Lesiones musculosqueléticas en cuidadores de ancianos: revisión integradora de la literatura

Gomes, Nildete Pereira; Pedreira, Larissa Chaves; Nunes, Simony Fabíola Lopes; Alvarez, Angela Maria; Siewert, Josiane Steil; Oliveira, Lélia Mendes Sobrinho de

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. Bras. Enferm. 74 (suppl 2) • 2021 • https://doi.org/10.1590/0034-7167-2020-0626 copiar

Lesiones musculosqueléticas en cuidadores de ancianos: revisión integradora de la literatura

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

analizar, en la literatura científica disponible, cuáles son las lesiones causadas al sistema musculoesquelético del cuidador de ancianos en el ámbito del hogar.

Métodos:

revisión integrativa de la literatura, indexada en las bases de datos PubMed, CINAHL, Web of Science, SCOPUS, BDENF, LILACS y SciELO.

Resultados:

la muestra totalizó 17 estudios que mostraron tres categorías temáticas: Sobrecarga de cuidados para la salud del cuidador; Enfermedad física del cuidador; Auto-negligencia del cuidador.

Conclusión:

la evidencia identificó problemas de salud para el cuidador de ancianos con respecto al sistema musculoesquelético, demostrando la importancia de considerar estrategias de intervención que brinden pautas para pautas de autocuidado, con el fin de prevenir las complicaciones musculoesqueléticas derivadas de las actividades de atención domiciliaria de los ancianos.

Descriptores:
Cuidadores; Anciano; Dolor Musculoesquelético; Sistema Musculoesquelético; Actividades Cotidianas

Databases	Search sequence
MEDLINE/PubMed	(("Caregivers"[Mesh] OR "Caregiver" OR "Carers" OR "Carer" OR "Care Givers" OR "Care Giver" OR "Spouse Caregivers" OR "Spouse Caregiver" OR "Family Caregivers" OR "Family Caregiver") AND ("Aged"[Mesh] OR "Elderly") AND ("Musculoskeletal Pain"[Mesh] OR "Musculoskeletal Pains" OR "complications"[Mesh] OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia"[Mesh] OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders"))
Scopus	TITLE-ABS-KEY(("Caregivers" OR "Caregiver" OR "Carers" OR "Carer" OR "Care Givers" OR "Care Giver" OR "Spouse Caregivers" OR "Spouse Caregiver" OR "Family Caregivers" OR "Family Caregiver") AND ("Aged" OR "Elderly") AND ("Musculoskeletal Pain" OR "Musculoskeletal Pains" OR "complications" OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia" OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders"))
Web of Science	TS=(("Caregivers" OR "Caregiver" OR "Carers" OR "Carer" OR "Care Givers" OR "Care Giver" OR "Spouse Caregivers" OR "Spouse Caregiver" OR "Family Caregivers" OR "Family Caregiver") AND ("Aged" OR "Elderly") AND ("Musculoskeletal Pain" OR "Musculoskeletal Pains" OR "complications" OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia" OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders"))
CINAHL	(("Caregivers" OR "Caregiver" OR "Carers" OR "Carer" OR "Care Givers" OR "Care Giver" OR "Spouse Caregivers" OR "Spouse Caregiver" OR "Family Caregivers" OR "Family Caregiver") AND ("Aged" OR "Elderly") AND ("Musculoskeletal Pain" OR "Musculoskeletal Pains" OR "complications" OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia" OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders"))
BVS (LILACS/BDENF)	(("Caregivers" OR "Care Giver" OR "Care Givers" OR "Caregiver" OR "Carer" OR "Carers" OR "Family Caregiver" OR "Family Caregivers" OR "Spouse Caregiver" OR "Spouse Caregivers" OR "Cuidadores" OR "Cuidador Familiar" OR "Cuidador de Familia" OR "Cuidadores Familiares" OR "Cuidadores de Esposos" OR "Cuidadores de Familia" OR "Familiar Cuidador" OR "Familiares Cuidadores" OR "Cuidadores" OR "Cuidador" OR "Cuidador Familiar" OR "Cuidador de Família" OR "Cuidadores Cônjuges" OR "Cuidadores Familiares" OR "Cuidadores de Família" OR "Cônjuges Cuidadores" OR "Familiar Cuidador" OR "Familiares Cuidadores" OR "Outro Apoiador") AND ("Aged" OR "Elderly" OR "Anciano" OR "Adulto Mayor" OR "Ancianos" OR "Persona Mayor" OR "Persona de Edad" OR "Personas Mayores" OR "Personas de Edad" OR "Idoso" OR "Idosos" OR "Pessoa Idosa" OR "Pessoa de Idade" OR "Pessoas Idosas" OR "Pessoas de Idade" OR "População Idosa") AND ("Musculoskeletal Pain" OR "Musculoskeletal Pains" OR "complications" OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia" OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders" OR "Dolor Musculoesquelético" OR "Dolor Osteomuscular" OR "Parestesia" OR "Disestesia" OR "Hormigueo" OR "Sensación de Quemaduras" OR "Dor Musculoesquelética" OR "Dor Osteomuscular" OR "Parestesia" OR "Disestesia" OR "Formigamento" OR "Sensações de Queimadura"))
Scielo	(("Caregivers" OR "Care Giver" OR "Care Givers" OR "Caregiver" OR "Carer" OR "Carers" OR "Family Caregiver" OR "Family Caregivers" OR "Spouse Caregiver" OR "Spouse Caregivers" OR "Cuidadores" OR "Cuidador Familiar" OR "Cuidador de Familia" OR "CuidadoresFamiliares" OR "Cuidadores de Esposos" OR "Cuidadores de Familia" OR "Familiar Cuidador" OR "Familiares Cuidadores" OR "Cuidadores" OR "Cuidador" OR "Cuidador Familiar" OR "Cuidador de Família" OR "Cuidadores Cônjuges" OR "Cuidadores Familiares" OR "Cuidadores de Família" OR "Cônjuges Cuidadores" OR "Familiar Cuidador" OR "Familiares Cuidadores" OR "Outro Apoiador") AND ("Aged" OR "Elderly" OR "Anciano" OR "Adulto Mayor" OR "Ancianos" OR "Persona Mayor" OR "Persona de Edad" OR "Personas Mayores" OR "Personas de Edad" OR "Idoso" OR "Idosos" OR "Pessoa Idosa" OR "Pessoa de Idade" OR "Pessoas Idosas" OR "Pessoas de Idade" OR "População Idosa") AND ("Musculoskeletal Pain" OR "Musculoskeletal Pains" OR "complications" OR "associated disease" OR "coexistent conditions" OR "sequels" OR "concomitant conditions" OR "concomitant disease" OR "sequelae" OR "associated conditions" OR "coexistent disease" OR "Paresthesia" OR "Paresthesias" OR "Dysesthesia" OR "Dysesthesias" OR "Painful Paresthesia" OR "Painful Paresthesias" OR "Distal Paresthesia" OR "Distal Paresthesias" OR "Formication" OR "Formications" OR "Musculoskeletal diseases" OR "chronic pain" OR "Musculoskeletal health" OR "work-related musculoskeletal disorders" OR "Dolor Musculoesquelético" OR "Dolor Osteomuscular" OR "Parestesia" OR "Disestesia" OR "Hormigueo" OR "Sensación de Quemaduras" OR "Dor Musculoesquelética" OR "Dor Osteomuscular" OR "Parestesia" OR "Disestesia" OR "Formigamento" OR "Sensações de Queimadura"))

Title	Year Country	Design/ participants	Objective	Main results	Musculoskeletal disorders
⁽ ⁴4 Gomes NP, Pedreira LC, Gomes NP, Fonseca EDOS, Reis LAD, Santos ADA. Health-related consequences of caring for dependent relatives in older adult caregivers. Rev Esc Enferm USP. 2019;53:e03446. https://doi.org/10.1590/s1980-220x2018002303446 https://doi.org/10.1590/s1980-220x201800... ⁾	2019 Brazil	Qualitative n=06	To know the consequences of care for the health of older adult caregivers of dependent family members.	Caregivers of dependent family members reported musculoskeletal pain, due to repetitive activities; Somatization resulting from extreme concern for the family; they do not seek health services and do not perform physical activities. They reported pain, bursitis, low back pain and arthrosis, with the upper limbs, knees, cervical and lumbar spine the most affected regions. They also reported movement limitations, such as squatting and climbing/descending stairs.	Repetitive activities; pain, bursitis, low back pain and arthrosis in the upper limbs, knees, cervical and lumbar spine; movement limitation; extreme concern; they do not seek health services and do not perform physical activities.
⁽ ⁵5 Stacey AF, Gill TK, Price K, Taylor AW. Biomedical health profiles of unpaid family carers in an urban population in South Australia. PloS One. 2019;14(3). https://doi.org/10.1371/journal.pone.0208434 https://doi.org/10.1371/journal.pone.020... ⁾	2019 Australia	Quantitative n=4,056	To compare the biomedical health profile and morbidity of adult caregivers with non-caregivers.	Caregivers reported chronic health conditions, such as: Anxiety (19.2%) and stress (17.1%), musculoskeletal diseases, such as arthritis (13.7%) and osteoporosis. They also reported insufficient or no exercise (26.6%).	Anxiety and stress; arthritis and osteoporosis; insufficient or no exercise.
⁽ ¹⁰10 Galatsch M, Prigerson HG, Schnepp W, zuSayn-Wittgenstein F, Li J. Caregiver exposure to critical events and distress in home-based palliative care in Germany a cross-sectional study using the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) scale. BMC Palliat Care, 2019; 18(1):9. https://doi.org/10.1186/s12904-019-0395-8. https://doi.org/10.1186/s12904-019-0395-... ⁾	2019 Germany	Quantitative n =106	To assess the exposure of the family caregiver to patients' critical health events and examine associations with general health in a palliative care situation.	Family caregivers of people in palliative care at home reported more exposure to severe/severe pain and discomfort (95%), in addition to insomnia (52.8%).	Intense/severe pain and discomfort; cannot sleep - insomnia
⁽ ¹¹11 Hassankhani H, Eghtedar S, Rahmani A, Ebrahimi H, Whitehead B. A Qualitative study on cancer care Burden: experiences of Iranian family caregivers. Holist Nurs Pract. 2019;33(1):17-26. https://doi.org/10.1097/HNP.0000000000000309 https://doi.org/10.1097/HNP.000000000000... ⁾	2019 Iran	Qualitative n=21	To explore the experiences of Iranian family caregivers in relation to the overload of care	Family caregivers reported physical problems resulting from stress due to care provision: pain in knees, wrists and stomach, general bodily pain, sleep disorders, weight loss and appetite, gradual decline in physical skills and fatigue.	Physical problems resulting from stress; pain in knees, wrists and stomach, general bodily pain; sleep disorders. weight loss and appetite; gradual decline in physical skills and fatigue.
⁽ ¹²12 Vaz LCS, Santos KOB, Ferraz DD. Condições de saúde e trabalho entre cuidadores de idosos frágeis. Rev Pesqui Fisioter. 2018;8(3):319-29. https://doi.org/10.17267/2238-2704rpf.v8i3.1987 https://doi.org/10.17267/2238-2704rpf.v8... ⁾	2018 Brazil	Quantitative n= 41	To assess the health and working conditions of caregivers of frail older adults using the State Reference Center for Health Care of Older adults	Caregivers had a high domestic overload, 90.2% reported being primarily responsible for the activities in their home, in addition to caring for older adults. The excess of activities performed caused physical overload and painful symptoms for the body, compromising the activity of care and the health of the caregiver. They presented musculoskeletal symptoms with a greater impact on the lumbar and dorsal spine.	Domestic overload, house activities, in addition to care for older adults; painful symptoms throughout the body impacting the lumbar and dorsal spine.
⁽ ¹³13 Moreira KLDAF, Ábalos-Medina GM, Villaverde-Gutiérrez C, Lucena NMG, Oliveira ABC, Pérez-Mármol JM. Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial. Disabil Health J. 2018;11(3):471-77. https://doi.org/10.1016/j.dhjo.2018.01.003 https://doi.org/10.1016/j.dhjo.2018.01.0... ⁾	2018 Brazil	Quantitative n=33	To assess the effectiveness of two home ergonomic interventions in order to reduce the intensity of pain and perceived stress and improve the quality of life in informal caregivers of chronic post-stroke patients.	The two groups of caregivers showed significant differences such as: pain intensity in the neck, right shoulder and right and left knees, and in the quality of life in relation to physical health. There was a reduction in pain intensity between the two experimental groups after the intervention (12 weeks of training in postural hygiene, kinesiotherapy and home adaptations). The intervention reduced the perceived intensity of pain in the neck, shoulders and knees of caregivers in both experimental groups and increased in the control group. Physical health worsened among caregivers who received only the usual intervention.	Pain in the neck, right shoulder and right and left knees; worse physical health.
⁽ ⁶6 Terassi M, Rossetti ES, Gramani-Say K, Alexandre TDS, Hortense P, Pavarini SCI. Comparison of the cognitive performance of elderly caregivers with and without chronic pain. Rev Esc Enferm USP. 2017;51:e03260. https://doi.org/10.1590/s1980-220x2016023203260 https://doi.org/10.1590/s1980-220x201602... ⁾	2017 Brazil	Quantitative n= 320	Knowing and characterizing chronic pain in older adult caregivers, checking the cognitive performance of older adults in the sample and checking if there is a difference in the cognitive performance of older adult caregivers with and without chronic pain.	Older adult caregivers with chronic pain and without pain, who lived with another older adult family member in the same household, reported chronic pain, with intensity in the last week, which varied from absent, weak, moderate, intense and unbearable, according to the report of the older adults. The main descriptors of pain were: uncomfortable, painful and persistent, being considered a situation of great discomfort and an important problem in the lives of caregivers.	Uncomfortable and persistent chronic pain.
⁽ ¹⁴14 Morais DD, Terassi M, Inouye K, Luchesi BM, Pavarini SCI. Chronic pain in elderly caregivers at different levels of frailty. Rev Gaúcha Enferm. 2016;37(4). https://doi.org/10.1590/1983-1447.2016.04.60700 https://doi.org/10.1590/1983-1447.2016.0... ⁾	2016 Brazil	Quantitative n= 187	To check for a difference in the intensity of chronic pain of frail, pre-frail and non-frail caregivers.	Caregivers presented chronic pain, being moderate pain and severe pain. The main descriptors of pain were: persistent, painful and uncomfortable. The most affected regions of the body were: lumbar region, lower limbs and dorsal region. The study found no significant difference in the intensity of chronic pain in older adults.	Chronic pain, being moderate and intense in regions such as lumbar, lower and dorsal limbs.
⁽ ⁷7 Darragh AR, Sommerich CM, Lavender SA, Tanner KJ, Vogel K, Campo M. Musculoskeletal discomfort, physical demand, and caregiving activities in informal caregivers. J Appl Gerontol. 2015; 34(6):734-60. https://doi.org/10.1177/0733464813496464 https://doi.org/10.1177/0733464813496464... ⁾	2015 USA	Qualitative and Quantitative n=46	To characterize the overload of care and musculoskeletal discomfort associated with the care of adults with chronic physical disabilities and describe the most physically demanding care activities and contributing factors perceived by the informally caregivers of adults with physical disabilities.	Caregivers of adults with physical disabilities reported high and very high levels of physical tension associated with care activities. They also reported musculoskeletal discomfort in more than one part of the body. The most affected body parts were: lumbar, knee, shoulder, wrist/hand, neck, hip.	Musculoskeletal discomfort in lumbar, knee, shoulder, wrist/hand, neck, hip; high levels of physical tension associated with care activities.
⁽ ¹⁵15 Reis LA, Santos KT, Reis LA, Gomes NP. Quality of life and associated factors for caregivers of functionally impaired elderly people. Braz J Phys Ther. 2013;17(2):146-51. https://doi.org/10.1590/S1413-35552012005000078 https://doi.org/10.1590/S1413-3555201200... ⁾	2013 Brazil	Quantitative n =40	To assess quality of life and associated factors in older adult caregivers with impaired functional capacity.	The study revealed a high presence of health problems in caregivers, such as rheumatism associated with migraine, hypertension associated with low back pain, musculoskeletal problems. These health problems, associated with being the main caregiver of older adults, were related to the decrease in aspects of quality of life, especially in the Physical Domain.	Rheumatism, migraine, hypertension, low back pain.
⁽ ¹⁶16 Marques AKMC, Landim FLP, Collares PM, Mesquita RBD. Apoio social na experiência do familiar cuidador. Ciênc Saúde Colet. 2011;16:945-55. https://doi.org/10.1590/S1413-81232011000700026 https://doi.org/10.1590/S1413-8123201100... ⁾	2011 Brazil	Qualitative n=18	To know the experience of caring for sick people in the context of homes, analyzing the implications of social support on the physical and emotional health of the family caregiver.	Family caregivers of people with chronic diseases reported impaired health related to the care performed, referring to back pain and migraine.	Back pain and migraine; Impairment of health because of care.
⁽ ¹⁷17 Jones SL, Hadjistavropoulos HD, Janzen JA, Hadjistavropoulos T. The relation of pain and caregiver burden in informal older adult caregivers. Pain Med. 2011;12(1):51-8. https://doi.org/10.1111/j.1526-4637.2010.01018.x https://doi.org/10.1111/j.1526-4637.2010... ⁾	2011 Canada	Quantitative n= 116	To study the associations between pain, depression and caregiver overload of older adults.	Caregivers in the study reported chronic pain in the last six months. Most reported moderate and severe pain.	Chronic pain from moderate to severe.
⁽ ¹⁸18 Alencar MDCB, Montrezor JB. Aspectos da organização do trabalho e os distúrbios osteomusculares: um estudo com trabalhadores em instituições de longa permanência de idosos. Rev Ter Ocup Univ São Paulo. 2010;21(1):15-22. https://doi.org/10.11606/issn.2238-6149.v21i1p15-22 https://doi.org/10.11606/issn.2238-6149.... ⁾	2010 Brazil	Qualitative and Quantitative n =50	To investigate based on workers' perceptions and the analysis of work activities, such as relationships between musculoskeletal disorders of workers who care for/assist older adults and aspects of work organization	Caregivers reported musculoskeletal pain in the last 30 days. The most affected regions were: lumbar and cervical, shoulders, hip and hands. They presented work-related overload, often performed tasks with inadequate postures, and the weight of older adults was an aspect of risk for musculoskeletal pain.	Low back and neck pain, shoulders, hip and hands. Work-related overload; they performed tasks with inadequate postures, in addition to the weight of older adults.
⁽ ¹⁹19 Tommis Y, Robinson CA, Seddon D, Woods B, Perry J, Russell IT. Carers with chronic conditions: changes over time in their physical health. Chronic Illn. 2009;5(3):155-64. https://doi.org/10.1177/1742395309339251 https://doi.org/10.1177/1742395309339251... ⁾	2009 Country of Wales	Qualitative and Quantitative n=90	To explore the experiences of individuals with chronic conditions who also care for another person, usually a family member.	The results indicate that the physical health of these caregivers is negatively affected by their role as caregivers. These neglect their health due to responsibilities and concerns of caring for others.	Negatively affected physical health; they neglect their health due to responsibilities and concerns of care.
⁽ ²⁰20 Gomes WD, Resck ZMR. A percepção dos cuidadores domiciliares no cuidado a clientes com sequelas neurológicas. Rev Enferm UERJ [Internet]. 2009 [cited 2020 Apr 27];17(4)496-501. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/bde-18012 https://pesquisa.bvsalud.org/portal/reso... ⁾	2009 Brazil	Qualitative n=05	To understand caregivers' perceptions in the care of clients with neurological sequel, proposing strategies to care for the caregiver.	Family caregivers of people with neurological impairment reported feelings of tiredness and excessive concern, leading to intense physical and psychological overload.	Feelings of tiredness and excessive worry, leading to intense physical and psychological overload.
⁽ ²¹21 McPherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Family caregivers' assessment of symptoms in patients with advanced cancer: concordance with patients and factors affecting accuracy. J Pain Symptom Manage. 2008;35(1):70-82. https://doi.org/10.1016/j.jpainsymman.2007.02.038 https://doi.org/10.1016/j.jpainsymman.20... ⁾	2008 Canada	Quantitative n=66	To examine the agreement between the assessments of patients and family caregivers of patients' symptoms and identify demographic and psychosocial factors that affect the levels of agreement.	Family caregivers of cancer patients undergoing palliative treatment reported lack of energy (94%), drowsiness (77%) and pain (77%). As an indirect consequence to the musculoskeletal system, the article points out that lack of energy and drowsiness has consequences for the body.	Lack of energy, drowsiness and pain in the body.
⁽ ²²22 Yueh-Feng Lu Y, Austrom MG. Distress responses and self-care behaviours in dementia family caregivers with high and low depressed mood. J Am Psychiatr Nurses Assoc. 2005:11(4):231-40. https://doi.org/10.1177/1078390305281422 https://doi.org/10.1177/1078390305281422... ⁾	2005 USA	Quantitative n=97	To compare care stress, health status, physical function, presence and severity of symptoms and self-care behaviors in family caregivers with depressed mood.	Caregivers with high depressed mood reported high levels of stress in care, presenting more symptoms, more severity and more difficulty in physical performance, when compared to caregivers with low depressed mood. The first presented stiffness and swelling in the joints.	Stress in care; stiffness and swelling in the joints; more difficulty in physical performance.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Nildete Pereira Gomes. E-mail: nildetesaude@yahoo.com.br