Risk factors for infection after cardiovascular surgery in children in Argentina
Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argenti...
Saved in:
Published in: | The Brazilian journal of infectious diseases Vol. 13; no. 6; pp. 414 - 416 |
---|---|
Main Authors: | , , , , , , |
Format: | Journal Article |
Language: | English |
Published: |
Brazil
Contexto
01-12-2009
Brazilian Society of Infectious Diseases Elsevier |
Subjects: | |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Abstract | Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53%) were boys, 21% (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16%) had previous surgery, 36 p (10%) had received previous antibiotics and 30 (9%) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88%). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25%) needed inotropic support with epinephrine, 147 p (42%) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97%) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11%). Superficial wound infection in 4 p (1%), 5 p (1.5%) had deep infection, 3p (1%) had mediastinitis and 26 p (7.5%) had other nonsurgical infections Eleven p (3%) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections. |
---|---|
AbstractList | Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53%) were boys, 21% (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16%) had previous surgery, 36 p (10%) had received previous antibiotics and 30 (9%) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88%). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25%) nedeed inotropic support with epinephrine, 147 p (42%) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97%) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11%). Superficial wound infection in 4 p (1%), 5 p (1.5%) had deep infection, 3p (1%) had mediastinitis and 26 p (7.5%) had other nonsurgical infections Eleven p (3%) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections. Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/ 11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53%) were boys, 21% (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16%) had previous surgery, 36 p (10%) had received previous antibiotics and 30 (9%) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88%). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25%) nedeed inotropic support with epinephrine, 147 p (42%) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97%) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11%). Superficial wound infection in 4 p (1%), 5 p (1.5%) had deep infection, 3p (1%) had mediastinitis and 26 p (7.5%) had other nonsurgical infections Eleven p (3%) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections. Key-Words: Infections, cardiovascular surgery, children. Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53%) were boys, 21% (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16%) had previous surgery, 36 p (10%) had received previous antibiotics and 30 (9%) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88%). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25%) needed inotropic support with epinephrine, 147 p (42%) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97%) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11%). Superficial wound infection in 4 p (1%), 5 p (1.5%) had deep infection, 3p (1%) had mediastinitis and 26 p (7.5%) had other nonsurgical infections Eleven p (3%) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections. |
Audience | Academic |
Author | Santillan, Alejandro Berberian, Griselda Rosanova, Maria Teresa Hernandez, Claudia Allaria, Adrian Landry, Luis Ceminara, Rodolfo |
AuthorAffiliation | Nurse Hospital Garrahan Hospital Garrahan |
AuthorAffiliation_xml | – name: Nurse Hospital Garrahan – name: Hospital Garrahan |
Author_xml | – sequence: 1 givenname: Maria Teresa surname: Rosanova fullname: Rosanova, Maria Teresa email: margris2@yahoo.com.ar organization: Hospital Garrahan, Buenos Aires, Argentina. margris2@yahoo.com.ar – sequence: 2 givenname: Adrian surname: Allaria fullname: Allaria, Adrian – sequence: 3 givenname: Alejandro surname: Santillan fullname: Santillan, Alejandro – sequence: 4 givenname: Claudia surname: Hernandez fullname: Hernandez, Claudia – sequence: 5 givenname: Luis surname: Landry fullname: Landry, Luis – sequence: 6 givenname: Rodolfo surname: Ceminara fullname: Ceminara, Rodolfo – sequence: 7 givenname: Griselda surname: Berberian fullname: Berberian, Griselda |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/20464331$$D View this record in MEDLINE/PubMed |
BookMark | eNp9kttq3DAQhkVJaA7tK7SGQnvlZGRJtnW5hB4CgYa0vRZjHXa19VqpZAfy9pXjJO1SKEJoGL5_NKcTcjCEwRLylsIZFRLOv1FOWdnWDVQAEgDqfEG8IMe0btqSM0kPsv0EHZGTlLYAlQAOL8lRBbzmjNFjcn3j08_CoR5DTIULsfCDs3r0YSjQjTYWGqPx4Q6TnnqMRZri2sb7jBV643sT7TDbq-wdRj_gK3LosE_29eN7Sn58-vj94kt59fXz5cXqqtSi5mOppRQoGTAnsWucNFwKXummNrI2CI4L01A0gmoDlREuO2vaNtgJLYwwhp2SyyWuCbhVt9HvMN6rgF49OEJcK4yj171VLVrbsZbPP3PW2U62nDmnhYW25Q3mWGdLrKS97YPahikOOXn10Gb1T5uz4MMiuI3h12TTqHY-adv3ONgwJdUwlidQtSyT7xZyjTmT3NswRtQzrVYzk2uq-J8E9qh8jN15nUfvfPbvCd7_JdhY7MdNCv00zy3tg80C6hhSitY9t4qCmlfpPzW-eaxx6nbWPOuedof9Bh_NwQI |
CitedBy_id | crossref_primary_10_1097_01_EPX_0000417997_16033_33 crossref_primary_10_1017_S1047951117002578 crossref_primary_10_1111_jocs_12243 crossref_primary_10_4103_ijccm_IJCCM_62_17 crossref_primary_10_1002_hsr2_1191 |
ContentType | Journal Article |
Copyright | COPYRIGHT 2009 Contexto This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
Copyright_xml | – notice: COPYRIGHT 2009 Contexto – notice: This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
DBID | CGR CUY CVF ECM EIF NPM AAYXX CITATION INF 7X8 GPN DOA |
DOI | 10.1590/S1413-86702009000600005 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed CrossRef ¡Informe! MEDLINE - Academic SciELO DOAJ Directory of Open Access Journals |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) CrossRef MEDLINE - Academic |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: DOA name: Directory of Open Access Journals url: http://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: ECM name: MEDLINE url: https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&site=ehost-live sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1678-4391 |
EndPage | 416 |
ExternalDocumentID | oai_doaj_org_article_8aeeb384c56443beb9843ffc5e08847a S1413_86702009000600005 A339118724 10_1590_S1413_86702009000600005 20464331 |
Genre | Journal Article |
GeographicLocations | Argentina |
GeographicLocations_xml | – name: Argentina |
GroupedDBID | --- --K .1- .FO 0R~ 0SF 1B1 1P~ 23N 2WC 4.4 457 53G 5GY 5VS 6I. 6J9 AACTN AAEDT AAEDW AAFTH AAIKJ AALRI AAXUO ABMAC ABXHO ACGFS ADBBV ADCUG ADEZE ADVLN AEGXH AENEX AEVXI AEXQZ AFCTW AFJKZ AFRHN AFTJW AGHFR AITUG AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ APOWU AZFZN BAWUL BCNDV C1A CGR CS3 CUY CVF DIK DU5 E3Z EBD EBS ECGQY ECM EIF EJD EMB EMOBN F5P FDB GROUPED_DOAJ GX1 HZ~ IAO IEA IHR IHW INF INH INR IPNFZ ITC IXB J1W KQ8 M41 NCXOZ NPM O-L O9- OD- OK1 OO. P6G PV9 RIG RNS ROL RPM RSC RZL SCD SES SSZ SV3 TR2 XH2 XSB Z5R AAYXX CITATION 7X8 GPN |
ID | FETCH-LOGICAL-c564t-c995a9303f9ab7f9d49542c76d96da0f45d71ad51cd02d5f6da6187ab5c5d5dd3 |
IEDL.DBID | DOA |
ISSN | 1413-8670 1678-4391 |
IngestDate | Tue Oct 22 15:16:23 EDT 2024 Tue Nov 19 21:56:11 EST 2024 Fri Jun 28 09:32:14 EDT 2024 Tue Nov 19 21:47:47 EST 2024 Wed Nov 13 00:55:04 EST 2024 Tue Aug 20 21:53:57 EDT 2024 Thu Sep 26 16:17:11 EDT 2024 Sat Sep 28 08:17:27 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 6 |
Keywords | cardiovascular surgery children Infections |
Language | English |
License | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. http://creativecommons.org/licenses/by-nc-nd/4.0 |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c564t-c995a9303f9ab7f9d49542c76d96da0f45d71ad51cd02d5f6da6187ab5c5d5dd3 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
OpenAccessLink | https://doaj.org/article/8aeeb384c56443beb9843ffc5e08847a |
PMID | 20464331 |
PQID | 733391283 |
PQPubID | 23479 |
PageCount | 3 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_8aeeb384c56443beb9843ffc5e08847a scielo_journals_S1413_86702009000600005 proquest_miscellaneous_733391283 gale_infotracmisc_A339118724 gale_infotracacademiconefile_A339118724 gale_healthsolutions_A339118724 crossref_primary_10_1590_S1413_86702009000600005 pubmed_primary_20464331 |
PublicationCentury | 2000 |
PublicationDate | 2009-12-01 |
PublicationDateYYYYMMDD | 2009-12-01 |
PublicationDate_xml | – month: 12 year: 2009 text: 2009-12-01 day: 01 |
PublicationDecade | 2000 |
PublicationPlace | Brazil |
PublicationPlace_xml | – name: Brazil |
PublicationTitle | The Brazilian journal of infectious diseases |
PublicationTitleAlternate | Braz J Infect Dis |
PublicationYear | 2009 |
Publisher | Contexto Brazilian Society of Infectious Diseases Elsevier |
Publisher_xml | – name: Contexto – name: Brazilian Society of Infectious Diseases – name: Elsevier |
References | Hehrlein, FW; Herrmann, H; Kraus, J 1972; 13 Mehta, PA; Cunningham, CK; Colella, CB; Alferis, G; Weiner, LB 2000; 19 Malviya, S; Voepel-Lewis, T; Siewert, M; Pandit, UA; Riegger, LQ; Tait, AR 2003; 98 Mrowczynski, W; Wojtalik, M; Zawadzka, D; Sharma, G; Henschke, J; Bartkowski, R; Pawelec-Wojtalik, M; Wodzinski, A; Westerski, P 2002; 10 Montgomery, VL; Strotman, JM; Ross, MP 2000; 28 Horan, TC; Gaynes, RP; Martone, WJ; Jarvis, WR; Enori, TG 1992; 20 McAnally, HB; Cutter, GR; Ruttenber, AJ; Clarke, D; Todd, JK 2001; 20 Ruttimann, UE 1994; 10 Allpress, AL; Rosenthal, GL; Goodrich, KM; Lupinetti, FM; Zerr, DM 2004; 23 Huddleston, CB 2004; 16 1996; 111 Wolters, U; Wolf, T; Stützer, H; Schroder, T 1996; 77 Pollock, EM; Ford-Jones, EL; Rebeyka, I; Mindorff, CM; Bohn, DJ; Edmonds, JF; Lightfoot, NE; Coles, J; Williams, WG; Trusler, GA; Geofrey, A; Barker, A 1990; 18 Edwards, MS; Baker, CJ 1983; 2 |
References_xml | – volume: 98 start-page: 628 year: 2003 end-page: 32 article-title: Risk factors for adverse postoperative outcomes in children presenting for cardiac surgery with upper respiratory tract infections publication-title: Anesthesiology contributor: fullname: Malviya, S; Voepel-Lewis, T; Siewert, M; Pandit, UA; Riegger, LQ; Tait, AR – volume: 2 start-page: 105 year: 1983 end-page: 9 article-title: Median sternotomy wound infections in children publication-title: Pediatr Infect Dis contributor: fullname: Edwards, MS; Baker, CJ – volume: 18 start-page: 378 year: 1990 end-page: 84 article-title: Early nosocomial infections in pediatric cardiovascular surgery patients publication-title: Crit Care Med contributor: fullname: Pollock, EM; Ford-Jones, EL; Rebeyka, I; Mindorff, CM; Bohn, DJ; Edmonds, JF; Lightfoot, NE; Coles, J; Williams, WG; Trusler, GA; Geofrey, A; Barker, A – volume: 20 start-page: 459 issue: 4 year: 2001 end-page: 62 article-title: Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection publication-title: Pediatr Infect Dis J contributor: fullname: McAnally, HB; Cutter, GR; Ruttenber, AJ; Clarke, D; Todd, JK – volume: 13 start-page: 390 year: 1972 end-page: 3 article-title: Complications of median sternotomy in cardiovascular surgery publication-title: J Cardiovasc Surg contributor: fullname: Hehrlein, FW; Herrmann, H; Kraus, J – volume: 77 start-page: 217 year: 1996 end-page: 22 article-title: ASA classification and perioperative variables as predictors of postoperative outcome publication-title: Br J Anaesth contributor: fullname: Wolters, U; Wolf, T; Stützer, H; Schroder, T – volume: 16 start-page: 108 issue: 1 year: 2004 end-page: 12 article-title: Mediastinal wound infections following pediatric cardiac surgery publication-title: Semin Thorac Cardiovasc Surg contributor: fullname: Huddleston, CB – volume: 23 start-page: 231 year: 2004 end-page: 4 article-title: Risk factors for surgical site infections after pediatric cardiovascular surgery publication-title: Pediatr Infect Dis J contributor: fullname: Allpress, AL; Rosenthal, GL; Goodrich, KM; Lupinetti, FM; Zerr, DM – volume: 28 start-page: 526 year: 2000 end-page: 31 article-title: Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery publication-title: Crit Care Med contributor: fullname: Montgomery, VL; Strotman, JM; Ross, MP – volume: 10 start-page: 19 year: 1994 end-page: 34 article-title: Statistical approaches to development and validation of predictive instruments publication-title: Crit Care Clin contributor: fullname: Ruttimann, UE – volume: 111 start-page: 1200 year: 1996 end-page: 7 article-title: Risk factors for deep sternal wound infection after sternotomy: a postoperative, multicenter study publication-title: J Thorac Cardiovasc Surg – volume: 19 start-page: 1000 issue: 10 year: 2000 end-page: 4 article-title: Risk factors for sternal wound and other infections in pediatric cardiac surgery patients publication-title: Pediatr Infect Dis J contributor: fullname: Mehta, PA; Cunningham, CK; Colella, CB; Alferis, G; Weiner, LB – volume: 10 start-page: 329 year: 2002 end-page: 33 article-title: Infection risk factors in pediatric cardiac surgery publication-title: Asian Cardiovasc Thorac Ann contributor: fullname: Mrowczynski, W; Wojtalik, M; Zawadzka, D; Sharma, G; Henschke, J; Bartkowski, R; Pawelec-Wojtalik, M; Wodzinski, A; Westerski, P – volume: 20 start-page: 271 year: 1992 end-page: 4 article-title: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections publication-title: Am J Infect Control contributor: fullname: Horan, TC; Gaynes, RP; Martone, WJ; Jarvis, WR; Enori, TG |
SSID | ssj0025040 |
Score | 1.8889859 |
Snippet | Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with... |
SourceID | doaj scielo proquest gale crossref pubmed |
SourceType | Open Website Open Access Repository Aggregation Database Index Database |
StartPage | 414 |
SubjectTerms | Adolescent Argentina Cardiac patients Cardiac Surgical Procedures - adverse effects cardiovascular surgery Child Child, Preschool children Cross Infection - etiology Development and progression Epinephrine Female Health aspects Humans Incidence Infant Infection Infections INFECTIOUS DISEASES Male Mortality Prospective Studies Risk Factors Statistics, Nonparametric |
Title | Risk factors for infection after cardiovascular surgery in children in Argentina |
URI | https://www.ncbi.nlm.nih.gov/pubmed/20464331 https://search.proquest.com/docview/733391283 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702009000600005&lng=en&tlng=en https://doaj.org/article/8aeeb384c56443beb9843ffc5e08847a |
Volume | 13 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://sdu.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1La9wwEBZtKKGX0qRps2260aGQk4hsWZZ83LZZUkpCyANyE3oZQosT4t3_3xlLXmJC6aU3I89BmtG80Mw3hHyBgK0VIQgmeOkY3JCauaKomdIOJM4r8EHDENsrdX6rv58gTM5m1BfWhCV44MS4Y20j5Hu68hI8t3DRNboSbetlBP2oVAqNeD0mUznVkjy1QoIpZthbmiu7ZMOPrwqw20zXiuPDwABIgoHLxC8N8P3PjfQTL_UKHdTvp75o-Za8yUEkXaTN75AXsdsl22f5mfwdubi863_RPEqHQlhKx5qrjg5DwamflKHSPjVHAxkdu7vxe4Gdmau7zu6Rm-XJ9bdTlkcnMOTTivmmkbYB99Q21qm2CZAHVaVXdWjqYHlbyaAKG2ThAy-DbGGxLrSyTnoZJMjuPdnq7ru4T2jQYBSdKp2wCI4ltLU1RAmx0hHB2qsZ4SPjzENCyDCYWQCvzcBr84zXM_IVGbwhR4jrYQEEb7Lgzb8EPyOHKB6T-kU3imoWAuQNZylhZ0cDBarq6tF6mzsO4FwIejWhPJhQgor5yW86XgGDv7AurYv3694ogUQQos3Ih3Q1Nocq8dFYiAJ2ke6Kydah_xtbPv4Ptnwir8s84oIXB2Rr9biOn8nLPqznoCI_fs4HRfkD_8QL3w |
link.rule.ids | 230,315,782,786,866,887,2106,27933,27934 |
linkProvider | Directory of Open Access Journals |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Risk+factors+for+infection+after+cardiovascular+surgery+in+children+in+Argentina&rft.jtitle=The+Brazilian+journal+of+infectious+diseases&rft.au=Rosanova%2C+Maria+Teresa&rft.au=Allaria%2C+Adrian&rft.au=Santillan%2C+Alejandro&rft.au=Hernandez%2C+Claudia&rft.date=2009-12-01&rft.eissn=1678-4391&rft.volume=13&rft.issue=6&rft.spage=414&rft.epage=416&rft_id=info:doi/10.1590%2FS1413-86702009000600005&rft.externalDBID=NO_FULL_TEXT |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1413-8670&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1413-8670&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1413-8670&client=summon |