Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.565
Filtrar
4.
J Leg Med ; 39(2): 121-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31503528

RESUMO

Empowered to play a larger role in the delivery and administration of health care, a number of states are attempting to solve the pharmaceutical pricing crisis in creative and varied ways. This essay summarizes three particular states' more activist approaches, including states that have sought to empower their Medicaid programs to limit coverage of certain drugs based on price, attempted to use leverage to impose cost-efficiency requirements, and, in the most dramatic example, relied on new usage of "gouging" laws to bring down the costs of prescription drugs. Although all three approaches have met substantial resistance, they illustrate a new era of state experimentation in an effort to bring down the cost of prescription drugs.


Assuntos
Controle de Custos , Custos de Medicamentos/legislação & jurisprudência , Honorários Farmacêuticos/legislação & jurisprudência , Medicamentos sob Prescrição/economia , Governo Estadual , Custos e Análise de Custo/legislação & jurisprudência , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Legislação como Assunto , Maryland , Massachusetts , Medicaid/legislação & jurisprudência , New York , Ativismo Político , Estados Unidos
5.
Environ Sci Pollut Res Int ; 26(29): 29799-29809, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407261

RESUMO

The economics of death and dying highlighted that environmental factors negatively influence healthcare sustainability. Therefore, this study conducted a system-based literature review to identify the negative externality of environmental damages on global healthcare reforms. Based on 42 peer-reviewed papers in the field of healthcare reforms and 12 papers in the field of environmental hazards, we identified 25 factors associated with death and dying and 15 factors associated with health-related damages across the world respectively. We noted that environmental factors are largely responsible to affect healthcare sustainability reforms by associating with the number of healthcare diseases pertaining to air pollutants. The study suggests healthcare practitioners and environmentalists to devise long-term sustainable healthcare policies by limiting highly toxic air pollutants through technology-embodied green healthcare infrastructure to attained efficient global healthcare recovery.


Assuntos
Poluição do Ar/economia , Assistência à Saúde/economia , Reforma dos Serviços de Saúde/economia , Modelos Econômicos , Poluição do Ar/efeitos adversos , Poluição do Ar/prevenção & controle , Atitude Frente a Morte , Política de Saúde/economia , Humanos , Desenvolvimento Sustentável/economia
6.
Health Psychol ; 38(8): 701-704, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368754

RESUMO

Founding figures in Western medicine both puzzled over and anticipated a day when demand for expensive treatments would outstrip financial wherewithal. In the United States, that day has arrived and, with it, the need for sound health care economic policy that selectively covers treatments of demonstrable effectiveness and efficiency. Standard cost-effectiveness methods exist to determine the value of alternative treatments, but they have rarely been applied to behavioral interventions in the United States. Cost-effectiveness analyses are one part of the solution to learning which treatment packages warrant coverage because they produce the most health for the most people. Another part of the solution involves applying novel multiphase optimize strategy methods to reengineer behavioral interventions so that they yield the maximum health benefit attainable for the least resource expenditure. Among the research designs in the multiphase optimize strategy toolkit are methods to derive algorithms that address naturally occurring population heterogeneity in the response to treatments. Such algorithms suggest a population-level protocol to adapt and prioritize treatment options once a patient has failed to respond to an evidence-based practice that was offered as first-line treatment. Developing sound health care economic policy for the population requires systematically figuring out who needs what care and how to provide them what they need-not less and not more. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Comportamental/economia , Análise Custo-Benefício/métodos , Política de Saúde/economia , Humanos
7.
Public Health ; 174: 110-117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326760

RESUMO

OBJECTIVES: Without urgent action, climate change will put the health of future populations at risk. Policies to reduce these risks require support from today's populations; however, there are few studies assessing public support for such policies. Willingness to pay (WtP), a measure of the maximum a person is prepared to pay for a defined benefit, is widely used to assess public support for policies. We used WtP to investigate whether there is public support to reduce future health risks from climate change and if individual and contextual factors affect WtP, including perceptions of the seriousness of the impacts of climate change. STUDY DESIGN: A cross-sectional British survey. METHODS: Questions about people's WtP for policies to reduce future climate change-related deaths and their perceptions of the seriousness of climate change impacts were included in a British survey of adults aged 16 years and over (n=1859). We used contingent valuation, a survey-based method for eliciting WtP for outcomes like health which do not have a direct market value. RESULTS: The majority (61%) were willing to pay to reduce future increases in climate change-related deaths in Britain. Those regarding climate change impacts as not at all serious were less willing to pay than those regarding the impacts as extremely serious (OR 0.04, 95% CI 0.02-0.09). Income was also related to WtP; the highest-income group were twice as likely to be willing to pay as the lowest-income group (OR 2.14, 95% CI 1.40-3.29). CONCLUSIONS: There was public support for policies to address future health impacts of climate change; the level of support varied with people's perceptions of the seriousness of these impacts and their financial circumstances. Our study adds to evidence that health, including the health of future populations, is an outcome that people value and suggests that framing climate change around such values may help to accelerate action.


Assuntos
Mudança Climática/mortalidade , Política de Saúde/economia , Saúde Pública , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Masculino , Inquéritos e Questionários , Reino Unido/epidemiologia
9.
Emerg Med J ; 36(9): 548-553, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31311785

RESUMO

OBJECTIVE: It is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types. METHODS: This observational study covers all ED visits between 2002 and 2015 by adult inhabitants of the Midi-Pyrénées region in France. Their characteristics were collected from the emergency visit summaries. We modelled the visit rates per year using linear regression models, and an increase was considered significant when the 95% CIs did not include zero. The severity of the patients' condition during ED visit was determined through the 'Clinical Classification of Emergency' score. Non-severe visits were those where the patient was stable, and the physician deemed no intervention necessary. Intermediate-severity visits concerned patients who were stable but requiring diagnostic or therapeutic procedures. RESULTS: The 37 studied EDs managed >7 million visits between 2002 and 2015. There was an average increase of +4.83 (95% CI 4.33 to 5.32) visits per 1000 inhabitants each year. The increase in non-severe visit types was +0.88 (95% CI 0.42 to 1.34) per 1000 inhabitants, while the increase in intermediate-severity visit types was +3.26 (95% CI 2.62 to 3.91) per 1000 inhabitants. This increase affected all age groups and all sexes. DISCUSSION: It appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Índice de Gravidade de Doença , Adolescente , Adulto , Fatores Etários , Idoso , Aglomeração/psicologia , Serviço Hospitalar de Emergência/economia , Feminino , França , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Admissão do Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Fatores Sexuais , Adulto Jovem
12.
Health Policy Plan ; 34(4): 316-325, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31157361

RESUMO

One of the important goals of Iran's health transformation programme (HTP) is to improve financial protection for households against health expenditure. This study aimed to investigate the occurrence, intensity and inequality in distribution of catastrophic health expenditure (CHE) using the WHO and the World Bank (WB) methodologies with different thresholds in the years before and after HTP. We used data from seven annual national repeated cross-sectional surveys on households' income and expenditures from 2011 to 2017. The intensity to CHE was calculated using overshoot and mean positive overshoot (MPO) indices. Finally, the inequality in distribution of exposure to CHE was calculated using the concentration index (CI), and the dominance test of concentration curves was used to inference about the significant changes in inequality of the years before and after HTP. The exposure rate to CHE in the total population and at 40% threshold of the WHO methodology changed from 1.99% in 2011 to 3.46% in 2017. Additionally, at 20% threshold of the WB methodology, it was changed from 5.14% to 8.68%. Overshoot and MPO indices increased on average based on two methodologies in urban and rural areas during seven years. The CIs for all the years show a negative value in both methodologies, indicating that CHE occurrence is higher among the poor households. In 2017, at 40% threshold of the WHO, the numerical values of the CIs were -0.15 and -0.14 in urban and rural populations, respectively. These values were -0.07 and -0.05 for the 20% threshold of WB, respectively. Results of dominance test showed no significant change in inequality for the years after than before HTP with two exceptions for total and rural populations based on the WB methodology. Generally, HTP had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies.


Assuntos
Doença Catastrófica/economia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Transversais , Características da Família , Política de Saúde/economia , Humanos , Irã (Geográfico) , Pobreza/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
13.
Lancet ; 393(10187): 2262-2271, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31162084

RESUMO

There is growing interest in preconception health as a crucial period for influencing not only pregnancy outcomes, but also future maternal and child health, and prevention of long-term medical conditions. Successive national and international policy documents emphasise the need to improve preconception health, but resources and action have not followed through with these goals. We argue for a dual intervention strategy at both the public health level (eg, by improving the food environment) and at the individual level (eg, by better identification of those planning a pregnancy who would benefit from support to optimise health before conception) in order to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy. Existing strategies that target common risks factors, such as obesity and smoking, should recognise the preconception period as one that offers special opportunity for intervention, based on evidence from life-course epidemiology, developmental (embryo) programming around the time of conception, and maternal motivation. To describe and monitor preconception health in England, we propose an annual report card using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health.


Assuntos
Cuidado Pré-Concepcional/organização & administração , Desenvolvimento de Programas , Indicadores de Qualidade em Assistência à Saúde , Inglaterra/epidemiologia , Feminino , Política de Saúde/economia , Humanos , Cuidado Pré-Concepcional/economia , Gravidez , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez/epidemiologia
14.
Matern Child Nutr ; 15 Suppl 3: e12720, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148403

RESUMO

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost-effectiveness of the fortification of edible oil by small- and medium-scale (SMS) producers in preventing VAD. The MASAVA project initiated the production of sunflower oil fortified with vitamin A by SMS producers in the Manyara and Shinyanga regions of Tanzania. A quasi-experimental nonequivalent control-group research trial and an economic evaluation were conducted. The household survey included mother and child pairs from a sample of 568 households before the intervention and 18 months later. From the social perspective, the incremental cost of fortification of sunflower oil could be as low as $0.13, $0.06, and $0.02 per litre for small-, medium-, and large-scale producers, respectively, compared with unfortified sunflower oil. The SMS intervention increased access to fortified oil for some vulnerable groups but did not have a significant effect on the prevention of VAD due to insufficient coverage. Fortification of vegetable oil by large-scale producers was associated with a significant reduction of VAD in children from Shinyanga. The estimated cost per disability-adjusted life year averted for fortified sunflower oil was $281 for large-scale and could be as low as $626 for medium-scale and $1,507 for small-scale producers under ideal conditions. According to the World Health Organization thresholds, this intervention is very cost-effective for large- and medium-scale producers and cost-effective for small-scale producers.


Assuntos
Análise Custo-Benefício , Alimentos Fortificados/economia , Óleo de Girassol/economia , Deficiência de Vitamina A/prevenção & controle , Vitamina A/economia , Pré-Escolar , Comércio , Estudos Controlados Antes e Depois , Feminino , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Humanos , Lactente , Política Nutricional/economia , Política Nutricional/legislação & jurisprudência , Prevalência , Empresa de Pequeno Porte/economia , Óleo de Girassol/administração & dosagem , Tanzânia/epidemiologia , Vitamina A/administração & dosagem , Deficiência de Vitamina A/epidemiologia
15.
J Manag Care Spec Pharm ; 25(7): 800-809, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232206

RESUMO

BACKGROUND: Headlines in popular media suggest that Alzheimer disease will bankrupt the Medicare program. Indeed, Alzheimer disease affects more than 5 million older Medicare beneficiaries. OBJECTIVE: To compare total Medicare-covered (allowed) costs of patients with Alzheimer disease with the risk adjusted costs of beneficiaries without dementia over their last years of life, using claims data. METHODS: Using the Medicare 5 Percent Limited Data Set claim files from 2006-2015, we conducted a cost impact analysis of costs for up to 8 years before the year of death. Risk adjustment was performed at a beneficiary level using Medicare's 2015 Hierarchical Condition Categories. Beneficiaries were classified into dementia categories based on their diagnoses during the last 3 years of life. Costs were trend adjusted to 2015. RESULTS: This study found that 40% of deceased beneficiaries have Alzheimer disease or unspecified dementia diagnoses in their claims history. In their last 9 years of life, Alzheimer disease added about 11% to the average $17,000 per year Medicare cost for same-risk beneficiaries without dementia. CONCLUSIONS: Like many diseases, Alzheimer disease and dementia are associated with aging, but unlike other diseases, families and Medicaid, rather than Medicare, bear most of the substantial cost burden. As research continues into Alzheimer treatments, it is not too early to consider how to better integrate Medicare and Medicaid to fund and improve patient outcomes, which will likely involve better diagnosis, treatment, and care coordination. DISCLOSURES: Funding for this project was provided by the Alliance for Aging Research, which received funding from Biogen, Eli Lilly, and Janssen Pharmaceuticals. Peschin and Jenkins are employed by the Alliance for Aging Research. Scott was employed by the Alliance for Aging Research at the time of this study and also reports consulting fees from Piramal Imaging, General Electric, and Allergan, outside of this study. Scott is chair of the Board of Directors for the Alliance for Aging Research, which is a volunteer position, and is also president of Applied Policy, a health policy and reimbursement consultancy. Pyenson and Steffens are employed by Milliman, which was contracted to work on this study. Goss Sawhney and Rotter were employed by Milliman at the time this work was performed. Milliman is a consultant to thousands of organizations in the health care industry.


Assuntos
Doença de Alzheimer/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Política de Saúde/economia , Medicare/economia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/terapia , Efeitos Psicossociais da Doença , Demência/diagnóstico , Demência/economia , Demência/terapia , Feminino , Humanos , Masculino , Estados Unidos
18.
J Manag Care Spec Pharm ; 25(5): 518-521, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039069

RESUMO

In the United States, there is an increased interest to understand the value of health technologies. Cost-effectiveness analysis is arguably the most appropriate framework to quantify value and to inform reimbursement decision making regarding medical interventions; however, a thorough analysis is resource intensive and complex. In many countries, the cost-effectiveness of medical interventions is evaluated by expert agencies at the national level, but in the United States, reimbursement decision making occurs at the local level. This raises the question of how we can provide a means to transparent cost-effectiveness analysis that reflects the local context and patient population and is based on the latest evidence and scientific insights. In other words, how can we maximize the relevance and credibility of cost-effectiveness evaluations in the context of a decentralized decision-making environment? Published cost-effectiveness analyses typically fail on these dimensions. Access to transparent open-source models that can be adapted to reflect the local setting in a relatively straightforward manner is an essential step toward such a goal. However, no model for cost-effectiveness analysis is ever truly "right" or "complete," and it must evolve along with clinical evidence and improvements in scientific methodology to ensure that its credibility remains. We propose a transparent approach of iterative development and collaboration between content and methodology experts to produce up-to-date, open-source consensus-based cost-effectiveness models that account for parameter and structural uncertainty to help local decision makers understand the confidence with which they might make a decision. Our proposed approach provides a way to adapt formal assessments of value-long the province of centralized health care systems-into the decentralized U.S. health care landscape. DISCLOSURES: This research was funded through the Innovation and Value Initiative, a nonprofit multistakeholder research organization. The Innovation and Value Initiative contracted with Precision Medicine Group for research activities related to this article. Jansen and Incerti are salaried employees and shareholders of Precision Medicine Group. Curtis is a paid consultant for the Innovation and Value Initiative. Curtis also reports consulting fees and grants from Amgen, AbbVie, BMS, Corrona, Janssen, Lilly, Myriad, Pfizer, Roche/Genentech, Radius, and UCB, unrelated to this article.


Assuntos
Análise Custo-Benefício/métodos , Assistência à Saúde/organização & administração , Política de Saúde/economia , Modelos Econômicos , Tecnologia Biomédica , Análise Custo-Benefício/normas , Assistência à Saúde/economia , Política de Saúde/legislação & jurisprudência , Invenções/economia , Invenções/legislação & jurisprudência , Formulação de Políticas , Anos de Vida Ajustados por Qualidade de Vida , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/legislação & jurisprudência , Estados Unidos
19.
PLoS Med ; 16(4): e1002788, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31039158

RESUMO

BACKGROUND: Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. METHODS AND FINDINGS: Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. CONCLUSIONS: The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.


Assuntos
Antituberculosos/uso terapêutico , Política de Saúde , Política Pública , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/economia , Argentina/epidemiologia , Estudos de Coortes , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Política Pública/economia , Remuneração , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/economia , Tuberculose/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
20.
Am J Public Health ; 109(6): e1-e12, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31067117

RESUMO

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.


Assuntos
Economia , Política de Saúde , Política , Saúde da População , Recessão Econômica , Emprego/economia , Política de Saúde/economia , Disparidades em Assistência à Saúde/economia , Habitação/economia , Humanos , Renda , Sistemas Políticos/economia , Local de Trabalho/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA