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1.
J Prof Nurs ; 37(1): 24-28, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33674102

RESUMO

Due to the COVID-19 pandemic, nursing programs were challenged to continue educating students at practice sites, and educational institutions limited or eliminated face-to-face education. The purpose of this article is to report on a university and community college nursing program and an academic medical center that implemented an academic-practice partnership with the goal of creating opportunities to continue clinical experiences for nursing students during the pandemic. Principles and implementation of this successful partnership provide direction for other nursing programs and practice settings that may continue to have challenges in returning students to clinical and keeping them in clinical as the pandemic continues.


Assuntos
Redes Comunitárias/organização & administração , Bacharelado em Enfermagem/organização & administração , Educação Continuada em Enfermagem/organização & administração , Hospitais Comunitários/organização & administração , Relações Interprofissionais , Recursos Humanos de Enfermagem/educação , Adulto , Comportamento Cooperativo , Feminino , Humanos , Masculino , Pandemias , Estados Unidos
4.
Bull Cancer ; 108(2): 163-176, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33455736

RESUMO

Sarcomas are a rare heterogeneous group of malignant neoplasms that can arise in almost any anatomic site and any age. Close collaboration among adult and pediatric cancer specialists in the management of these tumors is of foremost importance. In this review, we present the current multidisciplinary organization in care of patients with sarcoma in France and we review the main advances made in the last decades in systemic and radiotherapy treatment in the main sarcoma types diagnosed in children, adolescents and young adults (AYA), thanks to the international collaboration.


Assuntos
Neoplasias Ósseas/terapia , Institutos de Câncer , Equipe de Assistência ao Paciente/organização & administração , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Adolescente , Adulto , Fatores Etários , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Institutos de Câncer/organização & administração , Institutos de Câncer/provisão & distribução , Criança , Redes Comunitárias/organização & administração , Redes Comunitárias/provisão & distribução , Europa (Continente) , França , Humanos , Cooperação Internacional , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Quimioterapia de Manutenção , Oncologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Neoplasias Embrionárias de Células Germinativas/terapia , Osteossarcoma/terapia , Dosagem Radioterapêutica , Ensaios Clínicos Controlados Aleatórios como Assunto , Rabdomiossarcoma/terapia , Sarcoma Alveolar de Partes Moles/terapia , Sarcoma de Ewing/terapia , Sociedades Médicas , Adulto Jovem
5.
Ann Hematol ; 100(3): 825-830, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33409623

RESUMO

Among the different biomarkers predicting response in chronic lymphocytic leukemia (CLL), the most influential parameters are the mutational status of the IGHV genes and the presence of TP53 gene disruptions. Nevertheless, these important assessments are not readily available in most centers dealing with CLL patients. To provide this molecular testing across the country, the Spanish Cooperative Group on CLL (GELLC) established a network of four analytical reference centers. A total of 2153 samples from 256 centers were analyzed over a period of 30 months. In 9% of the patients, we found pathological mutations in the TP53 gene, whereas 48.96% were classified as IGHV unmutated. Results of the satisfaction survey of the program showed a Net Promoter Score of 85.15. Building a national network for molecular testing in CLL allowed the CLL population a broad access to complex biomarkers analysis that should translate into a more accurate and informed therapeutic decision-making.


Assuntos
Serviços de Laboratório Clínico/organização & administração , Análise Mutacional de DNA , Cadeias Pesadas de Imunoglobulinas/genética , Leucemia Linfocítica Crônica de Células B/genética , Encaminhamento e Consulta/organização & administração , Proteína Supressora de Tumor p53/genética , Biomarcadores Tumorais/genética , Serviços de Laboratório Clínico/provisão & distribução , Estudos de Coortes , Redes Comunitárias/organização & administração , Análise Mutacional de DNA/métodos , Humanos , Ciência da Implementação , Colaboração Intersetorial , Satisfação no Emprego , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/epidemiologia , Técnicas de Diagnóstico Molecular/métodos , Mutação , Prognóstico , Espanha/epidemiologia , Inquéritos e Questionários
7.
JAMA Netw Open ; 3(12): e2030090, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33320267

RESUMO

Importance: The vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place. Objective: To investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults. Design, Setting, and Participants: This comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020. Exposures: P2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments. Main Outcomes and Measures: Rates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up. Results: A total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study. Conclusions and Relevance: P2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.


Assuntos
Redes Comunitárias , Vida Independente/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistemas de Apoio Psicossocial , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Pesquisa Comparativa da Efetividade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Grupo Associado , Estados Unidos
8.
BMJ Open ; 10(10): e042392, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130573

RESUMO

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Cadeias de Markov , Modelos Organizacionais , Pandemias , Medicina Estatal/organização & administração , Listas de Espera , Adulto , Betacoronavirus , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Cirúrgicos Eletivos/classificação , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Medicina Estatal/estatística & dados numéricos
9.
J Am Board Fam Med ; 33(5): 645-649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989057

RESUMO

The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging disease, the human cost of pandemics and the need for robust research.1 For primary care, the advent of COVID-19 has forced an unprecedented wave of practice change. In turn, Practice-Based Research Networks (PBRNs) must rapidly pivot to address the changing environment and the critical challenges faced by primary care. The pandemic has also impacted the ability of PBRNs to deploy traditional research methods such as face-to-face patient and provider interactions, practice facilitation, and stakeholder engagement. Providers need more relevant, patient-centered evidence and the skills to effect change. These skills will become more important than ever as primary care practices evolve in response to the current COVID-19 pandemic and the disparities in health outcomes highlighted by COVID-19 and the global Black Lives Matter social movement for justice. Throughout this issue, authors detail the work conducted by PBRNs that demonstrate many of these evolving concepts. Articles explore how PBRNs can evaluate COVID-19 in primary care, the role of PBRNs in quality improvement, stakeholder engagement, prevention and chronic care management, and patient safety in primary care.


Assuntos
Betacoronavirus , Redes Comunitárias/tendências , Infecções por Coronavirus , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Redes Comunitárias/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
10.
J Am Board Fam Med ; 33(5): 774-778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989072

RESUMO

BACKGROUND: Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? DISCUSSION AND CONCLUSIONS: PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/tendências , Redes Comunitárias/tendências , Infecções por Coronavirus , Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Centros Comunitários de Saúde/organização & administração , Redes Comunitárias/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Ciência da Implementação , Disseminação de Informação , Inovação Organizacional , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
11.
Sante Publique ; 32(2): 239-246, 2020 09 15.
Artigo em Francês | MEDLINE | ID: mdl-32989953

RESUMO

INTRODUCTION: Professional and Territorial Health Communities aim at organizing the coordination of health professionals of primary and specialty care, in order to better structure care pathways and improve healthcare access. The flow of patients to specialty care outlines territories whose scale and organization can serve as a basis to identify these communities’ territories. METHOD: The analysis of patient flows to specialty care professionals in Centre-Val de Loire region in 2015 (SNIIRAM data) made it possible to classify medical specialties according to their scale of attractiveness (i.e. regional, departmental and sub-departmental specialties). Among sub-departmental specialties, 5 have been merged to identify common poles of attraction. These empirical poles have been compared to health professionals’ perception of territories where they practice in order to refine the territorial subdivision of the region. Patient flows to the General Hospitals (PMSI date) were then defined to compare them with the private practice patient poles. RESULTS: In the region, twenty or so attraction poles can be identified in the six departments of the region. Local areas have been divided into 5 classes, according to their degree of attraction to a pole. Attraction poles seem to be consistent with health professionals’ habits. The concordance with hospital patient poles reinforced the relevance of this division. CONCLUSION: Patients flows respond to a real territorial logic which, confronted to health professionals’ real-life practices, draws territories relevant for a first approach of the Professional and Territorial Health Communities.


Assuntos
Redes Comunitárias/organização & administração , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , França , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Especialização
13.
Sante Publique ; 32(2): 239-246, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985840

RESUMO

INTRODUCTION: Professional and Territorial Health Communities aim at organizing the coordination of health professionals of primary and specialty care, in order to better structure care pathways and improve healthcare access. The flow of patients to specialty care outlines territories whose scale and organization can serve as a basis to identify these communities’ territories. METHOD: The analysis of patient flows to specialty care professionals in Centre-Val de Loire region in 2015 (SNIIRAM data) made it possible to classify medical specialties according to their scale of attractiveness (i.e. regional, departmental and sub-departmental specialties). Among sub-departmental specialties, 5 have been merged to identify common poles of attraction. These empirical poles have been compared to health professionals’ perception of territories where they practice in order to refine the territorial subdivision of the region. Patient flows to the General Hospitals (PMSI date) were then defined to compare them with the private practice patient poles. RESULTS: In the region, twenty or so attraction poles can be identified in the six departments of the region. Local areas have been divided into 5 classes, according to their degree of attraction to a pole. Attraction poles seem to be consistent with health professionals’ habits. The concordance with hospital patient poles reinforced the relevance of this division. CONCLUSION: Patients flows respond to a real territorial logic which, confronted to health professionals’ real-life practices, draws territories relevant for a first approach of the Professional and Territorial Health Communities.


Assuntos
Redes Comunitárias/organização & administração , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , França , Acesso aos Serviços de Saúde , Humanos
15.
PLoS One ; 15(8): e0236721, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750071

RESUMO

Whereas governments are increasingly considering affirmative action programs to increase corporate board diversity, the effect of such programs can be superficial as they do not address the underlying problem, which is women's access to and inclusion in relevant corporate networks. To address this issue, we study the relationship among affirmative action programs (binding gender quotas and non-binding gender targets), director networks, and the number of board positions individual directors hold given their gender. We use personal, professional, and network characteristics of 25,127 unique directors from 2,435 public firms in 32 European countries over the period of 2000 through 2017. We find that in the absence of affirmative action programs, women directors benefit less from their networks than men directors suggesting the existence of a gender gap in network benefits. After the passage of binding gender quotas, this gender gap in network benefits narrows between women and men directors. Overall, this research suggests that binding gender quotas make director networks a more salient tool for hiring women and may help in leveling the playing field in the way these networks are used for achieving top management positions.


Assuntos
Redes Comunitárias/organização & administração , Ética nos Negócios , Cultura Organizacional , Corporações Profissionais/organização & administração , Política Pública , Mulheres Trabalhadoras , Europa (Continente) , Feminino , Humanos , Masculino
16.
Crit Care Nurs Q ; 43(4): 451-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833780

RESUMO

This article provides a road map to swiftly operationalize the structure and process for organizational readiness in response to the COVID-19 pandemic. The pandemic forced network leaders to face an unprecedented public health crisis while navigating circumstances driven by a widely impactful disease with minimal empirical evidence regarding disease spread, containment, and treatment. Key leaders across the enterprise planned, executed, and continually refined a strategy against the pandemic surge. Mission-driven decisions, communication, and actions were critical in connecting and informing the stakeholders about the evolving and uncertain conditions. In partnership with internal and external stakeholders, the use of data, technology, and innovation provided new opportunities to transform existing care and business models into adaptable prototypes for mitigating risks and informing tactical steps. Execution of testing sites, building a command center, and increasing bed capacity infused daily operations. Creating innovative processes, including working with private industry to secure resources and pioneering solutions, is the result of leveraging talented teams to produce solutions. Trustful partnerships among enterprise leaders and their constituents stemmed from a common, shared vision. Utilizing systems thinking led to optimizing a response and preparedness plan for now and for future pandemics.


Assuntos
Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Liderança , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Incerteza
17.
Age Ageing ; 49(4): 516-522, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32725209

RESUMO

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.


Assuntos
Infecções por Coronavirus , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Programas Médicos Regionais/organização & administração , Idoso , Betacoronavirus/isolamento & purificação , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , França/epidemiologia , Alocação de Recursos para a Atenção à Saúde/tendências , Serviços de Saúde para Idosos/ética , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/tendências , Humanos , Inovação Organizacional , Cuidados Paliativos/métodos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Web Semântica , Participação dos Interessados
18.
Indian J Med Microbiol ; 38(1): 9-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719203

RESUMO

High-throughput, accurate, cost-effective and rapid testing for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the need of the hour in face of the global coronavirus disease pandemic. This target is achievable, within a relatively short time through capacity building of reverse transcription polymerase chain reaction (RT-PCR) tests by utilising the strengths of intra and inter institutional networks. These networks act as force multiplier for vital resources which are required for capacity building, namely, leadership, expertise, equipment, space, infection control inputs and human resources. In this article, we report the experience of capacity building for delivery of RT-PCR tests for SARS CoV-2 from a cancer hospital in Eastern India. The relevance, mode of operation and value addition of this essential public health service are discussed in the context of inter departmental collaboration and interaction with other institutes through the existing diagnostic, surveillance and infection control networks. This networking model for service development and delivery could be used by other centres.


Assuntos
Betacoronavirus/isolamento & purificação , Fortalecimento Institucional/organização & administração , Técnicas de Laboratório Clínico/métodos , Redes Comunitárias/organização & administração , Infecções por Coronavirus/diagnóstico , Serviços de Diagnóstico/organização & administração , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Betacoronavirus/genética , Humanos , Índia , Pandemias
19.
J Evid Based Soc Work (2019) ; 17(4): 406-426, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32692640

RESUMO

PURPOSE: This qualitative study examined views of research-supported parenting interventions across three stakeholder groups that have critical roles in child welfare-case managers, clinicians, and judicial representatives in one rural community. METHOD: Semi-structured interviews were conducted with members in each stakeholder group. Two analytic approaches were used. First, views on the selection of research-supported interventions, strengths and weaknesses, and professional collaboration in implementation were examined. Second, several factors in the literature impacting research-supported interventions were used to compare views. RESULTS: All stakeholder groups supported the use of research-supported therapies while agreeing that the overriding importance in selecting any therapy was to ensure the best "fit" with a client. Professional collaboration was considered essential in a variety of forms and combinations by all groups. DISCUSSION AND CONCLUSION: The results highlight important considerations in selecting and implementing research-supported parent therapies. Recommendations to continue and expand this line of research are articulated.


Assuntos
Atitude do Pessoal de Saúde , Redes Comunitárias/organização & administração , Pessoal de Saúde/psicologia , Poder Familiar/psicologia , Pais/educação , Pais/psicologia , Serviço Social/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , População Rural
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