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1.
J Law Med ; 26(4): 764-785, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682356

RESUMO

Contemporary public health literature contains an increasing emphasis on the commercial determinants of health including the influence of unhealthy food, beverage and tobacco industries on government harm prevention policy agendas and global sustainable development goals. Effective capture by the industries of the crucial legislative process associated with the harm prevention initiatives would have a detrimental impact on public health. This article proposes a qualitative multi-spectrum prototype legislative capture test with broad application to a range of industries and jurisdictions at all levels of government where legislative capture may be suspected. It is predicated on a finding of significant encroachment of the public interest (PI) by special interest groups and reciprocating beneficial conduct between the lawmakers and the group. The test is populated from a critical case study of key New South Wales (NSW) alcohol industry statutory amendments within a doctrinal and social inquiry/power framework. It relies upon parliamentary records and secondary data to analyse critically the 2015 "fit for purpose" (FFP) reforms to NSW alcohol supply laws and their consistency with the PI and other constitutional safeguards. It aligns the reforms with other research relating to the magnitude of alcohol and gambling industry political donations and the operation of the alcohol outlet post reform approval process. The application of the test to the case study finds that the 2015 FFP amendments are indicative of legislative capture and associated clientele corruption - critical new considerations in the commercial determination of health. It also identifies the commodification of the PI.


Assuntos
Saúde Pública/legislação & jurisprudência , Jogo de Azar , Política de Saúde , Humanos , New South Wales , Saúde Pública/economia , Indústria do Tabaco
2.
Orv Hetil ; 160(45): 1767-1773, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31680541

RESUMO

Electronic cigarettes are becoming increasingly popular with smokers worldwide. This has created an entirely new public health dilemma. The central issue in the debate is the disease risk imposed by e-cigarettes. It is generally acknowledged that e-cigarettes are unlikely to be as harmful as conventional cigarettes, but there are little data that quantify their relative harms. Experiments in cell cultures and animal studies show that e-cigarettes can have multiple negative effects. Scientific evidence regarding their human acute health effects is limited. The long term effects in humans are unknown, and there is no evidence that e-cigarettes are safer than tobacco in the long term. This review higlights the recent data regarding e-cigarettes toxicity impact on lung and cardiovascular system. Orv Hetil. 2019; 160(45): 1767-1773.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Nicotina/efeitos adversos , Fumar/efeitos adversos , Animais , Humanos , Nicotina/administração & dosagem , Saúde Pública
3.
Lima; Perú. Ministerio de Salud; 20191100. 11 p. ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1024803

RESUMO

La norma tiene como finalidad contribuir a que los establecimientos dedicados a la salud o a la educación, dependencias públicas, interiores de los lugares de trabajo, espacios públicos cerrados y cualquier medio de transporte público, sean ambientes 100% libres de humo de tabaco, de acuerdo a lo dispuesto en la ley N° 28705.


Assuntos
Prevenção Primária , Saúde Pública , Normas Técnicas , Dispositivos para o Abandono do Uso de Tabaco
4.
Rev Sci Tech ; 38(1): 291-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564721

RESUMO

Animals, and the health systems which ensure their protection, play a vital role in the security and economic and social well-being of humanity, and are therefore a key component of the One Health concept. For global and national health security, prevention is better than cure, and targeting 'risk at source' in animal populations is a vital strategy in safeguarding the planet from risks of emerging zoonoses and antimicrobial resistance (AMR). Neglected zoonoses - such as rabies and brucellosis - continue to have a significant global impact on human health and are also best managed at their animal source. The World Organisation for Animal Health (OIE) has built international consensus on the principles of good governance and the quality of Veterinary Services, which are incorporated within its international standards. The OIE has a proven track record in the provision of Member Country support based on these standards, especially since the advent of its flagship Performance of Veterinary Services (PVS) Pathway programme in 2006-2007. To date, approximately 140 countries have benefited from the structured and sustainable process of animal health systems evaluation and planning afforded by the PVS Pathway. The PVS Tool, the basic methodology upon which the PVS Pathway is based, addresses One Health by evaluating the Veterinary Authority's ability to coordinate with other Competent Authorities that have a role to play in One Health, most notably public health, food safety, and environmental authorities. Despite the undoubted success of the PVS Pathway, the OIE felt that it was time to consider how the programme might be developed to adapt to new challenges. Consequently, during 2017-2018, the OIE embarked on a process of PVS evolution, during which it carried out extensive consultation and further tailored the PVS Pathway to a changing global context. These improvements, which include both fundamental adaptations to the PVS Pathway methods and the development of new PVS Pathway activities targeting topics such as multisectoral collaboration, rabies and AMR, have further strengthened and embedded the One Health approach within the PVS Pathway.


Assuntos
Saúde Única , Saúde Pública , Medicina Veterinária , Animais , Inocuidade dos Alimentos , Saúde Global , Humanos , Saúde Pública/tendências , Medicina Veterinária/tendências , Zoonoses/prevenção & controle
5.
Rev Sci Tech ; 38(1): 271-278, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564723

RESUMO

Within the last decade, One Health has gained momentum in government agencies, academic institutions, intergovernmental organisations and civil society organisations within Thailand. One Health is an approach of multisectoral and multidisciplinary collaboration that connects human, animal and environmental health sectors to improve the health of all. In 2014, the Coordinating Unit for One Health (CUOH), based within the Thai Ministry of Public Health, was officially established to serve as a focal point within Thailand for One Health collaboration both domestically and internationally. The unit's main functions are to share data, information and resources, and to support One Health activities within the country. The CUOH Steering Committee meets regularly to provide technical and administrative guidance on the functions and directions of the CUOH. A memorandum of understanding on One Health, signed in 2016 by seven Ministries and the Thai Red Cross Society, has strengthened One Health collaboration and provides a formalised channel through which the CUOH can facilitate activities across Ministries and with non-governmental agencies in Thailand.


Assuntos
Órgãos Governamentais , Saúde Única , Animais , Órgãos Governamentais/tendências , Humanos , Saúde Única/normas , Saúde Pública , Tailândia
6.
Rev Sci Tech ; 38(1): 185-198, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564731

RESUMO

Viral haemorrhagic fevers (VHFs) are a group of infectious, devastating and severe diseases caused by enveloped single-stranded RNA viruses. The endemicity, emergence or re-emergence of different VHF viruses and lack of vaccines and antiviral therapy for most VHFs result in a significant global threat. Most VHF viruses are restricted to specific parts of the world, and the dramatic expansion of their geographical distribution beyond their original habitats would greatly affect global public health. In the past few decades alone, several outbreaks have affected the Middle East, a part of the world containing arid to semi-arid, hot and water-scarce countries. Political instability, natural and humanitarian crises, direct contact with domesticated animals and climate change are the main factors in the dissemination of different zoonotic diseases, including vector-borne diseases. Some VHF viruses have been introduced into the Middle East (e.g. Alkhurma haemorrhagic fever) and others have been re-introduced and have become endemic in the region. Dengue fever, Crimean Congo haemorrhagic fever, Rift Valley fever and hantavirus haemorrhagic fever with renal syndrome are examples of re-emerging or endemic viruses in the region. The temporal and spatial extension of VHF distribution mandates a particular engagement from all the actors in the fields of animal, human and environmental health. The One Health concept is a multidisciplinary and multisectoral approach for promoting collaboration, coordination and communication among different nations, sectors and disciplines, which is highly relevant to the fight against endemic, emerging and re-emerging infectious agents at the human-animal-environment interface. The adoption of the One Health approach is a promising solution to addressing public health threats in the Middle East.


Assuntos
Febres Hemorrágicas Virais , Saúde Única , Animais , Surtos de Doenças , Febre Hemorrágica da Crimeia/epidemiologia , Febres Hemorrágicas Virais/epidemiologia , Humanos , Oriente Médio , Saúde Pública/normas , Zoonoses/epidemiologia
7.
Rev Sci Tech ; 38(1): 51-60, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564741

RESUMO

Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.


Assuntos
Saúde Única , Saúde Pública , Animais , Etiópia , Humanos , Saúde Única/tendências , Saúde Pública/tendências , Zoonoses/prevenção & controle
9.
Lancet ; 394(10208): 1580-1590, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31657733

RESUMO

We assess the current and describe possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. First, we describe global patterns of cannabis use and their most probable adverse health effects. Second, we summarise evidence regarding the effectiveness of cannabinoids for medicinal use and describe approaches that have been used to regulate the use of medicinal cannabis and how these approaches might have affected medicinal and recreational use and harms (eg, road crashes). Third, we describe how jurisdictions that have legalised recreational use have regulated production and sale of cannabis. Fourth, we evaluate the effects of cannabis legalisation on cannabis use and harms and on the use of alcohol, tobacco, and other drugs. Fifth, we use alcohol and tobacco policy examples to identify possible long-term public health effects of cannabis legalisation. Finally, we outline policy approaches that could minimise harms to public health arising from the legalisation of a commercial cannabis industry.


Assuntos
Cannabis , Uso da Maconha/epidemiologia , Maconha Medicinal/administração & dosagem , Saúde Pública/legislação & jurisprudência , Comércio/economia , Feminino , Humanos , Legislação de Medicamentos/economia , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
10.
Lancet Psychiatry ; 6(11): 935-950, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31588045

RESUMO

BACKGROUND: Antidepressants, opioids for non-cancer pain, gabapentinoids (gabapentin and pregabalin), benzodiazepines, and Z-drugs (zopiclone, zaleplon, and zolpidem) are commonly prescribed medicine classes associated with a risk of dependence or withdrawal. We aimed to review the evidence for these harms and estimate the prevalence of dispensed prescriptions, their geographical distribution, and duration of continuous receipt using all patient-linked prescription data in England. METHODS: This was a mixed-methods public health review, comprising a rapid evidence assessment of articles (Jan 1, 2008, to Oct 3, 2018; with searches of MEDLINE, Embase, and PsycINFO, and the Cochrane and King's Fund libraries), an open call-for-evidence on patient experience and service evaluations, and a retrospective, patient-linked analysis of the National Health Service (NHS) Business Services Authority prescription database (April 1, 2015, to March 30, 2018) for all adults aged 18 years and over. Indirectly (sex and age) standardised rates (ISRs) were computed for all 195 NHS Clinical Commissioning Groups in England, containing 7821 general practices for the geographical analysis. We used publicly available mid-year (June 30) data on the resident adult population and investigated deprivation using the English Indices of Multiple Deprivation (IMD) quintiles (quintile 1 least deprived, quintile 5 most deprived), with each patient assigned to the IMD quintile score of their general practitioner's practice for each year. Statistical modelling (adjusted incident rate ratios [IRRs]) of the number of patients who had a prescription dispensed for each medicine class, and the number of patients in receipt of a prescription for at least 12 months, was done by sex, age group, and IMD quintile. FINDINGS: 77 articles on the five medicine classes were identified from the literature search and call-for-evidence. 17 randomised placebo-controlled trials (6729 participants) reported antidepressant-associated withdrawal symptoms. Almost all studies were rated of very low, low, or moderate quality. The focus of qualitative and other reports was on patients' experiences of long-term antidepressant use, and typically sudden onset, severe, and protracted withdrawal symptoms when medication was stopped. Between April 1, 2017, and March 31, 2018, 11·53 million individuals (26·3% of residents in England) had a prescription dispensed for at least one medicine class: antidepressants (7·26 million [16·6%]), opioids (5·61 million [12·8%]), gabapentinoids (1·46 million [3·3%]), benzodiazepines (1·35 million [3·1%]), and Z-drugs (0·99 million [2·3%]). For three of these medicine classes, more people had a prescription dispensed in areas of higher deprivation, with adjusted IRRs (referenced to quintile 1) ranging from 1·10 to 1·24 for antidepressants, 1·20 to 1·85 for opioids, and 1·21 to 1·85 for gabapentinoids across quintiles, and higher ISRs generally concentrated in the north and east of England. In contrast, the highest ISRs for benzodiazepines and Z-drugs were generally in the southwest, southeast, and east of England, with low ISRs in the north. Z-drugs were associated with increased deprivation, but only at the highest quintile (adjusted IRR 1·11 [95% CI 1·01-1·22]). For benzodiazepines, prescribing was reduced for people in quintiles 4 (0·90 [0·85-0·96]) and 5 (0·89 [0·82-0·97]). In March, 2018, for each of medicine class, about 50% of patients who had a prescription dispensed had done so continuously for at least 12 months, with the highest ISRs in the north and east. Long-term prescribing was associated with a gradient of increased deprivation. INTERPRETATION: In 1 year over a quarter of the adult population in England had a prescription dispensed for antidepressants, opioids (for non-cancer pain), gabapentinoids, benzodiazepines, or Z-drugs. Long-term (>12 months) prescribing is common, despite being either not recommended by clinical guidelines or of doubtful efficacy in many cases. Enhanced national and local monitoring, better guidance for personalised care, and better doctor-patient decision making are needed. FUNDING: Public Health England.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos/efeitos adversos , Antidepressivos/efeitos adversos , Benzodiazepinas/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acetamidas/efeitos adversos , Adolescente , Adulto , Idoso , Compostos Azabicíclicos/efeitos adversos , Bases de Dados Factuais/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Gabapentina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Pregabalina/efeitos adversos , Saúde Pública , Pirimidinas/efeitos adversos , Síndrome de Abstinência a Substâncias/epidemiologia , Adulto Jovem , Zolpidem/efeitos adversos
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(10): 1173-1179, 2019 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-31658512

RESUMO

Epidemiology is a discipline developed in the practice of preventing diseases and promoting health and is the key of public health and preventive medicine. Since the founding of the People's Republic of China, with the changing of disease pattern in populations, the applications of epidemiology now have expanded from infectious diseases to chronic non-communicable diseases, injuries and health related events. The discipline has made remarkable achievements in the field of disease prevention and control, scientific research and teaching, institution building and academic journals. In this paper we briefly review the history and achievements of epidemiology in China in the past 70 years, and explore the future development of the discipline, which may leave a trace of history for the development of epidemiology in China.


Assuntos
Doenças Transmissíveis , Epidemiologia/história , Saúde Pública , China , Assistência à Saúde , História do Século XX , História do Século XXI , Humanos
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(10): 1203-1205, 2019 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-31658517

RESUMO

With accelerating and rapid ageing in China, there is an urgent need to collect reliable, valid and cross-nationally comparable data on health in the elderly to provide basis for richer and empirical analysis on the changing health over one's life course and compression of morbidity. To meet the demands of this growing special population, planning and preparing on related social protection mechanisms (health and pension systems) should also based on evidence-based decision-making process. Based on long-term follow-up, large scale cohort study is indispensible for the etiology of common chronic diseases and disabling conditions. This study aims to introduce the background, project objectives, contents, baseline characteristics, strength and weakness as well as prospect, related to the Study on global AGEing and adult health in China.


Assuntos
Envelhecimento , Doença Crônica , Pessoas com Deficiência , Saúde Pública , Adulto , Idoso , China , Estudos de Coortes , Humanos
14.
Pan Afr Med J ; 33: 171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565132

RESUMO

The African continent faced to many public health events. An effective organization is the key element for managing public health events. Health Emergency Operations Centers (HEOC) are strategic bodies that can help control such situations. We would like to share our experience about the HEOC implementation in Senegal, which is among the first in Africa while highlighting the challenges we have the HEOC concept is quite common in other continents, it is an innovation in Africa. And yet, Africa is the most affected by emergency situations and disasters and very few of its country possess HEOC. Consequently, emergency and disaster management interventions are done in a nonsystematic manner. The comprehension of the concept, the mission and organization need to be well understood for setting up a HEOC the added value of HEOC is great for African country to face public health events.


Assuntos
Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Saúde Pública , Desastres/prevenção & controle , Humanos , Senegal
15.
Lancet ; 394(10204): 1144, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31571600
16.
Global Health ; 15(1): 58, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601233

RESUMO

BACKGROUND: After Action Reviews (AARs) provide a means to observe how well preparedness systems perform in real world conditions and can help to identify - and address - gaps in national and global public health emergency preparedness (PHEP) systems. WHO has recently published guidance for voluntary AARs. This analysis builds on this guidance by reviewing evidence on the effectiveness of AARs as tools for system improvement and by summarizing some key lessons about ensuring that AARs result in meaningful learning from experience. RESULTS: Empirical evidence from a variety of fields suggests that AARs hold considerable promise as tools of system improvement for PHEP. Our review of the literature and practical experience demonstrates that AARs are most likely to result in meaningful learning if they focus on incidents that are selected for their learning value, involve an appropriately broad range of perspectives, are conducted with appropriate time for reflection, employ systems frameworks and rigorous tools such as facilitated lookbacks and root cause analysis, and strike a balance between attention to incident specifics vs. generalizable capacities and capabilities. CONCLUSIONS: Employing these practices requires a PHEP system that facilitates the preparation of insightful AARs, and more generally rewards learning. The barriers to AARs fall into two categories: concerns about the cultural sensitivity and context, liability, the political response, and national security; and constraints on staff time and the lack of experience and the requisite analytical skills. Ensuring that AARs fulfill their promise as tools of system improvement will require ongoing investment and a change in mindset. The first step should be to clarify that the goal of AARs is organizational learning, not placing blame or punishing poor performance. Based on experience in other fields, the buy-in of agency and political leadership is critical in this regard. National public health systems also need support in the form of toolkits, guides, and training, as well as research on AAR methods. An AAR registry could support organizational improvement through careful post-event analysis of systems' own events, facilitate identification and sharing of best practices across jurisdictions, and enable cross-case analyses.


Assuntos
Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Saúde Global , Saúde Pública , Humanos
17.
Artigo em Inglês | MEDLINE | ID: mdl-31610774

RESUMO

An outbreak of Salmonella enterica serovar Typhimurium with closely related Multiple Locus Variable-number Tandem Repeat Analysis (MLVA) patterns was detected by routine surveillance by the Australian Capital Territory Health Protection Service in May 2018. The outbreak consisted of three cases in 2018 (MLVA 03-10-10-09-496) and one in 2016 (MLVA 03-10-09-09-496), who reported eating home-cooked eggs from the same local producer. Environmental investigations found significant problems with egg cleaning, hand hygiene and documentation of food safety procedures on farm. Environmental samples collected from the farm were found to have the same MLVA pattern as the 2018 cases. Although poor farm practices most likely led to contamination of the eggs, this outbreak highlights the need for consumer education about safe handling of eggs in the home.


Assuntos
Ovos/microbiologia , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/microbiologia , Adolescente , Adulto , Território da Capital Australiana/epidemiologia , Criança , Surtos de Doenças , Monitoramento Ambiental , Feminino , Microbiologia de Alimentos , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Saúde Pública , Salmonella typhimurium , Sorogrupo , Adulto Jovem
18.
Sante Publique ; Vol. 31(3): 367-375, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640324

RESUMO

Health impact assessment (HIA) is defined as a method by which a policy, program or project may be judged as to its potential effects on the health of a population in order to mitigate negative impacts and strengthen the positive ones. During the 2017 French presidential elections, health promotion actors decided to conduct an HIA on the political platforms of the five main candidates. The assessment of each political platform was conducted by 7 evaluators and reviewed by 35 health promotion experts. Then, a comparative analysis of the platforms was led on 3 specific topics. This HIA was conducted in accordance with the international standards of practice. Within all of the 5 political platforms, the proposals related to Environmental and energy policy, and to Agricultural policy were the ones with widely positive impacts on the determinants of health. Concerning all of the other policy proposals, their respective impacts and affected populations broadly change from one platform to another. Due to its political object, this HIA had to deal with methodological challenges such as platform instability, uncertainty over the genuine implementation of measures as well as the importance of the underlying platform values. Nonetheless, such an implementation of the HIA process on the political platforms of candidates running for an important position is interesting because it represents an opportunity to look at the platforms with fresh eyes and enriches the advocacy to take public health into account in the policy making processes and tries to operationalize the concept of health in all policies.


Assuntos
Avaliação do Impacto na Saúde , Política , França , Humanos , Formulação de Políticas , Saúde Pública , Política Pública
19.
Clin Exp Rheumatol ; 37 Suppl 120(5): 31-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621558

RESUMO

Osteoarthritis (OA) is a painful joint disease affecting more than 32.5 million adults in the US and over 350 million adults worldwide. The prevalence is expected to rise continually over the next several decades with significant impacts to societal health and economic costs as well as individuals' daily activities and quality of life. In 2008, the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) led a collaborative effort to address approaches to reduce the burden of OA via public health interventions, policies (systems and environmental), and communication strategies. This collaboration resulted in the National Public Health Agenda for OA (OA Agenda), which was vetted by more than 75 stakeholder organisations and released in 2010. The OA Agenda listed ten recommendations focused on public health interventions for OA including weight management, physical activity, self-management education, and injury prevention, and policies, systems, communication, research and evaluation. In 2011, the CDC and AF mobilised the OA Action Alliance (OAAA), a national coalition of organisations concerned with mitigating the public health impact of OA, to operationalise the recommendations set forth in the OA Agenda. Since then, the OAAA has grown to include more than 110 organisations that work collectively to increase awareness about the prevention and management of OA, provide educational resources, and expand access to evidence-based programmes for target audiences including individuals with OA, community-based organisations, healthcare systems and providers, and policymakers. This review highlights the OAAA's progress to date in addressing the OA Agenda recommendations; successes and challenges in delivery of effective communication, programmes, and resources; and future implications.


Assuntos
Exercício/fisiologia , Obesidade/complicações , Osteoartrite/complicações , Saúde Pública , Artralgia , Humanos , Qualidade de Vida , Programas de Redução de Peso
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