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2.
Wiad Lek ; 72(7): 1343-1349, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31398167

RESUMO

Telemedicine is a relatively new form of medicine and healthcare combining elements of telecommunications, IT and medicine. Telemedicine is also increasingly important in Poland. Currently, the law allows for the provision of medical health services using ICT systems. For physicians in practice the most important is the possibility of teleconsultation. The public payer (National Health Fund) is financing in Poland the teleconsylum cardiology and geriatrics. The subject of the article is the presentation of the possibility of providing medical teleconsultations in the Polish healthcare system.


Assuntos
Consulta Remota , Telemedicina , Assistência à Saúde , Serviços de Saúde , Polônia
3.
Rev Lat Am Enfermagem ; 27: e3164, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432918

RESUMO

OBJECTIVE: to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus. METHOD: methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus. RESULTS: the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85. CONCLUSION: results showed content validity indicating the instrument's successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/normas , Autocuidado/normas , Inquéritos e Questionários/normas , Tradução , Brasil , Comparação Transcultural , Características Culturais , Feminino , Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Educação de Pacientes como Assunto/métodos , Valores de Referência , Reprodutibilidade dos Testes , Autocuidado/métodos
4.
Stud Health Technol Inform ; 264: 783-787, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438031

RESUMO

The purpose of this study was to assess the project management of a national health information technology project focused on developing digital health care services. An e-questionnaire was sent at the end of the development project, and 93 experts (18%) from five university hospitals responded. The questionnaire was based on the Common Assessment Framework (CAF) to identify management success and also to get an overview of the project's performance. The questionnaire contained 11 background variables and 17 Likert scale items in five themes on leadership, strategy and planning, people, partnerships and resources, and processes, and one open-ended question. After analysis using descriptive statistical methods, the results showed that, overall, participants felt confident about management of the project. Criticism focused on the distribution of resources and lack of knowledge about the status of development activities in other hospitals. The CAF enablers criteria revealed subjects for further development.


Assuntos
Assistência à Saúde , Informática Médica , Serviços de Saúde , Liderança
5.
Stud Health Technol Inform ; 264: 654-658, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438005

RESUMO

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. Assessing the interoperability maturity of the provided services helps to identify interoperability issues in public administration. This paper presents a typical healthcare digital service: the inpatient admission in a public hospital in Greece. The Interoperability Maturity Model (IMM) is applied to assess its maturity, identify improvement priorities, and compare it with digital services of the healthcare sector. An analysis is also performed to compare a group of fourteen healthcare digital public services with sixty-seven public services of other sectors in the country. The IMM is a useful tool to facilitate awareness raising and priority setting concerning interoperability in public administration. What is discovered, through this preliminary assessment, is that healthcare digital services seem to have higher overall interoperability maturity than those of other sectors in Greece.


Assuntos
Assistência à Saúde , Serviços de Saúde , Grécia , Hospitais Públicos
6.
Stud Health Technol Inform ; 266: 1-6, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397293

RESUMO

Identifying those patient groups, who have unwanted outcomes, in the early stages is crucial to providing the most appropriate level of care. In this study, we intend to find distinctive patterns in health service use (HSU) of transport accident injured patients within the first week post-injury. Aiming those patterns that are associated with the outcome of interest. To recognize these patterns, we propose a multi-objective optimization model that minimizes the k-medians cost function and regression error simultaneously. Thus, we use a semi-supervised clustering approach to identify patient groups based on HSU patterns and their association with total cost. To solve the optimization problem, we introduce an evolutionary algorithm using stochastic gradient descent and Pareto optimal solutions. As a result, we find the best optimal clusters by minimizing both objective functions. The results show that the proposed semi-supervised approach identifies distinct groups of HSUs and contributes to predict total cost. Also, the experiments prove the performance of the multi-objective approach in comparison with single- objective approaches.


Assuntos
Acidentes , Algoritmos , Análise por Conglomerados , Serviços de Saúde , Humanos , Medição de Risco
7.
Stud Health Technol Inform ; 266: 115-120, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397311

RESUMO

Recent research involving representatives from nursing professional organisations found a lack of governance regarding access and use of mobile technology has led to the maintenance of outdated safety and quality strategies. Current organisational policies and guidelines preclude nurses from aligning with the Australian National Safety and Quality in Health Service Standards. Continuance of the mobile technology paradox,where there is theinability of nurses to access and use mobile technology at point of care, hinders the promotion of positive two-way communication between consumers and nurses as the lack of connectivity impedes opportunities for nurses to partner with consumers to promote participation in their own healthcare, develop mutuality of understanding, and improve health and ehealth literacy. Legitimisation ofthe use of mobile technology at point of care is necessaryto supportmeeting consumer expectations, improve the consumer experience and promote participatory health, while contributing to delivery ofcontemporaryhealthcare.


Assuntos
Assistência à Saúde , Sistemas Automatizados de Assistência Junto ao Leito , Austrália , Comunicação , Serviços de Saúde , Humanos
8.
Stud Health Technol Inform ; 266: 168-173, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397319

RESUMO

Healthcare and wellness support that consider context within different dimensions can lead to intelligent, personalised recommendations that will more likely be accepted and acted upon by consumers. In this paper, we look at the main components of traditional personalised healthcare and wellness support services, and identify some of the challenges that should be addressed in creating a more intelligent and efficient solution. Our contribution lies in defining away forward in terms of designing such a solution.


Assuntos
Assistência à Saúde , Serviços de Saúde , Conscientização , Inteligência
9.
Stud Health Technol Inform ; 262: 184-187, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349297

RESUMO

The very act of using indicators by converting the raw data collected to information for purposes such as monitoring, evaluation, decision-making and management make indicators essential tools for health care services and health systems. In addition, Health Data Warehouses (HDWs) play an important role in development, and use of indicators in healthcare. Despite the numerous studies revolving around use of indicators in health care, analysis of usage of indicators by various studies in healthcare, which have leveraged HDWs are limited. To bridge this gap, we conducted a literature review to provide an analysis of usage of clinical indicators, and health indicators by various studies, which leverage HDWs in their development or use. We further discuss the benefits, and challenges of indicator use faced in these studies. As a result of the analysis, this paper thus aims to promote leveraging HDWs in development, and use of indicators for decision-making, and monitoring and evaluation efforts in health care.


Assuntos
Data Warehousing , Assistência à Saúde , Serviços de Saúde
10.
Stud Health Technol Inform ; 262: 300-303, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349327

RESUMO

Information quality has an important role in health care as digital services provide patients and healthcare professionals more opportunities for searching and utilising information. Information quality is one of the key factors affecting user satisfaction, perception of digital service usability and intention to use the service. The conceptual framework for this study was the updated Information Systems Success Model of DeLone and McLean. The study was conducted in the context of Health Village, a digital interactive and secured portal providing health services to patients and citizens. The purpose of the study was to survey health professionals' perception (n = 91) of information quality and its effect on user satisfaction. Concerns were raised about the interoperability of the portal with other health information systems and the ease of finding information. Generally, in the Health Village portal, information quality was considered relatively high.


Assuntos
Confiabilidade dos Dados , Pessoal de Saúde , Intenção , Serviços de Saúde , Humanos , Portais do Paciente , Inquéritos e Questionários
11.
Pan Afr Med J ; 32: 188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312300

RESUMO

Introduction: This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. Methods: Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. Results: The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed. Conclusion: Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Campos de Refugiados/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Tailândia
12.
J Ment Health Policy Econ ; 22(2): 71-79, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31319377

RESUMO

BACKGROUND: Youth mental health interventions aimed at reducing substance use and delinquency in adolescents compete with other types of interventions for reimbursement from public funding. Within the youth mental health domain, delinquent acts impose high costs on society. These costs should be included in economic evaluations conducted from a societal perspective. Although the relevance of these costs is recognized, they are often left out because the unit costs of delinquent acts are unknown. AIMS OF THE STUDY: This study aims to provide a method for estimating the unit costs per perpetrator of 14 delinquent acts common in the Netherlands and included in self reported delinquency questionnaires: robbery/theft with violence, simple theft/pickpocketing, receiving stolen goods, destruction/vandalism of private or public property, disorderly conduct/discrimination, arson, cybercrime, simple and aggravated assault, threat, forced sexual contact, unauthorised driving, driving under the influence, dealing in soft drugs, and dealing in hard drugs. METHODS: Information on government expenditures and the incidence of crimes, number of perpetrators, and the percentage of solved and reported crimes was obtained from the national database on crime and justice of the Research and Documentation Centre of the Ministry of Justice and Security, Statistics Netherlands, and the Council for the Judiciary in the Netherlands. We applied a top-down micro costing approach to calculate the point estimate of the unit costs for each of the delinquent acts and, subsequently, estimated the mean (SD) unit costs for each of the delinquent acts by taking random draws from a triangular distribution while taking into account a 10% uncertainty associated with the associated point estimate. RESULTS: The mean (SD) unit costs per delinquent act per perpetrator ranged between EUR495 (EUR1.30) for "Driving under the influence" and EUR33,813 (EUR78.30) for a "Cybercrime". These unit costs may be considered as outliers as most unit costs ranged between EUR 2,600 and EUR 13,500 per delinquent act per perpetrator. DISCUSSION: This study is the first to estimate the unit costs per delinquent act per perpetrator in the Netherlands. The results of this study enable the inclusion of government expenditures associated with crime and justice in economic evaluations conducted from a societal perspective. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Youth mental health interventions aimed at reducing substance use and delinquency in adolescents are increasingly subjected to economic evaluations. These evaluations are used to inform decisions concerning the allocation of scarce healthcare resources and should cover all the costs and benefits for society, including those associated with delinquent acts. IMPLICATIONS FOR HEALTH POLICIES: The results of this study facilitate economic evaluations of youth mental health interventions aimed at reducing substance use and delinquency in adolescents, conducted from a societal perspective. IMPLICATIONS FOR FURTHER RESEARCH: Based on health-economic evaluations conducted in the field of youth mental health and the results of the current study, we recommend including the estimated unit costs in guidelines for health-economic evaluations conducted from a societal perspective. Future research could aim at examining whether these unit costs require regular updating. The methodology applied in this study allows for this.


Assuntos
Serviços de Saúde do Adolescente/economia , Delinquência Juvenil/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Adolescente , Análise Custo-Benefício , Serviços de Saúde/economia , Humanos , Delinquência Juvenil/reabilitação , Saúde Mental , Países Baixos , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
14.
BMC Public Health ; 19(Suppl 4): 548, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196020

RESUMO

BACKGROUND: The presence of homelessness in Malaysia is not a new issue. The existence of homeless population is growing, along with the development of this country. With the increasing number of homelessness, the range of issues, such as health services financier among them, has surfaced. However, there was limited study conducted on this subject. The main objective of this study was thus, to identify the financier of health services among the homelessness in Kuala Lumpur and factors associated with it. METHODS: In this cross-sectional study, we include 196 homeless people aged above 18 years, Malaysian who were able to communicate with interviewers, and respondents who were not aggressive. These respondents were transits at Pusat Transit Gelandangan Kuala Lumpur and Anjung Singgah Kuala Lumpur and were available during interview sessions. They were selected via simple random sampling and were interviewed via face to face guided interviews using a validated structured questionnaire. Data were analysed descriptively, as well as using bivariate and multivariate analysis to explore the associated factors. RESULTS: The study showed that 57.7% homeless utilized the health services with only 37.8% assessed government health services. Only 42.5% of the respondents use their own money and 46.9% received aids to finance their health. Major influencing factors that influence homeless people to use their own money for health services were education level, income and disability, with adjusted OR (95% CI) of 3.15 (1.07-9.25), 0.08 (0.029-3.07) and 0.05 (0.003-0.88) while p value was 0.037, < 0.001 and 0.041 respectively. The influencing factors for receiving aid for health services were income and those who took drugs with adjusted OR (95% CI) of 6.50 (2.30-18.39), and 0.33 (0.11-0.95) while p value was < 0.001 and 0.041 respectively. CONCLUSION: There is low healthcare services utilization and affordability among homelessness. All parties should play a role in ensuring that homeless people are not left behind in the health care accessibility in Malaysia.


Assuntos
Acesso aos Serviços de Saúde/economia , Serviços de Saúde/economia , Financiamento da Assistência à Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
15.
BMJ ; 365: l4369, 2019 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-31243000
16.
BMJ ; 365: l4370, 2019 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-31243003
17.
Sante Publique ; Vol. 31(1): 125-135, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210508

RESUMO

OBJECTIVES: Involving citizens-patients in decisions regarding telehealth services could allow a better match between the services offered and the needs and contexts of individuals and communities. This study aims to explore the organizational and systemic conditions that can influence citizen-patient involvement in the development of telehealth in Quebec. METHODS: A qualitative study based on semi-structured interviews with 29 key informants was conducted. A deductive-inductive thematic analysis was performed based on an integrative framework derived from diffusion of innovation theories. RESULTS: Citizen-patient involvement in the development of telehealth remains dependent on many organizational and systemic conditions. At the organizational level, it could affect the dynamics, process, cultures, rules and operations in organizations; hence the needs for adequate human and material resources as well as the availability of support for change. At the systemic level, the ideology, the sociopolitical context and the decisions in favor (or not) of a citizen appropriation of the decision-making are central. Concerns about scientific evidence, training, as well as the roles of professional federations, and citizen-patient groups have also emerged. Organizational and systemic levels are interdependent. CONCLUSION: The organizational and systemic contexts may explain part of the contrast between the discourse in favor of citizen-patient involvement in telehealth decision-making and the reality observed in Quebec. This study provides a basis for analyzing citizen-patient involvement in services development from the perspective of organizational and systemic changes.


Assuntos
Difusão de Inovações , Serviços de Saúde , Participação do Paciente , Telemedicina , Atitude Frente a Saúde , Política de Saúde , Humanos , Pesquisa Qualitativa , Quebeque
18.
Diabetes Res Clin Pract ; 152: 146-155, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31063853

RESUMO

AIMS: To determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. METHODS: We conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method: 1-h, 50-g glucose-challenge test (GCT); 3-h, 100-g oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n = 25,535), normal OGTT (n = 2246), abnormal OGTT but not GDM (n = 1477), and GDM (n = 741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. RESULTS: Compared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. CONCLUSIONS: Health-services utilization increased with severity of glucose result, even among women without GDM.


Assuntos
Glicemia/análise , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez/sangue , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Glicemia/metabolismo , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/métodos , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Adulto Jovem
19.
J Altern Complement Med ; 25(6): 606-612, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31120303

RESUMO

Objectives: Complementary medicine (CM) has become increasingly available in hospital settings in several countries. Nonetheless, there are disparities in the provision and organization of CM between hospitals and even within a single hospital. This was the case at Lausanne University Hospital, where neither a registry of CM practices nor homogeneous guidelines for the provision of CM existed. The board of directors mandated the use of an internal consultant to assess practices, delineate the ward's needs, and draft proposals to structure the provision of CM services. Design: Lescarbeau et al.'s integrated model of consultation was used. Settings/Location: Academic medical center, Switzerland. Subjects: Heads of departments, medical and nurse directors, and CM practitioners. Interventions: Semi-structured interviews, online survey, and focus groups were used to focus on CM availability, needs, and practices; CM practitioner background, training, and position in the hospital; and the type of patients treated. Results: The assessment identified 15 types of CM in 51 wards, provided by CM practitioners who represented the profiles of 8 types of health care professionals. Three barriers to implementing CM were identified: heterogeneity in CM practitioners' training and project implementation, lack of CM information for patients and health care professionals, and variable access to CM among hospital wards and resulting lack in continuity of care. Three main needs regarding CM were delineated: to ensure CM quality, to provide structured interdepartmental CM clinical services, and to provide CM information to patients and health care professionals. Three action priorities were selected by the board of directors: to develop structured CM clinical services; to select CM provision based on the specific criteria of scientific evidence, therapies already available at hospital, and specific ward's needs; and to provide CM information to patients and health care professionals. Conclusions: This assessment permitted to structure CM provision according to internal consultation.


Assuntos
Centros Médicos Acadêmicos , Terapias Complementares , Assistência à Saúde , Serviços de Saúde , Hospitais , Grupos Focais , Pessoal de Saúde , Humanos , Inquéritos e Questionários , Suíça
20.
BMC Health Serv Res ; 19(1): 329, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122226

RESUMO

BACKGROUND: The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China. METHODS: Patient discharge records (n = 1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs. RESULTS: A small number of tertiary hospitals (n = 75, 12.41%) shared 51.71% (n = 770,823) of all admitted cases while a large number of primary/unrated hospitals (n = 321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR = 1.13) and those with a lower level of insurance entitlements (OR = 1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees). CONCLUSION: The level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.


Assuntos
Hospitalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitais , Humanos , Lactente , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transferência de Pacientes/economia , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Adulto Jovem
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