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2.
Rev. cir. (Impr.) ; 72(5): 395-404, oct. 2020. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1138730

RESUMO

Resumen Objetivo: Identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidos a cirugía de contorno corporal. Materiales y Método: Se estudió una cohorte prospectiva de 113 pacientes sometidos a cirugía de contorno corporal. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Body-Qol®. Para el análisis estadístico se utilizó estadística descriptiva, modelos de ecuaciones de estimación generalizada y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,0001) y por dominios. Los pacientes con pérdida masiva de peso tuvieron peores puntajes pre y postoperatorio, sin embargo, un delta de mejoría comparable con los pacientes estéticos. Dentro de los factores determinantes, existió una relación positiva entre la edad y la mejoría en la calidad de vida de forma global. El índice de masa corporal (IMC) se encontró asociado negativamente con la mejoría del puntaje global. Dentro de los factores de la cirugía, los pacientes sometidos a lipoabdominoplastía tuvieron una mayor mejoría con respecto a otras técnicas. Además, el patrón de resección ampliado y en flor de Lis se asoció a menor mejoría en el puntaje global. Conclusión: La cirugía de contorno corporal mejora la calidad de vida de forma significativa. Los principales factores determinantes de esta mejoría fueron la edad, el IMC, el antecedente de pérdida masiva de peso y el patrón de resección.


Aim: To identify the factors that have an impact on the quality of life of patients with body contouring surgery. Materials and Method: A prospective cohort of 113 patients was studied. Sociodemographic characteristics, antropometric measures and variables related to the surgery were analized. The Body-Qol® instrument was aplied. Descriptive statistic, generalized estimated equation models and lineal and logistic regresions were used for the statistical analysis. Results: Improvement in the quality of life was found globally (p < 0,0001) and in every domain of the scale. The patients with massive weight loss had worse scores pre- and post-operatively than the esthetic patients. A positive association between age and improvement on quality of life was found. Body mass index (BMI) was negatively associated with improvement of the score. The patients that had a lipoabdominoplasty had a major improvement in comparison with other techniques. Also, the extended resection pattern and Fleur de Lis pattern were associated with lesser improvement in the global score. Conclusion: Body contouring surgery improves quality of life significantly. The principal factors that have an impact on quality of life were age, BMI, massive weight loss and resection pattern.


Assuntos
Humanos , Masculino , Feminino , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Contorno Corporal , Perda de Peso , Índice de Massa Corporal , Epidemiologia Descritiva , Estudos Prospectivos
3.
Psychiatr Danub ; 32(Suppl 1): 150-152, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890380

RESUMO

BACKGROUND: The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring procedure. A report regarding the translation procedure into French and its preliminary results has been previously published. We here describe the finalization of the translation process and cultural validation. MATERIALS AND METHODS: The translation process followed guidelines established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). The process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patients. RESULTS: The 26 scales of the BODY-Q were translated and adapted into French. Each step of the process allowed to make changes leading to a conceptually and culturally equivalent French version. Backward translation comparison to the English version led to the identification of 16 differences necessitating re-translation. Overall feedback from patients over the final version was excellent. CONCLUSIONS: The BODY-Q proved to be a reliable and suited PRO for bariatric and body contouring patients. The thorough method of translation and cultural adaptation allowed us to achieve a conceptually and culturally valid French translation of the BODY-Q.


Assuntos
Contorno Corporal , Medidas de Resultados Relatados pelo Paciente , Traduções , Humanos , Linguística , Reprodutibilidade dos Testes , Inquéritos e Questionários
4.
Plast Reconstr Surg ; 146(2): 284-293, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740577

RESUMO

BACKGROUND: Gluteal prominence is a unique characteristic that is widely acknowledged in female contouring but ignored in the male population. This study focuses on male gluteal aesthetics based on a muscular anatomical approach. METHODS: A retrospective review of gluteal contouring in men from January of 2012 to September of 2019 was conducted. Male body sculpting surgery in the gluteal area was performed in most cases. Patients were included according to preoperative assessment and the American Heart Association risk analysis. The gluteal area was divided into four main anatomical contouring zones and classified according to the procedure type. The follow-up period of 3 months to 6 years was included with photographs and medical assessment data. A nonstandardized satisfaction survey was performed postoperatively. RESULTS: The analysis included data from 374 consecutive gluteal dynamic definition liposculptures performed in men (mean age, 38.2 years; range, 20 to 66 years). Patients were treated according to the authors' new classification of deformities. Fat extraction, liposhifting, and fat grafting were performed on a regular basis to enhance and define the gluteal area. A satisfaction index of 92.5 percent was reported. Minor complications were reported: seroma, 0.2 percent; prolonged bruising, 1.3 percent; and swelling, 1.8 percent. No necrosis, burns, or infections were reported. CONCLUSIONS: Men have been increasingly requesting improvement and definition of the buttocks, and our novel algorithm allows for a reliable method in this regard. The high satisfaction index supports the natural and athletic results accomplished with our new approach.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/métodos , Nádegas/anatomia & histologia , Estética , Lipectomia/métodos , Adulto , Idoso , Contorno Corporal/efeitos adversos , Nádegas/diagnóstico por imagem , Seguimentos , Humanos , Lipectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
5.
Harefuah ; 159(8): 607-611, 2020 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-32852163

RESUMO

INTRODUCTION: Obesity has become one of the most challenging diseases in the modern world due to its high prevalence, its metabolic pathways and its medical impacts. Although bariatric surgeries have become the main treatment for obesity, a new issue is being created - loose skin. Massive weight loss patients undergo body contouring plastic surgery (BCPS) to remove the excess skin and improve their quality of life. Patients' age, physical and medical status, amount of redundant skin and patients' personal preferences dictate the number of anatomical areas contoured at every surgical stage. Recent studies have shown that BCPS are a significant protective factor against long-term weight regain following bariatric surgery. Specifically, the number of operated areas have a direct influence on weight control: BCPS in three or more anatomical areas following massive weight loss (MWL) is associated with a higher chance of long-term weight loss following body-contouring surgery in comparison to surgery in one area alone. In summary, BCPS have become a fundamental part of the holistic treatment recommended for patients suffering from obesity.


Assuntos
Cirurgia Bariátrica , Contorno Corporal , Obesidade Mórbida , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Obesidade , Qualidade de Vida , Perda de Peso
9.
Clin Plast Surg ; 47(3): 335-349, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448471

RESUMO

Lipoabdominoplasty is one of the most frequent abdominal body contouring procedures performed today. It guarantees a safe combination of abdominoplasty and liposuction while minimizing the risk of ischemic flap complications. This is because of the limited undermining performed and the liposuction adjunct, both of which minimize perforator injury. In the last several years, the integration of anatomic definition through the use of liposuction has further refined the procedure, led to improved results, and increased patient satisfaction. The more natural results of the anatomic abdominal definition is a next step in abdominal contour refinement.


Assuntos
Contorno Corporal/métodos , Lipoabdominoplastia/métodos , Humanos , Satisfação do Paciente , Retalhos Cirúrgicos
10.
Clin Plast Surg ; 47(3): 365-377, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448473

RESUMO

Abdominoplasty is the fifth most common cosmetic plastic surgery procedure performed in the United States and combining it with other procedures has become more the norm than the outlier. Liposuction is the most common adjunctive procedure, followed by breast surgery, lower back lift, and thigh lift, in addition to hernia repair and gynecologic procedures. The goal of these combination procedures includes creating more global aesthetic improvement while protecting patients from complications, based on consideration of confounding medical variables and increased risks presented by surgery of prolonged duration and exposure.


Assuntos
Abdominoplastia/métodos , Dorso , Contorno Corporal , Estética , Herniorrafia , Humanos , Lipectomia , Mamoplastia
11.
Clin Plast Surg ; 47(3): 379-388, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448474

RESUMO

Noninvasive and minimally invasive treatments are increasingly supplanting, or complimenting, abdominoplasty. For optimal delivery of patient care and to maintain a dominant share of the body-contouring market, plastic surgeons need to embrace these new technologies. High capital purchases, costly disposables, maintenance fees, lack of experience, conflicting anecdotal reports, energy-related complications, marketing hyperbole, and rapid obsolescence are formidable barriers to this adoption. Receptive plastic surgeons may be best served by accepting brief short-term retrospective reports by reputable innovative body contouring surgeons who present a succinct and clinically supported message.


Assuntos
Abdominoplastia/métodos , Contorno Corporal/métodos , Humanos
12.
Clin Plast Surg ; 47(3): 389-396, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448475

RESUMO

After massive weight loss (MWL), patients present with deformities that are more severe and often different than those observed in standard cosmetic abdominoplasty. The first step is careful consideration of the special factors involved in preoperative screening of patients with MWL presenting for body contouring surgery. Once these patient factors are optimized and surgery is considered, careful analysis of anatomic deformities should ensue. Technical variations of standard abdominoplasty are often required. With proper attention to safe screening, analysis of the anatomic deformities, and application of relevant techniques, plastic surgeons can have a positive impact on the lives of these patients.


Assuntos
Contorno Corporal/métodos , Perda de Peso , Abdominoplastia/métodos , Índice de Massa Corporal , Humanos , Seleção de Pacientes
13.
Clin Plast Surg ; 47(3): 415-428, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448478

RESUMO

The abdominoplasty procedure poses a number of unique challenges. If the stigmata of the operation is to be avoided, careful planning and surgical execution are required. We describe our experience in full and mini abdominoplasties with a 360-degree approach, involving all muscular groups and body segments as described by high-definition liposculpture. Selective fat grafting is also safely performed in specific areas to improve projection and volume.


Assuntos
Contorno Corporal/métodos , Lipoabdominoplastia/métodos , Humanos
14.
Clin Plast Surg ; 47(3): 429-436, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32448479

RESUMO

The BODY-Q is a condition-specific patient-reported outcome measure that enables a comprehensive assessment of outcomes that are specific to patients undergoing body contouring procedures such as abdominoplasty. The BODY-Q scales were designed to be responsive to the effects of abdominoplasty on health-related quality of life and appearance outcomes. The BODY-Q covers a range of content domains, and the independently functioning scales enable surgeons to tailor the BODY-Q to their needs. The application of the BODY-Q in cosmetic clinics internationally may give rise to better understanding of abdominoplasty outcomes and optimize the care delivered to patients undergoing these procedures.


Assuntos
Abdominoplastia , Contorno Corporal , Humanos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Qualidade de Vida
15.
Plast Reconstr Surg ; 145(6): 1427-1438, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195859

RESUMO

BACKGROUND: High-intensity focused ultrasound (HIFU) lipolysis still lacks treatment efficacy. The authors hypothesized that electrical stimulation of muscular groups can enhance the metabolism of free lipids released from HIFU-ablated adipocytes. METHODS: Five-month-old, male Landrace swine, with an average initial weight of 95 kg, were divided randomly into sham, HIFU only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups. Subcutaneous adipose tissue of the porcine abdomen was treated once by HIFU on days 1 of weeks 1, 3, and 5, and electrical stimulation of the quadriceps was performed once on the day 1 of weeks 1 through 6. The numbers of ultrasonic sonications were 70 per treatment for the HIFU-only and HIFU plus electrical stimulation I groups and 400 for the HIFU plus electrical stimulation II group. The measured data are expressed as medians (ranges). RESULTS: The body weights of all pigs increased gradually with time. The waist circumferences below the sheath decreased from 97.7 ± 6.0 cm in week 1 and 97.9 ± 5.3 cm in week 3 to 96.4 ± 10.0 cm in week 6, and from 105.3 ± 5.1 cm and 101.2 ± 7.4 cm to 100.5 ± 6.1 cm for the HIFU plus electrical stimulation I and II groups, respectively, whereas they increased for the sham and HIFU-only groups. The reductions in the adipose tissue thickness were 0.59, 1.46, and 2.18 mm for the HIFU-only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups, respectively, when the sham group increased by 1.42 mm. Follow-up blood analyses demonstrated no significant changes in lipid panel parameters from baseline values. CONCLUSION: HIFU plus electrical stimulation can induce a substantial reduction in the waist circumference of pigs.


Assuntos
Contorno Corporal/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Gordura Subcutânea Abdominal/efeitos da radiação , Estimulação Elétrica Nervosa Transcutânea/métodos , Animais , Terapia Combinada/métodos , Masculino , Modelos Animais , Sus scrofa , Circunferência da Cintura/efeitos da radiação
16.
Biomed Res Int ; 2020: 1242086, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32190645

RESUMO

The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm2 was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq = 3.8 ± 1.1 µm. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq = 27.3 ± 4.9 µm. However, with increased smoothing, an augmentation in chondrocyte death up to 95% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage.


Assuntos
Doenças das Cartilagens/terapia , Terapia por Radiofrequência , Animais , Artroplastia , Artroscopia , Contorno Corporal , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Morte Celular , Condrócitos/patologia , Modelos Animais de Doenças , Humanos , Microscopia Confocal , Fotomicrografia , Ondas de Rádio , Suínos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
17.
Plast Reconstr Surg ; 145(4): 725e-733e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221206

RESUMO

BACKGROUND: Cryolipolysis is a noninvasive method for removal of subcutaneous fat for body contouring. Conventional cryolipolysis with topical cooling requires extracting heat from subcutaneous fat by conduction across the skin, thus limiting the amount and the location of the fat removed. The authors hypothesized that local injection of a physiological ice slurry directly into target adipose tissue would lead to more efficient and effective cryolipolysis. METHODS: Injectable slurries containing 20 percent and 40 percent ice content were made using common parenteral agents (normal saline and glycerol), then locally injected into the subcutaneous fat of swine. Ultrasound imaging, photography, histological, and gross tissue responses were monitored before and periodically up to 8 weeks after injection. RESULTS: Fat loss occurred gradually over several weeks following a single ice slurry injection. There was an obvious and significant 55 ± 6 percent reduction in adipose tissue thickness compared with control sites injected with the same volume of melted slurry (p < 0.001, t test). The amount of fat loss correlated with the total volume of ice injected. There was no scarring or damage to surrounding tissue. CONCLUSION: Physiological ice slurry injection is a promising new strategy for selective and nonsurgical fat removal.


Assuntos
Contorno Corporal/métodos , Criocirurgia/métodos , Gelo , Gordura Subcutânea/cirurgia , Animais , Contorno Corporal/efeitos adversos , Criocirurgia/efeitos adversos , Feminino , Injeções Subcutâneas/efeitos adversos , Injeções Subcutâneas/métodos , Modelos Animais , Sus scrofa
18.
Plast Reconstr Surg ; 145(4): 734e-743e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221207

RESUMO

BACKGROUND: Long-term aesthetic reduction of the legs in Asians is gaining increasing popularity among cosmetic patients. Current treatment options include botulinum toxin injection, radiofrequency, neurectomy, and total, subtotal, or partial muscle resection of the gastrocnemius. Partial resection using Kelly forceps was introduced in 2000. This article presents the use of a suction-assisted cartilage shaver to perform partial resection, describing the procedures and shaver modifications and evaluating its use. METHODS: A retrospective review of 71 cases with a minimum 6-month follow-up (average, 36.5 months; range, 6 to 160 months) was performed. Twenty partial calf reductions were performed with a short shaver, 27 with a long shaver, and 24 with an endoscope-guided long shaver. RESULTS: Mean reduction of calf circumference was 2 cm (range, -1 to 6 cm); the mean preoperative and postoperative calf circumferences were 35.8 cm and 33.8 cm, respectively. Mean tissue reduction per calf was 110 g (range, 25 to 300 g).Two patients developed larger calves after surgery, one because of weight gain and the other because of weight training. Complications included surface irregularity (n = 4, 5.6 percent), numbness over the lateral ankle or lateral foot (n = 9, 12.7 percent), hematoma clot requiring surgical evacuation (n = 11, 15.5 percent), prolonged seroma (n = 2, 2.8 percent), and left ankle plantar-flexion contracture due to tight, sustained postsurgery bandaging (n = 1, 1.5 percent). Scar-related complications were hyperpigmentation (n = 6, 8.5 percent), depressed scars (n = 5, 7 percent), and hypertrophic scars (n = 2, 2.8 percent). CONCLUSIONS: Short, long, and endoscope-guided long suction-assisted cartilage shavers for partial resection of calf muscles can be used effectively to reduce the calf. Several mostly treatable complications were noted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Contorno Corporal/instrumentação , Endoscopia/instrumentação , Músculo Esquelético/cirurgia , Miotomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Cicatriz/epidemiologia , Cicatriz/etiologia , Cicatriz/terapia , Contratura/epidemiologia , Contratura/etiologia , Contratura/terapia , Endoscopia/efeitos adversos , Endoscopia/métodos , Estética , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/terapia , Humanos , Hiperpigmentação/epidemiologia , Hiperpigmentação/etiologia , Hiperpigmentação/terapia , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Miotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Seroma/terapia , Sucção/efeitos adversos , Sucção/instrumentação , Sucção/métodos , Adulto Jovem
19.
Plast Reconstr Surg ; 145(4): 1089-1097, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221240

RESUMO

Currently, fat transplantation occurs immediately after harvesting procedures. Because low rates of fat graft take are well reported in the literature, many patients require multiple surgical procedures for fat graft harvest. These subsequent procedures lead to increased cost, donor-site morbidity, and patient discomfort in the long term. The ability to preserve our patients' own adipose aspirate would allow us to counteract these shortcomings and ultimately improve the clinical outcome after fat grafting. Unfortunately, there is no optimal and practical adipose tissue cryopreservation protocol for use by the plastic surgeon at the present time. Because of this dilemma, the senior author (L.L.Q.P.) has investigated this concept in an effort to create a protocol that is both technically sound and clinically achievable to allow for the long-term preservation of adipose tissue. In this article, the authors aim to outline this effort, review current clinical applications that have been reported in the literature, and detail exciting future perspectives in the use of preserved lipoaspirates for repeated fat grafting procedures or in the form of cell-based therapy engineered for reconstructive endeavors for their patients.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/métodos , Criopreservação/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Coleta de Tecidos e Órgãos/métodos , Tecido Adiposo/citologia , Sobrevivência de Enxerto , Humanos , Transplante Autólogo/métodos
20.
J Plast Reconstr Aesthet Surg ; 73(6): 1159-1165, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32173244

RESUMO

INTRODUCTION: Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool. METHODS: In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes. RESULTS: Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales. CONCLUSIONS: Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.


Assuntos
Cirurgia Bariátrica , Contorno Corporal , Reembolso de Seguro de Saúde , Adulto , Contorno Corporal/economia , Estudos Transversais , Feminino , Humanos , Cobertura do Seguro/normas , Cobertura do Seguro/estatística & dados numéricos , Reembolso de Seguro de Saúde/normas , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Perda de Peso
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