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  • 11
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    Access to medicines : relations with the institutionalization of pharmaceutical services
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 8s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 8s-
    Abstract: OBJETIVE: To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS: This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS: Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS: Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007138
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 12
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    Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 14s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 14s-
    Abstract: OBJECTIVE: To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. METHODS: The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. RESULTS: Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. CONCLUSIONS: We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007060
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 13
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    Characterization of the selection of medicines for the Brazilian primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 9s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 9s-
    Abstract: OBJECTIVE: To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS: The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS: As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007065
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 14
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    Polypharmacy : a challenge for the primary health care of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 19s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 19s-
    Abstract: OBJECTIVE: To characterize the polypharmacy in primary health care patients and to identify its associated factors. METHODS: This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson’s Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p 〈 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test. RESULTS: The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8–12.0) in the general population and 18.1% (95%CI 13.6–22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile. CONCLUSIONS: Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007136
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 15
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    Use of medicines by patients of the primary health care of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 18s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 18s-
    Abstract: OBJECTIVE: To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student’s t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS: Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were “other analgesics and antipyretics” (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS: Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007144
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 16
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    Pharmaceutical services in the primary health care of the Brazilian Unified Health System : advances and challenges
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 3s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 3s-
    Abstract: This study is a synthesis of the main results of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), Evaluation Component of the Basic Pharmaceutical Services. Based on the critical narrative of the elements of Brazil’s pharmaceutical policies, we discuss aspects related to the structure of the pharmaceutical services, the medicines’ sanitary state, human resources, access to medicines, rational use and management. Despite the advances that reflect the commitment of the group of actors involved, the results of the Survey indicate challenges, such as equitable access to medicines, the structuring of pharmaceutical services, the improvement of logistics and administration, and the implementation of actions directed to pharmaceutical care in the health units
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007146
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 17
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    Management of pharmaceutical services in the Brazilian primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 15s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 15s-
    Abstract: OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007063
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 18
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    Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 12s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 12s-
    Abstract: OBJECTIVE: To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21.RESULTS: The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS: The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007106
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 19
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    Conceptions on pharmaceutical services in Brazilian primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 5s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 5s-
    Abstract: OBJECTIVE: To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. METHODS: This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. RESULTS: Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. CONCLUSIONS: The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007107
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 20
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    Workforce in the pharmaceutical services of the primary health care of SUS, Brazil
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 16s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 16s-
    Abstract: OBJECTIVE: To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional and quantitative study, with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country’s regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables. RESULTS: We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions. CONCLUSIONS: The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007110
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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