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1.
Ned Tijdschr Tandheelkd ; 127(5): 287-291, 2020 May.
Artigo em Holandês | MEDLINE | ID: mdl-32609099

RESUMO

A 15-year-old girl was brought to the emergency department of a hospital by ambulance with extensive facial trauma following a horse's kick. The considerable impact resulted in a combination of injuries to the bone, teeth and soft tissue. Following the transfer from the ambulance, the AE physician immediately consulted an oral and maxillofacial surgeon. Consequently, the patient could be brought to the operating theatre almost straight after stabilisation. There, the oral and maxillofacial surgeon first repositioned her teeth in anatomical position, followed by repositioning and fixation of the mandibular fracture. Next, the teeth in the upper front were stabilised with an acid-etch composite splint and the lip was reconstructed.


Assuntos
Traumatismos Faciais , Fraturas Mandibulares , Adolescente , Animais , Feminino , Cavalos , Humanos
3.
J Spec Oper Med ; 20(2): 139-143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573752

RESUMO

This is the first of a two-part series on the history and effectiveness of mouthguards (MGs) for orofacial injury protection. Military studies have shown that approximately 60% of orofacial injuries are associated with military training activities and 20% to 30% with sports. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue, preventing lacerations and bruises. In 1975, CPT Leonard Barber was the first to advocate MGs for military sports activities. In 1998, Army health promotion campaigns promoted MG education and fabrication. A US Army basic training study in 2000-2003 showed that more MG use could reduce orofacial injuries and the Army Training and Doctrine Command subsequently required that basic trainees be issued and use MGs. Army Regulation 600-63 currently directs commanders to enforce MG use during training and sports activities that could involve orofacial injuries. In the civilian sector, MGs were first used by boxers and then were required for football. MGs are currently required nationally for high school and college football, field hockey, ice hockey, and lacrosse, and are recommended for 29 sport and exercise activities.


Assuntos
Traumatismos em Atletas/prevenção & controle , Traumatismos Faciais/prevenção & controle , Militares , Protetores Bucais/história , Boca/lesões , História do Século XX , Humanos , Esportes , Ferimentos e Lesões/prevenção & controle
4.
Adv Skin Wound Care ; 33(8): 418-427, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32530822

RESUMO

OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath an N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high-risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when performing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored, created, and tested a stepwise process to protect the skin under these masks while ensuring that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. Staff also self-reported increased comfort with less friction. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method enabling staff to apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.


Assuntos
Infecções por Coronavirus/prevenção & controle , Traumatismos Faciais/etiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Bandagens , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Desenho de Equipamento , Traumatismos Faciais/fisiopatologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pneumonia Viral/epidemiologia , Lesão por Pressão/etiologia , Estudos Prospectivos , Estados Unidos
5.
J Wound Care ; 29(5): 245-259, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: covidwho-294439

RESUMO

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos e Provisões/efeitos adversos , Controle de Infecções/normas , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais/etiologia , Traumatismos Faciais/prevenção & controle , Humanos , Controle de Infecções/métodos , Pneumonia Viral/etiologia , Pneumonia Viral/transmissão , Lesão por Pressão/etiologia , Pele/lesões , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
6.
Br J Oral Maxillofac Surg ; 58(5): 571-576, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-47526

RESUMO

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Traumatismos Faciais , Pandemias , Pneumonia Viral , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Tomada de Decisões , Traumatismos Faciais/cirurgia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Medição de Risco , Centros de Traumatologia
8.
J Wound Care ; 29(5): 245-259, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32421479

RESUMO

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos e Provisões/efeitos adversos , Controle de Infecções/normas , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais/etiologia , Traumatismos Faciais/prevenção & controle , Humanos , Controle de Infecções/métodos , Pneumonia Viral/etiologia , Pneumonia Viral/transmissão , Lesão por Pressão/etiologia , Pele/lesões , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
9.
Br J Oral Maxillofac Surg ; 58(5): 571-576, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32349902

RESUMO

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Traumatismos Faciais , Pandemias , Pneumonia Viral , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Tomada de Decisões , Traumatismos Faciais/cirurgia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Medição de Risco , Centros de Traumatologia
10.
J Craniofac Surg ; 31(6): e626-e630, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32404623

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease that is caused by severe respiratory syndrome coronavirus 2. Although elective surgical procedures are being cancelled in many parts of the world during the COVID-19 pandemic, acute craniomaxillofacial (CMF) trauma will continue to occur and will need to be appropriately managed. Surgical procedures involving the nasal, oral, or pharyngeal mucosa carry a high risk of transmission due to aerosolization of the virus which is known to be in high concentration in these areas. Intraoperative exposure to high viral loads through aerosolization carries a very high risk of transmission, and the severity of the disease contracted in this manner is worse than that transmitted through regular community transmission. This places surgeons operating in the CMF region at particularly high risk during the pandemic. There is currently a paucity of information to delineate the best practice for the management of acute CMF trauma during the COVID-19 pandemic. In particular, a clear protocol describing optimal screening, timing of intervention and choice of personal protective equipment, is needed. The authors have proposed an algorithm for management of CMF trauma during the COVID-19 pandemic to ensure that urgent and emergent CMF injuries are addressed appropriately while optimizing the safety of surgeons and other healthcare providers. The algorithm is based on available evidence at the time of writing. As the COVID-19 pandemic continues to evolve and more evidence and better testing becomes available, the algorithm should be modified accordingly.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Traumatismos Faciais , Doenças Maxilares/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Doença Aguda , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Face , Humanos , Doenças Maxilares/complicações , Doenças Maxilares/virologia , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/transmissão
11.
Facial Plast Surg Aesthet Med ; 22(3): 164-169, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-72250

RESUMO

COVID-19 is an emerging viral illness that has rapidly transmitted throughout the world. Its impact on society and the health care system has compelled hospitals to quickly adapt and innovate as new information about the disease is uncovered. During this pandemic, essential medical and surgical services must be carried out while minimizing the risk of disease transmission to health care workers. There is an elevated risk of COVID-19 viral transmission to health care workers during surgical procedures of the head and neck due to potential aerosolization of viral particles from the oral cavity/naso-oropharynx mucosa. Thus, patients with facial fractures pose unique challenges to the variety of injuries and special considerations, including triaging injuries and protective measures against infection. The proximity to the oral cavity/naso-oropharyngeal mucosa, and potential for aerosolization of secretions containing viral particles during surgical procedures make most patients undergoing operative interventions for facial fractures high risk for COVID-19 transmission. Our proposed algorithm aims to balance patient care with patient/medical personnel protection as well as judicious health care utilization. It stratifies facial trauma procedures by urgency and assigns a recommended level of personal protective equipment, extreme or enhanced, incorporating current best practices and existing data on viral transmission. As this pandemic continues to evolve and more information is obtained, the protocol can be further refined and individualized to each institution.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Triagem/métodos , Protocolos Clínicos , Infecções por Coronavirus/transmissão , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/terapia , Humanos , Pneumonia Viral/transmissão
14.
Plast Reconstr Surg ; 145(5): 975e-983e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332548

RESUMO

BACKGROUND: Patients with craniomaxillofacial injuries are frequently transferred for specialist evaluation. Although transfer guidelines have improved outcomes for trauma care, no standards exist for craniomaxillofacial injuries. As a result, many patients are unnecessarily transferred emergently between facilities, resulting in high costs to patients and the health care system. This study assesses the regional frequency and necessity of transfers for isolated craniomaxillofacial injury. METHODS: A retrospective review was conducted of all transfers with a diagnosis of "facial trauma" from 2013 to 2018. Using a previously validated framework, emergency interfacility transfers were deemed either necessary or unnecessary. RESULTS: A total of 368 transfers were identified with isolated craniomaxillofacial injuries. Only 27 percent of transfers required admission. Half of transfers were unnecessary, none of which required intervention by the facial trauma service. Of 49.5 percent of necessary transfers, 38 percent required admission for surgery or management of symptoms related to facial injury, 62 percent were discharged from the emergency department, and three patients required emergency surgery. CONCLUSIONS: Isolated craniomaxillofacial trauma rarely requires emergency surgery; however, transferred patients occasionally require urgent and elective procedures. Unnecessary transfers result in substantial expense to the patient and the health care system, and patients ultimately experience a delay in definitive care. Unnecessary patient evaluation diverts emergency staff and resources, increasing wait times and morbidity for other patients. This study demonstrates an opportunity for transfer guidelines to improve interfacility triage of patients with facial injury. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Traumatismos Faciais/diagnóstico , Sobremedicalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Triagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Traumatismos Faciais/cirurgia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Sobremedicalização/prevenção & controle , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Centros de Traumatologia/normas , Triagem/normas
16.
Facial Plast Surg Aesthet Med ; 22(3): 164-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302216

RESUMO

COVID-19 is an emerging viral illness that has rapidly transmitted throughout the world. Its impact on society and the health care system has compelled hospitals to quickly adapt and innovate as new information about the disease is uncovered. During this pandemic, essential medical and surgical services must be carried out while minimizing the risk of disease transmission to health care workers. There is an elevated risk of COVID-19 viral transmission to health care workers during surgical procedures of the head and neck due to potential aerosolization of viral particles from the oral cavity/naso-oropharynx mucosa. Thus, patients with facial fractures pose unique challenges to the variety of injuries and special considerations, including triaging injuries and protective measures against infection. The proximity to the oral cavity/naso-oropharyngeal mucosa, and potential for aerosolization of secretions containing viral particles during surgical procedures make most patients undergoing operative interventions for facial fractures high risk for COVID-19 transmission. Our proposed algorithm aims to balance patient care with patient/medical personnel protection as well as judicious health care utilization. It stratifies facial trauma procedures by urgency and assigns a recommended level of personal protective equipment, extreme or enhanced, incorporating current best practices and existing data on viral transmission. As this pandemic continues to evolve and more information is obtained, the protocol can be further refined and individualized to each institution.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Triagem/métodos , Protocolos Clínicos , Infecções por Coronavirus/transmissão , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/terapia , Humanos , Pneumonia Viral/transmissão
17.
Am J Nurs ; 120(4): 72, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32218058
18.
Plast Reconstr Surg ; 145(4): 1012-1023, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221225

RESUMO

BACKGROUND: The purpose of this study was to assess the incidence, cause, characteristics, presentation, and management of pediatric frontal bone fractures. METHODS: A retrospective cohort review was performed on all patients younger than 15 years with frontal fractures that presented to a single institution from 1998 to 2010. Charts and computed tomographic images were reviewed, and frontal bone fractures were classified into three types based on anatomical fracture characteristics. Fracture cause, patient demographics, management, concomitant injuries, and complications were recorded. Primary outcomes were defined by fracture type and predictors of operative management and length of stay. RESULTS: A total of 174 patients with frontal bone fractures met the authors' inclusion criteria. The mean age of the patient sample was 7.19 ± 4.27 years. Among these patients, 52, 47, and 75 patients were classified as having type I, II, and III fractures, respectively. A total of 14, 9, and 24 patients with type I, II, and III fractures underwent operative management, respectively. All children with evidence of nasofrontal outflow tract involvement and obstruction underwent cranialization (n = 11). CONCLUSIONS: The authors recommend that type I fractures be managed according to the usual neurosurgical guidelines. Type II fractures can be managed operatively according to the usual pediatric orbital roof and frontal sinus fracture indications (e.g., significantly displaced posterior table fractures with associated neurologic indications). Lastly, type III fractures can be managed operatively as for type I and II indications and for evidence of nasofrontal outflow tract involvement. The authors recommend cranialization in children with nasofrontal outflow tract involvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Osso Frontal/lesões , Seio Frontal/lesões , Fraturas Cranianas/cirurgia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Criança , Traumatismos Faciais/etiologia , Feminino , Osso Frontal/cirurgia , Seio Frontal/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Fraturas Cranianas/etiologia , Resultado do Tratamento
19.
Niger J Clin Pract ; 23(3): 343-348, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32134033

RESUMO

Background: Dental trauma is a major public oral health problem owing to its high prevalence. The school sports teachers who observe children when they participate in sports have a key role in the prevention and management of traumatic injuries. The present study aims to determine the awareness of sports teachers on the occurrence and prevention of oral-facial trauma in southern Saudi Arabia. Methods: The present study was a cross-sectional study design among sports teachers in a southern subpopulation of Saudi Arabia. A draft questionnaire with 11 items was constructed under three domains: occurrence pattern, prevention, and management of dental trauma. Results: A total of 191 sports teachers from various schools participated in the survey. The majority (88%) of the teachers had encountered orofacial trauma among children during sporting activity in schools. The most common orofacial structure involved in injury was the teeth (33.5%) and lips (25.2%). Only 50.8% of subjects knew stock tray as a type of mouthguard and 27.7% of teachers responded that they do not recommend mouthguards for children during sporting activities. Nearly 80.6% teachers were aware of the possibility of reimplanting an avulsed tooth. About 72.8% teachers had poor knowledge of immediate action necessary for successful outcomes of reimplanted teeth. Conclusions: Orofacial trauma was commonly encountered by sports teachers among children during sporting activities in the school. There was poor awareness regarding types of mouth guards and its significance among the sports school teachers. The knowledge related to the management of emergency oral injuries was inadequate.


Assuntos
Traumatismos em Atletas , Traumatismos Faciais , Conhecimentos, Atitudes e Prática em Saúde , Professores Escolares , Esportes/educação , Estudos Transversais , Humanos , Arábia Saudita , Professores Escolares/psicologia , Professores Escolares/estatística & dados numéricos , Traumatismos Dentários
20.
J Forensic Leg Med ; 69: 101888, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056805

RESUMO

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.


Assuntos
Traumatismos Faciais/mortalidade , Traumatismos Cranianos Penetrantes/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Grupos de Populações Continentais/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio Consumado/estatística & dados numéricos , Adulto Jovem
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