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1.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31613375

RESUMO

This article highlights a special subtype of this dilemma, in which the patient requests a treatment that the physician judges to be substandard. Reasons for and against providing substandard treatment in the name of patient autonomy are presented and discussed. It is suggested that physicians carefully consider the risk of crowding out of other patients if substandard treatment is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde/ética , Preferência do Paciente , Qualidade da Assistência à Saúde/ética , Beneficência , Ética Médica , Prioridades em Saúde , Humanos , Participação do Paciente , Direitos do Paciente , Autonomia Pessoal , Papel do Médico
2.
BMC Med Ethics ; 20(1): 20, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30890158

RESUMO

End-of-life disputes in Ontario are currently overwhelmingly assessed through the singular lens of patient autonomy. The current dispute resolution mechanism(s) does not adequately consider evidence-based medical guidelines, standards of care, the patient's best interests, expert opinion, or distributive justice. We discuss two cases adjudicated by the Consent and Capacity board of Ontario that demonstrate the over emphasis on patient autonomy. Current health care policy and the Health Care Consent Act also place emphasis on patient autonomy without considering other ethically defensible factors. We argue that current policy and legislation require amendment, and unless there are measures undertaken to modify them, both the quality of care provided and the long-term capabilities of the health care system to remain publicly-funded, comprehensive and equitable, are at stake.


Assuntos
Consentimento Livre e Esclarecido/ética , Defesa do Paciente/ética , Qualidade da Assistência à Saúde/ética , Assistência Terminal/ética , Atitude do Pessoal de Saúde , Dissidências e Disputas , Ética Médica , Guias como Assunto , Pesquisas sobre Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Ontário , Defesa do Paciente/legislação & jurisprudência , Formulação de Políticas , Assistência Terminal/legislação & jurisprudência
3.
Arch Phys Med Rehabil ; 100(3): 578-580, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30786978

RESUMO

The Center for Medicare and Medicaid Innovation under the Centers for Medicare and Medicaid Services has invited institutions to demonstrate ways to bundle services into a 90-day episode of acute care that will lower costs and hospital re-admission rates. While these goals are laudable, they overlook the need for and value attained in postacute treatment. This article argues for elimination of the diagnosis of stroke from the proposed demonstration project due to misaligned financial incentives that will severely compromise patient outcomes.


Assuntos
Pacotes de Assistência ao Paciente/ética , Qualidade da Assistência à Saúde/ética , Mecanismo de Reembolso/ética , Reabilitação do Acidente Vascular Cerebral/ética , Acidente Vascular Cerebral , Juramento Hipocrático , Humanos , Estados Unidos
4.
J Clin Nurs ; 28(9-10): 2009-2019, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30706591

RESUMO

AIMS AND OBJECTIVES: To measure the professional values of registered nurses and determine whether these values are significantly related to postlicensure ethics education and years of experience. BACKGROUND: Nursing guilds in many countries reference the American Nurses Association's code of ethics to define expected professional nursing values. Strong professional values contribute to high-quality patient care and are influenced by complex practice environments. DESIGN: Causal-comparative design. METHODS: A convenience sample of actively licensed registered nurses in Washington State, United States of America, participated in an electronically administered survey (N = 2,439). Analyses were conducted using descriptive statistics, analysis of variance and correlation. Reporting utilised the STROBE checklist. RESULTS: Results suggested values of highest and lowest importance to nurses. Scores varied significantly based on years of nursing experience; a higher score indicated stronger orientation toward professional nursing values. Nurses with experience of 10 years or more had the highest scores. There was a modest, positive relationship between professional values and amount of time spent in postlicensure ethics education. CONCLUSIONS: Professional values of Washington State nurses are similar to other nurses in national and global workforces. Results suggest key areas of strength in nurses' professional values and areas needing additional focus and support. Professional values are highest among nurses with longer practice experience and among nurses who have had increased ethics education. RELEVANCE TO CLINICAL PRACTICE: Knowledge of nurses' priority values can assist leaders and educators to identify areas of needed support among nursing staff members. Organisational commitment to support of nurses' professional values through investment in ethics education may produce positive enduring consequences, such as workplace retention and high-quality patient care. Healthcare leaders and clinical educators who promote ethics education may help to mitigate negative effects of morally challenging situations, such as moral distress and work leaving.


Assuntos
Ética em Enfermagem/educação , Enfermeiras e Enfermeiros/normas , Adulto , Códigos de Ética , Humanos , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários , Washington
5.
Nurs Ethics ; 26(2): 378-389, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28659067

RESUMO

BACKGROUND:: Dignity is seen as an important but complex concept in the healthcare context. In this context, the discussion of dignity includes concepts of other ethical principles such as autonomy and privacy. Patients consider dignity to cover individuality, patient's feelings, communication, and the behavior of healthcare personnel. However, there is a lack of knowledge concerning the realization of patients' dignity in hospital care and the focus of the study is therefore on the realization of dignity of the vulnerable group of patients with stroke. AIM:: The aim of the study was to create a theoretical construct to describe the dignity realization of patients with stroke in hospital care. RESEARCH DESIGN AND PARTICIPANTS:: Patients with stroke (n = 16) were interviewed in 2015 using a semi-structured interview containing open questions concerning dignity. The data were analyzed using constant comparison of Grounded Theory. ETHICAL CONSIDERATIONS:: Ethical approval for the research was obtained from the Ethics Committee of the University. The permission for the research was given by the hospital. Informed consent was obtained from participants. FINDINGS:: The "Theory of Dignity Realization of Patients with Stroke in Hospital Care" consists of a core category including generic elements of the new situation and dignity realization types. The core category was identified as "Dignity in a new situation" and the generic elements as health history, life history, individuality and stroke. Dignity of patients with stroke is realized through specific types of realization: person-related dignity type, control-related dignity type, independence-related dignity type, social-related dignity type, and care-related dignity type. DISCUSSION:: The theory has similar elements with the previous literature but the whole construct is new. The theory reveals possible special characteristics in dignity realization of patients with stroke. CONCLUSION:: For healthcare personnel, the theory provides a frame for a better understanding and recognition of how dignity of patients with stroke is realized.


Assuntos
Pessoalidade , Acidente Vascular Cerebral/complicações , Adulto , Ética em Enfermagem , Feminino , Finlândia , Teoria Fundamentada , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Acidente Vascular Cerebral/psicologia
6.
BMC Med Educ ; 18(1): 289, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514272

RESUMO

BACKGROUND: Society demands a university education grounded on ethical principles. Education in ethics values is responsibility of universities but will not be viable unless also adopted by directly responsible agents, the teachers who work with the students. For this reason, our primary research objective was to conduct an in-depth analysis of how Health Sciences students self-perceive the ethical dimension. METHODS: A mixed research methodology with two phases, qualitative and quantitative, allowed us to address our research question from two complementary viewpoints. Conversational interviews were conducted in an intentional and purposive sample to identify a wide range of discursive representations. A questionnaire was designed based on previous studies and the topics of qualitative research. The response format for the questionnaire followed a Likert scale and modulators such as sex, age, degree and the score of a social desirability test were examined. RESULTS: After 24 conversational interviews, three main thematic blocks (coinciding with the three subscales of the questionnaire) were identified: "attitudes for harmony in human relations", "construction of the self" and "rules and regulations". A total of 246 students completed a questionnaire with 39 items. The total scores ranged from 93 to 152 points, with an average score of 122.72 ± 10.64 points. Responsibility, the basic rules of education and respect were perceived as the two most important values, whereas solidarity and social participation as the least important. Results showed a significant positive linear correlation between total score on the questionnaire and age and social desirability. Age was also a significant predictor for the total score and the subscale score "rules and regulations". The students´ responses seemed to be conditioned by the degree of social desirability that they present. CONCLUSIONS: The ad-hoc questionnaire captured the maintenance of high ethical values in our college undergraduate students, which may be directly related to enhanced social desirability. The scores obtained on the questionnaire were correlated with the students' age, which may indicate that values might tend to acquire progressively more importance as students grow older. Further research is warranted to delve deeper on the determinants of professionalism and ethical decision-making in college students.


Assuntos
Currículo , Tomada de Decisões/ética , Percepção , Estudantes de Medicina/psicologia , Empatia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Princípios Morais , Projetos Piloto , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários , Adulto Jovem
7.
Rev. cuba. oftalmol ; 31(4): 34-44, oct.-dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-991111

RESUMO

Debe ser interés de todos los profesionales de la salud brindar un servicio de excelencia y de calidad que conlleve la satisfacción de las necesidades de los pacientes que concurran a las consultas de las diferentes especialidades. El examen clínico en todas sus fases es un eje medular para lograr este propósito, apoyado en los avances tecnológicos, pertinentes para la atención de cada paciente de manera individual. Por esta razón surgió la motivación de profundizar en el conocimiento y en la interpretación de los resultados obtenidos en la medición de la agudeza visual de los pacientes con baja visión y en la ambliopía profunda, atendidos en el Servicio de Baja Visión del Instituto Cubano de Oftalmología Ramón Pando Ferrer, mediante la utilización de optotipos de escala logarítmica. Para esto se realizó una exhaustiva, amplia y profunda revisión bibliográfica sobre el tema, que ayudó a aumentar y a mejorar el conocimiento sobre la utilidad y las ventajas del empleo del optotipo LogMAR en esta subespecialidad y en la Oftalmología en general(AU)


All the health professionals should be interested in providing excellent service of quality that meet the requirement of the patients who go to the different specialty services The clinical exam in all its phases is fundamental to achieve this purpose, supported by the technological advances and in line with the customized care of each patient. For these reasons, this study is aimed at delving into the knowledge and the interpretation of results achieved in the measurement, using logarithmic optotypes, of the visual acuity of low vision and deep ambliopia patients seen at the Low Vision Service of Ramon Pando Ferrer Cuban Institute of Ophthalmology. A comprehensive, broad and deep literature review was made on this topic, which helped to expand and to improve the knowledge on the usefulness and advantages of the use of LogMAR optotype in this subspecialty and in the ophthalmological field in general(AU)


Assuntos
Humanos , Qualidade da Assistência à Saúde/ética , Refração Ocular , Acuidade Visual , Baixa Visão , Literatura de Revisão como Assunto
8.
Rev. cuba. oftalmol ; 31(4): 34-44, oct.-dic. 2018. ilus
Artigo em Espanhol | CUMED | ID: cum-73501

RESUMO

Debe ser interés de todos los profesionales de la salud brindar un servicio de excelencia y de calidad que conlleve la satisfacción de las necesidades de los pacientes que concurran a las consultas de las diferentes especialidades. El examen clínico en todas sus fases es un eje medular para lograr este propósito, apoyado en los avances tecnológicos, pertinentes para la atención de cada paciente de manera individual. Por esta razón surgió la motivación de profundizar en el conocimiento y en la interpretación de los resultados obtenidos en la medición de la agudeza visual de los pacientes con baja visión y en la ambliopía profunda, atendidos en el Servicio de Baja Visión del Instituto Cubano de Oftalmología Ramón Pando Ferrer, mediante la utilización de optotipos de escala logarítmica. Para esto se realizó una exhaustiva, amplia y profunda revisión bibliográfica sobre el tema, que ayudó a aumentar y a mejorar el conocimiento sobre la utilidad y las ventajas del empleo del optotipo LogMAR en esta subespecialidad y en la Oftalmología en general(AU)


All the health professionals should be interested in providing excellent service of quality that meet the requirement of the patients who go to the different specialty services The clinical exam in all its phases is fundamental to achieve this purpose, supported by the technological advances and in line with the customized care of each patient. For these reasons, this study is aimed at delving into the knowledge and the interpretation of results achieved in the measurement, using logarithmic optotypes, of the visual acuity of low vision and deep ambliopia patients seen at the Low Vision Service of Ramon Pando Ferrer Cuban Institute of Ophthalmology. A comprehensive, broad and deep literature review was made on this topic, which helped to expand and to improve the knowledge on the usefulness and advantages of the use of LogMAR optotype in this subspecialty and in the ophthalmological field in general(AU)


Assuntos
Humanos , Qualidade da Assistência à Saúde/ética , Refração Ocular , Acuidade Visual , Baixa Visão , Literatura de Revisão como Assunto
9.
Med. paliat ; 25(4): 291-297, oct.-dic. 2018.
Artigo em Espanhol | IBECS | ID: ibc-180511

RESUMO

Objetivo: Ofrecer la sistemática del análisis bioético a partir de un caso clínico. Método: Tras la exposición del caso clínico se abordan 3 posibles conflictos éticos utilizando como modelo de deliberación la metodología principialista de Diego Gracia. Conclusiones: La atención al final de la vida está jalonada de daciones complejas en las que entran en conflicto valores y perspectivas que deben ser analizadas para que la decisión final sea la mejor


Aim: To show the bioethics analysis procedure based on a case report. Method: After the case report we will analyze 3 possible ethical conflicts by using as a deliberation model the principalism methodology by Diego Gracia. Conclusions: End-of-life care is full of complex decision making processes where values and perspectives must be analysed to arrive at the best decision


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Bioética , Tomada de Decisões/ética , Prática Profissional/ética , Cuidados Paliativos/ética , Autonomia Profissional
12.
J Med Ethics ; 44(11): 774-781, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29936435

RESUMO

While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well.


Assuntos
Grupos de Populações Continentais , Grupos Étnicos , Disparidades em Assistência à Saúde/ética , Efeito Placebo , Beneficência , Empatia/ética , Ética Médica , Acesso aos Serviços de Saúde/ética , Humanos , Autonomia Pessoal , Relações Médico-Paciente/ética , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Apoio Social
13.
Rev. cuba. salud pública ; 44(2)abr.-jun. 2018. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1042980

RESUMO

Introducción: Garantizar el acceso a servicios de salud de calidad es una de las condiciones necesarias para la reducción de la pobreza y de la desigualdad en un país. Objetivo: Analizar la percepción de la calidad en la prestación de servicios de salud en un hospital asistencial. Métodos: Estudio transversal realizado en pacientes atendidos durante los meses de marzo y abril de 2016 en las áreas de urgencias y consulta externa del Hospital Lázaro Alfonso Hernández Lara, Colombia. La muestra quedó conformada por 220 pacientes, seleccionados de forma aleatoria. Se aplicó la metodología seis sigma, útil para organizar el mejoramiento continuo de los servicios de salud. Los datos de la población objetivo se obtuvieron mediante la encuesta SERVQUAL, instrumento que mide la percepción de la calidad. Resultados: Respecto a la calidad de atención percibida, la dimensión seguridad apareció confundida con empatía, y, como factor diferenciador, surgió la dimensión comodidad, separada de elementos tangibles. La calificación global de la percepción corroboró que alrededor del 50 por ciento de los pacientes tuvieron percepciones bajas en las dimensiones de calidad evaluadas. Conclusiones: Los pacientes manifiestan una baja percepción de la calidad en servicios de salud recibidos. Ello permite recomendar a las directivas del hospital revisar los procesos relacionados con la calidad de los servicios prestados, y proponer políticas de mejoramiento en las áreas de urgencias y de consulta externa de acuerdo con las necesidades y las condiciones de los usuarios(AU)


Introduction: Ensuring access to quality health services is one of the necessary conditions for reducing poverty and inequality in a country. Objective: To analyze the perception of quality in the provision of health services in a public care hospital. Methods: A cross-sectional study of patients treated from March to April 2016 in the emergency and outpatients clinics of Lázaro Alfonso Hernández Lara Hospital, in Colombia. The sample included 220 patients that were randomly selected. Six sigma methodology which is useful for organizing the continuous improvement of health services was applied. Data from the target population were obtained through the SERVQUAL survey, which measures the perception of quality. Results: Regarding the perceived quality of care, the security dimension appeared confused with empathy, and as a differentiating factor, the comfort dimension emerged, separated from tangible elements. The overall rating of perception confirmed that about 50 percent of patients had low perceptions on the quality's dimensions assessed. Conclusions: Patients show low quality's perception regarding the health services they receive. This makes possible to recommend hospital directives to review the processes related to the quality of the services provided, and to propose improvement policies in the emergency and outpatient areas, according to the needs and conditions of the users(AU)


Assuntos
Qualidade da Assistência à Saúde/ética , Gestão da Qualidade , Assistência à Saúde , Hospitais , Estudos Transversais , Análise Fatorial , Colômbia
14.
Acad Med ; 93(11): 1610-1612, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29697430

RESUMO

Professionalism is essential for a successful physician-patient relationship and widely acknowledged as an intrinsic and important component of medical education for learners at all levels, from medical school to residency to continuing medical education. The problem is defining the educational end points for learners and then determining how to assess these outcomes. This Invited Commentary focuses on what medical educators can and should do to refine the vision of professionalism in medical education. The authors propose a multistep process in which learners, educators, and the public are engaged in articulating clearly and definitively the end points of professionalism education.


Assuntos
Ética Médica/educação , Profissionalismo/ética , Metas , Humanos , Relações Médico-Paciente/ética , Competência Profissional , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/normas , Estudantes de Medicina
17.
Eur J Oncol Nurs ; 33: 1-7, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29551170

RESUMO

PURPOSE: Although quality of care and caregivers' well-being are important issues in their own right, relatively few studies have examined both, especially in oncology. The present research thus investigated the relationship between job-related well-being and patients' perceptions of quality of care. More specifically, we examined the indirect effects of ethical leadership on patients' perceived quality of care through caregivers' well-being. METHOD: A cross-sectional design was used. Professional caregivers (i.e., doctors, nurses, assistant nurses, and other members of the medical staff; n = 296) completed a self-report questionnaire to assess perceptions of ethical leadership and well-being, while patients (n = 333) competed a self-report questionnaire to assess their perceptions of quality of care. The study was conducted in 12 different oncology units located in France. RESULTS: Results revealed that ethical leadership was positively associated with professional caregivers' psychological well-being that in turn was positively associated with patients' perceptions of quality of care. CONCLUSIONS: Professional caregivers' well-being is a psychological mechanism through which ethical leadership relates to patients' perceptions of quality of care. Interventions to promote perceptions of ethical leadership behaviors and caregivers' mental health may thus be encouraged to ultimately enhance the quality of care in the oncology setting.


Assuntos
Pessoal de Saúde/psicologia , Neoplasias/enfermagem , Enfermagem Oncológica/ética , Enfermagem Oncológica/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , França , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/ética , Inquéritos e Questionários , Adulto Jovem
19.
J Assoc Nurses AIDS Care ; 29(2): 266-274, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28967489

RESUMO

The level of ethical sensitivity of health care professionals who care for patients with HIV may shed light on ethical behaviors in HIV care. However, little research has determined how such professionals view ethical issues in clinical practice in China. The purpose of our qualitative descriptive study was to explore the ethical sensitivity of health care professionals in Hunan Province, China, and to discuss the existing deficiencies. We used purposive sampling to recruit 17 health care professionals who provided direct care to patients with HIV and conducted interviews with them. Interview transcripts were analyzed by thematic analysis. Informants showed certain sensitivities to ethical issues, but the majority also held stigmatizing attitudes toward patients with HIV, and exhibited ethics driven by HIV-related laws and regulations rather than ethical principles. There is room to improve the ethical sensitivity of health care professionals who care for patients with HIV in China.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Infecções por HIV/psicologia , Pessoal de Saúde/psicologia , Direitos do Paciente/ética , Relações Profissional-Paciente/ética , Qualidade da Assistência à Saúde/ética , Estereotipagem , Adulto , Antirretrovirais/uso terapêutico , China , Confidencialidade , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/ética , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
20.
Scand J Caring Sci ; 32(2): 645-653, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28833418

RESUMO

BACKGROUND: Ethical challenges arise in all types of care, and leaders need to be aware of how to resolve these challenges. Healthcare systems tend to be organised around medical conditions, and the patient is often faced with a series of uncoordinated visits to multiple specialties. Ideally, care should be organised around the patient's needs. AIM: The purpose of this article was to highlight some ethical challenges perceived by leaders with responsibility for management and service distribution, finance and ensuring quality of community health services for older people. METHOD: This study had a qualitative design with a qualitative content analysis of one focus group with six leaders that met four times in total. Leaders from the community healthcare sector in one Norwegian municipality were included, representing both nursing homes and home-based health care. The study followed the intentions of the Declaration of Helsinki and standard ethical principles. The Norwegian Social Science Data Services approved the study. All participants voluntarily gave written informed consent. FINDINGS: The main theme that emerged from this study was the ethical challenge leaders felt in the form of an inherent conflict between a caring rationale versus economic or technological rationales. Four categories emerged: (i) Management: quality versus economy; (ii) Prioritisation: fair distribution of healthcare services; (iii) Responsibility: considering individuals' needs versus the needs of the whole community; and (iv) Welfare technology: possibilities and challenges. CONCLUSION: Leaders' responsibilities in community health care for older people need to strike a balance between ethical principles in the management of limited resources.


Assuntos
Serviços de Saúde Comunitária/ética , Serviços de Saúde Comunitária/organização & administração , Instituição de Longa Permanência para Idosos/ética , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/ética , Casas de Saúde/organização & administração , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/organização & administração , Pessoal Administrativo/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Pesquisa Qualitativa
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