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1.
An Acad Bras Cienc ; 96(2): e20230815, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38747837

RESUMO

The objective of the current study was to carry out a survey of the main anatomopathological alterations in raising quails and evaluate possible interference of these in the bone tissue. To obtain the data, 23 quails were collected from farm in the central Serrana region of Espírito Santo. Necropsies with macroscopic descriptions, microbiological, coproparasitological, radiographic and histomorphometric tests were carried out. It was done data descriptive analysis and average comparision using Student T test. It was found that they presented lesions predominantly in the digestive system, followed by urinary and reproductive, and muscular system, were the altered color of the liver (47%) was the most frequent lesion. In the parasitological exams, it was found oocysts of Eimeira sp. (39.13%). In the microbiological exams, it was detected predominantly Escherichia coli (83%). Moderate osteopenia in quails, but the percentage of trabecular bone on bones was similar between healthy and diseased quails, without bone changes in histology. Microscopically, it was observed lung congestion as predominant lesion. It is concluded that there was predominance of alterations in the digestive system and mild parasitic infection; and although there was moderate level of osteopenia, there wasn't bone change as a result of the observed infections.


Assuntos
Codorniz , Animais , Feminino , Doenças das Aves Domésticas/patologia
2.
Explor Res Clin Soc Pharm ; 14: 100443, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38655194

RESUMO

INTRODUCTION: Autonomy is considered a vital principle of professionalism. In recent years, despite important advances, the Pharmacy and pharmacists' autonomy has been questioned due to conflicts that jeopardize the consolidation of this profession in the division of work in health. OBJECTIVE: to understand the construct of autonomy based on perceptions of formal leaders associated with professional organizations. METHODS: A qualitative study was conducted through interviews with key informants. The data obtained were submitted to content analysis. RESULTS: Perceptions about the autonomy in pharmaceutical practice were categorized according to strengths, weaknesses, opportunities, and threats to this construct. CONCLUSION: The findings allowed us to understand the autonomy of pharmaceutical practice in Brazil, generate hypotheses about the future of Pharmacy, and build strategies to maintain its occupational status.

3.
Explor Res Clin Soc Pharm ; 13: 100405, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38283100

RESUMO

Background: In recent years, pharmaceutical professionalism has been questioned due to the social role of pharmacy, which is ambiguous in the literature. This raises questions about the purpose of the profession among pharmacists, despite the efforts of their professional organizations and formal leaders to consolidate the occupational status of the profession. Objective: To understand the social role of pharmacy in Brazil through its historical evolution based on the perceptions of formal leaders of the profession. Methods: A qualitative study was conducted between July 2020 and February 2021 with pharmacists who held leadership positions in formal and professional pharmacy organizations in Brazil. The data obtained from the interviews were submitted to content analysis. Results: A total of 17 pharmacists participated in this study. The data analyzed presented perceptions about the social role of the pharmaceutical profession in Brazil, which promotes access to health through different means. These include the manager pharmacist, who facilitates access to public health policies; the caring pharmacist, who promotes health education and the rational use of medicines; and the technologist pharmacist, who researches, develops, and promotes access to safe and cost-effective medicines. The interviewees also discussed the evolution of this social role based on influential factors such as legislation, clinical movement, pharmaceutical education, labor market, behaviors, and attitudes of pharmacists. Conclusion: In this study, pharmaceutical professionalism was conceptualized based on its social role, which should be centered on the patient. Understanding such issues is part of the evolutionary purpose of the profession in Brazil and should be encouraged in the behaviors and attitudes of pharmacists despite the challenges faced by the profession.

4.
Am J Pharm Educ ; 88(1): 100597, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37805042

RESUMO

OBJECTIVES: To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy. FINDINGS: We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation. SUMMARY: The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.


Assuntos
Educação em Farmácia , Farmácia , Estudantes de Farmácia , Humanos , Identificação Social , Educação em Farmácia/métodos , Profissionalismo/educação , Currículo
6.
BMC Med Educ ; 23(1): 871, 2023 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-37974140

RESUMO

BACKGROUND: Professionalism is the demonstration of behaviors that guide the actions of health professionals. In Pharmacy, its implementation is possible through assessment instruments for pharmacists, such as the "Modification of Hall's Professionalism Scale for Use with Pharmacists". OBJECTIVE: To translate the "Modification of Hall's Professionalism Scale for Use with Pharmacists" into a Brazilian Portuguese version and evaluate its psychometric properties for pharmacists. METHOD: The methodological process of this study took place in three stages: translation and cross-cultural adaptation of the instrument original version into a Brazilian Portuguese version; validation of the scale content through consensus among geographically distinct experts and, finally; examination of the scale psychometric measurement properties through a convenience sample of 600 Brazilian pharmacists. At this stage, construct validity was verified using Exploratory Factor Analysis (EFA) and reliability was examined by calculating the composite reliability. RESULTS: The adapted instrument to a Brazilian Portuguese version demonstrated content validity with coefficients considered acceptable, above 0.8. The EFA demonstrated a structure supported by six factors and 39 items. The H index suggested high stability for all factors as well as composite reliability. CONCLUSION: The Brazilian Portuguese version of the instrument presented appropriate content validity coefficients and psychometric properties. This measure may be useful for future studies on professionalism regarding teaching strategies and assessment of this construct among pharmacists.


Assuntos
Comparação Transcultural , Farmacêuticos , Humanos , Inquéritos e Questionários , Psicometria , Profissionalismo , Reprodutibilidade dos Testes , Brasil , Traduções
7.
Indian J Med Res ; 157(4): 293-303, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37102510

RESUMO

Background & objectives: During the COVID-19 pandemic, the death rate was reportedly 5-8 fold lower in India which is densely populated as compared to less populated western countries. The aim of this study was to investigate whether dietary habits were associated with the variations in COVID-19 severity and deaths between western and Indian population at the nutrigenomics level. Methods: In this study nutrigenomics approach was applied. Blood transcriptome of severe COVID-19 patients from three western countries (showing high fatality) and two datasets from Indian patients were used. Gene set enrichment analyses were performed for pathways, metabolites, nutrients, etc., and compared for western and Indian samples to identify the food- and nutrient-related factors, which may be associated with COVID-19 severity. Data on the daily consumption of twelve key food components across four countries were collected and a correlation between nutrigenomics analyses and per capita daily dietary intake was investigated. Results: Distinct dietary habits of Indians were observed, which may be associated with low death rate from COVID-19. Increased consumption of red meat, dairy products and processed foods by western populations may increase the severity and death rate by activating cytokine storm-related pathways, intussusceptive angiogenesis, hypercapnia and enhancing blood glucose levels due to high contents of sphingolipids, palmitic acid and byproducts such as CO2 and lipopolysaccharide (LPS). Palmitic acid also induces ACE2 expression and increases the infection rate. Coffee and alcohol that are highly consumed in western countries may increase the severity and death rates from COVID-19 by deregulating blood iron, zinc and triglyceride levels. The components of Indian diets maintain high iron and zinc concentrations in blood and rich fibre in their foods may prevent CO2 and LPS-mediated COVID-19 severity. Regular consumption of tea by Indians maintains high high-density lipoprotein (HDL) and low triglyceride in blood as catechins in tea act as natural atorvastatin. Importantly, regular consumption of turmeric in daily food by Indians maintains strong immunity and curcumin in turmeric may prevent pathways and mechanisms associated with SARS-CoV-2 infection and COVID-19 severity and lowered the death rate. Interpretation & conclusions: Our results suggest that Indian food components suppress cytokine storm and various other severity related pathways of COVID-19 and may have a role in lowering severity and death rates from COVID-19 in India as compared to western populations. However, large multi-centered case-control studies are required to support our current findings.


Assuntos
COVID-19 , Ingredientes de Alimentos , Humanos , Nutrigenômica , Dióxido de Carbono , Lipopolissacarídeos , Pandemias , Síndrome da Liberação de Citocina , Ácido Palmítico , SARS-CoV-2 , Dieta/métodos , Comportamento Alimentar , Zinco , Chá , Ferro , Triglicerídeos
8.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1536248

RESUMO

Objetivo: Refletir sobre a infodemia da COVID-19 sob a luz da Teoria da Complexidade de Edgar Morin e seus três principais principios, a saber o princípio dialógico, da recursão organizacional e hologramático. Metodologia: Trata-se de ensaio teórico de caráter reflexivo da literatura acerca da infodemia de COVID-19 sob a luz da Teoria da Complexidade de Edgar Morin. Resultados: Interrelacionando o princípio dialógico com a infodemia, pode-se refletir sobre a relação da ambivalência complexa entre a desinformação e informações validadas cientificamente e dos diversos conteúdos dissipados nos meios de comunicação. Ressalta-se que é necessário realizar uma síntese coerente e confiável sobre os conteúdos abordados e amplamente difundidos. A infodemia de COVID-19 submerge de uma intenção que ocorre nas entrelinhas dos meios de comunicação, e nessa intencionalidade há participação direta da sociedade. Compreende-se que a desinformação se amplia na medida em que a produção de conteúdo aumenta, nesse sentido, a desinformação produz a infodemia que, consequentemente, é produzida também pela desinformação. É possível refletir sobre a infodemia através da noção de que está pode influenciar e ser influenciada pelo todo, envolvendo assim, questões que atravessam a saúde pública, a economia, a política, ao mesmo tempo que é fomentada e influenciada por esses eixos específicos. Considerações finais: Os princípios do pensamento complexo, constituem-se como elementos que auxiliam a compreensão do fenômeno infodemia sua influência no contexto informacional. Espera-se que este estudo reflexivo possa contribuir para que sejam mitigadas as repercussões da infodemia no cotidiano dos usuários das redes de informação.


Objective: To reflect on the COVID-19 infodemic in the light of Edgar Morin's Complexity Theory and its three main principles, namely the dialogic principle, organizational and hologrammatic recursion. Methodology: This is a theoretical essay with a reflective character of the literature on the COVID-19 infodemic in the light of Edgar Morin's Complexity Theory. Result: Interrelating the dialogic principle with the infodemic, one can reflect on the relationship of the complex ambivalence between disinformation and scientifically validated information and the various contents dissipated in the media. It is noteworthy that it is necessary to carry out a coherent and reliable synthesis of the contents covered and widely disseminated. The COVID-19 infodemic is submerged in an intention that occurs between the lines of the media, and in this intention, there is direct participation by society. It is understood that disinformation increases as the production of content increases, in this sense, disinformation produces the infodemic which, consequently, is also produced by disinformation. It is possible to reflect on the infodemic through the notion that it can influence and be influenced by the whole, thus involving issues that cross public health, the economy, politics, at the same time that it is fostered and influenced by these specific axes. Final considerations: the principles of complex thinking are elements that help the understanding of the infodemic phenomenon and its influence in the informational context. It is hoped that this reflective study can contribute to mitigate the repercussions of the infodemic in the daily lives of users of information networks.


Objetivo: Reflexionar sobre la infodemia de la COVID-19 a la luz de la Teoría de la Complejidad de Edgar Morin y sus tres principios fundamentales, a saber, el principio dialógico, el organizativo y el hologramático de la recursividad. Metodología: Se trata de un ensayo teórico con carácter reflexivo de la literatura sobre la infodemia del COVID-19 a la luz de la Teoría de la Complejidad de Edgar Morin. Resultados: Interrelacionando el principio dialógico con la infodemia, se puede reflexionar sobre la relación de la compleja ambivalencia entre la desinformación y la información científicamente validada y los diversos contenidos disipados en los medios. Cabe destacar que es necesario realizar una síntesis coherente y confiable de los contenidos abordados y ampliamente difundidos. La infodemia del COVID-19 está sumergida en una intención que se da entre líneas mediáticas y en esa intención hay una participación directa de la sociedad. Se entiende que la desinformación se expande a medida que aumenta la producción de contenidos. En ese sentido, la desinformación produce la infodemia que, en consecuencia, también es producida por la desinformación. Es posible reflexionar sobre la infodemia a partir de la noción de que puede influir y ser influenciada por el conjunto, involucrando así cuestiones que cruzan la salud pública, la economía, la política, al tiempo que es fomentada e influenciada por estos ejes específicos. Consideraciones finales: Los principios del pensamiento complejo son elementos que ayudan a la comprensión del fenómeno infodémico y su influencia en el contexto informacional. Se espera que este estudio reflexivo pueda contribuir a mitigar las repercusiones de la infodemia en la cotidianidad de los usuarios de las redes de información.

9.
RECIIS (Online) ; 16(3): 606-623, jul.-set. 2022.
Artigo em Português | LILACS | ID: biblio-1398917

RESUMO

Neste artigo são delineadas reflexões teórico-etnográficas a partir de pesquisa de campo realizada em três grupos do WhatsApp formados por pessoas que vivem com HIV/aids (PVHA). Tem como objetivo compreender as experiências afetivo-sexuais dessas pessoas, construídas por meio de diálogos, interações e socialidades vividas nesses grupos pesquisados. A partir da descrição das socialidades nos grupos e dos modos como, por meio da biscoitagem, as pessoas fazem circular afetos e desejos sem, necessariamente, constituírem relacionamentos afetivo-sexuais, argumenta-se que, em suas interações sociais, os interlocutores conectavam pessoas, artefatos sociotécnicos, lugares, situações, emoções, relações, projetos de vida etc., de tal maneira que produziam mais que simplesmente apoio, suporte, ajuda ou comunicação sobre o HIV, visto que teciam seus próprios mundos sociais. Estes achados ganham relevância especial ao se considerar a experiência de PVHA que mantêm algum grau de segredo sobre sua sorologia positiva para o HIV


This article outlines theoretical-ethnographic reflection based on a field research about three WhatsApp groups formed by people living with HIV/AIDS (PLWHA). It aims to understand the affective-sexual experiences of these people constructed through dialogues, interactions and socialities on these WhatsApp groups. From the description of sociality in these groups and the ways in which, through biscoitagem, people circulated affections and desires without necessarily constituting affective-sexual relationships, it is argued that, in their social interactions, the interlocutors connected people, socio-technical artefacts, places, situations, emotions, relationships, life projects etc., in a way that produced more than support, mutual help or communication about HIV, insofar as they were weaving their own social worlds. These findings gain special relevance when we consider the experience of the PLWHA who maintain some degree of secrecy about their positive HIV serology


Este artículo esboza reflexiones teórico-etnográficas a partir de una investigación de campo en tres grupos en WhatsApp formados por personas viviendo con VIH/SIDA (PVVS). El objetivo es comprender las experiencias afectivo-sexuales de estas personas construidas a través de diálogos, interacciones y socialidades vividas en estos grupos. A partir de la descripción de la sociabilidad en los grupos investigados y de las formas en que, a través de la biscoitagem, las personas circulaban afectos y deseos sin constituir necesariamente relaciones afectivo-sexuales, se argumenta que, en sus interacciones sociales, los interlocutores conectaron personas, artefactos sociotécnicos, lugares, situaciones, emociones, relaciones, proyectos de vida etc., de manera que produjeron más que solamente apoyo, soporte, ayuda o comunicación sobre VIH, ya que tejian sus propios mundos sociales. Estos hallazgos adquieren especial relevancia cuando se considera la experiencia de las PVVS que mantienen cierto grado de secreto sobre su serología positiva para el VIH


Assuntos
Humanos , HIV , Privacidade , Rede Social , Interação Social , Síndrome da Imunodeficiência Adquirida , Relações Interpessoais , Acontecimentos que Mudam a Vida , Antropologia Cultural
10.
Ann Diagn Pathol ; 56: 151844, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34753094

RESUMO

We report the clinicopathological findings of the first series of 3 patients from Brazil with fumarate hydratase-deficient renal cell carcinoma. The clinicopathological findings disclosed a very aggressive tumor. All 3 patients had solitary tumor at the left side, metastasis and advanced stage at the time of diagnosis; were females with a median age of 40 years; had a history of uterine leiomyomas; and, at follow-up two patients are deceased and one patient alive. The microscopic findings of these 3 patients are in accordance with the literature disclosing a variety of morphologic features being papillary arrangement, eosinophilic cytoplasm, and prominent nucleoli surrounded by clear halo the constant and most frequent findings. Previously not reported in this tumor, we describe presence of cannibalism, lymphocytic emperipolesis, and cytoplasmic vacuoles with eosinophilic inclusions associated with overexpression of p62 in immunohistochemistry which is considered to be evidence of defective autophagy. Lymphocytic emperipolesis was a more frequent finding than cannibalism and immunohistochemistry for p62 was overexpressed only in the 2 patients disclosing cytoplasmic vacuoles with eosinophilic inclusions. The presence, frequency and significance of these novel findings should be checked in large series of this rare and aggressive tumor aiming to associate with clinical behavior and eventually influence the strategy of treatment.


Assuntos
Autofagia/fisiologia , Carcinoma de Células Renais/patologia , Emperipolese/fisiologia , Fumarato Hidratase/genética , Neoplasias Renais/patologia , Adulto , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/metabolismo , Feminino , Fumarato Hidratase/metabolismo , Humanos , Imuno-Histoquímica , Neoplasias Renais/genética , Neoplasias Renais/metabolismo , Pessoa de Meia-Idade
11.
Rev. cub. inf. cienc. salud ; 33: e1871, 2022. tab, graf
Artigo em Português | LILACS, CUMED | ID: biblio-1408118

RESUMO

O fenômeno denominado infodemia refere-se ao aumento do volume informacional sobre um tema em específico, que se multiplica rapidamente em um curto período de tempo, e tem-se destacado frente ao contexto da crise sanitária desencadeada pela pandemia de COVID-19. O excesso de informações pode suscitar sentimentos de medo, ansiedade, estresse e outras condições de sofrimento mental. O estudo tem como objetivo descrever o perfil de exposição a informações sobre COVID-19 e suas repercussões na saúde mental de idosos brasileiros. Trata-se de um estudo transversal realizado com 1924 idosos brasileiros. Coletaram-se dados por meio de web-based survey enviada aos idosos por redes sociais e e-mail, no período de julho a outubro de 2020. Os resultados da análise descritiva dos dados demonstram que a maioria dos idosos apresentou idade entre 60 e 69 anos (69,02por cento), é do sexo feminino (71,26por cento), casados (53,79 por cento) e de cor branca (75,57por cento). Cerca de 21,67por cento (n = 417) concluíram a graduação, 19,75por cento (380) concluíram especialização e 16,63por cento (320) concluíram mestrado ou doutorado. Foram reportados como fontes frequentes de exposição às notícias ou informações sobre a COVID-19, a televisão 862 (44,80por cento) e as redes sociais 651 (33,84por cento). Os participantes assinalaram que a televisão (46,47por cento; n = 872), as redes sociais (30,81por cento; n = 575) e o rádio (14,48por cento; 251) os afetavam psicológica e/ou fisicamente. Receber notícias falsas sobre a COVID-19 pela televisão (n = 482; 19,8por cento) e pelas redes sociais (n = 415; 21,5por cento) repercutiu, principalmente, estresse e medo. As informações disseminadas contribuem para conscientização, mas, também, afetam física e/ou psicologicamente muitos idosos, principalmente gerando medo e estresse(AU)


El fenómeno denominado infodemia hace referencia al aumento del volumen de información sobre un tema específico, que se multiplica rápidamente en un corto período, y ha destacado en el contexto de la crisis sanitaria desencadenada por la pandemia de la COVID-19. Demasiada información puede desencadenar sentimientos de miedo, ansiedad, estrés y otras condiciones de angustia mental. El estudio tiene como objetivo describir el perfil de exposición a la información sobre la COVID-19 y sus repercusiones en la salud mental de los ancianos brasileños. Se trata de un estudio transversal realizado con 1924 ancianos brasileños. Los datos fueron recolectados a través de una encuesta web enviada a los ancianos a través de redes sociales y correo electrónico, de julio a octubre de 2020. Los resultados del análisis descriptivo de los datos muestran que la mayoría de los ancianos tenían entre 60 y 69 años (69,02 por ciento), mujer (71,26 por ciento), casada (53,79 por ciento) y blanca (75,57 por ciento). El 21,67 por ciento (n = 417) concluyó su graduación, el 19,75 por ciento (380) concluyó especialización y el 16,63 por ciento (320) concluyó maestría o doctorado. La televisión 862 (44,80 por ciento) y las redes sociales 651 (33,84 por ciento) se reportaron como fuentes frecuentes de exposición a noticias o información sobre el COVID-19. Los participantes indicaron que la televisión (46,47 por ciento; n = 872), las redes sociales (30,81 por ciento; n = 575) y la radio (14,48 por ciento; 251) les afectaban psicológica y/o físicamente. Recibir noticias falsas sobre el COVID-19 en la televisión (n = 482; 19,8 por ciento) y en las redes sociales (n = 415; 21,5 por ciento) resultó principalmente en estrés y miedo. La información difundida contribuye a la sensibilización, pero también afecta física y/o psicológicamente a muchas personas mayores, generando principalmente miedo y estrés(AU)


The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02percent), female (71.26percent), married (53.79percent) and white (75.57percent). About 21.67percent (n = 417) concluded their graduation, 19.75percent (380) concluded their specialization and 16.63percent (320) concluded their master's or doctoral degrees. Television 862 (44.80percent) and social networks 651 (33.84percent) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47percent; n = 872), social networks (30.81percent; n = 575) and radio (14.48percent; 251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482; 19.8percent) and on social media (n = 415; 21.5percent) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress(AU)


Assuntos
Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Disseminação de Informação/métodos , Comunicação em Saúde/métodos , COVID-19/epidemiologia , Infodemia , Infodemiologia , Enfermagem Geriátrica , Brasil , Estudos Transversais , Estudo Multicêntrico , Estudos de Avaliação como Assunto , Comportamento Exploratório
12.
Preprint em Português | SciELO Preprints | ID: pps-3078

RESUMO

The study aimed to evaluate possible factors associated with retention and intentionality of avoidance of the Pharmacy course of a Public University of the Northeast. This is a cross-sectional study conducted between July and December 2019 with students from the two undergraduate courses in Pharmacy, from the Federal University of Sergipe. For data collection, an instrument was used that included: 1) Sociodemographic data and; 2) Factors related to the intentionality of evasion, questions about locking, and failure in modules/disciplines. The study participated in 335 students, 132 from the Lagarto campus and 203 students from São Cristóvão. Of these, 69.30% (n=232) were women, the majority (81.20%) aged between 18 and 24 years, 60.90% (n=204) declared themselves brown, 96.70% were single and 5.10% (n= 17) had children. Regarding failure and intentionality of evasion, 176 (52.50%) stated that they had already failed and 62,10% (n=208) had the intention to drop out of the course. Among the factors that have an impact on the intentionality of the evasion was: "schedule of the disciplines offered", "curriculum matrix", "teaching methodology", "form of evaluation", "relationship between student and teacher/coordinator", "interpersonal relationships", "student assistance", "low remuneration of the professional", "financial difficulties", "lack of study skills", "difficulties of adaptation to the university", "disenchantment or demotivation with the course", "learning difficulties, translated into disapproval and low frequency", "inadaptation with the course" and "mental health problem". The results reinforce the need for strategies that support students during graduation, in order to reduce the impact of retention and dropout in higher education.


El estudio tenía como objetivo evaluar posibles factores asociados con la retención e intencionalidad de la evasión del curso de Farmacia de una Universidad Pública del Noreste. Estudio transversal realizado entre julio y diciembre de 2019 con estudiantes de los dos cursos de Farmacia de la Universidad Federal de Sergipe. Se recopilaron los siguientes datos: 1) datos sociodemográficos; 2) Factores relacionados con la intencionalidad de la evasión, preguntas sobre bloqueo y retención en módulos/disciplinas. Participó del estudio 335 estudiantes, 132 del campus de Lagarto y 203 de São Cristóvão. De ellos,  69,30% (n=232) eran mujeres, la mayoría (81,20%) entre 18 y 24 años, 60,90% (n=204) se declararon pardas, 96,70% eran solteros y 5,10% (n=17) tenían hijos. En cuanto al retención y la intencionalidad de la evasión, 176 (52,50%) afirmaron que ya habían reprobado y 62,10% (n=208) tenían la intención de evasión. Se destacaron los siguientes factores de intencionalidad de la evasión: "programa de las disciplinas ofrecidas", "matriz curricular", "metodología de enseñanza", "forma de evaluación", "relación entre estudiante y profesor/coordinador", "relaciones interpersonales", "asistencia al estudiante", "baja remuneración del profesional", "dificultades financieras", "falta de habilidades de estudio", "dificultades de adaptación a la universidad", "desencanto o desmotivación con el curso", "dificultades de aprendizaje, traducidas en desaprobación y baja frecuencia", "inadaptación con el curso" y "problema de salud mental". Los resultados refuerzan la necesidad de estrategias que apoyen a los estudiantes durante la graduación, con el fin de reducir el impacto en la retención escolar y la deserción escolar en la educación superior.


O estudo objetivou avaliar possíveis fatores associados à retenção e à intencionalidade de evasão do curso de Farmácia de uma Universidade Pública do Nordeste. Trata-se de um estudo transversal realizado entre julho a dezembro de 2019 com estudantes dos dois cursos de graduação em Farmácia, da Universidade Federal de Sergipe. Para a coleta de dados utilizou-se um instrumento que contemplava: 1) Dados Sociodemográficos e; 2) Fatores ligados à intencionalidade de evasão questões, sobre trancamento e reprovação em módulos / disciplinas. Participaram da pesquisa 335 estudantes, sendo 132 do campus Lagarto e 203 estudantes de São Cristóvão.Destes, 69,30% (n = 232) eram mulheres, a maioria (81,20%) apresentava idade entre 18 e 24 anos, 60,90% (n = 204) se autodeclaram pardos, 96,70% eram solteiros e 5,10% (n = 17) possuíam filhos. Quanto a reprovação e intencionalidade de evasão, 176 (52,50%) afirmaram já ter reprovado e 62,10% (n = 208) a intenção de desistir do curso.Entre os fatores que impactam na intencionalidade da evasão destacou-se: "horário das disciplinas ofertadas", "matriz curricular", "metodologia de ensino", "forma de avaliação", "relação entre aluno e professor / coordenador", "relações interpessoais "," Assistência aos alunos "," baixa renda do profissional "," dificuldades financeiras "," falta de habilidades de estudo "," dificuldade de adaptação à universidade "," desencanto ou desmotivação com o curso "," dificuldades de aprendizagem, traduzidas em reprovação e baixa frequência "," inadaptação com o curso "e" problema de saúde mental ". Os resultados reforçam a necessidade de aplicar que subsidiem os estudantes durante a graduação,

13.
Parasitology ; 148(10): 1171-1185, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33190649

RESUMO

Trypanosoma cruzi has three biochemically and morphologically distinct developmental stages that are programmed to rapidly respond to environmental changes the parasite faces during its life cycle. Unlike other eukaryotes, Trypanosomatid genomes contain protein coding genes that are transcribed into polycistronic pre-mRNAs and have their expression controlled by post-transcriptional mechanisms. Transcriptome analyses comparing three stages of the T. cruzi life cycle revealed changes in gene expression that reflect the parasite adaptation to distinct environments. Several genes encoding RNA binding proteins (RBPs), known to act as key post-transcriptional regulatory factors, were also differentially expressed. We characterized one T. cruzi RBP, named TcZH3H12, which contains a zinc finger domain and is up-regulated in epimastigotes compared to trypomastigotes and amastigotes. TcZC3H12 knockout (KO) epimastigotes showed decreased growth rates and increased capacity to differentiate into metacyclic trypomastigotes. Transcriptome analyses comparing wild type and TcZC3H12 KOs revealed a TcZC3H12-dependent expression of epimastigote-specific genes such as genes encoding amino acid transporters and proteins associated with differentiation (PADs). RNA immunoprecipitation assays showed that transcripts from the PAD family interact with TcZC3H12. Taken together, these findings suggest that TcZC3H12 positively regulates the expression of genes involved in epimastigote proliferation and also acts as a negative regulator of metacyclogenesis.


Assuntos
Expressão Gênica , Proteínas de Protozoários/genética , Trypanosoma cruzi/genética , Dedos de Zinco/genética , Sequência de Aminoácidos , Filogenia , Proteínas de Protozoários/química , Proteínas de Protozoários/metabolismo , Alinhamento de Sequência , Trypanosoma cruzi/metabolismo
14.
Rev. bras. educ. méd ; 45(3): e143, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1279855

RESUMO

Abstract: Introduction: Clinical teaching is based on a real work environment, in professional practice settings, such as health services and units, under the supervision of the preceptor. Providing medical teachers with an assessment of their teaching skills is a powerful tool for improving clinical learning for students in training. In this context, the EFFECT (Evaluation and Feedback for Effective Clinical Teaching) questionnaire was developed by Dutch researchers in 2012 for teacher evaluation, being validated based on the literature about medical teaching in the workplace and incorporates the skills of the Canadian competency-based medical curriculum. Objective: To translate and cross-culturally adapt into Brazilian Portuguese and to validate the EFFECT questionnaire for teacher evaluation by Medical students. Method: Cross-cultural adaptation with the following steps: initial translation of the English version, synthesis of translated versions, back-translation, creation of a consensual version in Brazilian Portuguese, with adaptation, review, and analysis of content validity by an expert committee, pre-test with retrospective clarification interview, and reliability analysis by factorial analysis and internal consistency test (Cronbach's alpha coefficient). Result: In the translation and back-translation stages, the disagreements were related to the use of synonyms and none of the items were modified in terms of their understanding, but in terms of adaptation into the Brazilian context. The evaluation of the expert committee showed the versions maintained the semantic and idiomatic equivalences of the content. Eighty-nine students participated in the pre-test. The internal consistency of the EFFECT questionnaire in Brazilian Portuguese was excellent for all domains, with Cronbach's alpha coefficient ranging from 0.82 to 0.94. Conclusion: The translated and adapted version of the EFFECT questionnaire into Brazilian Portuguese is equivalent to the original instrument and has evidence of high validity and reliability, being able to constitute a national tool to evaluate the efficiency of clinical medicine teaching.


Resumo: Introdução: O ensino clínico é baseado em ambiente de trabalho real, em cenários de prática profissional, como serviços e unidades de saúde, sob a supervisão do preceptor. Proporcionar aos docentes de graduação médica uma avaliação sobre suas habilidades de ensino é uma ferramenta poderosa para melhorar a aprendizagem clínica dos estudantes em formação. Nesse contexto, o questionário Evaluation and Feedback for Effective Clinical Teaching (EFFECT) foi desenvolvido por pesquisadores holandeses em 2012 para avaliação docente, sendo validado com base na literatura sobre o ensino médico em local de trabalho. Esse instrumento incorpora as competências do currículo baseado em competências canadense. Objetivo: Este estudo teve como objetivos traduzir, adaptar transculturalmente para português do Brasil e validar o questionário EFFECT para avaliação docente por estudantes de Medicina. Método: A adaptação transcultural empregou as seguintes fases: tradução inicial da versão em inglês; síntese de versões traduzidas; tradução reversa; criação de versão consensual em português do Brasil, com adaptação, revisão e análise de validade de conteúdo por comitê de especialistas; pré-teste com entrevista retrospectiva de esclarecimento e análise de confiabilidade por análise fatorial e teste de consistência interna (coeficiente alfa de Cronbach). Resultado: Nas etapas de tradução e tradução reversa, as discordâncias relacionaram-se ao uso de sinônimos, e nenhum dos itens foi modificado em relação ao seu entendimento, e sim na adequação para a realidade brasileira. A avaliação do comitê de especialistas demonstrou que as versões mantinham a equivalência semântica e idiomática do conteúdo. Participaram do pré-teste 89 alunos. A consistência interna do EFFECT em português do Brasil mostrou-se excelente para todos os domínios, com coeficiente alfa de Cronbach variando de 0,82 a 0,94. Conclusão: A versão traduzida e adaptada do questionário EFFECT em português do Brasil possui equivalência cultural com o instrumento original e evidência de alta validade e confiabilidade, podendo constituir-se em instrumento nacional de avaliação da eficiência do ensino clínico de docente de Medicina.


Assuntos
Humanos , Adulto , Estudantes de Medicina , Inquéritos e Questionários , Docentes/normas , Psicometria , Tradução , Brasil , Comparação Transcultural
15.
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(2): 282-286, set 24, 2020. tab
Artigo em Português | LILACS | ID: biblio-1358177

RESUMO

Introdução: as queimaduras promovem declínio funcional, diminuição de qualidade de vida, como também aumento da morbimortalidade dos acometidos. O perfil epidemiológico dos pacientes queimados pode variar de acordo com a região e a época estudada, sendo necessário a análise contínua e ampla dessas populações acometidas. Objetivo: analisar o perfil epidemiológico de pacientes vítimas de queimaduras, tratados em um ambulatório de um hospital de Anápolis. Metodologia: o presente estudo foi de caráter observacional transversal (prevalência), coletando dados retrospectivos de prontuários em arquivos mortos de pacientes atendidos no Hospital Municipal Jamel Cecílio de Anápolis-GO. Foram coletados dados a respeito da caracterização da amostra, da caracterização das queimaduras e os seus agentes causais. Os dados foram expressos em média, desvio-padrão, frequência e porcentagem. Resultados: foram incluídos no presente estudo 144 prontuários de pacientes, com média de idade de 32,28 (±18,49) anos, sendo maior parte do sexo feminino (52,8%) e acidentados em casa (47,6%). O agente causal mais comum dessas queimaduras foi o físico (90,3%), destes, principalmente causados por líquidos superaquecidos e acidentes motociclísticos (69,5%), promovendo queimaduras principalmente de espessura parcial superficial (EPS) e espessura parcial profunda (EPP) (86,1%), classificando-os pela extensão e localização em pequenos queimados. A maior parte das queimaduras foram nos membros superiores, especificamente, no membro superior esquerdo (MSE) (34,7%). Conclusão: o perfil identificado na pesquisa evidenciou preferencialmente mulheres adultas, que se acidentaram em casa, por líquidos superaquecidos, com maior porcentagem de queimaduras de EPS e EPP em membros superiores. Os acidentes por motocicleta caracterizam uma realidade evidenciada e relatada no hospital pesquisado.


Introduction: burns promote functional decline, decreased quality of life, as well as increased morbidity and mortality. The epidemiological profile of burned patients may vary according to the region and time studied, requiring continuous and broad analysis of these affected populations. Objective: to analyze the epidemiological profile of burn victims treated at an outpatient clinic of an Anapolis hospital. Methodology: this was a retrospective observational study, collecting data from archives of patients treated at Jamel Cecílio de Anápolis-GO Municipal Hospital. Data were collected regarding the characterization of the sample, the characterization of the burns and their causal agents. Data were expressed as mean, standard deviation, frequency and percentage. Results: one hundred and forty-four patient records were included in this study, with a mean age of 32.28 (± 18.49) years, most of them female (52.8%) and injured at home (47.6%). The most common causal agent of these burns was physical (90.3%), mainly caused by overheated liquids and motorcycle accidents (69.5%), promoting mainly partial surface thickness (EPS) and deep partial thickness (EPP) burns. ) (86.1%), classifying them by extension and location in small burns. Most of the burns were in the upper limbs, specifically the left upper limb (MSE) (34.7%). Conclusion: therefore, the profile of the patients was preferably adult women, who were injured at home by overheated liquids, promoting burns of EPS and EPP in the upper limbs.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pacientes Ambulatoriais , Perfil de Saúde , Queimaduras , Demografia , Prontuários Médicos , Estudo Observacional
16.
Sensors (Basel) ; 20(1)2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31877690

RESUMO

Collaboration between multiple Unmanned Aerial Vehicles (UAVs) to establish a Flying Ad-hoc Network (FANET) is a growing trend since future applications claim for more autonomous and rapidly deployable systems. In this context, Software-Defined Networking FANET (SDN-FANET ) separates the control and data plane and provides network programmability, which considers a centralized controller to perform all FANET control functions based on global UAV context information, such as UAV positions, movement trajectories, residual energy, and others. However, control message dissemination in an SDN-FANET with low overhead and high performance is not a trivial task due to FANET particular characteristics, i.e., high mobility, failures in UAV to UAV communication, and short communication range. With this in mind, it is essential to predict UAV information for control message dissemination as well as consider hierarchical network architecture, reducing bandwidth consumption and signaling overhead. In this article, we present a Cluster-bAsed control Plane messages management in sOftware-defined flying ad-hoc NEtwork, called CAPONE. Based on UAV contextual information, the controller can predict UAV information without control message transmission. In addition, CAPONE divides the FANET into groups by computing the number of clusters using the Gap statistics method, which is input for a Fuzzy C-means method to determine the group leader and members. In this way, CAPONE reduces the bandwidth consumption and signaling overhead, while guaranteeing the control message delivering in FANET scenarios. Extensive simulations are used to show the gains of the CAPONE in terms of Packet Delivery Ratio, overhead, and energy compared to existing SDN-FANET architectures.

17.
Cad Saude Publica ; 34(11): e00063618, 2018 11 08.
Artigo em Português | MEDLINE | ID: mdl-30427411

RESUMO

This ethnographic study aimed to understand the experience of health professionals working in a Specialized Service for HIV/AIDS Care in a remote area of Northeast Brazil. Data collection used participant observation and a semi-structured interview with seven professionals in the health care team. The thematic coding technique yielded three categories: "I didn't even know what it was": aspects of becoming a specialist in HIV/AIDS; "They're all out there, kind of hidden": strategies for dealing with the (in)visibility of serological status; and "We live on the tightrope": experiences in the work process. The study's most relevant aspect was the service's institutional invisibility as a result of the current configuration of the AIDS structure in Brazil. The results revealed several difficulties that are typical of services located in remote areas, especially the health professionals' lack of experience, aggravated by the lack of continuing education, unmet infrastructure needs, the position of HIV/AIDS care on the local political agenda, and the physician-centered organization of the work process. The study also highlighted the interlocutors' agency in the production of strategies to deal with these difficulties. The study further emphasized the local dimension as a social marker of difference that modeled the interlocutors' experiences, where the health policy's guidelines and principles are performed by health professionals, administrators, and users, comprising diverse material forms.


Esta etnografia objetivou compreender a experiência de profissionais da saúde que trabalham em um Serviço de Atenção Especializada em HIV/aids num contexto de área remota, no Nordeste brasileiro. Para a coleta de dados, utilizaram-se observação participante e entrevista semiestruturada com sete profissionais que compunham a equipe do serviço estudado. Por meio da técnica de codificação temática, obtiveram-se três categorias: "eu não sabia nem o que era": aspectos do vir a ser profissional especializado em HIV/aids; "está todo mundo lá meio que escondido": estratégias de enfrentamento à (in)visibilidade do status sorológico; e "a gente vive em cima da corda bamba": experiências no processo de trabalho. O aspecto mais relevante deste estudo diz respeito à invisibilidade institucional do serviço como reflexo da atual configuração do dispositivo da aids no Brasil. Os resultados assinalaram algumas dificuldades próprias de serviços localizados em áreas remotas, notadamente a inexperiência dos profissionais e seu agravamento pela carência de educação permanente, necessidades infraestruturais, o lugar das ações de saúde em HIV/aids na agenda política local e a centralidade do fazer médico na organização do processo de trabalho. Destacou-se, ainda, a agência dos interlocutores na produção de estratégias de enfrentamento dessas dificuldades. Este estudo acrescenta ao ressaltar a dimensão local como um marcador social da diferença que modelava as experiências dos interlocutores, pois é ali onde as diretrizes e os princípios da política de saúde são performados por profissionais, gestores e usuários compondo materialidades diversas.


Este estudio etnográfico tuvo como objetivo comprender la experiencia de profesionales de salud, que trabajan en un Servicio de Atención Especializada en VIH/SIDA en un contexto de área remota, en el nordeste brasileño. Para la recogida de datos, se utilizaron técnicas observación participante y entrevista semiestructurada con siete profesionales que componían el equipo del servicio estudiado. Mediante la técnica de codificación temática, se obtuvieron tres categorías: "yo no sabía ni lo que era": aspectos de lo que supone convertirse en un profesional especializado en VIH/SIDA; "está todo el mundo allí medio escondido": estrategias de enfrentamiento a la (in)visibilidad del estatus serológico; y "la gente vive sobre una cuerda floja": experiencias en el proceso de trabajo. El aspecto más relevante de este estudio se refiere a la invisibilidad institucional del servicio, como reflejo de la actual red de atención al SIDA en Brasil. Los resultados señalaron algunas dificultades propias de servicios localizados en áreas remotas, resaltándose la inexperiencia de los profesionales y su agravamiento por la carencia de formación permanente; necesidad de infraestructuras; el lugar de las acciones de salud en relación con VIH/SIDA dentro de la agenda política local, y la centralidad del quehacer médico en la organización del proceso de trabajo. Se destaca, no obstante, la voluntad de los interlocutores para generar estrategias que enfrenten esas dificultades. Este estudio es relevante al resaltar la dimensión local, como un marcador social de las diferencias que modelaban las experiencias de los interlocutores, pues es allí donde se llevan a cabo las directrices y los principios de política de salud por parte de profesionales, gestores y usuarios formando materialidades diversas.


Assuntos
Síndrome da Imunodeficiência Adquirida/etnologia , Infecções por HIV/etnologia , Pessoal de Saúde/educação , Serviços de Saúde Rural , Síndrome da Imunodeficiência Adquirida/terapia , Brasil/etnologia , Atenção à Saúde , Infecções por HIV/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Equipe de Assistência ao Paciente , Relações Profissional-Paciente , Pesquisa Qualitativa , População Rural
18.
Sensors (Basel) ; 18(12)2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30486376

RESUMO

Collaboration between multiple Unmanned Aerial Vehicles (UAVs) to set up a Flying Ad Hoc Network (FANET) is a growing trend since future applications claim for more autonomous and rapid deployable systems. The user experience on watching videos transmitted over FANETs should always be satisfactory even under influence of topology changes caused by the energy consumption of UAVs. In addition, the FANET must keep the UAVs cooperating as much as possible during a mission. However, one of the main challenges in FANET is how to mitigate the impact of limited energy resources of UAVs on the FANET operation in order to monitor the environment for a long period of time. In this sense, UAV replacement is required in order to avoid the premature death of nodes, network disconnections, route failures, void areas, and low-quality video transmissions. In addition, decision-making must take into account energy consumption associated with UAV movements, since they are generally quite energy-intensive. This article proposes a cooperative UAV scheme for enhancing video transmission and global energy efficiency called VOEI. The main goal of VOEI is to maintain the video with QoE support while supporting the nodes with a good connectivity quality level and flying for a long period of time. Based on an Software Defined Network (SDN) paradigm, the VOEI assumes the existence of a centrailized controller node to compute reliable and energy-efficiency routes, as well as detects the appropriate moment for UAV replacement by considering global FANET context information to provide energy-efficiency operations. Based on simulation results, we conclude that VOEI can effectively mitigate the energy challenges of FANET, since it provides energy-efficiency operations, avoiding network death, route failure, and void area, as well as network partitioning compared to state-of-the-art algorithm. In addition, VOEI delivers videos with suitable Quality of Experience (QoE) to end-users at any time, which is not achieved by the state-of-the-art algorithm.

20.
Rev. Ciênc. Plur ; 4(2): 87-101, 2018. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-980214

RESUMO

Introdução:A Puericultura forma o principal pilar da atenção integral à saúde da criança. No contexto da Atenção Primária à Saúde, as consultas de Crescimento e Desenvolvimento -CD são a materialização dessa prática, onde a Colaboração Interprofissional pode ser vista como um potencializador de ações e resultados.Objetivo:Evidenciar a integralidade do cuidado voltado ao público infantil, relatando uma experiência da parceria do Programa de Residência Multiprofissional em Atenção Básica da Escola Multicampi de Ciências Médicas da Universidade Federal do Rio Grande do Norte com uma unidade da Estratégia Saúde da Família.Métodologia:As consultas de CD foram realizadas na modalidade "coletiva e compartilhada", onde as crianças foram classificadas por faixa etária e estabelecido um cronograma, contando com a participação de assistente social, cirurgião-dentista, enfermeira, farmacêutico, fisioterapeuta, fonoaudiólogo, nutricionista, psicólogo ­juntamente com a enfermeira preceptora da referida unidade.Resultados:Asações aconteceram na sala da enfermeira, onde se montava um cenário propício à sua execução. Inicialmente à consulta, era estimulado uma conversa informal com as mães/responsáveis, e posteriormente um dos profissionais explanava sobre sua expertise na atenção à saúde infantil, abrindo para a colaboração Inter profissional onde para finalizar, eram tomadas as medidas de vigilância tradicionais às consultas de puericultura. Conclusão:A interação entre as profissões, dentro de cada expertise, pôde promover aspectos de prevenção e promoção de Saúde Bucal, potencializando a área da Odontologia e fortalecendo o trabalho Interprofissional (AU).


Introduction: Childcare is the main pillar of comprehensive health care for children. In the context of Primary Health Care, the Growth and Development -CD consultations are the materialization of this practice, where Interprofessional Collaboration can be seen as a potentiator of actions and results.Purpose:To demonstrate the integrality of the care directed to the children, reporting an experience of the partnership of the Multiprofessional Residency Program in Basic Attention of the Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte with a unit of the Family Health Strategy.Methodology: CD consultations were carried out in a "collective and shared" modality, where the children were classified by age group and established a schedule, counting on the participation of social worker, dental surgeon, nurse, pharmacist, physiotherapist, speech therapist, nutritionist , a psychologist -along with the nurse who governs the said unit.Results: The actions took place in the nurse's room, where a scenario was set up to facilitate its execution. At the beginning of the consultation, an informal conversation with the mothers / guardians was stimulated, and later one of the professionals explained about their expertise in child health care, opening up to the Inter professional collaboration where, to finish, traditional surveillance measures were taken. childcare.Conclusion: The interaction among the professions, within each expertise, was ableto promote aspects of prevention and promotion of Oral Health, boosting the area of Dentistry and strengthening Interprofessional work (AU).


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Atenção Primária à Saúde , Cuidado da Criança , Desenvolvimento Infantil , Saúde Bucal , Relações Interprofissionais/ética , Equipe de Assistência ao Paciente , Brasil , Saúde da Criança
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