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2.
Medicine (Baltimore) ; 100(35): e27099, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477146

RESUMO

ABSTRACT: Transcatheter occlusion and surgical ligation are the treatments of choice for most patent ductus arteriosus (PDA) in children. Fifty-five children who had PDA completed a pulmonary function test and a symptom-limited treadmill exercise test from 2016 to 2018 at 1 medical center in southern Taiwan. The study group was divided into surgical ligation and catheterization groups, which were compared to a healthy control group matched for age, sex, and body mass index. Data about the performance on the exercise test, including metabolic equivalent at anaerobic threshold and peak, were analyzed. No differences in the pulmonary function and ventilatory parameters were observed between the surgery, catheterization, and control groups. Heart rate at peak and at anaerobic threshold significantly differed in the investigated groups. The post hoc analysis showed that the surgery group had a lower heart rate at peak and threshold compared to the catheterization and control groups (P = .02, P < .001, respectively). No significant difference was found between the catheterization group and the control group. A larger and younger group of patients were recruited, allowing for newer data about the cardiopulmonary function to be obtained. The findings suggest that patients with PDA could undergo physical training after intervention. The imposition of restrictions to limit sports activities should be avoided.


Assuntos
Débito Cardíaco/fisiologia , Permeabilidade do Canal Arterial/complicações , Testes de Função Cardíaca/estatística & dados numéricos , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Criança , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Testes de Função Cardíaca/métodos , Humanos , Masculino , Pediatria/métodos , Resultado do Tratamento
3.
J Binocul Vis Ocul Motil ; 71(3): 110-117, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34348581

RESUMO

BACKGROUND: The coronavirus (COVID-19) global pandemic has been a poignant reminder of the value of telehealth services to deliver care, especially as a means of reducing the risk of infectious disease transmission caused by close personal contact, decreasing unnecessary travel for medical consultations, and limiting the number of individuals in waiting rooms. The role of telehealth in ophthalmology has historically been limited to store-and-forwarding of images, much like what is used in radiology. PATIENTS AND METHODS: Remote evaluation using two-way audio-video communications over the initial 10-week period of clinic shutdowns. Visual acuity (VA) measurement was attempted using a printed single surrounded HOTV or Snellen chart. The VA measurement of fellow eyes was compared to the prior in person clinical visit. External and strabismus examinations were also conducted. RESULTS: Fifty-eight patients were evaluated with a mean age 12.5 years (range 5 months to 82 years). Twenty of 58 (34%) were younger than 5 years of age. Reasons for evaluation were strabismus in 26 patients (45%), refractive error in 25 (43%), and amblyopia in 10 patients (19%). Recognition visual acuity was obtained in 69% (40 of 58), including every patient older than 5 years of age. Nine children from 2 to 5 years of age (mean 3 years) were unable to perform HOTV VA testing. Of nine children unable to do complete VA testing, five had been premature and seven had developmental delay. There was a mean bias of -0.12 logMAR in favor of the prior in office test in the right eyes of 21 non-amblyopic patients. The 95% limits of agreement between the in-person visit and the subsequent telehealth video visit logMAR VA were +0.20 logMAR upper limit, -0.44 logMAR lower limit. CONCLUSIONS: Telehealth video visits provided basic ophthalmic information in patients who are physically incapable to come to the office, leading to improved triage. Vision could be tested remotely in young children, but we found substantial variability in the measurement of clinically normal eyes. Improvements in the reliability of at-home visual acuity testing are needed.


Assuntos
COVID-19/epidemiologia , Consulta Remota/métodos , SARS-CoV-2 , Estrabismo/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atropina/administração & dosagem , Criança , Pré-Escolar , Óculos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Oftalmologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Privação Sensorial , Estrabismo/fisiopatologia , Estrabismo/terapia , Estados Unidos/epidemiologia , Testes Visuais/métodos , Acuidade Visual/fisiologia
6.
Br J Radiol ; 94(1125): 20210176, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34233469

RESUMO

OBJECTIVES: While hypofractionated stereotactic body radiotherapy (SBRT) has been largely adopted in the adult setting, its use remains limited in pediatric patients. This is due, among other factors, to fear of potential toxicities of hypofractionated regimens at a young age. In this context, we report the preliminary acute (<3 months from SBRT) and middle-term (3-24 months) toxicity results of a national prospective study investigating SBRT in pediatric patients. METHODS: Between 2013 and 2019, 61 patients were included. The first 40 patients (median age: 12 y, range: 3-20) who completed a 2-year-follow-up were included in the present analysis. SBRT was used for treating lung, brain or (para)spinal lesions, either as first irradiation (35%) or in the reirradiation setting (65%). RESULTS: Acute and middle-term grade ≥2 toxicities occurred in 12.5 and 7.5% of the patients, respectively. No grade ≥4 toxicities occurred. Almost all toxicities occurred in the reirradiation setting. CONCLUSION: SBRT showed a favorable safety profile in young patients treated for lung, brain, and (para)spinal lesions. ADVANCES IN KNOWLEDGE: SBRT appeared to be safe in pediatric patients treated for multiple oncology indications. These results support further evaluation of SBRT, which may have a role to play in this patient population in the future.


Assuntos
Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Neoplasias Pulmonares/radioterapia , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , França , Humanos , Masculino , Pediatria/métodos , Estudos Prospectivos , Radiocirurgia/efeitos adversos , Reirradiação/métodos , Resultado do Tratamento , Adulto Jovem
9.
J Pediatr Orthop ; 41(Suppl 1): S75-S79, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096542

RESUMO

INTRODUCTION: Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy. With the potential for long-term treatment, such as is required for scoliosis or osteogenesis imperfecta, patients are at even greater risk of radiation-induced carcinogenesis. DISCUSSION: Although an association between radiation and cancer risk is evident, causation is difficult to prove because comorbidities or genetic predispositions may play a role in the higher baseline rates of malignancy later in life. Efforts have been made over the years to reduce exposure using more modern imaging techniques and simple radiation reduction strategies. Educational efforts and clinical practice guidelines are decreasing the rate of computed tomography scan use in pediatrics. Although considerable work is being done on the development of radiation-free imaging modalities, imaging that uses ionizing radiation will, in the near term, be necessary in specific circumstances to provide optimal care to pediatric orthopaedic patients. CONCLUSION: Knowledge of the ionizing radiation exposure associated with commonly used tests as well as radiation-reduction strategies is essential for the optimal and safe care of pediatric orthopaedic patients.


Assuntos
Diagnóstico por Imagem , Ortopedia , Pediatria , Exposição à Radiação , Criança , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/normas , Humanos , Ortopedia/métodos , Ortopedia/normas , Pediatria/métodos , Pediatria/normas , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Saúde Radiológica/métodos , Saúde Radiológica/normas , Risco Ajustado/métodos , Tomografia Computadorizada por Raios X/métodos
10.
Eur J Endocrinol ; 185(2): 265-278, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061767

RESUMO

Objective: Metabolic syndrome is a cluster of cardio-metabolic risk factors associated with an increased risk of cardiovascular disease and type 2 diabetes. In the last two decades, several definitions of metabolic syndrome have been proposed for the pediatric population; all of them agree on the defining components but differ in the suggested criteria for diagnosis. This review aims to analyze the current diagnostic criteria of metabolic syndrome in pediatrics with reference to their feasibility and reliability in clinical practice. Methods: The systematic research was conducted from January 2003 to June 2020 through MEDLINE via PubMed, Cochrane Library and EMBASE databases. Results: After the selection phase, a total of 15 studies (182 screened) met the inclusion criteria and are reported in the present review. Twelve studies were cross-sectional, two were longitudinal and one was a consensus report. The sample population consisted of multiethnic group or single ethnic group, including Turkish, European, Asian and Hispanic subjects. Conclusions: To date, there is not a univocal, internationally accepted pediatric definition of metabolic syndrome, which guarantees a high sensitivity and stability of the diagnosis. The definition proposed by IDF results the most straightforward and easy to use in clinical practice, having the unquestionable advantage of requiring measurements quickly accessible in clinical practice, without the adoption of multiple reference tables. Further research is needed to validate a new version of such definition which includes the diagnostic cut-off points recently suggested by published guidelines.


Assuntos
Técnicas de Diagnóstico Endócrino , Síndrome Metabólica/diagnóstico , Pediatria , Adolescente , Idade de Início , Criança , Pré-Escolar , Técnicas de Diagnóstico Endócrino/normas , Técnicas de Diagnóstico Endócrino/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pediatria/métodos , Pediatria/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Reprodutibilidade dos Testes
11.
AAPS PharmSciTech ; 22(5): 193, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34184163

RESUMO

The human immunodeficiency virus (HIV) impacts up to 37 million people globally, of which 1.8 million are children. To date, there is no cure for HIV, although treatment options such as antiretroviral therapy (ART) are available. ART, which involves a patient taking a combination of antiretrovirals, is being used to treat HIV clinically. Despite the effectiveness of ART, there is currently no palatable pediatric formulation to treat HIV in children, which has hindered patient compliance and overall treatment efficacy. In addition, anti-HIV therapeutics are often poorly water-soluble, and hence have poor bioavailability. In the present study, we developed a pediatric-friendly formulation for anti-HIV therapeutics with improved dissolution characteristics of the therapeutic agents. Lopinavir (LPV) and ritonavir (RTV), available as FDA-approved fixed-dose combination products, were chosen as model ART drugs, and the formulation and processing parameters of spray-dried cyclodextrin (CD)-based LPV and RTV complexes were studied. Results showed that the spray-dried complexes exhibited enhanced dissolution profiles in comparison to pure drugs, particularly spray-dried ß-CD complexes, which showed the most favorable dissolution profiles. This current formulation with enhanced dissolution and taste-masking ability through the use of cyclodextrin has the potential to address the unmet need for the development of suitable pediatric formulations.


Assuntos
Fármacos Anti-HIV/análise , Fármacos Anti-HIV/síntese química , Ciclodextrinas/análise , Ciclodextrinas/síntese química , Desenvolvimento de Medicamentos/métodos , Secagem por Atomização , Fármacos Anti-HIV/uso terapêutico , Criança , Ciclodextrinas/uso terapêutico , Composição de Medicamentos/métodos , Infecções por HIV/tratamento farmacológico , Humanos , Espectroscopia de Ressonância Magnética/métodos , Pediatria/métodos , Difração de Raios X/métodos
12.
Paediatr Drugs ; 23(4): 349-359, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34036532

RESUMO

Lidocaine is an amino amide with a well-established role as a local anesthetic agent. Systemic intravenous administration expands its clinical use to include acute and chronic pain circumstances, such as postoperative pain, neuropathic pain, postherpetic neuralgia, hyperalgesia, visceral pain, and centrally mediated pain. For refractory pain that has not responded to conventional therapy or if further escalation of treatment is prevented by contraindications or side effects to standard therapies, a continuous infusion of lidocaine may be considered as a single intervention or as a sequence of infusions. Here, we review and evaluate published data reflecting the use of lidocaine continuous infusions for pain management in the pediatric population.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Manejo da Dor/métodos , Pediatria/métodos , Adolescente , Anestesia Local/métodos , Criança , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Infusões Intravenosas , Masculino , Neuralgia/diagnóstico , Neuralgia/tratamento farmacológico , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
13.
Nurs Clin North Am ; 56(2): 299-309, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023123

RESUMO

The breadth of childhood sleep problems is broad and can be associated with biologic, psychiatric, behavioral, social, and environmental processes. Unrecognized childhood sleep problems may threaten daytime behaviors and negatively impact school and psychosocial functioning. Left unattended, overall child biopsychosocial development may be impaired. Thus, identifying and addressing sleep problems has potential to optimize childhood health, development, and overall well-being. Nurses need to be cognizant of detrimental impacts of child sleep deprivation and advocate for appropriate sleep assessments while offering sleep education to parents and children.


Assuntos
Transtornos do Sono-Vigília/etiologia , Sono/fisiologia , Humanos , Determinação de Necessidades de Cuidados de Saúde/tendências , Pediatria/métodos , Exame Físico/métodos , Polissonografia/métodos
14.
Nurs Clin North Am ; 56(2): 311-323, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023124

RESUMO

Sleep deficiency in children is a public health concern, and it is highly comorbid in pediatric chronic pain conditions. Children may be particularly vulnerable to the deleterious effects of sleep deficiency, because comorbid sleep deficiency in chronic pain may further exacerbate already existent symptoms of pain, anxiety, depressions, daytime function, and increase health care use. Sleep deficiency is modifiable and integrating human-centered approaches into the development of sleep interventions is a pragmatic approach to partner with parents and children to provide them with the knowledge, motivation, and skills for setting and achieving goals, adapting to setbacks, and problem solving.


Assuntos
Dor Crônica/complicações , Transtornos do Sono-Vigília/etiologia , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Artrite Juvenil/complicações , Artrite Juvenil/fisiopatologia , Dor Crônica/psicologia , Gastroenteropatias/complicações , Gastroenteropatias/fisiopatologia , Cefaleia/complicações , Cefaleia/fisiopatologia , Humanos , Pediatria/métodos , Pediatria/tendências , Transtornos do Sono-Vigília/fisiopatologia , Inquéritos e Questionários
15.
Clin Pediatr (Phila) ; 60(8): 350-362, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34008439

RESUMO

There is an urgent need for new clinical models to improve access to child mental health care. Pediatricians are tasked to care for youth with mild to moderate mental health problems, but require additional training. This article describes an outpatient child psychiatry consultation clinic (CPC) designed to empower pediatricians to care for youth with depression, anxiety, and attention deficit/hyperactivity disorder. Over a 2-year period, 40 primary care physicians (PCPs) referred 159 patients to the CPC. The most common primary diagnoses of patients seen for consultation were generalized anxiety disorder (35%), major depressive disorder (24%), and attention deficit/hyperactivity disorder (20%). Most patients (89%) had at least 2 psychiatric diagnoses. Nearly four fifths (79%) of these patients successfully returned to their PCP for ongoing care. PCPs reported that the CPC enhanced their skills and improved access to mental health care. Similar models are needed to facilitate early intervention for the millions of youth with mental health problems.


Assuntos
Psiquiatria Infantil/métodos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta , Adolescente , Criança , Pré-Escolar , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/psicologia , Pediatria/métodos , Atenção Primária à Saúde/métodos
17.
Hosp Pediatr ; 11(6): 636-649, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34021029

RESUMO

CONTEXT: Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been conducted to explicitly examine the humanistic impact of FCRs. OBJECTIVE: The objective with this review is to determine if FCRs promote the core values of humanism in medicine by answering the question, "Do FCRs promote humanistic pediatric care?" DATA SOURCES: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and Dissertation Abstracts for peer-reviewed pediatric studies through January 1, 2020. We used search terms including FCRs, communication, humanism, and the specific descriptors in the Gold Foundation's definition of humanism. STUDY SELECTION: Abstracts (n = 1003) were assessed for 5 primary outcomes: empathy, enhanced communication, partnership, respect, and satisfaction and service. We evaluated 158 full-text articles for inclusion, reconciling discrepancies through an iterative process. DATA EXTRACTION: Data abstraction, thematic analysis, and conceptual synthesis were conducted on 29 studies. RESULTS: Pediatric family-centered rounds (FCRs) improved humanistic outcomes within all 5 identified themes. Not all studies revealed improvement within every category. The humanistic benefits of FCRs are enhanced through interventions targeted toward provider-family barriers, such as health literacy. Patients with limited English proficiency or disabilities or who were receiving intensive care gained additional benefits. CONCLUSIONS: Pediatric FCRs promote humanistic outcomes including increased empathy, partnership, respect, service, and communication. Limitations included difficulty in defining humanism, variable implementation, and inconsistent reporting of humanistic outcomes. Future efforts should include highlighting FCR's humanistic benefits, universal implementation, and adapting FCRs to pandemics such as coronavirus disease 2019.


Assuntos
Atitude do Pessoal de Saúde , Humanismo , Pediatria/métodos , Relações Profissional-Família , Visitas com Preceptor/métodos , Criança , Criança Hospitalizada , Comunicação , Empatia , Humanos
18.
Isr Med Assoc J ; 23(4): 233-238, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33899356

RESUMO

BACKGROUND: Evaluation of children's anthropometrics poses challenges due to age-related changes. The main focus is on height and weight. However, since weight is height-dependent, body mass index (BMI) is the best surrogate measurement of adiposity. Israel has not developed national growth tables; therefore, researchers and clinicians utilize either World Health Organization (WHO) or U.S. Centers for Disease Control and Prevention (CDC) tables as benchmarks. OBJECTIVES: To evaluate the anthropometrics of Israeli children benchmarked by CDC and WHO tables. METHODS: A retrospective review was conducted of the 1987-2003 birth cohort (age 4-18 years) from Clalit Health Services databases. Anthropometrics were retrieved twice: at study entry and one year later. We evaluated them as separate cohorts. Gender-specific age-matched median height and BMI were compared with CDC and WHO height and BMI tables. RESULTS: he study consisted of 15,650, mean age at study entry 9.5 years (range 4-18). Gender-specific median heights of the Israeli children were similar to CDC and WHO values at younger ages, but were slightly shorter than the age-matched CDC and WHO toward the age of final height in both cohorts. However, gender-specific median BMI was considerably and statistically significant higher compared to CDC and WHO values consistently along the entire age range in both cohorts. CONCLUSIONS: Israeli children were slightly shorter toward the age of final height, compared to WHO and CDC. However, BMI in Israeli children was significantly higher compared to the CDC and WHO consistently along the age range, which raises an alarm regarding obesity patterns.


Assuntos
Antropometria/métodos , Estatura , Índice de Massa Corporal , Obesidade , Pediatria , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/prevenção & controle , Pediatria/métodos , Pediatria/normas , Padrões de Referência , Fatores Sexuais , Organização Mundial da Saúde
19.
Medicine (Baltimore) ; 100(17): e25654, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907127

RESUMO

BACKGROUND: Anorexia is a common and frequent disease in clinical pediatrics. It refers to a chronic digestive disorder syndrome with loss of appetite or disappearance and reduced food intake. The incidence of anorexia in children is very high, if not timely, safe and effective treatment, will have a huge impact on the growth and development of children. The toxic side effects of related treatment drugs often worry clinicians. Pediatric massage is external therapy, with green, safe and effective characteristics, lack of evidence-based medicine evidence support. A systematic evaluation and meta-analysis of the safety and efficacy of pediatric massage in the treatment of anorexia will be carried out in this paper to provide a powerful evidence. METHODS: We'll retrieve 8 electronic databases, including the PubMed, Embase, Cochrane Library, Web Of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), China Science Journal Database (VIP), the retrieval date was established from the database to March 2021. The authors will screen the study independently, Extracting data, and through Coch bias tools to assess the quality hazards of methods. RevmanV.5.3 software will be used for statistical analysis. RESULTS: The results of this study need to be obtained after the completion of this program. CONCLUSIONS: The conclusion of this study will confirm the efficacy and safety of pediatric massage in the treatment of anorexia, and provide reliable evidence for clinical selection of pediatric massage in the treatment of anorexia. ETHICS AND DISSEMINATION: This study does not need to be reviewed by the Ethics Committee, because this paper is not a clinical study or a related experimental study, and this paper is only a literature study. INPLASY REGISTRATION NUMBER: INPLASY202130050.


Assuntos
Anorexia/terapia , Massagem/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Metanálise como Assunto , Pediatria/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
20.
Nurs Res ; 70(3): E21-E28, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33891385

RESUMO

BACKGROUND: Despite the increasing number of studies using photo-elicitation for data collection in qualitative research, there is a need to further explore its use among families of children and adolescents living with chronic illness. OBJECTIVE: The aim of this study was to discuss methodological and pragmatic considerations about the use of photo-elicitation interviews (PEIs) for data collection with families of children and adolescents living with chronic illness. METHODS: We discussed methodological aspects of using PEIs as reported in publications. A search of the literature was carried out to identify articles presenting information on methodological aspects of the use of PEIs in qualitative data collection, regardless of age group. In pursuit of complementing the evidence with pragmatic considerations of using PEIs, we illustrate with an example of a recent qualitative study of our own that aimed to understand the narratives about hope of families of children and adolescents living with chronic illness. RESULTS: We synthesized common aspects that need to be considered when using PEIs with different populations: ethical issues, cameras, guidance, and interviews. We also presented our experience of using the PEI technique to collect data from families. Because of our experience, we denominate our method as the "family photo-elicitation interview" (FPEI). Our method goes beyond the PEI technique because it integrates aspects of family nursing theories when conducting interviews with families. FPEIs strengthen family interaction and allow family members to share their perspectives. DISCUSSION: We present a new perspective of PEIs-the FPEI-in the pediatric context. Previous studies have not addressed considerations about using PEIs for families. We hope our results assist novice researchers in planning and implementing FPEIs in qualitative research. We recommend that researchers explore the use of FPEIs in other contexts, such as geriatrics or palliative care.


Assuntos
Doença Crônica/psicologia , Relações Familiares/psicologia , Entrevistas como Assunto/métodos , Fotografação/métodos , Adolescente , Criança , Humanos , Pediatria/métodos , Pesquisa Qualitativa , Projetos de Pesquisa
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