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1.
PLoS One ; 16(4): e0250022, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831125

RESUMO

Populations of migratory waterbirds are facing dramatic declines worldwide due to illegal hunting, habitat loss and climate change. Conservation strategies to reverse these trends are imperative, especially in tropical developing countries, which almost invariably allocate insufficient levels of investment for environmental protection. Here, we compared the effectiveness of sustainable-use Protected Areas (PAs) and Community-based Conservation (CBC) arrangements for the conservation of migratory waterbirds that breed on seasonal riverine sandy beaches in Brazilian Amazonia. We modeled local population responses of four migratory waterbird species on 155 beaches along a ~1,600 km section of a major tributary of the Amazon, as a function of community enforcement, official protection status, human pressure and landscape features. We show that 21 community-protected beaches within the study area host more than 80% of all sampled birds. Black Skimmers showed the most dramatic response, with breeding numbers 135-fold larger in CBC arrangements compared to beaches with no official protection status. The same pattern was observed for nesting Large-Billed and Yellow-Billed Terns. For the Near Threatened Orinoco Goose, PA status was the strongest predictor of local population size. These dramatic results demonstrate the value of protected refugia, achieved through the concerted action of participating local communities, to support breeding populations of key waterbird species. This highly-effective and low-cost conservation model can potentially be replicated in other regions of the developing world experiencing increasingly intensive exploitation of riverine natural resources.


Assuntos
Charadriiformes/fisiologia , Pesquisa Participativa Baseada na Comunidade/métodos , Conservação dos Recursos Naturais/métodos , Migração Animal/fisiologia , Animais , Biodiversidade , Aves , Brasil , Cruzamento , Charadriiformes/metabolismo , Pesquisa Participativa Baseada na Comunidade/tendências , Ecossistema , Humanos , Densidade Demográfica , Dinâmica Populacional , Refúgio de Vida Selvagem , Estações do Ano , Áreas Alagadas
2.
Autism Res ; 13(8): 1248-1257, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32588542

RESUMO

The number of empirical studies on sexuality and intimate relationships in autistic people has grown over the last years with the increasing awareness that sexuality and intimate relationships are an important part of life and well-being for autistic people. Further, expression and enjoyment of sexuality is a fundamental, basic human right. This paper reports on needs for future research in this area based on the input of autistic adults, researchers, and other stakeholders (e.g., parents and professionals). Utilizing the nominal group technique, 65 individuals participated in eight groups in which they brainstormed on research questions they deemed most important. Responses were categorized into themes and ranked according to importance based on the level of priority attributed by participants. Findings suggest that future research should focus on developing ways to support sexual and relationship well-being and getting a better understanding of sexuality and relationships in autistic people. Also, attention was drawn to the need for studying the influence of stereotypical societal views, and stigma. Finally, the importance of participatory research to include perspectives of autistic people in research and practice was stressed. LAY SUMMARY: Sexuality and romantic relationships are part of daily life for most people, including autistic people. For this study, groups of autistic people, professionals, and autism researchers discussed which research on autism, sexuality, and relationships is needed and can help autistic adolescents and adults. The group discussions revealed that more research is needed on how to support well-being relating to romantic relationships and sexuality in autistic people and how the people around them can contribute to this. Therefore, we also need to learn more about how autistic people of all ages and throughout their lives experience sexuality and relationships. Finally, the need for attention to the role of stereotypical ideas and stigma about autism, sexuality, and relationships was pointed out. Attention to the experiences of autistic people can help professionals, researchers, and policy makers to offer and organize attuned support and do relevant research. Autism Res 2020, 13: 1248-1257. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.


Assuntos
Transtorno do Espectro Autista/psicologia , Relações Interpessoais , Sexualidade , Participação dos Interessados , Pesquisa Participativa Baseada na Comunidade/tendências , Feminino , Humanos , Masculino , Opinião Pública
3.
Am J Public Health ; 110(6): 803-806, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298180

RESUMO

Intersectionality, an analytical approach rooted in Black feminist theory and praxis, has become more widely used in population health research. The majority of quantitative population health studies have used intersectionality as a theoretical framework to investigate how multiple social identities rather than social inequalities simultaneously influence health inequities.Although a few researchers have developed methods to assess how multiple forms of interpersonal discrimination shape the health of multiply marginalized groups and others have called for the use of multilevel modeling to examine the role of intersecting dimensions of structural discrimination, critical qualitative, multidisciplinary, and community-based participatory research approaches are needed to more fully incorporate the core ideas of intersectionality-including social inequality, relationality, complexity, power, social context, and social justice-into quantitative population health research studies or programs.By more comprehensively capturing and addressing the influence of intersecting structural factors, social and historical processes, and systems of power and oppression on the health of multiply marginalized individuals, quantitative population health researchers will more fully leverage intersectionality's transformational power and move one step closer to achieving social justice and health equity.


Assuntos
Pesquisa Participativa Baseada na Comunidade/tendências , Colaboração Intersetorial , Saúde da População , Saúde Pública/tendências , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31936190

RESUMO

African American young adults continue to be disproportionately affected by HIV/AIDS. The Southern United States has been particularly affected by HIV/AIDS, accounting for 52% of the new HIV diagnoses. Efforts to reduce the burden of HIV among young African Americans are still needed. Project HAPPY (HIV/AIDS Prevention Project for Youth) was developed and implemented using a community-based participatory research (CBPR) model. There were several challenges that arose during implementation of Project HAPPY that included recruitment, partner engagement, and retention. The realities of implementing an HIV prevention project with urban adolescents is discussed in detail and strategies to overcome these challenges, using a CBPR approach are described. The lessons learned from CBPR implementation of Project HAPPY include: (1) Create a feedback loop to receive community input and guidance throughout the life of the project; (2) Periodic community inventory to determine who is providing similar services to avoid saturation; (3) Prepare for Alternative Partner Engagement; (4) Consult (formally and informally) with the Institutional Review Board prior to submitting proposed changes to avoid unnecessary delays in implementation; (5) Select meaningful incentives for your priority population; and (6) Maintain multiple points of contact with community partners to mitigate the effects of staff turnover.


Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Terapia Comportamental/métodos , Pesquisa Participativa Baseada na Comunidade/normas , Comportamentos Relacionados com a Saúde , Adolescente , Negro ou Afro-Americano/psicologia , Terapia Comportamental/organização & administração , Pesquisa Participativa Baseada na Comunidade/tendências , Feminino , Humanos , Estados Unidos , Adulto Jovem
6.
Hawaii J Med Public Health ; 78(3): 83-88, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30854253

RESUMO

Community-based participatory research (CBPR) continues to be recognized as an effective research approach in which academic researchers work in partnership with communities to address health disparities. Although the literature suggests benefits associated with CBPR, more needs to be done to advance CBPR to ultimately reduce health disparities. Hawai'i presents a research-rich opportunity for CBPR because of its ethnic diversity and geographic location, resulting in close-knit communities with unique experiences and concerns. This study aims to better understand the experiences of academic researchers who are conducting CBPR in Hawai'i and their perceptions of its benefits and challenges as well as recommendations to advance the field. Twelve academic researchers with Hawai'i-based CBPR experience were interviewed. Four major themes emerged from their responses: the importance of prioritizing relationship-building; reciprocal learning and other benefits of CBPR; navigating the tensions between CBPR and funding priorities; and building an academic setting that supports CBPR. Increasing awareness of CBPR and its benefits, as well as transforming the culture in all spaces where CBPR occurs may maximize its potential to ultimately promote health equity.


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Disparidades nos Níveis de Saúde , Pesquisa Participativa Baseada na Comunidade/tendências , Havaí , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Projetos de Pesquisa
7.
Hawaii J Med Public Health ; 78(3): 111-114, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30854258

RESUMO

There are substantial and persistent health disparities among Native Hawaiians that are best addressed through multilevel socio-ecological approaches, which are tailored to the needs of the community. Partnerships that link academic investigators with grass roots community members have the potential to profoundly reduce health disparities and improve health and wellness by increasing the capacity of community-based organizations to provide leadership in health advocacy, support community health promotion, and participate in health research. We describe a 14-year partnership to reduce Native Hawaiian health disparities between investigators from The Queen's Medical Center and University of Hawai'i John A. Burns School of Medicine (QMC-JABSOM) and community members in Hana, a geographically isolated, underserved, rural community with the second largest concentration of Native Hawaiians in the state. Our relationship started as an investigator-initiated, National Institutes of Health-sponsored study to explore familial cardiomyopathy, and transitioned to a community-based project that combined community cardiovascular health screening fairs with a qualitative research study to understand attitudes towards genetic research. Most recently, QMC-JABSOM has partnered closely with Ma Ka Hana Ka 'Ike, an award-winning construction skills training program for at-risk youth in Hana, to develop innovative, culturally based interventions to improve health and well-being among Native Hawaiians using principles of community-based participatory research.


Assuntos
Disparidades nos Níveis de Saúde , Saúde Pública/métodos , Pesquisa Participativa Baseada na Comunidade/métodos , Pesquisa Participativa Baseada na Comunidade/tendências , Havaí , Humanos
9.
BMC Geriatr ; 18(1): 287, 2018 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-30470201

RESUMO

BACKGROUND: Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care. METHODS: The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling. DISCUSSION: The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care. TRIAL REGISTRATION: ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/ ).


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Atenção à Saúde/métodos , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Satisfação no Emprego , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Pesquisa Participativa Baseada na Comunidade/tendências , Atenção à Saúde/tendências , Feminino , Pessoal de Saúde/tendências , Instituição de Longa Permanência para Idosos/tendências , Humanos , Liderança , Nova Zelândia/epidemiologia , Instituições Residenciais/tendências
10.
Soc Sci Med ; 215: 80-91, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30218806

RESUMO

Participatory research carried out by or with children, has become a well-established and valuable part of the research landscape investigating children's lives, views and needs. So too has a critical agenda about its ethical implications and methodological complexities. One criticism is that the involvement of children who may be considered 'vulnerable' or 'marginalised' has been slower to take root within mainstream participatory practice. This means that there has been less focus on how groups such as disabled children or children affected by abuse or neglect can shape and challenge adult-dominated types of knowledge and decision-making that are likely to affect them. This article reports on the findings of a qualitative systematic literature review of thirteen contemporary papers. The review was undertaken by a UK team in 2017. The included articles explored some core ethical and methodological issues involved in carrying out participatory research with vulnerable children and young people. It reports on three themes: 1) The extent to which participatory spaces could recalibrate opportunities and attention given to marginalised and silenced groups; 2) The ways in which these children and young people could develop skills and exercise political and moral agency through participatory activity, and, 3) How to facilitate meaningful engagement with individuals and groups and reconcile this with a critical appreciation of the important but limited nature of research as means of political and social change. The review provides a unique, contemporary analysis of participatory research with vulnerable children, illuminating in particular its conceptual complexities and contradictions, particularly regarding power, empowerment and voice. Its overall utility and interest is augmented by the disciplinary and geographical breadth of the included articles, rendering it relevant to many contexts and countries.


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Pesquisa Qualitativa , Populações Vulneráveis/psicologia , Adolescente , Criança , Pré-Escolar , Pesquisa Participativa Baseada na Comunidade/normas , Pesquisa Participativa Baseada na Comunidade/tendências , Crianças com Deficiência/psicologia , Humanos
12.
Pediatrics ; 140(Suppl 2): S127-S131, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29093047

RESUMO

Research on the social implications of adolescent technology use often focuses on identifying and preventing risk. However, adolescence is also a time of rapidly expanding capacities, expectations of autonomy, and identity exploration. In this article, we highlight findings from research in the field of youth civic development, which point to the importance of youth civic engagement during adolescence for later adult civic engagement as well as for promoting positive developmental outcomes. Researchers suggest that certain forms of Internet use (such as information seeking, social network site use, media production, and participation in online communities) promote civic engagement and that digital tools play an important role in youth empowerment efforts. In this article, we suggest a need for greater attention to efforts to promote digital media competencies among adolescents and for greater coordination of research on adolescent risk and adolescent autonomy and empowerment related to Internet use.


Assuntos
Comportamento do Adolescente/psicologia , Computadores/tendências , Política , Mídias Sociais/tendências , Responsabilidade Social , Adolescente , Pesquisa Participativa Baseada na Comunidade/métodos , Pesquisa Participativa Baseada na Comunidade/tendências , Humanos , Internet/tendências , Relações Interpessoais
13.
Neurodegener Dis Manag ; 6(2): 107-18, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27033990

RESUMO

AIM: To describe an innovative community-wide program aimed at increasing awareness of risks of missing person events among persons with dementia targeting various cultural groups and to present preliminary evaluation findings. METHODS: Review of program records to describe program implementation and a community partner survey. RESULTS: Over 23 months, 386 partnerships were established to implement the program; 941 awareness-raising sessions were conducted reaching 23,495 individuals. There is an upward trend in number of sessions conducted in various languages and attendance. Community partners' (>85%) responded positively to the program and consultation process. CONCLUSION: This partnership experience demonstrates the effectiveness of a collaborative approach to the development and widespread dissemination of information and resource materials aimed at ensuring the safety of a vulnerable population.


Assuntos
Conscientização , Pesquisa Participativa Baseada na Comunidade/métodos , Comportamento Cooperativo , Demência/epidemiologia , Demência/terapia , Desenvolvimento de Programas/métodos , Pesquisa Participativa Baseada na Comunidade/tendências , Demência/psicologia , Humanos , Ontário/epidemiologia
14.
BMC Med Ethics ; 16: 78, 2015 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-26573410

RESUMO

BACKGROUND: Implementation science research, especially when using participatory and co-design approaches, raises unique challenges for research ethics committees. Such challenges may be poorly addressed by approval and governance mechanisms that were developed for more traditional research approaches such as randomised controlled trials. DISCUSSION: Implementation science commonly involves the partnership of researchers and stakeholders, attempting to understand and encourage uptake of completed or piloted research. A co-creation approach involves collaboration between researchers and end users from the onset, in question framing, research design and delivery, and influencing strategy, with implementation and broader dissemination strategies part of its design from gestation. A defining feature of co-creation is its emergent and adaptive nature, making detailed pre-specification of interventions and outcome measures impossible. This methodology sits oddly with ethics committee protocols that require precise pre-definition of interventions, mode of delivery, outcome measurements, and the role of study participants. But the strict (and, some would say, inflexible) requirements of ethics committees were developed for a purpose - to protect participants from harm and help ensure the rigour and transparency of studies. We propose some guiding principles to help square this circle. First, ethics committees should acknowledge and celebrate the diversity of research approaches, both formally (through training) and informally (by promoting debate and discussion); without active support, their members may not understand or value participatory designs. Second, ground rules should be established for co-design applications (e.g. how to judge when 'consultation' or 'engagement' becomes research) and communicated to committee members and stakeholders. Third, the benefits of power-sharing should be recognised and credit given to measures likely to support this important goal, especially in research with vulnerable communities. Co-design is considered best practice, for example, in research involving indigenous peoples in New Zealand, Australia and Canada.


Assuntos
Pesquisa Participativa Baseada na Comunidade/ética , Pesquisa Participativa Baseada na Comunidade/tendências , Comitês de Ética em Pesquisa , Projetos de Pesquisa , Pesquisadores/ética , Sujeitos da Pesquisa , Austrália , Canadá , Comportamento Cooperativo , Comitês de Ética em Pesquisa/normas , Humanos , Nova Zelândia , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa/normas , Projetos de Pesquisa/tendências
16.
Nicotine Tob Res ; 17(8): 908-23, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26180215

RESUMO

INTRODUCTION: In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework. METHODS: We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework. RESULTS: Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP. CONCLUSIONS: The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.


Assuntos
Redes Comunitárias/tendências , Pesquisa Participativa Baseada na Comunidade/tendências , Disparidades nos Níveis de Saúde , National Cancer Institute (U.S.)/tendências , Neoplasias/prevenção & controle , Prevenção do Hábito de Fumar , Pesquisa Participativa Baseada na Comunidade/métodos , Humanos , Neoplasias/etnologia , Fumar/etnologia , Nicotiana , Estados Unidos
17.
J Environ Public Health ; 2015: 191856, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25815016

RESUMO

OBJECTIVES: To undertake a critical review describing key strategies supporting development of participatory research (PR) teams to engage partners for creation and translation of action-oriented knowledge. METHODS: Sources are four leading PR practitioners identified via bibliometric analysis. Authors' publications were identified in January 1995-October 2009 in PubMed, Embase, ISI Web of Science and CAB databases, and books. Works were limited to those with a process description describing a research project and practitioners were first, second, third, or last author. RESULTS: Adapting and applying the "Reliability Tested Guidelines for Assessing Participatory Research Projects" to retained records identified five key strategies: developing advisory committees of researchers and intended research users; developing research agreements; using formal and informal group facilitation techniques; hiring co-researchers/partners from community; and ensuring frequent communication. Other less frequently mentioned strategies were also identified. CONCLUSION: This review is the first time these guidelines were used to identify key strategies supporting PR projects. They proved effective at identifying and evaluating engagement strategies as reported by completed research projects. Adapting these guidelines identified gaps where the tool was unable to assess fundamental PR elements of power dynamics, equity of resources, and member turnover. Our resulting template serves as a new tool to measure partnerships.


Assuntos
Serviços de Saúde Comunitária , Pesquisa Participativa Baseada na Comunidade , Saúde Pública , Serviços de Saúde Comunitária/tendências , Pesquisa Participativa Baseada na Comunidade/tendências , Saúde Pública/tendências
18.
Artigo em Inglês | MEDLINE | ID: mdl-24859098

RESUMO

BACKGROUND: The Mental Health-Clergy Partnership Program established partnerships between institutional (Department of Veterans' Affairs [VA] chaplains, mental health providers) and community (local clergy, parishioners) groups to develop programs to assist rural veterans with mental health needs. OBJECTIVES: Describe the development, challenges, and lessons learned from the Mental Health-Clergy Partnership Program in three Arkansas towns between 2009 and 2012. METHODS: Researchers identified three rural Arkansas sites, established local advisory boards, and obtained quantitative ratings of the extent to which partnerships were participatory. RESULTS: Partnerships seemed to become more participatory over time. Each site developed distinctive programs with variation in fidelity to original program goals. Challenges included developing trust and maintaining racial diversity in local program leadership. CONCLUSIONS: Academics can partner with local faith communities to create unique programs that benefit the mental health of returning veterans. Research is needed to determine the effectiveness of community based programs, especially relative to typical "top-down" outreach approaches.


Assuntos
Clero , Serviços Comunitários de Saúde Mental/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Saúde dos Veteranos/estatística & dados numéricos , Arkansas , Serviços Comunitários de Saúde Mental/tendências , Pesquisa Participativa Baseada na Comunidade/tendências , Humanos , Parcerias Público-Privadas , Religião e Psicologia , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/tendências , Saúde dos Veteranos/tendências , Recursos Humanos
19.
Glob Health Promot ; 21(1 Suppl): 58-63, 2014 Mar.
Artigo em Francês | MEDLINE | ID: mdl-24737817

RESUMO

The process of joint evaluation involving several actors is criss-crossed by a process of negotiation and adjustment between different concerns, responsibilities and interests. How can we encourage a dialogue between knowledge from expertise and knowledge from experience, in order to produce knowledge that is scientifically based and useful for those who are involved in the programs? Far from being a mechanical process, this involves the delicate task of striking a balance, which relies on a negotiated partnership framework. The implementation of an advisory committee, organized by an interface function between the stakeholders of the intervention under study, has increasingly become recognized as a necessary condition for success in partnership-based research. These conditions enable the deployment of a reflexive system that can support social innovation--when the formulation of the problem and its resulting actions become enriched, as knowledge about the intervention develops.


Assuntos
Pesquisa Participativa Baseada na Comunidade/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde , Pesquisa Participativa Baseada na Comunidade/normas , Pesquisa Participativa Baseada na Comunidade/tendências , Relações Comunidade-Instituição , Pesquisa sobre Serviços de Saúde/normas , Pesquisa sobre Serviços de Saúde/tendências , Humanos , Relações Interinstitucionais , Inovação Organizacional
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