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1.
Orv Hetil ; 161(32): 1322-1330, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750020

RESUMO

International migration is a current and growing phenomenon, which has become an increasingly critical issue in Europe since 2013 and this has posed new challenges to the healthcare systems of the European Union (EU). The need for 'culturally competent' healthcare systems that can adapt and respond to the needs of a changing population while taking into account cultural, religious, linguistic and gender diversity, has become more and more an agenda across Europe. Nowadays, it is widely accepted that inequalities in health conditions are mainly due to socio-economic factors, and disparities are particularly evident among certain ethnic and cultural minority groups. Additionally, minorities often face difficulties during their attempts in accessing healthcare, including linguistic and cultural barriers. These barriers are primarily manifested in communication and other interactions between the patient and the healthcare provider. Communication difficulties and misunderstandings may lead to frustration and prejudice among caregivers and also to a lack of cooperation from patients, and consequently, may contribute to poorer health outcomes. Therefore, in order to ensure the highest quality of care for migrants, ethnic or other minority populations in our increasingly diverse societies, it is of crucial importance to overcome the difficulties arising from linguistic, cultural and religious differences. To achieve these goals, an important step is the development of intercultural competences within the healthcare system. Our paper discusses the concept, content and opportunities for the development of intercultural competence in clinical and healthcare settings. Orv Hetil. 2020; 161(32): 1322-1330.


Assuntos
Barreiras de Comunicação , Competência Cultural , Assistência à Saúde Culturalmente Competente , Assistência à Saúde/métodos , Pessoal de Saúde/psicologia , Disparidades em Assistência à Saúde , Relações Profissional-Paciente , Qualidade da Assistência à Saúde , Comunicação , Diversidade Cultural , Europa (Continente) , Humanos , Hungria , Grupos Minoritários , Multilinguismo , Migrantes
2.
Artigo em Inglês | MEDLINE | ID: mdl-32764480

RESUMO

Health crisis situations generate greater attention and dependence on reliable and truthful information from citizens, especially from those organisations that represent authority on the subject, such as the World Health Organization (WHO). In times of global pandemics such as COVID-19, the WHO message "health for all" takes on great communicative importance, especially from the point of view of the prevention of the disease and recommendations for action. Therefore, any communication must be understandable and accessible by all types of people, regardless of their technology, language, culture or disability (physical or mental), according to the World Wide Web Consortium (W3C), taking on special relevance for public health content. This study analysed whether the WHO is accessible in its digital version for all groups of citizens according to the widely accepted standards in the field of the Internet. The conclusion reached was that not all the information is accessible in accordance with the Web Content Accessibility Guidelines 2.1, which implies that there are groups that are, to some extent, left out, especially affecting the elderly. This study can contribute to the development of proposals and suggest ways in which to improve the accessibility of health content to groups especially vulnerable in this pandemic.


Assuntos
Comunicação , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Organização Mundial da Saúde/organização & administração , Fatores Etários , Idoso , Betacoronavirus , Competência Cultural , Pessoas com Deficiência , Humanos , Internet , Idioma , Pandemias , Saúde Pública
4.
Cent Eur J Public Health ; 28(2): 149-154, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32592561

RESUMO

OBJECTIVES: Since the beginning of the civil war in Syria, over 3.5 million Syrians have fled to Turkey. Considering the massive burden of healthcare service needs of this population, the Turkish government has launched an initiative as employing Syrian doctors to provide health services to their citizens in Refugee Health Centres. In this study, we aimed to explore the social adaptation status of Syrian physicians living in Turkey using a structured questionnaire and the Social Adaptation Self Evaluation Scale (SASS). METHODS: Between November 2016 and April 2018, 799 physicians who participated in "Syrian Physicians' Adaptation Training" were enrolled in the study and underwent a structured questionnaire that questioned socio-demographic data and the SASS. The participants were divided into two groups as having poor and normal/high SASS scores. The binary SASS groups were compared with some demographic data. RESULTS: The median SASS score of the respondents was found as 43 (min. 10, max. 60, IQR 10) which can be accepted as normal. In the binary grouping, it was seen that 107 (13.39%) participants had poor social adaptation, whereas 692 (86.61%) participants had normal or high social adaptation scores. The physicians who were certain about not going back to Syria had significantly higher SASS scores. CONCLUSION: The social adaptation scores of the Syrian physicians were considerably high. The adaptation status was found to be associated with some characteristics like living in Turkey for a long time and having pre-knowledge about the Turkish healthcare system.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde/provisão & distribução , Médicos/psicologia , Refugiados/psicologia , Ajustamento Social , Adaptação Psicológica , Adulto , Competência Cultural , Feminino , Humanos , Masculino , Atenção Primária à Saúde/organização & administração , Campos de Refugiados , Síria/etnologia , Turquia/epidemiologia
6.
Stud Health Technol Inform ; 269: 561-574, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32594021

RESUMO

Improving health care quality and value requires increased attention to patient and family-centeredness as well as care equity. Although health literacy, language access, and cultural competency have been perceived as separate constructs. each represents a dimension of patient and family-centeredness and care equity. Developing and using integrated measures of health literacy, language access, and cultural competency could provide a viable strategy to improve patient and family-centeredness and equity in health care. While there are challenges to the development and use of integrated measures, some responsive strategies include: using more patient, family and caregiver-reported information; utilizing patient demographic data from electronic health records; and incorporating the latter elements within measures of patient experience. Integrated quality measures also create opportunities for collaborative and interdisciplinary research, and for health care delivery innovation.


Assuntos
Competência Cultural , Letramento em Saúde , Assistência à Saúde , Humanos , Idioma , Qualidade da Assistência à Saúde
7.
Br J Hosp Med (Lond) ; 81(5): 1-4, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: covidwho-476058

RESUMO

Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.


Assuntos
Grupo com Ancestrais do Continente Africano , Infecções por Coronavirus/etnologia , Competência Cultural , Comunicação em Saúde/métodos , Pneumonia Viral/etnologia , Betacoronavirus , Comorbidade , Grupos Étnicos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Pandemias , Risco , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Reino Unido/epidemiologia
8.
Lima; Perú. Ministerio de Salud; 20200500. 70 p. tab, graf.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1023642

RESUMO

La norma contiene la finalidad y justificación técnica, ámbito de aplicación, base legal y disposiciones generales y específicas para la atención integral de salud de adolescentes.


Assuntos
Adolescente , Assistência Integral à Saúde , Normas Técnicas , Competência Cultural
9.
Med Care ; 58(6): 557-565, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412942

RESUMO

OBJECTIVE: The objective of this study was to develop the classification system for version of the SF-6D (SF-6Dv2) from the SF-36v2. SF-6Dv2 is an improved version of SF-6D, one of the most widely used generic measures of health for the calculation of quality-adjusted life years. STUDY DESIGN AND SETTING: A 3-step process was undertaken to generate a new classification system: (1) factor analysis to establish dimensionality; (2) Rasch analysis to understand item performance; and (3) tests of differential item function. To evaluate robustness, Rasch analyses were performed in multiple subsets of 2 large cross-sectional datasets from recently discharged hospital patients and online patient samples. RESULTS: On the basis of factor analysis, other psychometric evidence, cross-cultural considerations, and amenability to valuation, the 6-dimension classification used in SF-6D was maintained. SF-6Dv2 resulted in the following modifications to SF-6D: a simpler classification of physical function with clearer separation between levels; a more detailed 5-level description of role limitations; using negative wording to describe vitality; and using pain severity rather than pain interference. CONCLUSIONS: The SF-6Dv2 classification system describes more distinct levels of health than SF-6D, changes the descriptions used for a number of dimensions and provides clearer wording for health state valuation. The second stage of the study has developed a utility value set using discrete choice methods so that the measure can be used in health technology assessment. Further work should investigate the psychometric characteristics of the new instrument.


Assuntos
Análise Custo-Benefício/métodos , Nível de Saúde , Saúde Mental , Desempenho Físico Funcional , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Análise Custo-Benefício/normas , Estudos Transversais , Competência Cultural , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Psicometria , Anos de Vida Ajustados por Qualidade de Vida , Reprodutibilidade dos Testes , Participação Social , Fatores Socioeconômicos , Adulto Jovem
10.
Br J Hosp Med (Lond) ; 81(5): 1-4, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32468944

RESUMO

Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.


Assuntos
Grupo com Ancestrais do Continente Africano , Infecções por Coronavirus/etnologia , Competência Cultural , Comunicação em Saúde/métodos , Pneumonia Viral/etnologia , Betacoronavirus , Comorbidade , Grupos Étnicos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Pandemias , Risco , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Reino Unido/epidemiologia
13.
PLoS One ; 15(4): e0231406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271846

RESUMO

The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants' perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a "two-eyed seeing" Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider-patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived "household" as a unit of care in comparison to non-Cree who viewed "health care services" as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.


Assuntos
Competência Cultural , Saúde Bucal , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Pacientes/psicologia , Atenção Primária à Saúde , Quebeque
14.
PLoS One ; 15(4): e0231154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251431

RESUMO

BACKGROUND: Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low- and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised. METHOD: We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N = 50), alongside policy document review in both countries. Data were analysed thematically. Results informed development of Systems Thinking diagrams hypothesizing potential intervention points to improve cultural competency, namely via addressing language barriers. RESULTS: Language ability was a core tenet of cultural competency as described by participants in both countries. Malay was perceived to be an easy language that migrants could learn quickly, with perceived proficiency differing by source country and length of stay in Malaysia. Language barriers were a source of frustration for both migrants and health workers, which compounded communication of complex conditions including mental health as well as obtaining informed consent from migrant patients. Health workers in Malaysia used strategies including google translate and hand gestures to communicate, while migrant patients were encouraged to bring friends to act as informal interpreters during consultations. Current health services are not migrant friendly, which deters use. Concerns around overuse of services by non-citizens among the domestic population may partly explain the lack of policy support for cultural competency in Malaysia. Service provision for migrants in Thailand was more culturally sensitive as formal interpreters, known as Migrant Health Workers (MHW), could be hired in public facilities, as well as Migrant Health Volunteers (MHV) who provide basic health education in communities. CONCLUSION: Perceptions of overuse by migrants in a health system acts as a barrier against system or institutional level improvements for cultural competency, in an already stretched health system. At the micro-level, language interventions with migrant workers appear to be the most feasible leverage point but raises the question of who should bear responsibility for cost and provision-employers, the government, or migrants themselves.


Assuntos
Competência Cultural/psicologia , Assistência à Saúde Culturalmente Competente , Acesso aos Serviços de Saúde , Refugiados/psicologia , Migrantes/psicologia , Adulto , Criança , Barreiras de Comunicação , Grupos Étnicos/psicologia , Feminino , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Malásia , Masculino , Grupos Minoritários/psicologia , Pesquisa Qualitativa , Participação dos Interessados/psicologia , Análise de Sistemas , Tailândia , Tradução
15.
Rev Saude Publica ; 54: 29, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32215537

RESUMO

OBJECTIVE: To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS: Using Sue & Sue's theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS: The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION: The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.


Assuntos
Atitude do Pessoal de Saúde , Competência Cultural , Pessoal de Saúde/estatística & dados numéricos , Chile , Assistência à Saúde Culturalmente Competente , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Inquéritos e Questionários
17.
Med Care ; 58(6): 566-573, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32221100

RESUMO

OBJECTIVE: An updated version of the SF-6D Classification System (SF-6Dv2) has been developed, and utility value sets are required. The aim of this study was to test the development of a United Kingdom SF-6Dv2 value set, and address limitations of the existing SF-6D value set (which results in a narrow range of utilities). This was done using 2 discrete-choice experiment (DCE) tasks. Interactions and preference heterogeneity were also investigated. RESEARCH DESIGN AND SUBJECTS: An online sample of respondents (n=3014) completed 10 DCE with duration choice sets from an efficient design of 300 (Design 1) and 2 DCE with duration choice sets including immediate death from a set of 60 (Design 2). Conditional logit regression was used to estimate value set models with and without interactions. We investigated preference heterogeneity using latent class models. RESULTS: Models including ordered coefficients within each dimension were developed, with the favored model including an additional interaction term when one dimension was at the most severe level. Value sets differed across Designs 1 and 2. Design 1 models had a wider utility range and a higher proportion of negative values. The most important dimensions were pain, mental health, and physical functioning. Preference heterogeneity was apparent, with a 2-class model describing the data. CONCLUSIONS: We developed and applied a protocol to value the SF-6Dv2 using DCE. The results provide a provisional value set for use in resource allocation. The protocol can be applied internationally. Further work should investigate how to account for preference heterogeneity in value set production.


Assuntos
Análise Custo-Benefício/métodos , Técnicas de Apoio para a Decisão , Nível de Saúde , Saúde Mental , Desempenho Físico Funcional , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento de Escolha , Análise Custo-Benefício/normas , Estudos Transversais , Competência Cultural , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Psicometria , Anos de Vida Ajustados por Qualidade de Vida , Reprodutibilidade dos Testes , Participação Social , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
18.
BMC Public Health ; 20(1): 284, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131784

RESUMO

BACKGROUND: Paediatric burns are highly painful and traumatising injuries that are overrepresented among Aboriginal and Torres Strait Islander people. Paediatric burn patients' pain remains poorly managed by pharmacological interventions, leading to increased anxiety, distress, and trauma in patients and their caregivers. Non-pharmacological psychosocial interventions have been suggested as effective in reducing pain and psychological morbidities among paediatric burn patients and their caregivers; however, their degree of effectiveness and appropriateness for Aboriginal and Torres Strait Islander people is unclear. METHODS: A non-date restricted systematic review was conducted through four databases. Studies published in English assessing psychosocial interventions on paediatric burn patients' physical pain along with theirs and/or their caregiver's anxiety, distress, or trauma symptoms were identified and included in this review. Included studies were assessed for their ability to reduce one of the outcomes of interests and for their reflection of Aboriginal and Torres Strait Islander peoples' perspectives of health. RESULTS: Of the 3178 identified references, 17 were eligible. These include distraction based techniques (n = 8), hypnosis/familiar imagery (n = 2), therapeutic approaches (n = 4), and patient preparation/procedural control (n = 3). Distraction techniques incorporating procedural preparation reduced pain, while discharge preparation and increased 'patient control' reduced patient and caregiver anxiety; and internet based Cognitive Behaviour Therapy reduced short-term but not long-term post-traumatic stress symptoms. No interventions reflected Aboriginal and Torres Strait Islander peoples' perspectives of health; and few targeted caregivers or focused on reducing their symptoms. CONCLUSIONS: The development and assessment of psychosocial interventions to appropriately meet the needs of Aboriginal and Torres Strait Islander paediatric burn patients is required.


Assuntos
Queimaduras/psicologia , Queimaduras/terapia , Cuidadores/psicologia , Psicoterapia , Criança , Competência Cultural , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
BMC Public Health ; 20(1): 292, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32138713

RESUMO

BACKGROUND: Over the last decades, due to high rates of immigration, many high-income countries have witnessed demographic shifts towards more cultural diversity in the population. Socio-economic deprivation and traumatic experiences pre-migration contribute to a high risk for mental health problems among immigrant background youth. Moreover, when adapting to the multi-cultural contexts of the resettlement countries they face several acculturation demands, which may also affect their mental health in adaptive or hazardous ways. One of these acculturation tasks involves developing the cultural competence necessary to thrive and participate socially within the heritage and the majority cultural domains. From a public mental health perspective, it is important to have thorough knowledge about acculturation-related risk and protective factors. However, this responsibility has been challenged by a lack of acculturation measures that are theoretically linked to mental health, and target the cultural competencies of immigrant background youth. Therefore, the current study aimed at examining if a construct of peer-related culture competence, operationalized in the Youth Culture Competence Scale (YCCS), captured the same competence-phenomenon across different language, age, and immigrant groups in two immigrant-receiving countries. The scale includes two dimensions: one of heritage, and one of majority peer-related culture competence. METHODS: Self-report questionnaire data were collected from 895 unaccompanied refugees and 591 immigrant background high school students in Norway, and from 321 immigrant university students in the United States. To examine if the measure assessed the same phenomenon of peer-related culture competence across these three multi-ethnic samples with an age range from 13 to 28, we examined its measurement equivalence. Additionally, we examined if the association between peer-related culture competence and depressive symptoms was similar in these groups. RESULTS: Confirmatory factor analyses supported the proposed two factor structure of the YCCS across the three samples. The structural equation model assessing the effects of heritage and majority culture competence on depressive symptoms confirmed that each culture competence dimension had a unique association with depressive symptoms across the samples. CONCLUSIONS: We conclude that the YCCS is a robust acculturation measure that may be included in public health studies of mental health among multi-ethnic refugee and immigrant samples of varied ages.


Assuntos
Criança Abandonada/psicologia , Competência Cultural , Depressão/epidemiologia , Emigrantes e Imigrantes/psicologia , Refugiados/psicologia , Aculturação , Adolescente , Adulto , Criança Abandonada/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Masculino , Noruega/epidemiologia , Refugiados/estatística & dados numéricos , Instituições Acadêmicas , Autorrelato , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
20.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32184336

RESUMO

BACKGROUND: In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services. METHODS: Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis. RESULTS: A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care). CONCLUSIONS: Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity.


Assuntos
Infecções por HIV/prevenção & controle , Serviços de Saúde para Pessoas Transgênero , Pessoas Transgênero/psicologia , Adolescente , Competência Cultural , Tomada de Decisões , Feminino , Grupos Focais , Identidade de Gênero , Infecções por HIV/transmissão , Humanos , Relações Interpessoais , Masculino , Pesquisa Qualitativa , Medição de Risco , Autoimagem , Autoeficácia , Educação Sexual , Apoio Social , Pessoas Transgênero/estatística & dados numéricos , Estados Unidos , Adulto Jovem
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