day month year URL * Paper extracted from doctoral dissertation "Neonatal Skin Safe : Mobile ap... more day month year URL * Paper extracted from doctoral dissertation "Neonatal Skin Safe : Mobile application to support the decision of nurses in the prevention of skin lesions in hospitalized newborns", presented to Universidade Federal
Introdução: Apesar de se reconhecer que a maior parte da dor experimentada pelo recém-nascido (RN... more Introdução: Apesar de se reconhecer que a maior parte da dor experimentada pelo recém-nascido (RN) pode ser prevenida ou substancialmente aliviada, inúmeros estudos continuam a revelar um tratamento insuficiente. Objectivos: Determinar a prevalência e gravidade da dor sentida pelo RN submetido a cuidados intensivos e a efectividade das medidas terapêuticas não farmacológicas. Metodologia: Numa UCIN de um Hospital Universitário estudaram-se 170 RN, ao longo de um ano, de que resultaram 844 observações. Os dados foram colhidos através da observação do RN, entrevista a pais e enfermeiros prestadores de cuidados e análise retrospectiva seriada dos registos intermitentes efectuados no processo clínico. A Intensidade da dor foi medida através da escala Echelle Douleur et d'Inconfort du Nouveau-Né (EDIN). Resultados: Em oito horas de observação, as 844 observações realizadas mostraram uma alta prevalência de dor (94,8%), com predomínio para a dor ligeira (72,7%). As intervenções não farmacológicas foram utilizadas em 88,7% das observações, com evidência para os posicionamentos, massagens e técnicas de conforto. Conclusões: Os enfermeiros usam com frequência e eficácia as medidas não farmacológicas de conforto, massagem e posicionamentos, mas outras técnicas deveriam ser incrementadas como o uso de sacarose, glicose ou aleitamento materno.
Sabendo-se que o lactente normal e saudável necessita apenas de suplementos de flúor em gotas e, ... more Sabendo-se que o lactente normal e saudável necessita apenas de suplementos de flúor em gotas e, eventualmente, de vitamina D quando alimentado exclusivamente ao peito, pretendia-se saber até que ponto estes dados cientificamente reconhecidos são aceites por profissionais de saúde (médicos, enfermeiros) e mães e traduzidos no primeiro quadrimestre de vida do lactente da região do Baixo Mondego. Foi delineada uma investigação descritiva, com um desenho longitudinal, com duas vertentes: uma que consta de um inquérito de opinião a médicos, enfermeiros e mães de lactentes com menos de um mês de vida sobre a suplementação vitamínica e mineral e outra de um formulário a aplicar a estas mães na primeira consulta do lactente no centro de saúde (diagnóstico precoce) e aquando da vacinação dos 2 e 4 meses, visando a caracterização da realidade prática da suplementação. O estudo decorreu em 12 centros de saúde e dos resultados regista-se que a suplementação dos lactentes reflecte as opiniões dos inquiridos, sendo poucos os que reconhecem as recomendações vigentes no país, excepto para a suplementação com ferro. As crenças das mães sobre os benefícios da suplementação espelham a imagem de um bebé ideal (bem nutrido, rosado, grande, com dentes fortes, inte-ligente e saudável). Provavelmente por isso, cerca de um quinto das mães dão doses de vitaminas acima do recomendado. A classe médica mostrou-se preponderante na iniciativa da suplementação. Tanto os clínicos gerais como os pediatras suplementam de igual modo, embora os últimos sejam mais resistentes à suplementação da vitamina C. Os gastos calculados para a suplementação, eventualmente desnecessária, seriam mais do que suficientes para a suplementação de todos os lactentes, segundo as recomendações vigentes no País.
Background: Body temperature is one of the most evaluated vital signs in pediatric health care fo... more Background: Body temperature is one of the most evaluated vital signs in pediatric health care for clinical assessment and guidance. Objectives: To evaluate the agreement between axillary and tympanic thermometry in children aged 6 to 36 months. Methodology: An observational and descriptive study was carried out in a level II hospital in Portugal. The thermometry protocol followed the guidelines of the Portuguese Directorate-General of Health. Results: A total of 331 children participated in the study. The difference between tympanic and axillary temperatures ranged from 0.00ºC to 1.40ºC, with a mean of 0.45ºC ± 0.30ºC and a median of 0.50ºC, an almost perfect agreement between both methods. An effect on the temperature value was observed according to the technique used in all variables studied. Conclusion: There is an almost perfect agreement between these two thermometry methods, not influencing clinical decision-making. Advantages of the tympanic method over the traditional axillary method include easy implementation and feasibility. Therefore, it can be routinely implemented in assessing temperature in children aged 6 to 36 months.
Objetivo: identifi car estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hosp... more Objetivo: identifi car estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hospitalizados, publicadas em periódicos científi cos no período de 2013 a 2018. Método: revisão integrativa de literatura realizada em dois momentos de busca em bases de dados, sendo selecionados 37 estudos publicados entre os anos de 2013 e 2018. Resultados: termorregulação, uso de antisséptico, uso de emolientes e limpeza do coto umbilical foram as recomendações mais encontradas. Entre as práticas baseadas em evidência, destacam-se as que previnem o risco de hipotermia, como o uso de saco de polietileno e o contato pele a pele, que respaldam a assistência e que garantem segurança no cuidado do paciente neonatal. Conclusão: a prevenção de lesões de pele é um tema relevante, entretanto, existe escassez de evidências robustas para sustentar, com segurança, as práticas de cuidados com o RN. Observa-se ainda que as evidências são insufi cientes para englobar o universo do tema, demonstrando que o cuidado com a pele é um tema que demanda investimentos e mais pesquisas.
Contexto: As crianças com multideficiência apresentam comportamentos inespecíficos de dor, devido... more Contexto: As crianças com multideficiência apresentam comportamentos inespecíficos de dor, devido às suas limitações cognitivas e neuromusculares. Estes comportamentos são difíceis de diagnosticar e interpretar, o que tem contribuído para o sub-tratamento da dor. Objetivo: Traduzir e validar semântica e culturalmente a escala Face, Legs, Activity, Cry, Consolability -Revised (FLACC-R) para Português e avaliar as suas propriedades psicométricas (validade e fiabilidade) em crianças com multideficiência dos 4 aos 18 anos. Metodologia: Estudo metodológico com o desenvolvimento de painéis e aplicação da escala de forma simultânea e independente a 40 crianças selecionadas de forma aleatória. Resultados: O processo de validação cultural foi fácil de obter, apesar da necessidade de consenso em relação a alguns termos dos indicadores face, atividade e consolabilidade. A consistência interna calculada pelo α de Cronbach foi de 0,76. O nível de concordância entre observadores variou entre um valor de Kappa de 0,69 e 0,76. O coeficiente de correlação intraclasse foi de 0,97. Conclusão: A FLACC-R/ PT quando utilizada em crianças com multideficiência dos 4 aos 18 anos internadas em serviços hospitalares revela ser válida e fiável. Porém, sugerem-se outros estudos e que a aplicação da escala seja feita por enfermeiros com formação em avaliação de dor.
Objective to determine the content validity of Nursing interventions to prevent skin lesions in h... more Objective to determine the content validity of Nursing interventions to prevent skin lesions in hospitalized newborns, with an experts committee. Method a content validation methodological research study conducted by means of an online form between April and June 2018. The participants were five nurses from different Brazilian regions, with experience in the neonatal area: two professors, two stomatherapists, and one assistance nurse. The interventions evaluated were constructed based on scientific knowledge, resorting to the literature based on the available evidence, technical manuals and books, in addition to the researchers' experience in care for the newborn. The content was validated in two rounds. First, each intervention and its set were evaluated regarding agreement, using a minimum Committee Agreement Index (CAI) of 80%. Subsequently, a minimum Content Validity Index (CVI) of 0.8 was used to validate the clarity and relevance of the interventions. Results a total of 29...
Paediatric Pain in Portugal: Results of Awareness-Raising and Training
Introduction: Sensitization and formation of health professionals in the area of pain was a natio... more Introduction: Sensitization and formation of health professionals in the area of pain was a national strategic option since 2001, but its impact on care is unknown. The aim was to evaluate the impact of sensitizing and formatting events conducted over the past ten years in the care provided by nurses for hospitalized children, in the area of pain. Methods and materials: An observational, descriptive, cross-sectional retrospective study of records within 24 hours, performed by nurses in the clinical process of children until the 18 years. Results: Of the 830 cases analyzed clinical history of pain was recorded at 47.8%, being well prepared and performed in the first 24 hours of hospitalization. Within eight hours the record of the pain assessment was 36.7%. The choice of the pain scale was adequate in 59.3% of cases. Approximately 79.9% of the children showed no or mild pain was 12.5%. There was a good pain management in 92.5% of the children. In about 42.2% of the cases were no repo...
Background and Aims: Although it has been recognized that most of the pain experienced by the new... more Background and Aims: Although it has been recognized that most of the pain experienced by the newborn can be prevented or substantially relieved. This study aimed to determine the prevalence and severity of the pain experienced by newborns receiving intensive care, as well as the effectiveness of the non-pharmacological therapeutic measures. Methods: At a Neonatal Intensive Care Unit, 170 newborns were studied during one year, resulting in 844 observations. Data were collected based on newborn observation, an interview with parents and nurses who provide care, and a retrospective analysis of the clinical records. Pain intensity was measured using the Echelle Douleur et d'Inconfort du Nouveau-Né. Results: During 8 hours of observation, 94.8% of the 844 observations showed a high prevalence of pain, mostly mild pain (72.7%). Non-pharmacological interventions were applied to 88.7% of the observations, especially related to positioning, massage and comfort techniques. The prevalence of the daily assessment of pain intensity was 21.7%, and the intensity of the pain experienced by the newborn was not influenced by the frequency of pain assessment or its treatment. Conclusions: Despite the high prevalence of pain, about 3 / 4 of the observations show that newborns experience mild pain or no pain at all. The assessment of pain intensity should be promoted and considered when deciding on the treatment. Nurses use nonpharmacological measures of comfort, massage and positioning often and effectively, but other techniques should also be promoted, such as the use of sucrose, glucose or maternal breastfeeding.
43rd Biennial Convention (07 November - 11 November 2015), Mar 21, 2016
Background and aims As pain is both subjective and multidimensional, tools that allow the assessm... more Background and aims As pain is both subjective and multidimensional, tools that allow the assessment of other dimensions of pain besides intensity are needed. As far as we know, no multidimensional tool is available to assess pain in Portuguese children. The Adolescent Pediatric Pain Tool (APPT) is a comprehensive self-report measure that is widely used in North-american children diagnosed with a variety of conditions. 1 The APPT was originally developed to assess pain in English-speaking hospitalized children aged 8-17 years old. APPT assesses not only pain intensity, but also pain location and pain quality. It has three components: the Body Outline Diagram, the Word Graphic Rating Scale and a List of pain descriptors. The aim of this study is to examine the psychometric properties of the Portuguese version of the Adolescent Pediatric Pain Tool (APPT-PT) in Portuguese children with cancer. Methods Prospective methodological study with 150 Portuguese children with cancer aged 8-17 years-old. Data collection occurred both in outpatients and inpatients. Hospitalized children reported their pain during a maximum of 4 times. Children completed the Portuguese version of the APPT according to their pain at the moment or their last pain episode. At the same time, the Visual Analogue Scale (VAS) was used to report pain intensity.
International Journal of Environmental Research and Public Health
The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a... more The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a few instruments measure nursing students’ autonomy, and the PALOP® Scale is one of them. This study aimed to semantically and culturally adapt the PALOP® Scale to European Portuguese and assess the psychometric properties of a short version. A methodological study was conducted with 530 second and fourth-year undergraduate nursing students. Content validity was assessed using exploratory and discriminant factor analysis, and reliability was determined through analyses of internal consistency, temporal stability, and floor and ceiling effects. The analysis of the psychometric properties of a short version of the PALOP®—PT Scale revealed complete agreement (100%) among panel members for content validity. The scale also showed discriminative capacity among second- and fourth-year students (t (528) = −7.907, p < 0.001) with a five-factor structure, with a total explained variance of 57.2...
Quality of life among children with cancer: agreement between child and parent reports Qualidade ... more Quality of life among children with cancer: agreement between child and parent reports Qualidade de vida em crianças com câncer: concordância entre crianças e pais Calidad de vida de niños con cáncer: concordancia entre niños y padres
day month year URL * Paper extracted from doctoral dissertation "Neonatal Skin Safe : Mobile ap... more day month year URL * Paper extracted from doctoral dissertation "Neonatal Skin Safe : Mobile application to support the decision of nurses in the prevention of skin lesions in hospitalized newborns", presented to Universidade Federal
Introdução: Apesar de se reconhecer que a maior parte da dor experimentada pelo recém-nascido (RN... more Introdução: Apesar de se reconhecer que a maior parte da dor experimentada pelo recém-nascido (RN) pode ser prevenida ou substancialmente aliviada, inúmeros estudos continuam a revelar um tratamento insuficiente. Objectivos: Determinar a prevalência e gravidade da dor sentida pelo RN submetido a cuidados intensivos e a efectividade das medidas terapêuticas não farmacológicas. Metodologia: Numa UCIN de um Hospital Universitário estudaram-se 170 RN, ao longo de um ano, de que resultaram 844 observações. Os dados foram colhidos através da observação do RN, entrevista a pais e enfermeiros prestadores de cuidados e análise retrospectiva seriada dos registos intermitentes efectuados no processo clínico. A Intensidade da dor foi medida através da escala Echelle Douleur et d'Inconfort du Nouveau-Né (EDIN). Resultados: Em oito horas de observação, as 844 observações realizadas mostraram uma alta prevalência de dor (94,8%), com predomínio para a dor ligeira (72,7%). As intervenções não farmacológicas foram utilizadas em 88,7% das observações, com evidência para os posicionamentos, massagens e técnicas de conforto. Conclusões: Os enfermeiros usam com frequência e eficácia as medidas não farmacológicas de conforto, massagem e posicionamentos, mas outras técnicas deveriam ser incrementadas como o uso de sacarose, glicose ou aleitamento materno.
Sabendo-se que o lactente normal e saudável necessita apenas de suplementos de flúor em gotas e, ... more Sabendo-se que o lactente normal e saudável necessita apenas de suplementos de flúor em gotas e, eventualmente, de vitamina D quando alimentado exclusivamente ao peito, pretendia-se saber até que ponto estes dados cientificamente reconhecidos são aceites por profissionais de saúde (médicos, enfermeiros) e mães e traduzidos no primeiro quadrimestre de vida do lactente da região do Baixo Mondego. Foi delineada uma investigação descritiva, com um desenho longitudinal, com duas vertentes: uma que consta de um inquérito de opinião a médicos, enfermeiros e mães de lactentes com menos de um mês de vida sobre a suplementação vitamínica e mineral e outra de um formulário a aplicar a estas mães na primeira consulta do lactente no centro de saúde (diagnóstico precoce) e aquando da vacinação dos 2 e 4 meses, visando a caracterização da realidade prática da suplementação. O estudo decorreu em 12 centros de saúde e dos resultados regista-se que a suplementação dos lactentes reflecte as opiniões dos inquiridos, sendo poucos os que reconhecem as recomendações vigentes no país, excepto para a suplementação com ferro. As crenças das mães sobre os benefícios da suplementação espelham a imagem de um bebé ideal (bem nutrido, rosado, grande, com dentes fortes, inte-ligente e saudável). Provavelmente por isso, cerca de um quinto das mães dão doses de vitaminas acima do recomendado. A classe médica mostrou-se preponderante na iniciativa da suplementação. Tanto os clínicos gerais como os pediatras suplementam de igual modo, embora os últimos sejam mais resistentes à suplementação da vitamina C. Os gastos calculados para a suplementação, eventualmente desnecessária, seriam mais do que suficientes para a suplementação de todos os lactentes, segundo as recomendações vigentes no País.
Background: Body temperature is one of the most evaluated vital signs in pediatric health care fo... more Background: Body temperature is one of the most evaluated vital signs in pediatric health care for clinical assessment and guidance. Objectives: To evaluate the agreement between axillary and tympanic thermometry in children aged 6 to 36 months. Methodology: An observational and descriptive study was carried out in a level II hospital in Portugal. The thermometry protocol followed the guidelines of the Portuguese Directorate-General of Health. Results: A total of 331 children participated in the study. The difference between tympanic and axillary temperatures ranged from 0.00ºC to 1.40ºC, with a mean of 0.45ºC ± 0.30ºC and a median of 0.50ºC, an almost perfect agreement between both methods. An effect on the temperature value was observed according to the technique used in all variables studied. Conclusion: There is an almost perfect agreement between these two thermometry methods, not influencing clinical decision-making. Advantages of the tympanic method over the traditional axillary method include easy implementation and feasibility. Therefore, it can be routinely implemented in assessing temperature in children aged 6 to 36 months.
Objetivo: identifi car estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hosp... more Objetivo: identifi car estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hospitalizados, publicadas em periódicos científi cos no período de 2013 a 2018. Método: revisão integrativa de literatura realizada em dois momentos de busca em bases de dados, sendo selecionados 37 estudos publicados entre os anos de 2013 e 2018. Resultados: termorregulação, uso de antisséptico, uso de emolientes e limpeza do coto umbilical foram as recomendações mais encontradas. Entre as práticas baseadas em evidência, destacam-se as que previnem o risco de hipotermia, como o uso de saco de polietileno e o contato pele a pele, que respaldam a assistência e que garantem segurança no cuidado do paciente neonatal. Conclusão: a prevenção de lesões de pele é um tema relevante, entretanto, existe escassez de evidências robustas para sustentar, com segurança, as práticas de cuidados com o RN. Observa-se ainda que as evidências são insufi cientes para englobar o universo do tema, demonstrando que o cuidado com a pele é um tema que demanda investimentos e mais pesquisas.
Contexto: As crianças com multideficiência apresentam comportamentos inespecíficos de dor, devido... more Contexto: As crianças com multideficiência apresentam comportamentos inespecíficos de dor, devido às suas limitações cognitivas e neuromusculares. Estes comportamentos são difíceis de diagnosticar e interpretar, o que tem contribuído para o sub-tratamento da dor. Objetivo: Traduzir e validar semântica e culturalmente a escala Face, Legs, Activity, Cry, Consolability -Revised (FLACC-R) para Português e avaliar as suas propriedades psicométricas (validade e fiabilidade) em crianças com multideficiência dos 4 aos 18 anos. Metodologia: Estudo metodológico com o desenvolvimento de painéis e aplicação da escala de forma simultânea e independente a 40 crianças selecionadas de forma aleatória. Resultados: O processo de validação cultural foi fácil de obter, apesar da necessidade de consenso em relação a alguns termos dos indicadores face, atividade e consolabilidade. A consistência interna calculada pelo α de Cronbach foi de 0,76. O nível de concordância entre observadores variou entre um valor de Kappa de 0,69 e 0,76. O coeficiente de correlação intraclasse foi de 0,97. Conclusão: A FLACC-R/ PT quando utilizada em crianças com multideficiência dos 4 aos 18 anos internadas em serviços hospitalares revela ser válida e fiável. Porém, sugerem-se outros estudos e que a aplicação da escala seja feita por enfermeiros com formação em avaliação de dor.
Objective to determine the content validity of Nursing interventions to prevent skin lesions in h... more Objective to determine the content validity of Nursing interventions to prevent skin lesions in hospitalized newborns, with an experts committee. Method a content validation methodological research study conducted by means of an online form between April and June 2018. The participants were five nurses from different Brazilian regions, with experience in the neonatal area: two professors, two stomatherapists, and one assistance nurse. The interventions evaluated were constructed based on scientific knowledge, resorting to the literature based on the available evidence, technical manuals and books, in addition to the researchers' experience in care for the newborn. The content was validated in two rounds. First, each intervention and its set were evaluated regarding agreement, using a minimum Committee Agreement Index (CAI) of 80%. Subsequently, a minimum Content Validity Index (CVI) of 0.8 was used to validate the clarity and relevance of the interventions. Results a total of 29...
Paediatric Pain in Portugal: Results of Awareness-Raising and Training
Introduction: Sensitization and formation of health professionals in the area of pain was a natio... more Introduction: Sensitization and formation of health professionals in the area of pain was a national strategic option since 2001, but its impact on care is unknown. The aim was to evaluate the impact of sensitizing and formatting events conducted over the past ten years in the care provided by nurses for hospitalized children, in the area of pain. Methods and materials: An observational, descriptive, cross-sectional retrospective study of records within 24 hours, performed by nurses in the clinical process of children until the 18 years. Results: Of the 830 cases analyzed clinical history of pain was recorded at 47.8%, being well prepared and performed in the first 24 hours of hospitalization. Within eight hours the record of the pain assessment was 36.7%. The choice of the pain scale was adequate in 59.3% of cases. Approximately 79.9% of the children showed no or mild pain was 12.5%. There was a good pain management in 92.5% of the children. In about 42.2% of the cases were no repo...
Background and Aims: Although it has been recognized that most of the pain experienced by the new... more Background and Aims: Although it has been recognized that most of the pain experienced by the newborn can be prevented or substantially relieved. This study aimed to determine the prevalence and severity of the pain experienced by newborns receiving intensive care, as well as the effectiveness of the non-pharmacological therapeutic measures. Methods: At a Neonatal Intensive Care Unit, 170 newborns were studied during one year, resulting in 844 observations. Data were collected based on newborn observation, an interview with parents and nurses who provide care, and a retrospective analysis of the clinical records. Pain intensity was measured using the Echelle Douleur et d'Inconfort du Nouveau-Né. Results: During 8 hours of observation, 94.8% of the 844 observations showed a high prevalence of pain, mostly mild pain (72.7%). Non-pharmacological interventions were applied to 88.7% of the observations, especially related to positioning, massage and comfort techniques. The prevalence of the daily assessment of pain intensity was 21.7%, and the intensity of the pain experienced by the newborn was not influenced by the frequency of pain assessment or its treatment. Conclusions: Despite the high prevalence of pain, about 3 / 4 of the observations show that newborns experience mild pain or no pain at all. The assessment of pain intensity should be promoted and considered when deciding on the treatment. Nurses use nonpharmacological measures of comfort, massage and positioning often and effectively, but other techniques should also be promoted, such as the use of sucrose, glucose or maternal breastfeeding.
43rd Biennial Convention (07 November - 11 November 2015), Mar 21, 2016
Background and aims As pain is both subjective and multidimensional, tools that allow the assessm... more Background and aims As pain is both subjective and multidimensional, tools that allow the assessment of other dimensions of pain besides intensity are needed. As far as we know, no multidimensional tool is available to assess pain in Portuguese children. The Adolescent Pediatric Pain Tool (APPT) is a comprehensive self-report measure that is widely used in North-american children diagnosed with a variety of conditions. 1 The APPT was originally developed to assess pain in English-speaking hospitalized children aged 8-17 years old. APPT assesses not only pain intensity, but also pain location and pain quality. It has three components: the Body Outline Diagram, the Word Graphic Rating Scale and a List of pain descriptors. The aim of this study is to examine the psychometric properties of the Portuguese version of the Adolescent Pediatric Pain Tool (APPT-PT) in Portuguese children with cancer. Methods Prospective methodological study with 150 Portuguese children with cancer aged 8-17 years-old. Data collection occurred both in outpatients and inpatients. Hospitalized children reported their pain during a maximum of 4 times. Children completed the Portuguese version of the APPT according to their pain at the moment or their last pain episode. At the same time, the Visual Analogue Scale (VAS) was used to report pain intensity.
International Journal of Environmental Research and Public Health
The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a... more The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a few instruments measure nursing students’ autonomy, and the PALOP® Scale is one of them. This study aimed to semantically and culturally adapt the PALOP® Scale to European Portuguese and assess the psychometric properties of a short version. A methodological study was conducted with 530 second and fourth-year undergraduate nursing students. Content validity was assessed using exploratory and discriminant factor analysis, and reliability was determined through analyses of internal consistency, temporal stability, and floor and ceiling effects. The analysis of the psychometric properties of a short version of the PALOP®—PT Scale revealed complete agreement (100%) among panel members for content validity. The scale also showed discriminative capacity among second- and fourth-year students (t (528) = −7.907, p < 0.001) with a five-factor structure, with a total explained variance of 57.2...
Quality of life among children with cancer: agreement between child and parent reports Qualidade ... more Quality of life among children with cancer: agreement between child and parent reports Qualidade de vida em crianças com câncer: concordância entre crianças e pais Calidad de vida de niños con cáncer: concordancia entre niños y padres
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