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1.
PLoS One ; 14(2): e0210955, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726259

RESUMO

BACKGROUND: Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs. METHODOLOGY/PRINCIPAL FINDINGS: Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education. CONCLUSIONS/SIGNIFICANCE: Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.


Assuntos
Cuidadores/psicologia , Aconselhamento/métodos , Hanseníase/psicologia , Educação de Pacientes como Assunto , Relações Profissional-Paciente , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hanseníase/diagnóstico , Hanseníase/terapia , Amor , Masculino , Nepal , Grupo Associado , Pesquisa Qualitativa , Estigma Social , Adulto Jovem
2.
Lepr Rev ; 88(1): 2-22, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30188085

RESUMO

Objectives: People affected by leprosy are often stigmatised, but stigma is rarely quantified and the effectiveness of interventions is often not evaluated. The SARI Project aimed to test and evaluate three interventions: counselling (involving peer counsellors), socio-economic development (SED) and contact between community members and affected people. Results: This study used a controlled trial design in which pairs of the stigma-reduction interventions were randomly allocated to sub-districts in Cirebon District,Indonesia. The study sample consisted of one cohort of people affected by leprosy (on treatment or treated) and two independent samples of community members. The latter were selected through purposive sampling. Three scales (e.g. SARI Stigma Scale, Participation scale) were applied among leprosy-affected people and two scales (e.g. Social Distance Scale) were used among community members pre- and post-intervention. Among affected people (n=237), significant differences in reduction of stigma and participation restrictions were found in all intervention areas and an improvement in quality of life in some intervention areas. Social distance and social stigma significantly reduced among community members (n=213 and 375) in the two intervention areas where the contact intervention was implemented. Two of the five instruments indicated changes in the control area, but the changes in the intervention areas were much larger. Conclusion: The SARI Project has demonstrated that a measurable reduction in leprosy-related stigma can be achieved, both at community level and among people affected by leprosy, using reproducible interventions that can be adapted to different settings and target groups.


Assuntos
Hanseníase/economia , Hanseníase/psicologia , Adulto , Aconselhamento , Desenvolvimento Econômico , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Grupo Associado , Qualidade de Vida , Estigma Social , Adulto Jovem
3.
PLoS Negl Trop Dis ; 10(12): e0005088, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27959932

RESUMO

BACKGROUND: This paper assesses the impact of a counselling intervention on reducing leprosy-related stigma in Cirebon District, Indonesia. The unique features of this intervention are its rights-based approach, the underlying Cognitive Behavioural Therapy (CBT) model, the three types of counselling and the lay and peer counsellors who were involved. METHODOLOGY/PRINCIPAL FINDINGS: Mixed methods (e.g. three scales, interviews, focus group discussions and reflection notes) were used to assess the impact of the intervention, which ran over a two-year period. There was a control area with no interventions. The study participants were people affected by leprosy and other key persons (e.g. family members). The sample size differs per method, for example, data regarding 67 counselling clients and 57 controls from a cohort, and notes from 207 counselling clients were examined. The notes showed that most clients faced stigma on a daily basis, whether internalized, anticipated and/or enacted. A significant reduction was found between the before and after total scores of the SARI Stigma Scale (p-value < 0.001), Participation Scale Short (p-value < 0.001) and WHO Quality of Life score (p-value < 0.001) among the counselling clients. While there is also an effect in the control group, it is much larger in the intervention group. Qualitative data indicates that knowledge and rights trigger change. Clients took steps to improve their life such as re-connecting with neighbours, helping in household activities and applying for jobs. Challenges include the wish to conceal their condition. CONCLUSION/SIGNIFICANCE: The findings show that the counselling intervention was effective in reducing stigma, promoting the rights of people with leprosy and facilitating their social participation. More research is needed on how to create a more sustainable intervention, preferably structurally embedded in the health or social services.


Assuntos
Aconselhamento/métodos , Hanseníase/psicologia , Estigma Social , Terapia Cognitivo-Comportamental , Humanos , Indonésia/epidemiologia , Hanseníase/epidemiologia , Direitos do Paciente , Qualidade de Vida , Participação Social
4.
Lepr Rev ; 86(1): 37-53, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26065146

RESUMO

OBJECTIVE: Counselling has been identified as a promising strategy to reduce stigma. Lay and peer counsellors have provided counselling in various fields, but this has not yet been studied in the field of leprosy. The Stigma Assessment and Reduction of Impact (SARI) project in Cirebon District, Indonesia took up this endeavour. This paper describes the initial experiences based on the perspectives of the lay and peer counsellors and aims to provide lessons learnt for future initiatives. METHODS: The selection of lay and peer counsellors was based upon pre-defined criteria such as completed junior high school and level of confidence. This study draws on the notes of seven monitoring and evaluation meetings and 21 group discussions the main researcher facilitated with the lay and peer counsellors and the notes written by the lay and peer counsellors on the sessions with their clients. RESULTS: In total, 198 people affected by leprosy were offered counselling by the 11 lay and 12 peer counsellors; 145 accepted this offer. The other 53 either did not need counselling or did not want to participate for example due to worries about disclosure. Effective communication skills such as listening and asking effective questions were important, but also difficult to acquire for the lay and peer counsellors. Sharing personal experiences was highly appreciated by clients and stimulated a deepened reflection. CONCLUSION: Challenges related to concealment and effective skills exist, but some people affected by leprosy and others can become effective counsellors making it at the outset a challenging but nevertheless promising intervention.


Assuntos
Aconselhamento , Hanseníase/psicologia , Estigma Social , Adolescente , Adulto , Aconselhamento/economia , Pessoas com Deficiência/psicologia , Feminino , Humanos , Indonésia , Hanseníase/economia , Masculino , Pessoa de Meia-Idade , Grupo Associado , Adulto Jovem
5.
Lepr Rev ; 85(3): 149-57, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25509715

RESUMO

BACKGROUND: Interventions to reduce leprosy-related stigma reduce the manifestations of stigma that cause so much suffering to individuals and their families. PURPOSE: This systematic review aims to identify interventions that have been used to reduce such stigma and to summarise what is known about their efficacy. METHOD: Electronic searches were undertaken using PubMed (Medline), CINAHL and PsycInfo databases. The internet was searched using Google Scholar for papers not published in these databases. All relevant papers written in Thai or English were included. RESULTS: After reading 55 papers, three duplications and parallel literatures were removed, 18 were removed on abstract screening and nine after reading the full papers; eventually, 25 were included in this review. Interventions with some evidence of effectiveness in terms of stigma reduction comprise the integration of leprosy programmes into general health care; Information Education and Communication (IEC) programmes; and socio-economic rehabilitation. CONCLUSION: More evaluations are needed of the effect of the integration of leprosy programmes into general health services. The design and implementation of IEC interventions need to be preceded by careful study of the target area and population and should be undertaken in combination with other activities.


Assuntos
Hanseníase/psicologia , Estigma Social , Comunicação , Aconselhamento , Humanos , PubMed
6.
Lepr Rev ; 84(3): 199-208, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24428114

RESUMO

BACKGROUND & OBJECTIVES: Counsellors provide psychological support, appropriate education and coping skills to persons affected by adverse events. Counselling of leprosy patients is essential to enable them to cope with perceived stigma as well as managing severe enacted stigma at home, place of work or elsewhere. Professional counselling was instituted at the Leprosy Mission Community Hospital in Naini, Allahabad District, India, in 2004. In this paper we describe how the use of the Participation Scale helped in developing Counselling strategies for a variety of leprosy patients. MATERIAL & METHODS: A random sample of 250 leprosy patients visiting the hospital for the first time during 2011-2012 were chosen, 50 each from those with only hidden patches (Grade 0a), patients with visible patches (Grade 0b), those with only anaesthesia or weakness (Grade I), patients with paralytic deformities (Grade 2a), and patients with visible disabilities and ulcers Grade 2b). The P-scale consisting of 18 items was administered in the local language (Hindi) and used by the Counsellor along with relevant clinical and socioeconomic details. RESULTS: There were 84 women and 166 men, distributed in all the five categories. Overall, 142 patients out of 250 (56.8%) had no participation restrictions; 39 (15.6%) had mild social restrictions; 20 (8.0%) had moderate, 28 (11.2%) had severe and 21 (84%) had extreme participation restrictions. Paradoxically, there were some cases without severe deformity who are also subjected to restrictions. Patients in Grades 0a and 0b, had practically no severe or even moderate restrictions in their social participation, but their perceived stigma was high, requiring suitable leprosy education, family counselling and coping skills to feel confident that they were capable of normal work like any of their peers. Counselling became more intensive in Grade 1 and for almost all in Grade 2, who experienced moderate to severe restrictions in meeting new people, participating in social activities and indulging in socioeconomic activities. Counselling for such groups of patients required multiple approaches, including in-depth leprosy education for regular treatment, self-care measures, mobilisation of coping skills, self-confidence and acceptance counselling, and follow-up counselling for thos released from treatment after multidrug therapy. CONCLUSIONS & RECOMMENDATIONS: The P-scale provides essential information to enable a Counsellor to offer more meaningful and balanced counselling to leprosy-affected people, especially in coping with enacted stigma. Education oriented counselling and psychological supportive counselling are necessary adjuncts for clinical care and treatment. Client-oriented counselling allows clients to freely express their fears and anxieties, and promotes coping skills and confidence.


Assuntos
Aconselhamento/métodos , Hanseníase/psicologia , Hanseníase/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ocupações , Estigma Social
7.
J Couns Psychol ; 57(3): 297-303, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21133581

RESUMO

The main purpose of this study was to investigate how receiving personal counseling at a university counseling center helps students deal with their personal problems and facilitates academic functioning. To that end, this study used both clinical and academic outcome measures that are relevant to the practice of counseling provided at a counseling center and its unique function in an institution of higher education. In addition, this study used the clinical significance methodology (N. S. Jacobson & P. Truax, 1991) that takes into account clients' differences in making clinically reliable and significant change. Pre-intake and post-termination surveys, including the Outcome Questionnaire (M. J. Lambert, K. Lunnen, V. Umphress, N. Hansen, & G. Burlingame, 1994), were completed by 78 clients, and the responses were analyzed using clinical significance methodology. The results revealed that those who made clinically reliable and significant change (i.e., the recovered group) reported the highest level of improvement in academic commitment to their educational goals and problem resolution, compared with those who did not make clinically significant change. The implications of the findings on practice for counseling at university counseling centers and for administrators in higher education institutions are discussed.


Assuntos
Logro , Aconselhamento , Resolução de Problemas , Serviços de Saúde para Estudantes , Adolescente , Adulto , Feminino , Humanos , Individualidade , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Autoeficácia , Adulto Jovem
8.
PLoS One ; 4(12): e8351, 2009 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-20020051

RESUMO

BACKGROUND: Leprosy was eliminated as a public health problem (<1 case per 10,000) in India by December 2005. With this target in sight the need for a separate vertical programme was diminished. The second phase of the National Leprosy Eradication Programme was therefore initiated: decentralisation of the vertical programme, integration of leprosy services into the primary health care (PHC) system and development of a surveillance system to monitor programme performance. METHODOLOGY/PRINCIPAL FINDINGS: To study the process of integration a qualitative analysis of issues and perceptions of patients and providers, and a review of leprosy records and registers to evaluate programme performance was carried out in the state of Orissa, India. Program performance indicators such as a low mean defaulter rate of 3.83% and a low-misdiagnosis rate of 4.45% demonstrated no detrimental effect of integration on program success. PHC staff were generally found to be highly knowledgeable of diagnosis and management of leprosy cases due to frequent training and a support network of leprosy experts. However in urban hospitals district-level leprosy experts had assumed leprosy activities. The aim was to aid busy PHC staff but it also compromised their leprosy knowledge and management capacity. Inadequate monitoring of a policy of 'new case validation,' in which MDT was not initiated until primary diagnosis had been verified by a leprosy expert, may have led to approximately 26% of suspect cases awaiting confirmation of diagnosis 1-8 months after their initial PHC visit. CONCLUSIONS/SIGNIFICANCE: This study highlights the need for effective monitoring and evaluation of the integration process. Inadequate monitoring could lead to a reduction in early diagnosis, a delay in initiation of MDT and an increase in disability rates. This in turn could reverse some of the programme's achievements. These findings may help Andhra Pradesh and other states in India to improve their integration process and may also have implications for other disease elimination programmes such as polio and guinea worm (dracunculiasis) as they move closer to their elimination goals.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Atenção Primária à Saúde/organização & administração , Conscientização , Aconselhamento , Quimioterapia Combinada , Educação em Saúde , Humanos , Índia/epidemiologia , Hanseníase/diagnóstico , Hanseníase/terapia , Cooperação do Paciente , Qualidade da Assistência à Saúde , Sistema de Registros , Reprodutibilidade dos Testes
9.
Int J Tuberc Lung Dis ; 12(4): 424-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18371269

RESUMO

SETTING: Kenya, one of the 22 tuberculosis (TB) high-burden countries, whose TB burden is fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To monitor and evaluate the implementation of HIV testing and provision of HIV care to TB patients in Kenya through the establishment of a routine TB-HIV integrated surveillance system. DESIGN: A descriptive report of the status of implementation of HIV testing and provision of HIV interventions to TB patients one year after the introduction of the revised TB case recording and reporting system. RESULTS: From July 2005 to June 2006, 88% of 112835 TB patients were reported to the National Leprosy and TB Control Programme, 98773 (87.9%) of whom were reported using a revised recording and reporting system that included TB-HIV indicators. HIV testing of TB patients increased from 31.5% at the beginning of this period to 59% at the end. Of the 46428 patients tested for HIV, 25558 (55%) were found to be HIV-positive, 85% of whom were provided with cotrimoxazole preventive treatment and 28% with antiretroviral treatment. CONCLUSION: A country-wide integrated TB-HIV surveillance system in TB patients can be implemented and provides essential data to monitor and evaluate TB-HIV related interventions.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Tuberculose/complicações , Tuberculose/diagnóstico , Sorodiagnóstico da AIDS , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Antirretrovirais/uso terapêutico , Criança , Pré-Escolar , Aconselhamento , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-18032854

RESUMO

Liposuction is a commonly performed procedure to remove localized deposits of fat. Liposuction under general anesthesia is associated with significant morbidity and risk of mortality. Dermatologic surgeons have made significant contributions in this field. Tumescent liposuction using microcannuale under local anesthesia, as practised by dermatologic surgeons is safe and effective. This article describes the procedure of microcannular tumescent liposuction.


Assuntos
Anestesia Local , Lipectomia/métodos , Tecido Adiposo/patologia , Aconselhamento , Humanos , Lipectomia/efeitos adversos , Educação de Pacientes como Assunto , Seleção de Pacientes , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios
11.
J Indian Med Assoc ; 102(12): 678-9, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15871350

RESUMO

Mycobacterium leprae, the causative organism of leprosy is slow-growing and the reason is its long incubation period of 2-4 years. Males are predominantly affected and deformity is produced in less than 2% of people affected with the disease. The disease manifests in the skin as macules, papules, nodules, plaques or infiltration. Hypopigmented or erythematous skin patches with definite sensory deficit is one of the clinical cardinal signs by which one can make a definite diagnosis. Demonstration of bacilli in the slit skin smear is the bacteriological cardinal sign used to make definite diagnosis of leprosy. Involvement of common cutaneous nerves with thickening and/or tenderness with its dysfunction is the second clinical cardinal sign used to diagnose leprosy. Diagnosis can be made by eliciting definite sensory deficit in the skin lesions (other than nodules and infiltration). In the absence of two clinical cardinal signs and when there is a strong suspicion of leprosy, slit skin smear should be taken from both ear lobes and one of the lesions for demonstration of acid-test bacilli. Clinical classification is based on characteristics like number of lesions, their margin, sensory deficit, satellite lesions, symmetry of lesions, central healing and scaling. Up to 5 lesions are grouped under paucibacillary and six and more are grouped under multibacillary leprosy.


Assuntos
Hanseníase/patologia , Pele/patologia , Aconselhamento , Feminino , Humanos , Hipopigmentação/microbiologia , Hipopigmentação/patologia , Índia , Hanseníase/classificação , Hanseníase/diagnóstico , Masculino , Mycobacterium leprae/isolamento & purificação , Educação de Pacientes como Assunto , Autocuidado , Fatores Sexuais , Pele/microbiologia
12.
J Indian Med Assoc ; 102(12): 680-3, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15871351

RESUMO

Leprosy is curable now-a-days if initiatives are taken for prevention of disability along with complete and regular chemotherapy. Common disabilities encountered in leprosy are: Claw hand, foot drop, lagophthalmos, plantar ulcers and depressed bridge of nose. Objectives of prevention of disabilities are preservation of nerve function, preservation of vision, to regain functional ability and self-esteem. Measures to prevent disabilities include early diagnosis and treatment with effective chemotherapy, to train leprosy cases to perform self-care practices, providing them with protective aids and referring the cases for surgery if indicated. Lepra reactions are episodes of sudden increase in the activity of the disease. Lepra reactions are treated by bed rest, analgesics rest to affected nerve by splints and a suggested course of prednisolone. Besides, leprosy-affected persons should be encouraged for self-care practices. Counselling and holding care and concern camps (POD camps) are very much integrated wtih the prevention of disabilities.


Assuntos
Atividades Cotidianas , Pessoas com Deficiência/reabilitação , Hanseníase/patologia , Aconselhamento , Pé/patologia , Doenças do Pé/etiologia , Mãos/patologia , Humanos , Hanseníase/complicações , Tecido Nervoso/patologia , Nariz/anormalidades , Nariz/patologia , Educação de Pacientes como Assunto
13.
J Indian Med Assoc ; 102(12): 684-7, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15871352

RESUMO

"Counselling is a helping process where one person explicitly and purposefully gives his/her time, attention and skills to assist a client to explore their situation, identity and act upon solutions within the limitations of their given environment". The GATHER (greet, ask, tell, help, explain, return visit) technique can be useful in successful counselling. Counselling services have been proven successful in reducing stigma. While the scope for counselling is quite enormous, it will vary according to the specific need. The few common points which have been detailed in the text must be followed by all while providing counselling in different situations. The points as specified are: (1) Counselling of new patients. (2) Counselling of patients under treatment for few months. (3) Counselling of patients on completion of treatment. (4) Counselling of family members. (5) Counselling of community members. The points mentioned are about issues on which counselling should be centred.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Aconselhamento/métodos , Hanseníase/terapia , Aconselhamento/organização & administração , Atenção à Saúde/métodos , Saúde da Família , Programas Governamentais , Humanos , Índia
14.
Int J Lepr Other Mycobact Dis ; 72(4): 437-47, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15755198

RESUMO

Leprosy in Nepal is a stigmatizing disease. This paper explores the different coping strategies employed by people affected by leprosy to manage stigma. It is based on a qualitative study conducted in the eastern part of Nepal. It will show that a difference exists between experienced stigma and the anticipation of stigma. Both types of stigma result in different coping strategies. In managing stigma people go through different phases. This paper will show that stigma is a dynamic process, and I will elaborate on the concealment cycle, as developed by Hyland, to produce a more detailed understanding of the stigmatization process in Nepal. Doing so, it highlights the importance of a mutual concealment phase and the importance of triggers to exposure and discrimination. Changing from one phase to a subsequent phase in the stigmatization process is always triggered. It highlights further, that even within the same culture and even the same village, social differentiation makes a significant difference on the impact of stigma and the coping strategies employed in managing stigma. Stigma enforces already existing inequalities in social class, gender, and age.


Assuntos
Atitude Frente a Saúde , Hanseníase/psicologia , Estereotipagem , Adaptação Psicológica , Aconselhamento , Família , Feminino , Humanos , Masculino , Nepal , Isolamento Social
16.
Lepr Rev ; 71(4): 499-504, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11201905

RESUMO

Stigmatization of persons with leprosy causes the emotional harm of social, economic and spiritual deprivation. Individual counselling has benefits in addressing these psychosocial problems but is a slow process and effects few people at any one time. Our experience of group counselling of stigmatized persons achieved the following: addressing common issues to more than one person at a time, encouraging the unity of sufferers, developing compassion for others, understanding the common effects of stigmatization, and beginning to overcome its harmful effects.


Assuntos
Aconselhamento/métodos , Hanseníase/psicologia , Hanseníase/reabilitação , Psicoterapia de Grupo/métodos , Estereotipagem , Adaptação Psicológica , Feminino , Humanos , Masculino , Nepal , Projetos Piloto , Isolamento Social , Resultado do Tratamento
17.
Sao Paulo; Martins Fontes; 5 ed; 1997. xxiv,489 p. 21cm.
Monografia em Português | LILACS, HANSEN, SESSP-ILSLACERVO, SES-SP | ID: biblio-1085721
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