles imposes experiences on the other. Moreover, the experience in front of the other produces an effect on our body, which Merleau-Ponty characterizes as sexuality or sexed body, as a dimension of human perception. Thus, the sexed body, like the other dimensions of one’s own body, is revealed in the ambiguity of the interweaving that involves, at the same time, an openness to the other and a narcissistic event1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015.. Which means, for example, that by perceiving the other, I also perceive myself.

Therefore, Merleau-Ponty, referring to the Freudian thought about sexuality, makes the following consideration: “the sexual is not the genital, sexual life is not the simple effect of processes of which the genitals are the place1414. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015.”. For the philosopher, sexuality, in the perspective of an openness to the other, allows us to return to our sensitive world, the universe of feelings, which make us coexist. It is in this perspective that the notion of the sexed body, described by the author, is inscribed.

However, what exactly is the significance of trying to understand the experiences of the participants in our study according to the mirage of the sexualized body? It was from this point of view that we observed that one of the essential needs of university professors was the interaction between them, dialogue, sharing, intersubjectivity and coexistence. We note that the social interaction of peers in the work environment is essential to promote mental health of workers2222. Santos GMRF, Silva ME, Belmonte BR. COVID-19: emergency remote teaching and university professors’ mental health. Rev Bras Saúde Mater Infant. 2021;21(Suppl 1):237-43. doi: https://doi.org/10.1590/1806-9304202100S100013
https://doi.org/10.1590/1806-9304202100S...
. Thus, we understand that social interaction is an experience of sexuality and, therefore, of human care, since it produces satisfaction, pleasure and learning.

The professors participants of the study expressed that the lack of interaction between them has become a reality in everyday academic life and the emergence of the COVID-19 pandemic, as well as the consequent social distancing, contributed to worsen the situation, confirming the study developed in São Paulo, with 70 professors from academic centers2323. Zago MC, organizadora. Saúde mental no século XXI: indivíduo e coletivo pandêmico [Internet]. Científica Digital: Guarujá-SP; 2021 [cited 2021 Feb 04]. Available from https://downloads.editoracientifica.org/books/978-65-87196-90-9.pdf
https://downloads.editoracientifica.org/...
. In this context, the TCI circles in a virtual environment proved to be effective in sharing psychosocial and physical demands, as well as in the collective discussion of problem situations and the search for joint solutions. In this sense, ICT has been characterized as an important technology for the care and promotion of professors’ mental health2424. Barreto AP, Filha MOF, Silva MZ, Di Nicola V. Integrative Community Therapy in the Time of the New Coronavirus Pandemic in Brazil and Latin America. World Soc Psychiatry 2020;2:103-5.

When describing on how our perception (own body) operates, Merleau-Ponty states that the experience of the present (perceptive body) “hides time”, that is, at each moment our perception brings together a past and a future1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.. Therefore, the professors’ descriptions of the experience of participating in ICT circles during the pandemic made us see clearly the Merleau-Ponty’s philosophy in action.

The look at the experiences of professors regarding participation in ICT circles, during the COVID 19 pandemic, mobilized us to recognize how powerful we are in problem resolution. As ICT authors defend, we have problems, but we also have the solution1010. Castro R, Freitas CA, Rodrigues EP, Silva MB. Terapia comunitária sistêmica e integrativa como instrumento de avaliação e diagnóstico da saúde de servidores da secretaria de educação de Uberaba-MG. Temas em Educação e Saúde. 2016;12(1):85-96 doi: https://doi.org/10.26673/tes.v12i0.9814
https://doi.org/10.26673/tes.v12i0.9814...
,1111. Lemes AG, Rocha EM, Nascimento VF, Volpato RJ, Almeida MASO, Franco SEJ et al. Benefits of integrative community therapy revealed by psychoactive drug users. Acta Paul Enferm. 2020;33:e-APE20190122. doi: https://doi.org/10.37689/acta-ape/2020ao0122
https://doi.org/10.37689/acta-ape/2020ao...
,1515. Oliveira DST, Ferreira Filha MO. Contribuição dos recursos culturais para a Terapia Comunitária Integrativa na visão do terapeuta. Rev Gaúcha Enferm. 2011;32(3):524-30. doi: https://doi.org/10.1590/S1983-14472011000300013
https://doi.org/10.1590/S1983-1447201100...
. This perceptive look also allowed us to see in the other its power to become another; and to value intersubjectivity and intercorporeality more as priorities for knowledge production and effective health practices.

In times of pandemic, such as COVID 19, engagement in groups is essential for strengthening self-esteem1717. Santos DAS, Moura MES, Paes ARM, Portela NLC, Vilanova AKL. Vivência da entrevista fenomenológica com adolescentes grávidas: relato de experiência. Rev Augustus. 2019;19(38):29-35. doi: https://doi.org/10.15202/10.15202.2014v19n38p29
https://doi.org/10.15202/10.15202.2014v1...
, as shown by the results of this study. Likewise, the study also revealed that this engagement drives us to move forward, despite the epidemiological, economic and political crises, such as the participation of professors in ICT circles.

In the process of unfolding the participants’ statements, an admirable profile of one’s own body was unveiled - the body of the other or the experience of the other, a notion that does not refer to the other, but the experience of transcendence, as revealed in the interviews, in which the professors who shared a deep feeling of fear and anguish, felt more relieved and devoid of these emotions after participating in the ICT circles.

Merleau-Ponty’s descriptions of the other’s body reveal the subtlety and care with which he approaches the process of transcendence, which occurs through social interaction and intersubjectivity1313. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.. For the philosopher, there is no explanation for the occurrence of change; it is a phenomenological experience that takes place in the intertwining of two totalities: the private and the social.

In the interface between the ICT theoretical framework and Maurice Merleau-Ponty’s philosophy of the one’s own body, we found grounds for discussing the results of the study and building knowledge that we consider capable of highlighting ICT as a care technology for the promotion of mental health of university professors.

CONCLUSION

The study showed the potential of Community Therapy as a care technology and promotion of the mental health of university professors. In our study, we sought to make an interface between the epistemology that supports therapy and the dimensions of one’s own body evidenced by Merleau-Ponty’s philosophy.

In the speaking body dimension, for example, we observed the power of language to mobilize and produce intersubjectivities. As happens in the contemplation of a work of art, through the intertwining of the artist's sensitivity with the sociocultural environment, the social interaction in the therapy circles generated results, which re-signified the participants’ way of being, acting and living.

From this perspective, the professors in our study described their participation in therapy circles as an opportunity to open up to the other, to relate to the other, establishing and/or strengthening bonds of friendship.

What constituted as therapy in the perception of the professors who participated in this study was intersubjectivity, intercorporeality, interweaving, coexistence that allows the resumption of the sensitive body and makes coexistence possible. Thus, we recognize the potential of the circles to produce meetings between “equals”, among similar people in the same work context, which makes us see the same and the different that produces hope, courage, relief, strength, optimism, while mobilizes resilience, self-esteem and well-being.

The study revealed the potential of therapy to become a permanent space for the expression of feelings that imposes upon us, regardless of our will, in a phenomenal way. Thus, therapy brings out the power of sharing feelings and reflections for the personal and professional development of professors, especially nurses, since both the researchers and participants in this study are inserted in this field of practice.

Despite achieving the proposed objective and recognizing that in phenomenological studies knowledge is always unfinished, we highlight as a limitation of the study the fact that some participants may feel embarrassed for being in a familiar environment or in others that allow people to listen by whom they would not want to share their lives. Additionally, the remote environment is subject to technological problems such as signal instability, failures in electronic devices and digital applications, aspects that can hinder communication.

Acknowledgments:

To the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq) for the scientific initiation scholarship.

REFERENCES

  • 1. Baptista MN, Soares TFP, Raad AJ, Santos LM. Burnout, estresse, depressão e suporte laboral em professores universitários. Rev Psicol Organ Trab. 2019;19(1):564-70. doi: https://doi.org/10.17652/rpot/2019.1.15417
    » https://doi.org/10.17652/rpot/2019.1.15417
  • 2. Neme GGS, Limongi JE. Prevalência e fatores relacionados a transtornos mentais comuns entre professores universitários de uma universidade federal brasileira. Hygeia. 2019;15(32):112-20. doi: https://doi.org/10.14393/Hygeia153249863
    » https://doi.org/10.14393/Hygeia153249863
  • 3. Santos DAS, Azevedo CA, Araújo TM, Soares JFS. Reflexões sobre a saúde docente no contexto de mercantilização do ensino superior. Rev Docência Ens Sup. 2016;6(1):159-86. doi: https://doi.org/0000-0001-6695-3638
    » https://doi.org/0000-0001-6695-3638
  • 4. Campos T, Véras RM, Araújo TM. Trabalho docente em universidades públicas brasileiras e adoecimento mental: uma revisão bibliográfica. Rev Docência Ens Sup. 2020;10:e015193. doi: https://doi.org/10.35699/2237-5864.2020.15193
    » https://doi.org/10.35699/2237-5864.2020.15193
  • 5. World Health Organization [Internet]. Coronavírus disease (COVID-19) out break situation. Geneva: WHO; 2020 [cited 2021 Feb 01]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
    » https://www.who.int/emergencies/diseases/novel-coronavirus-2019
  • 6. Arshad Ali S, Baloch M, Ahmed N, Arshad Ali A, Iqbal A. The outbreak of Coronavirus Disease 2019 (COVID-19) - an emerging global health threat. J Infect Public Health. 2020;13(4):644‐6. doi: https://doi.org/10.1016/j.jiph.2020.02.033
    » https://doi.org/10.1016/j.jiph.2020.02.033
  • 7. Ministério da Educação (BR). Gabinete do Ministro. Portaria nº 343, de 17 de novembro de 2020. Dispõe sobre a substituição das aulas presenciais por aulas em meios digitais enquanto durar a situação de pandemia do Novo Coronavírus - COVID-19. Diário Oficial União. 2020 mar 18 [cited 2021 Feb 01];158(53 Seção 1):39. Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=18/03/2020&jornal=515&pagina=39
    » https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=18/03/2020&jornal=515&pagina=39
  • 8. Silva TF, Ramos TCS. Graduation in the area of health in times of pandemic from COVID-19: teaching the discipline of health promotion practice and disease prevention. Res Soc Dev. 2020;9(9):e782997974. doi: https://doi.org/10.33448/rsd-v9i9.7974
    » https://doi.org/10.33448/rsd-v9i9.7974
  • 9. Palú J, Schutz JA, Mayer L, organizadores. Desafios da educação em tempos de pandemia. Cruz Alta: Ilustração; 2020.
  • 10. Castro R, Freitas CA, Rodrigues EP, Silva MB. Terapia comunitária sistêmica e integrativa como instrumento de avaliação e diagnóstico da saúde de servidores da secretaria de educação de Uberaba-MG. Temas em Educação e Saúde. 2016;12(1):85-96 doi: https://doi.org/10.26673/tes.v12i0.9814
    » https://doi.org/10.26673/tes.v12i0.9814
  • 11. Lemes AG, Rocha EM, Nascimento VF, Volpato RJ, Almeida MASO, Franco SEJ et al. Benefits of integrative community therapy revealed by psychoactive drug users. Acta Paul Enferm. 2020;33:e-APE20190122. doi: https://doi.org/10.37689/acta-ape/2020ao0122
    » https://doi.org/10.37689/acta-ape/2020ao0122
  • 12. Ministério da Saúde (BR). Gabinete do Ministro. Portaria nº 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Naturopatia, Osteopatia, Quiropraxia, Reflexoterapia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares. Diário Oficial União. 2017 mar 28 [cited 2019 Apr 28];154(60 Seção 1):68-9. Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=28/03/2017&jornal=1&pagina=68&totalArquivos=132
    » https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=28/03/2017&jornal=1&pagina=68&totalArquivos=132
  • 13. Merleau-Ponty M. A prosa do mundo. São Paulo: Cosac Naify; 2012.
  • 14. Merleau-Ponty M. Fenomenologia da percepção. 5. ed. São Paulo: Martins Fontes; 2015.
  • 15. Oliveira DST, Ferreira Filha MO. Contribuição dos recursos culturais para a Terapia Comunitária Integrativa na visão do terapeuta. Rev Gaúcha Enferm. 2011;32(3):524-30. doi: https://doi.org/10.1590/S1983-14472011000300013
    » https://doi.org/10.1590/S1983-14472011000300013
  • 16. Barreto AP. Terapia comunitária passo a passo. 4. ed. Fortaleza: Gráfica LCR; 2010.
  • 17. Santos DAS, Moura MES, Paes ARM, Portela NLC, Vilanova AKL. Vivência da entrevista fenomenológica com adolescentes grávidas: relato de experiência. Rev Augustus. 2019;19(38):29-35. doi: https://doi.org/10.15202/10.15202.2014v19n38p29
    » https://doi.org/10.15202/10.15202.2014v19n38p29
  • 18. Paula CC, Padoin SMM, Terra MG, Souza IEO, Cabral IE. Modos de condução da entrevista em pesquisa fenomenológica: relato de experiência. Rev Bras Enferm. 2014;67(3):468-72. doi: https://doi.org/10.5935/0034-7167.20140063
    » https://doi.org/10.5935/0034-7167.20140063
  • 19. De Jesus IS, Oliveira MAF, Santos VTC, Carvalho PAL, Andrade LM, Pereira LC, et al. Perception of basic education students about drugs: a look at the light of Merleau-Ponty. Rev Gaúcha Enferm. 2017;38(4):e65013. doi: https://doi.org/10.1590/1983-1447.2017.04.65013
    » https://doi.org/10.1590/1983-1447.2017.04.65013
  • 20. Sena ELS, Araújo ML, Ribeiro BS, Santos VTC, Malhado SCB, Soares CJ, et al. Ambiguity of care in the experience of drug consumers. Rev Gaúcha Enferm. 2017;38(2):e64345. doi: http://doi.org/10.1590/1983-1447.2017.02.64345
    » http://doi.org/10.1590/1983-1447.2017.02.64345
  • 21. Silva MZ, Barreto AP, Ruiz JEL, Camboim SP, Lazarte R, Ferreira Filha MO. O cenário da terapia comunitária integrativa no Brasil: história, panorama e perspectivas. Temas Educ Saúde. 2020;16(esp 1):341-59. doi: https://doi.org/10.26673/tes.v16iesp.1.14316
    » https://doi.org/10.26673/tes.v16iesp.1.14316
  • 22. Santos GMRF, Silva ME, Belmonte BR. COVID-19: emergency remote teaching and university professors’ mental health. Rev Bras Saúde Mater Infant. 2021;21(Suppl 1):237-43. doi: https://doi.org/10.1590/1806-9304202100S100013
    » https://doi.org/10.1590/1806-9304202100S100013
  • 23. Zago MC, organizadora. Saúde mental no século XXI: indivíduo e coletivo pandêmico [Internet]. Científica Digital: Guarujá-SP; 2021 [cited 2021 Feb 04]. Available from https://downloads.editoracientifica.org/books/978-65-87196-90-9.pdf
    » https://downloads.editoracientifica.org/books/978-65-87196-90-9.pdf
  • 24. Barreto AP, Filha MOF, Silva MZ, Di Nicola V. Integrative Community Therapy in the Time of the New Coronavirus Pandemic in Brazil and Latin America. World Soc Psychiatry 2020;2:103-5
  • Authorship contribution:

    Project administration: Edite Lago da Silva Sena. Formal analysis: Edite Lago da Silva Sena, Daiane Brito Ribeiro, Luma Costa Pereira Peixoto, Patrícia Anjos Lima de Carvalho. Conceptualization: Edite Lago da Silva Sena, Daiane Brito Ribeiro. Writing - original draft: Edite Lago da Silva Sena, Daiane Brito Ribeiro. Writing - review & editing: Vanessa Thamyris Carvalho dos Santos, Helca Franciolli Teixeira Reis, Patrícia Anjos Lima de Carvalho. Investigation: Daiane Brito Ribeiro, Luma Costa Pereira Peixoto, Vanessa Thamyris Carvalho dos Santos, Helca Franciolli Teixeira Reis, Patrícia Anjos Lima de Carvalho. Methodology: Edite Lago da Silva Sena, Patrícia Anjos Lima de Carvalho, Daiane Brito Ribeiro, Luma Costa Pereira Peixoto, Vanessa Thamyris Carvalho dos Santos, Helca Franciolli Teixeira Reis. Funding acquisition: Edite Lago da Silva Sena. Supervision: Edite Lago da Silva Sena. Validation: Edite Lago da Silva Sena, Daiane Brito Ribeiro.

Edited by

Associate editor:

Dagmar Elaine Kaiser

Editor-in-chief:

João Lucas Campos de Oliveira

Publication Dates

  • Publication in this collection
    13 Oct 2023
  • Date of issue
    2023

History

  • Received
    27 May 2021
  • Accepted
    23 Dec 2022
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