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1.
Soins ; 64(841): 26-29, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31864508

RESUMO

The ageing of the French population and the high occurrence of cancers in the population of patients aged over 75 has resulted in the convergence of the competences of two specialties, oncology and geriatrics, in order to optimise the quality of the care provided. Geriatric oncology care must be adapted to the medical, psychological and social situation of each patient.


Assuntos
Geriatria/organização & administração , Oncologia/organização & administração , Neoplasias/terapia , Idoso , França/epidemiologia , Humanos , Neoplasias/epidemiologia , Qualidade da Assistência à Saúde
2.
Rev Lat Am Enfermagem ; 27: e3212, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31664416

RESUMO

OBJECTIVE: to analyze the relation between resilience and demographic variables, quality of life and symptoms of depression in elderlies attended at a Geriatric Outpatient Clinic. METHOD: analytical cross-sectional study, conducted with 148 elderlies, with a questionnaire of sociodemographic and health characterization, the Resilience Scale, the World Health Organization Quality of Life Bref, the World Health Organization Quality of Life Old, and the Center for Epidemiologic Survey - Depression Scale. Descriptive statistics, Student's t-test and Pearson correlation were used for data analysis. RESULTS: there was a positive correlation between resilience and schooling (r = 0.208; p = 0.010), income (r = 0.194; p = 0.017), the World Health Organization Quality of Life Bref (r = 0.242; p = 0.003), and the World Health Organization Quality of Life Old (r = 0.522; p <0.001), and negative correlation regarding symptoms of depression (r = -0.270; p = 0.001). CONCLUSION: Resilience presented relation to schooling, income, quality of life and symptoms of depression in the elderly. These results are expected to help the multidisciplinary team plan actions aimed at developing resilience towards the promotion of health and good quality of life in old age.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Depressão/psicologia , Geriatria/organização & administração , Qualidade de Vida , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional , Fatores Socioeconômicos , Inquéritos e Questionários
3.
Am J Health Syst Pharm ; 76(8): 554-559, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361866

RESUMO

PURPOSE: Implementation of the SAFE PAIN algorithm for reducing opioid use for chronic pain in older adults is described. SUMMARY: A multidisciplinary team at Sheppard Pratt Health System, the largest private provider of psychiatric care in Maryland, used lean methodology to identify the root causes for noncompliance to evidence-based practices for patients in the geropsychiatry unit treated for osteoarthritis or chronic back pain. The team collaborated to develop a facility-specific treatment algorithm, called SAFE PAIN (Sheppard Pratt Health System Algorithm For Elderly Patient Centered Analgesia Interdisciplinary Nagara), was based on the Center for Disease Control and Prevention's evidence-based recommendations that included nonpharmacologic interventions as a first-line therapy for patients with osteoarthritis or chronic back pain. Rates of prescribing new opioids and prescribing evidence-based alternative medications via the SAFE PAIN algorithm were evaluated from March 1 to September 30, 2017 and compared with baseline (2012-2016). The lean methodology interventions led to zero new opioid orders during the study period, a significant decrease compared with previous years (p < 0.01). The rates of prescribing evidence-based alternative medications increased significantly from the baseline period to postimplementation (p < 0.01). Lean methodology interventions also decreased waste in several processes. CONCLUSION: The prescribing rate of new opioids for osteoarthritis and chronic back pain decreased and the prescribing rate for evidence-based medications increased after implementation of the SAFE PAIN algorithm in a geropsychiatry unit.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Procedimentos Clínicos , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/reabilitação , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Feminino , Geriatria/organização & administração , Geriatria/normas , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Humanos , Masculino , Maryland , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Osteoartrite/complicações , Osteoartrite/reabilitação , Manejo da Dor/normas , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psiquiatria/organização & administração , Psiquiatria/normas
4.
Br J Hosp Med (Lond) ; 80(5): 252-257, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31059337

RESUMO

A majority of cancer cases now occur among older people, but this group is less likely to receive treatment and outcomes are poorer than in younger people. Age by itself can be a poor predictor of who will benefit from treatment with surgery, chemotherapy or radiotherapy. Comprehensive geriatric assessment is a multidisciplinary, multidomain process that helps to identify frailty, which is associated with increased mortality. Comprehensive geriatric assessment highlights areas that should be optimized before treatment and helps support a shared decision-making approach. Geriatricians, oncologists and surgeons now work together to help assess and support older people with cancer.


Assuntos
Avaliação Geriátrica/métodos , Neoplasias/terapia , Afeto , Idoso , Idoso de 80 Anos ou mais , Cognição , Comorbidade , Meio Ambiente , Fragilidade/epidemiologia , Geriatria/organização & administração , Humanos , Oncologia/organização & administração , Neoplasias/epidemiologia , Estado Nutricional , Equipe de Assistência ao Paciente/organização & administração , Desempenho Físico Funcional , Qualidade de Vida , Apoio Social
5.
Soins Gerontol ; 24(136): 23-27, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30879615

RESUMO

From the disclosure of a diagnosis to the withdrawal of treatments, an elderly patient with cancer is confronted with numerous disclosures along the care pathway. These become mixed up with the care and support actions. Collaboration and procedures shared between doctors and nurses are essential for the optimised care of the elderly patient and his or her helpers.


Assuntos
Revelação , Neoplasias/diagnóstico , Relações Médico-Enfermeiro , Idoso , Geriatria/organização & administração , Humanos , Oncologia/organização & administração
6.
Australas J Ageing ; 38(1): E1-E6, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30887640

RESUMO

OBJECTIVE: To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions. METHODS: Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality. RESULTS: Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care. CONCLUSIONS: It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.


Assuntos
Serviços de Saúde Comunitária , Geriatria , Pessoal de Saúde , Serviços de Saúde para Idosos , Instituição de Longa Permanência para Idosos , Casas de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Atitude do Pessoal de Saúde , Austrália , Pesquisa Biomédica , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Prestação Integrada de Cuidados de Saúde , Geriatria/organização & administração , Geriatria/normas , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Instituição de Longa Permanência para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/normas , Humanos , Capacitação em Serviço , Casas de Saúde/organização & administração , Casas de Saúde/normas , Cultura Organizacional , Assistência Centrada no Paciente , Publicações Periódicas como Assunto , Relações Profissional-Paciente , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Local de Trabalho
7.
Soins Gerontol ; 24(135): 15-18, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30765080

RESUMO

The implementation of cross-functional measures along the care pathway of cancer patients in France is globally lower in the elderly. However, age is not a criterion for excluding curative treatment, and the evaluation of physical, psychological and social resources and comorbidities is particularly significant in this population. Identifying needs in terms of support care which influences the patient's quality of life as well as the efficacy of treatments is also essential. The objective of geriatric oncology coordination is to offer elderly cancer patients global treatment, curative or otherwise, through the putting in place of a personalised care programme.


Assuntos
Assistência à Saúde/organização & administração , Neoplasias/terapia , Idoso , França , Geriatria/organização & administração , Humanos , Oncologia/organização & administração , Qualidade de Vida
8.
Soins Gerontol ; 24(135): 19-21, 2019.
Artigo em Francês | MEDLINE | ID: mdl-30765081

RESUMO

The assessment of risks in medical geriatric oncology requires close collaboration between oncologists and geriatricians. Vulnerability, death and severe chemotoxicity during cancer treatment represent the main risks to be assessed before making a decision regarding treatment in elderly patients with cancer. A comprehensive geriatric assessment and predictive scores enable a multidimensional assessment of the elderly cancer patient to be carried out.


Assuntos
Geriatria/organização & administração , Oncologia/organização & administração , Neoplasias/terapia , Idoso , Tomada de Decisão Clínica , Avaliação Geriátrica , Humanos , Medição de Risco
9.
Health Aff (Millwood) ; 38(1): 164-168, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615526

RESUMO

Motivated by the increasing number of older people-many with chronic illnesses-and the lack of support for them, the John A. Hartford Foundation (JAHF) made improving the care of older adults one of its two priorities in 1983 and its sole priority in 1994. To accomplish this, the foundation adopted a two-part strategy: first, create a field of professionals capable of caring for an aging population, and second, test models of care for older adults. The JAHF steadfastly pursued that strategy until 2013, when it adopted an approach focused on advancing age-friendly health systems. Geriatrics is now a recognized medical, nursing, and social work specialty, although low reimbursement, the stigma associated with caring for older people, and low prestige discourage students from entering it. Foundation-funded models of care have proven viable, and one of them-palliative care-has been widely adopted. The JAHF focused on an important social need for more than three decades, and this targeted and consistent effort has magnified its impact.


Assuntos
Fundações/organização & administração , Geriatria , Serviço Social/educação , Idoso , Idoso de 80 Anos ou mais , Geriatria/educação , Geriatria/organização & administração , Humanos
11.
Ann Pharm Fr ; 77(2): 136-145, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30392589

RESUMO

Our multidisciplinary geriatric mobile unit works in behalf of the frail elderly people, aged at least 75, who are in loss of self-reliance. One of its main aims is so optimize medical prescriptions. The purpose of this study was to show the benefit of geriatrician and pharmacist interventions over the quality of medical prescriptions for the elderly. Medication reconciliation of treatment and reassessment of the appropriateness of the prescriptions was systematically carried out. The problems related to drug therapy have been listed and classified according to the criteria of pharmaceutical interventions defined by the French Society of Clinical Pharmacy (SFPC). Out of 181 patients, 86,2% had potentially an inappropriate or sub-optimal prescription. Finally, 462 optimizations were proposed (2.9±1.9 by patients): 204 withdrawals, 166 additions, 58 dosage adaptations, 21 therapeutic follow-ups and 13 modalities of administration. This reassessment of the prescriptions allowed to develop between our geriatric mobile unit and the liberal professionals a communication focused on the therapeutic optimization and to spread recommendations on the proper use of drugs in the elderly population.


Assuntos
Idoso/estatística & dados numéricos , Prescrições de Medicamentos/normas , Geriatria/organização & administração , Unidades Móveis de Saúde/organização & administração , Idoso de 80 Anos ou mais , Tratamento Farmacológico/normas , Feminino , Idoso Fragilizado , França , Humanos , Prescrição Inadequada , Masculino , Reconciliação de Medicamentos , Farmacêuticos , Serviço de Farmácia Hospitalar
12.
Clin Geriatr Med ; 35(1): 1-12, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30390975

RESUMO

The changing epidemiology of the geriatric population in the United States has diverse social, medical, and financial implications that will continue to expand over the next few decades. According to the US Census Bureau, 20% of the US population will be 65 years or older by 2030 and more than 50% will eventually belong to a minority group. These changes are expected to be accompanied by several effects on the geriatric population's demographics, injury characteristics, surgical interventions, and the cost of caring for the geriatric population, which will ultimately broaden the financial burden.


Assuntos
Geriatria , Transição Epidemiológica , Procedimentos Cirúrgicos Operatórios , Idoso , Geriatria/métodos , Geriatria/organização & administração , Humanos , Administração dos Cuidados ao Paciente , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia
13.
Z Gerontol Geriatr ; 52(6): 598-606, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-30178120

RESUMO

BACKGROUND: A large number of older acutely ill patients with cognitive impairment are treated in geriatric care units. Since 1990 some geriatric departments in Germany have established special care units (SCU) for this patient population. In 2010 the first inventory of SCUs in Germany was carried out, which was not based on a nationwide systematic survey. OBJECTIVE: Nationwide systematic survey of SCUs for patients with cognitive impairment in geriatric institutions in Germany. METHODS: An online questionnaire (SurveyMonkey®, San Mateo, CA, USA) was sent to all heads of geriatric departments that provide advanced education in geriatric medicine of at least 12 months as registered by the German Society for Geriatric Medicine (DGG). RESULTS: The questionnaire was sent to 495 geriatric institutions of which 161 answered (response rate 32.5%). Additionally, 13 institutions answered through a weblink sent in a newsletter by the DGG. In 2017 a total of 42 SCUs existed with a mean size of 13.5 ± 4.7 beds. A further 15 hospitals plan to install an SCU in the near future, 5 probably in 2018. In four geriatric departments an existing SCU was closed down. All SCUs implemented special architectural, structural and personnel measures as recommended by the position paper of the DGG. The few conducted evaluations indicated beneficial results for mobility and disruptive behavior. CONCLUSION: In recent years the number of SCUs has increased considerably. A methodologically sound evaluation with respect to patient-related outcomes including follow-up and cost-effectiveness is lacking and should be carried out in the near future.


Assuntos
Disfunção Cognitiva/terapia , Demência/terapia , Geriatria/organização & administração , Departamentos Hospitalares/organização & administração , Idoso , Disfunção Cognitiva/psicologia , Previsões , Alemanha , Humanos , Inquéritos e Questionários
14.
Dtsch Med Wochenschr ; 143(24): 1745-1748, 2018 12.
Artigo em Alemão | MEDLINE | ID: mdl-30508852

RESUMO

In the "2018 ESC/ESH Guidelines for the management of arterial hypertension" there are new blood pressure (BP) recommendations with regard to older patients based on randomized controlled trials and well-conducted meta-analyses performed during the last years.It is recommended to base the diagnosis of hypertension on repeated office BP measurements under standardized conditions and in older people in out-of-office BP measurement with ABPM and/or HBPM if logistically and economically feasible. Furthermore lying and standing BP measurements should also be considered in subsequent visits in older people to exclude orthostatic hypotension.Older people should measure their BP in upper arms by validated devices with a well readable display.In the new guidelines more attention is directed on frailty, concomitant treatments and independence influencing the likely tolerability of BP-lowering medications. In fit older patients, it is now recommended that systolic BP should be targeted to a BP range of 130 - 139 mmHg, if tolerated.Lifestyle changes are also recommended in elder patients. Preferred combination therapies are a RAS blocker with a CCB or thiazid diuretic, preferably in a "single pill". When combination therapy is used, this should be initiated at the lowest available doses in elder people.


Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Europa (Continente) , Geriatria/organização & administração , Humanos , Sociedades Médicas
15.
Gerokomos (Madr., Ed. impr.) ; 29(4): 160-164, dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-182260

RESUMO

La valoración geriátrica integral es una herramienta básica en el modelo de atención multidisciplinar al paciente anciano. Objetivos: los objetivos de este estudio son evaluar el estado funcional de los pacientes visitados en una consulta de geriatría hospitalaria de un hospital terciario, conocer la prevalencia de los síndromes geriátricos mayores y valorar la percepción de su calidad de vida. Metodología: Estudio descriptivo prospectivo en el que se incluyeron 260 pacientes mayores de 70 años que acudieron a una consulta de geriatría. A todos ellos se les realizó una valoración geriátrica integral que incluye una evaluación funcional, cognitiva y de percepción de la calidad de vida. También se recogieron los síndromes geriátricos mayores. Resultados: La población analizada tenía una buena capacidad funcional. Los síndromes geriátricos eran muy prevalentes, especialmente en el subgrupo de mayores de 81 años, siendo la polifarmacia el más destacado. Los pacientes con más síndromes geriátricos tenían una peor percepción de la calidad de vida. Conclusión: Los síndromes geriátricos eran muy prevalentes en la población analizada y se asocian a una mala percepción de la calidad de vida. El rol enfermero en su detección e implementación de actividades preventivas y terapéuticas puede mejorar la calidad de vida de estos ancianos


The comprehensive geriatric assessment is a basic tool in the model of multidisciplinary care to the elderly patient. Objectives: To evaluate the functional status of the elderly visited in a hospital Geriatrics consultation of third level. To know the major geriatric syndrome's prevalence. To evaluate the perception of the quality of life of the patients visited in the consultation. Methodology: A prospective descriptive study of 260 patients over 70 years old, who were visited at the nurse consultation. All patients underwent a comprehensive geriatric assessment including a functional evaluation cognitive and perception of the quality of life. Major geriatric syndromes were collected. Results: The population analyzed has a good functional capacity. The geriatric syndromes are prevalent especially in the subgroup of over 81 years, with the most prominent polypharmacy. Patients with geriatric syndromes, have a worse perception of quality of life. Conclusion: Geriatric syndromes are very prevalent in the analyzed population and are associated with poor perception of quality of life. The role of nurses in their detection and implementation of preventive and therapeutic activities can improve the quality of life of these elderly people


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Geriatria/organização & administração , Serviços de Saúde para Idosos/organização & administração , Papel do Profissional de Enfermagem , Assistência Integral à Saúde/métodos , Doença Crônica/prevenção & controle , Estudos Prospectivos , Qualidade de Vida , Idoso Fragilizado
16.
Clin Med (Lond) ; 18(5): 374-379, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30287429

RESUMO

There is increasing recognition that the ageing population represents a challenge to existing surgical services. National reports recommend that geriatricians proactively review older surgical patients to improve care and outcomes. However, this approach has not been widely translated into practice. A qualitative study was conducted using 12 semi-structured interviews of surgeons and geriatricians to explore the role of the geriatrician in the care of older surgical patients. Participants agreed that the current system did not meet the needs of older surgical patients. Geriatricians valued their holistic way of working but these generalist skills can overlap with other specialties, seen by some as wasting resources. Three models of care were proposed, with the ownership and location of the patient as well as the role of education being the key variables. The main obstacle preventing integrated working was the concern of de-skilling the surgeons, narrowing their role to that of a 'technician'. Other barriers included loss of autonomy; lack of evidence; and a lack of recognition of the need for a geriatrician. There is acceptance that closer working practices are necessary to meet the needs of this complex patient group but a lack of evidence, together with significant human factors, are challenges that must be addressed to realise this aim.


Assuntos
Assistência à Saúde , Geriatras , Geriatria , Cirurgiões Ortopédicos , Idoso de 80 Anos ou mais , Geriatria/métodos , Geriatria/organização & administração , Humanos , Comunicação Interdisciplinar , Pesquisa Qualitativa
19.
J Am Geriatr Soc ; 66(7): 1404-1408, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29963688

RESUMO

Small fellowship programs face challenges in providing learners with sufficiently diverse experiences and patient populations. The Fellows Most Difficult Case Conference is designed to broaden geriatric medicine fellows' exposure to cases and to faculty and fellows from around the country through a monthly telephone conference. We describe this innovative approach to a national monthly complex case conference that fellows from almost one-third of geriatrics fellowship programs attend, including its value to geriatric fellows and faculty and administrative costs. Once per month, a fellow presents a case, a moderator leads the discussion, and 2 faculty members provide teaching points during the 60-minute session. Participants rated the conference's value using an 11-item on-line survey followed by a debriefing held during a regularly scheduled 2017 monthly conference. Thirty-six percent of eligible participants responded to the survey (67/186), with 75% of respondents reporting that they applied knowledge gained from the conferences to their patient care at least 1 or 2 times per month and 41% that they applied it at least once per week. Participants appreciated the inclusion of multiple programs, the duration of the conference, and the interactive approach. Our administration time was less than 5 hours per month, plus a few additional hours annually to create the academic year schedule. We believe that this national case conference, the first of its kind in the country, involving almost one-third of geriatrics fellowship programs, is an innovative and valuable way for fellows to explore complex cases and variations in regional perspectives and to connect with additional colleagues.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Bolsas de Estudo/organização & administração , Geriatria/educação , Competência Profissional , Congressos como Assunto , Geriatria/organização & administração , Humanos , Estados Unidos
20.
J Gerontol A Biol Sci Med Sci ; 73(9): 1229-1237, 2018 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-29982466

RESUMO

Age is the strongest risk factor for physical disability and Alzheimer's disease (AD) and related dementias. As such, other aging-related risk factors are also shared by these two health conditions. However, clinical geriatrics and gerontology research has included cognition and depression in models of physical disability, with less attention to the pathophysiology of neurodegenerative disease. Similarly, AD research generally incorporates limited, if any, measures of physical function and mobility, and therefore often fails to consider the relevance of functional limitations in neurodegeneration. Accumulating evidence suggests that common pathways lead to physical disability and cognitive impairment, which jointly contribute to the aging phenotype. Collaborations between researchers focusing on the brain or body will be critical to developing, refining, and testing research paradigms emerging from a better understanding of the aging process and the interacting pathways contributing to both physical and cognitive disability. The National Institute of Aging sponsored a workshop to bring together the Claude D. Pepper Older Americans Independence Center and AD Center programs to explore areas of synergies between the research concerns of the two programs. This article summarizes the proceedings of the workshop and presents key gaps and research priorities at the intersection of AD and clinical aging research identified by the workshop participants.


Assuntos
Doença de Alzheimer/terapia , Envelhecimento Cognitivo , Geriatria , Desempenho Físico Funcional , Idoso , Envelhecimento Cognitivo/fisiologia , Envelhecimento Cognitivo/psicologia , Geriatria/métodos , Geriatria/organização & administração , Geriatria/tendências , Humanos , Pesquisa
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