ORAL CARE AND CONDITIONS IN HOSPITALIZED ELDERLY PEOPLE – INTEGRATIVE REVIEW

Autores

  • Monira Samaan Kallás
  • Bruno Guardieiro
  • Márcia Maria Rendeiro

DOI:

https://doi.org/10.25110/arqsaude.v27i4.2023-014

Palavras-chave:

Oral Health, Aging, Hospitalized, Institutionalized

Resumo

Through an integrative review, the objective of this article was to answer a question: what are the conditions and oral care in hospitalized elderly patients? We used 6 main databases and obtained 1051 articles, of which 78 met the inclusion criteria. Conclusions: there is a high prevalence of oral problems in the hospitalized elderly population; poor oral health is not an isolated health problem – it is related to pneumonia, sarcopenia, poor nutrition, and quality of life; oral hygiene protocols in daycare routines improve oral conditions and quality of life and integrating dentistry into medical screening: hospitalization offers a privileged opportunity to identify and correct oral problems and promote oral health.

Referências

Aagaard, K., Meléndez‐Torres, G. J., & Overgaard, C. (2020). Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 29(17/18), 3392–3402. https://doi.org/10.1111/jocn.15373

Bellissimo-Rodrigues, W. T., Menegueti, M. G., Gaspar, G. G., Nicolini, E. A., Auxiliadora-Martins, M., Basile-Filho, A., Martinez, R., & Bellissimo-Rodrigues, F. (2014). Effectiveness of a Dental Care Intervention in the Prevention of Lower Respiratory Tract Nosocomial Infections among Intensive Care Patients: A Randomized Clinical Trial. Source: Infection Control and Hospital Epidemiology, 35(11), 1342–1348. https://doi.org/10.1086/678427

Caplan, D. J., Ghazal, T. S., Cowen, H. J., & Oliveira, D. C. (2017). Dental status as a predictor of mortality among nursing facility residents in eastern Iowa. Gerodontology, 34(2), 257–263. https://doi.org/10.1111/ger.12260

Cheruvathoor, D. D., Thomas, V., Kumar, N. R., & Jose, M. (2020). High prevalence of oral mucosal lesions in elderly: Call for revolutionizing geriatric dental care strategies. Journal of Family Medicine and Primary Care, 9(8), 4375–4380. https://doi.org/10.4103/jfmpc.jfmpc_51_20

Choufani, A., Folliguet, M., El-Osta, N., Rammal, S., & Doumit, M. (2020). Oral health status and care of institutionalized elderly individuals in Lebanon. Indian Journal of Dental Research, 31(4), 507–514. https://doi.org/10.4103/ijdr.IJDR_208_20

Coker, E., Ploeg, J., Kaasalainen, S., & Carter, N. (2017). Nurses’ oral hygiene care practices with hospitalised older adults in postacute settings. International Journal of Older People Nursing, 12(1), n/a-N.PAG. https://doi.org/10.1111/opn.12124

Cruz, M. K. da, Morais, T. M. N. de, & Trevisani, D. M. (2014). Clinical assessment of the oral cavity of patients hospitalized in an intensive care unit of an emergency hospital. Revista Brasileira de Terapia Intensiva, 26(4). https://doi.org/10.5935/0103-507X.20140058

Curi, J. P., Fernandes, M. M., Oliveira, M. R. de, Deitos, A. R., Oliveira, R. N. de, & Crosato, E. M. (2019). Oral health of older adults in brazilian nursing ho mes: case report involving the department of public prosecution TT - Saúde bucal de idosos em instituições de longa permanência no brasil: relato de caso envolvendo a atuação do ministério público. Biosci. j. (Online), 35(3), 977–982. https://doi.org/10.14393/BJ-v35n3a2019-42501

Czwikla, J., Herzberg, A., Kapp, S., Kloep, S., Schmidt, A., Rothgang, H., Schwendicke, F., & Hoffmann, F. (2021). Home care recipients have poorer oral health than nursing home residents: Results from two German studies. Journal of Dentistry, 107. https://doi.org/10.1016/j.jdent.2021.103607

de Pinho, N. B., Martucci, R. B., Rodrigues, V. D., D’Almeida, C. A., Thuler, L. C. S., Saunders, C., Jager-Wittenaar, H., & Peres, W. A. F. (2020). High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study. Cancer, 126(1), 156–164. https://doi.org/10.1002/cncr.32437

Deps, T. D., Carneiro, N. C. R., Nicolau, B., Pordeus, I. A., & Borges-Oliveira, A. C. (2020). Oral health-related quality of life of young people with mucopolysaccharidosis: A paired cross-sectional study. Brazilian Oral Research, 34. https://doi.org/10.1590/1807-3107BOR-2020.VOL34.0109

Didilescu, A. C., Skaug, N., Marica, C., & Didilescu, C. (2005). Respiratory pathogens in dental plaque of hospitalized patients with chronic lung diseases. Clinical Oral Investigations. https://doi.org/10.1007/s00784-005-0315-6

Fujiwara, A., Minakuchi, H., Uehara, J., Miki, H., Inoue-Minakuchi, M., Kimura-Ono, A., Nawachi, K., Maekawa, K., & Kuboki, T. (2019). Loss of oral self-care ability results in a higher risk of pneumonia in older inpatients: A prospective cohort study in a Japanese rural hospital. Gerodontology, 36(3), 236–243. https://doi.org/10.1111/ger.12402

Gibney, J. M. (2018). Improving the oral health of older people in hospital. September 2020. https://doi.org/10.1111/ajag.12588

Gibney, J. M., Wright, C., Sharma, A., D’Souza, M., & Naganathan, V. (2017). The oral health status of older patients in acute care on admission and Day 7 in two Australian hospitals. Age and Ageing, 46(5), 852–856. https://doi.org/10.1093/ageing/afx085

Girestam Croonquist, C., Dalum, J., Skott, P., Sjögren, P., Wårdh, I., & Morén, E. (2020). Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff’s Oral Health Knowledge and Attitudes. Clinical Interventions in Aging, 15, 1305–1315. https://doi.org/10.2147/CIA.S236460

Hakeem, F. F., Bernabé, E., Fadel, H. T., & Sabbah, W. (2020). Association between Oral Health and Frailty among Older Adults in Madinah, Saudi Arabia: A Cross-Sectional Study. Journal of Nutrition, Health & Aging, 24(9), 975–980. https://doi.org/10.1007/s12603-020-1506-1

Hoben, M., Clarke, A., Huynh, K. T., Kobagi, N., Kent, A., Hu, H., Pereira, R. A. C., Xiong, T., Yu, K., Xiang, H., & Yoon, M. N. (2017). Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis. International Journal of Nursing Studies, 73, 34–51. https://doi.org/10.1016/j.ijnurstu.2017.05.003

Hoeksema, A. R., Peters, L. L., Raghoebar, G. M., Meijer, H. J. A., Vissink, A., & Visser, A. (2017). Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death. Clinical Oral Investigations, 21(7), 2189–2196. https://doi.org/10.1007/s00784-016-2011-0

Huang, W.-J. (2017). Medical and Caring Needs of Older People from Sociological Perspective. Chinese General Practice, 20(7), 842–851. https://doi.org/10.3969/j.issn.1007-9572.2017.07.017

Huppertz, V. A. L., van der Putten, G.-J., Halfens, R. J. G., Schols, J. M. G. A., & de Groot, L. C. P. G. M. (2017). Association Between Malnutrition and Oral Health in Dutch Nursing Home Residents: Results of the LPZ Study. Journal of the American Medical Directors Association, 18(11), 948–954. https://doi.org/10.1016/j.jamda.2017.05.022

Izumi, M., & Akifusa, S. (2021). Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives. Journal of Oral Rehabilitation, 48(12), 1395–1403. https://doi.org/10.1111/joor.13266

Izumi, M., Sonoki, K., Ohta, Y., Fukuhara, M., Nagata, M., & Akifusa, S. (2021). Tongue cleaning maintains respiratory function in older individuals: A 1‐year randomised controlled trial. Journal of Oral Rehabilitation, 48(6), 730–737. https://doi.org/10.1111/joor.13165

Kallás, M. S., Mendes, M. A., Dias, M., Negreiros, R. M., Alves, L. A. C., Siniauskas, A., & Azevedo, L. C. P. (2022). Evaluation of oral changes and modification of the oral microbiome in patients admitted to the Intensive Care Unit. Research, Society and Development, 11(3), e59411326866. https://doi.org/10.33448/rsd-v11i3.26866

Kamil, W., Kruger, E., Turlach, B., & Tennant, M. (2021). Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis. Geriatrics (Basel, Switzerland), 7(1). https://doi.org/10.3390/geriatrics7010002

Kerr, E., Watson, S., McMullan, J., Srinivasan, M., & McKenna, G. J. (2021). General dentists’ attitudes and perceived barriers in providing domiciliary dental care to older adults in long-term care facilities or their homes in Northern Ireland: A descriptive qualitative study. Gerodontology. https://doi.org/10.1111/ger.12565

Konstantopoulou, K., & Kossioni, A. (2021). The effect of a training programme on the knowledge and attitudes of nursing home staff towards oral health and care provision to residents. European Geriatric Medicine, 12(SUPPL 1), S296. https://doi.org/10.1007/s41999-021-00585-2

Kumar, P. S. (2017). From focal sepsis to periodontal medicine: a century of exploring the role of the oral microbiome in systemic disease. The Journal of Physiology, 595(2), 465–476. https://doi.org/10.1113/JP272427

Lee, K. H., Lee, K. Y., Choi, Y. Y., & Jung, E. S. (2020). Effects of Professional Oral Health Care Programs for Elderly Residents of Nursing Facilities. Journal of Dental Hygiene, 94(6), 33–39. https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=148771962&lang=pt-br&site=ehost-live

Lopes, S., Tavares, V., Mascarenhas, P., Lopes, M., Cardote, C., Godinho, C., Oliveira, C., Santos, C. A., Oom, M., Grillo-Evangelista, J., & Fonseca, J. (2022). Oral Health Status of Adult Dysphagic Patients That Undergo Endoscopic Gastrostomy for Long Term Enteral Feeding. International Journal of Environmental Research and Public Health, 19(8). https://doi.org/10.3390/ijerph19084827

Mahdani, F. Y., Radithia, D., Parmadiati, A. E., & Ernawati, D. S. (2019). Prevalence of oral mucosal lesions in geriatric patients in Universitas Airlangga Dental Hospital. Acta Medica Philippina, 53(5), 407–411. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073822166&partnerID=40&md5=5b5df0908087ec7f62448fe7977acd1b

Maille, G., Saliba-Serre, B., Ferrandez, A.-M., & Ruquet, M. (2019). Objective and perceived oral health status of elderly nursing home residents: A local survey in southern France. Clinical Interventions in Aging, 14, 1141–1151. https://doi.org/10.2147/CIA.S204533

Marín, D., Gil, J., & Willumsen, T. (2019). Effectiveness of a training program for the nursing staff on the oral health of institutionalised aged. Randomised trial. Acta Odontol. Colomb. (En Linea), 9(1), 58–70. https://doi.org/10.15446/aoc.v9n1.76124

Matsumura, M., Shigeishi, H., Su, C.-Y., Nishimura, R., Ohta, K., & Sugiyama, M. (2020). High Rate of Oral Candida Detection in Dependent Japanese Older People. Geriatrics (Basel, Switzerland), 5(1). https://doi.org/10.3390/geriatrics5010021

Matsuo, K. M., Taniguchi, H. T., Nakagawa, K. N., Kanazawa, M. K., Furuya, J. F., Tsuga, K. T., Ikebe, K. I., Ueda, T. U., Tamura, F. T., Nagao, H. N., Yamamoto, K. Y., Sakuari, K. S., & Minakuchi, S. M. (2017). Relationships between decline in oral functions and nutritional status in elderly patients in an acute hospital. Dysphagia, 32(1), 205. https://doi.org/10.1007/s00455-016-9766-y

Medeiros, M. M. D., Pinheiro, M. A., Figueredo, O. M. C., Oliveira, L. F. S., Wanderley, R. L., Cavalcanti, Y. W., Rodrigues Garcia, R. C. M., de Medeiros, M. M. D., Pinheiro, M. A., de Figueredo, O. M. C., de Oliveira, L. F. S., Wanderley, R. L., Cavalcanti, Y. W., & Rodrigues Garcia, R. C. M. (2020). Masticatory function in nursing home residents: Correlation with the nutritional status and oral health–related quality of life. Journal of Oral Rehabilitation, 47(12), 1511–1520. https://doi.org/10.1111/joor.13096

Mehta, A., Govind, M., & Broadbent, J. (2020). Oral Health-Related Quality of Life of Older Patients Attending a Government Dental Hospital in India. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY, 18(2), 151–155. https://doi.org/10.4103/jiaphd.jiaphd_113_19

Mouth care: Do we care? A one-day national flash audit of mouth care practice in hospitalised older adults. (2018). Age and Ageing, 47, iii8. https://doi.org/10.1093/ageing/afy113.01

Nasibullina, A. K., Valishin, D. A., Kabirova, M. F., Rakhimova, R. F., & Izosimov, A. A. (2021). The state of the oral mucosa in patients with a laboratory-confirmed diagnosis of COVID-19, severe to moderate severity. World Heart Journal, 13(1), 295–297.https://www.embase.com/search/results?subaction=viewrecord&id=L2013518199&from=export

Nishizawa, T., Ota, H., Kida, G., Tsukahara, Y., Tsumiyama, E., Yamakawa, H., Kawabe, R., Oba, T., Sato, S., Niikura, Y., Kurai, D., Akasaka, K., Amano, M., Ishii, H., Matsushima, H., Yamashita, N., & Takizawa, H. (2019). Pilot study for risk assessment of aspiration pneumonia. European Respiratory Journal, 54. https://doi.org/10.1183/13993003.congress-2019.PA2908

Noetzel, N., Meyer, A. M., Siri, G., Pickert, L., Heeß, A., Verleysdonk, J., Benzing, T., Pilotto, A., Barbe, A. G., & Polidori, M. C. (2021). The impact of oral health on prognosis of older multimorbid inpatients: the 6-month follow up MPI oral health study (MPIOH). European Geriatric Medicine, 12(2), 263–273. https://doi.org/10.1007/s41999-020-00427-7

Nomoto, A., Shimizu, A., Ohno, T., Tohara, H., Hashidume, M., Hatano, M., & Fujishima, I. (2021). Poor oral health and anorexia in older rehabilitation patients. Gerodontology, 39(1), 59–66. https://doi.org/10.1111/ger.12600

Oda, K., Montayre, J., Parsons, J., & Boyd, M. (2021). Oral Care in Hospital Settings: Breaking the Vicious Circle of Older Adult Deconditioning. Journal of Gerontological Nursing, 47(6), 7–12. https://doi.org/10.3928/00989134-20210507-01

Ogami, K., Ueda, T., Ryu, M., Tajima, S., & Sakurai, K. (2018). Evaluation of Factors Associated with Tongue Coating Status in Elderly with Care Needs. The Bulletin of Tokyo Dental College, 59(3), 163–169. https://doi.org/10.2209/tdcpublication.2017-0041

Oishi, M. M., Momany, E. T., Cacchione, P. Z., Collins, R. J., Gluch, J. I., Cowen, H. J., Damiano, P. C., & Marchini, L. (2020). Setting the PACE for frail older adults in the community: An underused opportunity for furthering medical-dental integration. Journal of the American Dental Association, 151(2), 108–117. https://doi.org/10.1016/j.adaj.2019.10.001

Reggentin, H. (2019). Ambulant dental treatment of dementia patients in nursing homes. European Geriatric Medicine, 10, S165–S166. https://doi.org/10.1007/s41999-019-00221-0

Sachdev, M., Brealey DavidBrealey, D., Jung Ryu, uclhnhsuk H., Bercades, G., Nagle, J., Borja-Boluda, S., Agudo, E., Petrie, A., Suvan, J., Donos, N., Singer, M., Needleman, I., Ready, D., Brealey, D., Hyun Ryu, J., author, C., & Needleman ineedleman, I. (2013). Changes in dental plaque following hospitalisation in a critical care unit: an observational study Critical Care Changes in dental plaque following hospitalisation in a critical care unit – an observational study. Critical Care, 17. https://doi.org/10.1186/cc12878

Saito, M., Shimazaki, Y., Nonoyama, T., & Tadokoro, Y. (2019). Associations of number of teeth with medical costs and hospitalization duration in an older Japanese population. Geriatrics & Gerontology International, 19(4), 335–341. https://doi.org/10.1111/ggi.13622

Saúde, B. M. da S. S. de A. à S. S. de V. em. (2012). SB Brasil 2010. Pesquisa Nacional de Saúde Bucal. Resultados Principais. https://bvsms.saude.gov.br/bvs/publicacoes/pesquisa_nacional_saude_bucal.pdf

Scannapieco, F. a., & Binkley, J. (2012). Modest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine. Journal of Evidence-Based Dental Practice, 12(3 SUPPL.), 15–17. https://doi.org/10.1016/S1532-3382(12)70004-0

Scannapieco, F. A., Dasanayake, A. P., & Chhun, N. (2010). “Does Periodontal Therapy Reduce the Risk for Systemic Diseases?” In Dental Clinics of North America. https://doi.org/10.1016/j.cden.2009.10.002

Scannapieco, F. A., Yu, J., Raghavendran, K., Vacanti, A., Owens, S. I., Wood, K., & Mylotte, J. M. (2009). A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Critical Care (London, England). https://doi.org/10.1186/cc7967

Sermsuti-Anuwat, N., & Piyakhunakorn, P. (2021). Association between oral health literacy and number of remaining teeth among the thai elderly: A cross-sectional study. Clinical, Cosmetic and Investigational Dentistry, 13, 113–119. https://doi.org/10.2147/CCIDE.S306110

Shiraishi, A., Wakabayashi, H., & Yoshimura, Y. (2020a). Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems. Journal of Nutrition, Health & Aging, 24(10), 1094–1099. https://doi.org/10.1007/s12603-020-1439-8

Shiraishi, A., Wakabayashi, H., & Yoshimura, Y. (2020b). Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems. Journal of Nutrition, Health & Aging, 24(10), 1094–1099. https://doi.org/10.1007/s12603-020-1439-8

Sinor, M. Z., Ahmad, B., Ariffin, A., & Hassan, A. (2018). Main Medical Illness, Oral Health Complaints and Treatment in Elderly Patients Attending Hospital Universiti Sains Malaysia (HUSM) Dental Clinic. International Medical Journal, 25(4), 230–232. https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=131215565&lang=pt-br&site=ehost-live

Smith, M. B., & Thomson, W. M. (2017). “Not on the radar”: dentists’ perspectives on the oral health care of dependent older people. Gerodontology, 34(1), 90–100. https://doi.org/10.1111/ger.12227

Stanbouly, D., & Chuang, S.-K. (2021). Stepping into Trouble: Craniomaxillofacial Trauma in the Geriatric Population From Stairway Falls. Journal of Oral & Maxillofacial Surgery (02782391), 79(10), 2125.e1-2125.e7. https://doi.org/10.1016/j.joms.2021.05.036

Steel, B. J. (2017). Oral hygiene and mouth care for older people in acute hospitals: part 1. Nursing Older People, 29(9), 26–31. https://doi.org/10.7748/nop.2017.e947a

Steel, B. J. (2021a). A cross-sectional study of the oral healthand oral-health-related quality of life of older adults admitted to an acute hospitalin the north east of England. Age and Ageing, 50(SUPPL 1). https://doi.org/10.1093/ageing/afab028.04

Steel, B. J. (2021b). A CROSS-SECTIONAL STUDY OF THE ORAL HEALTH AND ORAL-HEALTH-RELATED QUALITY OF LIFE OF OLDER ADULTS ADMITTED TO AN ACUTE HOSPITAL IN THE NORTH EAST OF ENGLAND...British Geriatrics Society Autumn Meeting, November 25-27 2020 (Virtual). Age & Ageing, 50, i1–i1. https://doi.org/10.1093/ageing/afab028.04

Takeuchi, K., Izumi, M., Furuta, M., Takeshita, T., Shibata, Y., Kageyama, S., Ganaha, S., & Yamashita, Y. (2017). Association between posterior teeth occlusion and functional dependence among older adults in nursing homes in Japan. Geriatrics & Gerontology International, 17(4), 622–627. https://doi.org/10.1111/ggi.12762

Takeuchi, K., Izumi, M., Furuta, M., Takeshita, T., Shibata, Y., Kageyama, S., Okabe, Y., Akifusa, S., Ganaha, S., & Yamashita, Y. (2019). Denture Wearing Moderates the Association between Aspiration Risk and Incident Pneumonia in Older Nursing Home Residents: A Prospective Cohort Study. International Journal of Environmental Research and Public Health, 16(4). https://doi.org/10.3390/ijerph16040554

van de Rijt, L. J. M., Feast, A. R., Vickerstaff, V., Sampson, E. L., & Lobbezoo, F. (2021). Oral function and its association with nutrition and quality of life in nursing home residents with and without dementia: A cross-sectional study. Gerodontology, 38(4), 404–413. https://doi.org/10.1111/ger.12535

van Kuijk, M., Smith, M. B., Ferguson, C. A., Kerse, N. M., Teh, R., Gribben, B., & Thomson, W. M. (2021). Dentition and nutritional status of aged New Zealanders living in aged residential care. Oral Diseases, 27(2), 370–377. https://doi.org/10.1111/odi.13536

Vernon, L. T., Teng, K. A., Kaelber, D. C., Heintschel, G. P., & Nelson, S. (2021). Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration. Gerodontology. https://doi.org/10.1111/ger.12561

Weening-Verbree, L. F., Schuller, D. A. A., Cheung, S.-L., Zuidema, P. D. S. U., Schans, P. D. C. P. Van Der, & Hobbelen, D. J. S. M. (2021). Barriers and facilitators of oral health care experienced by nursing home staff. Geriatric Nursing (New York, N.Y.), 42(4), 799–805. https://doi.org/10.1016/j.gerinurse.2021.04.012

Willis, P. J. (n.d.). The Role of Dentistry in the Hospital.

Wimardhani, Y. S., Patoni, P., & Irmagita, A. (2020). Oral health literacy and oral cancer knowledge of the caregiver of older adults at the nursing homes in Jakarta, Indonesia. Journal of International Dental and Medical Research, 13(3), 1081–1086. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85092116161&partnerID=40&md5=08c21ce4602e71fa1da12e128721032b

Wright, F. A. C., Law, G., Chu, S. K. ‐Y. K.-Y. Y., Cullen, J. S., Le Couteur, D. G., & Chu, S. K. ‐Y. K.-Y. Y. (2017). Residential age care and domiciliary oral health services: Reach-OHTThe development of a metropolitan oral health programme in Sydney, Australia. Gerodontology, 34(4), 420–426. https://doi.org/10.1111/ger.12282

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09-05-2023

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KALLÁS, Monira Samaan; GUARDIEIRO, Bruno; RENDEIRO, Márcia Maria. ORAL CARE AND CONDITIONS IN HOSPITALIZED ELDERLY PEOPLE – INTEGRATIVE REVIEW. Arquivos de Ciências da Saúde da UNIPAR, [S. l.], v. 27, n. 4, p. 1797–1824, 2023. DOI: 10.25110/arqsaude.v27i4.2023-014. Disponível em: https://revistas.unipar.br/index.php/saude/article/view/9709. Acesso em: 22 nov. 2024.

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