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A= COLHIMENTO DE TRAVESTIS E TRANSEXUAIS NA ATENÇÃO PRIMÁRIA À SAÚDE: UMA REVISÃO BIBLIOGRÁFICA

A= CCOMMODATION OF TRANSVESTIS AND TRANSSEXUALS IN PRIMARY HEALTH CARE: A LITERATURE REVIEW=

Pedro Henrique = Lima Veras[1] * = Kaio Germano Sousa da Silva[2] * Luana Pereira Ibiapina Coêlho[3]  Eduardo Brito da Silva[4] * Raphaela Lau da Silva e Silva[5] * Victória Ribeiro de Sousa Marques[6]  Eudilene da Silva Mesquita[7] * Maria Gabriela de Sousa Bacelar[8] * Leiliane Barbosa de Aguiar[9]  Tiago Santos de Sousa[10]<= ![endif]> * Pedro Vitor Mendes Santos[11]<= ![endif]> * Pedro Henrique Medeiros de Andrade[12]<= ![endif]> * Maria Eduarda Leal de Carvalho Santos[13]<= ![endif]> * Vivienne Matos Gomes dos Santos[14]<= ![endif]>

RESUMO

Objetivo: analisar, conhecer sobre o acolhimento= de Travestis e Transexuais na Atenção Primária à Saúde. Mét= odos: trata-se de = uma pesquisa bibliográfica de caráter exploratório com abordagem qualitativa, na qual realizou-se uma busca no período de março a junho de 2020 em base de d= ados confiáveis, em português, dentre os quais Scientifc Electronic Library Online Brasil (SciELO), Google Scholar e o site do Ministério da Saúde podem ser citados, dentre outros periódicos de referênc= ia na área. Resultados: após análise detalhada das publicações, verificou-se 16 publicações exploravam realmente= o tema em questão, sendo utilizados para a construção da pesquisa. Consideraç= ões Finais: há um método principal para que o acolhimento seja qualificado e holístico, que é a capacitação do enfermeiro juntamente com a educação continuada para que ele ajude a mudar a realidade da vida do público Trans = no âmbito de saúde.

Palavras-chave: Acolhimento; Pessoas Transgênero; Atenção Primária à Saúde; Enfermagem; Equipe de Assistência ao Paciente.

 

ABSTRACT

Objective: to analyze and learn about the reception of Transvestites and Trans= sexuals in Primary Health Care. Methods: this is an exploratory bibliographic research with a qualitative approach, in which = a search was carried out from March to June 2020 in reliable database, in Portuguese, among which Scientif= c Electronic Library Online Brazil (SciELO), Google Scholar and the Ministry of Health website can be cited, among other reference periodicals in the= area. Results: after detailed analysis of the publications, it was found that= 16 publications actually explored the topic in que= stion, being used for the construction<= /span> of the research. Final Considerations: there is a main= method for the reception to be qualified and holistic, which is the training of nurses <= span class=3DSpellE>along with continuing edu= cation so that they help change the reality of life for the Trans public in the health field.

Keywords: User<= /span> Embracement; Transgender = Persons; Primary Health Care; Nursing; Patient Care Team.

 

INTRODUÇÃO

 <= /o:p>

      =       Mesmo com o propósito de um atendimento humanizado, muitas equipes de saúde não e= stão capacitadas a assistirem determinados grupos. Pessoas lésbicas, gays, bissexuais, transexuais, travestis, transgêneros, quee= r, intersexuais, assexuais e mais (LGBTQIA+) são as que mais relatam insatisfa= ção com o acolhimento, sendo importante ressaltar o estigma pré-existente no am= paro de travestis, homens e mulheres transexuais, por beirarem à marginalidade, resultante do preconceito e da ignorância social(1).<= /span>

      =       Diante do exposto, nota-se a necessidade da capacitação do enfermeiro ainda em sua graduação para saber lidar com estes casos. Enquanto acadêmico, o profissio= nal de enfermagem quase não possui acesso a informações sobre gênero e sexualid= ade, o que resulta em condutas errôneas na hora do atendimento e insatisfação dos pacientes Trans(2).

      =       A mudança corporal por meio de cirurgias plásticas clandestinas e o uso indiscriminado de hormônios e outros medicamentos é uma das causas de adoecimento desses indivíduos. Desde agosto de 2008, com o auxílio da porta= ria nº 457/SAS/MS, o Sistema Único de Saúde (SUS) oferta o amparo ao indivíduo = que deseja submeter-se à cirurgia de redesignação sexual e tratamento hormonal. Mesmo que de forma gratuita, ainda assim, o procedimento acaba não sendo acessível a todos desse grupo(3).

      =       A Portaria nº 1.820/09 do Ministério da Saúde (MS), que dispõe sobre os direi= tos e deveres dos usuários do SUS, assegura o direito de travestis e transexuais usarem seu nome social em toda a rede de saúde pública. A descriminalização= no atendimento desse grupo é a principal queixa trazida por eles, visto que mu= itos profissionais não respeitam o nome social e associam a saúde do indivíduo a= uma doença pré-existente(4).

      =       O interesse por este tema se deu diante da percepção do pesquisador quando realizava estágios em Unidades Básicas de Saúde (UBS). Foi percebida a baixa adesão na procura de atendimento médico e de enfermagem por mulheres e home= ns Trans, como também a inépcia na recepção dessas pessoas por alguns membros = da equipe de saúde.

      =       Nesse contexto, questiona-se: “estão os profissionais de enfermagem capacitados p= ara ofertarem um atendimento de qualidade para o público Trans?”. Para responder essa questão, objetiva-se de forma geral conhecer sobre o acolhimento de Travestis e Transexuais na Atenção Primária à Saúde (APS); e de forma específica analisar situações que possibilitem ajudar a humanizar o atendim= ento da população Trans na Atenção Primária à Saúde; auxiliar na reflexão sobre o conceito de gênero e corpo e sua importância na promoção do atendimento humanizado e qualificado para o público Trans; e identificar fatores que in= terferem positiva e negativamente na prática do atendimento de enfermagem com o mesmo público.

 

MÉTODOS

 <= /o:p>

      =       O presente estudo trata-se de uma pesquisa bibliográfica de caráter explorató= rio com abordagem qualitativa. A pesquisa bibliográfica, mesmo que exploratória, consiste na avaliação de uma situação concreta desconhecida em um determina= do local, alguém ou grupo, e deve ser baseada em estudos previamente feitos por algum indivíduo ou em pesquisas semelhantes que possam complementar a pesqu= isa pretendida. A procura por fontes documentais ou bibliográficas tornam-se imprescindíveis para a não-duplicação de esforços, a não "descoberta&q= uot; de ideias já expressas, a não-inclusão de "lugares-comuns" no trabalho(5).

      =       A pesquisa qualitativa responde a questões muito particulares. A mesma, dentro das ciências sociais, preocupa-se com um nível da realidade que não pode ser quantificado. Em outras palavras, ela trabalha com significados, aspirações, crenças, atitudes e valores, equivalente a um espaço mais profundo das rela= ções, dos processos e fenômenos que não podem ser diminuídos quando se operam em variáveis(6).

      =       Realizou-se uma busca, sendo o recorte temporal de 1999 a 2020, em base de dados confiáveis, em português, dentre os quais: Scientifc Electronic Library Online Brasil (SciELO), Google Scholar e o site do Ministério da Saúde podem ser citados, dentre outros periódicos de referênc= ia na área.

      =       Optou-se por pesquisas cujos artigos tinham como as palavras-chaves: LGBT, Atenção Primária à Saúde, acolhimento, humanização, e enfermagem, combinados entre = si. Foram utilizados livros-textos clássicos e recentes dentro da temática, considerando a relevância e o valor informativo do material.

 

RESULTADOS

 

      =       Foi identificado um total de 45 publicações nas bases de dados selecionadas seg= undo os descritores utilizados: acolhimento na atenção primária, acolhimento de enfermagem de travestis e transexuais, acolhimento de travestis e transexua= is na atenção básica (AB).

      =       Após análise detalhada das publicações, verificou-se que apenas 16 exploravam realmente o tema em questão, sendo utilizados para a construção da pesquisa. Destes, 43,75% encontrava-se na base de dados SciELO e 31,25% na base de da= dos Acadêmico e 25% em outras fontes.

      =       Os artigos selecionados foram lidos na íntegra e analisados detalhadamente para compor os dados da amostra da pesquisa, conforme estão apresentados na Tabe= la 1 abaixo.

 <= /o:p>

Tabela 1 – Disposiçã= o dos estudos utilizados na revisão integrativa no período de 1999-2020. Caxias –= MA, 2020.

Nº

Ano da Publicação<= /p>

Tipo de Estudo

Revista

Título do Trabalho=

1

1999

Qualitativo

Caderneta de Saúde Pública, RJ<= /o:p>

O acolhimento            e processos= de trabalho em saúde: o caso de Betim, Minas Gerais

2

2002

Qualitativo

Livro Ministério da Saúde=

Atenção Primária, Equilíbrio

entra necessidades de saúde, serviços e tecnologia

3

2009

Qualitativo

Revista Ciência e Saúde Coletiva

Acolhimento na Atenção Básica: reflexões éticas sobre a Atenção à Saúde dos Usuários<= o:p>

4

2012

Qualitativo

Psicologia: Ciência e

Profissão.

Saúde e População LGBT: Demandas e Especificidades em Questão=

5

2013

Descritivo

Cartilha Ministério da Saúde

Cartilha Política Nacional de Humanização - PNH

6

2013

Qualitativo

Revista Interac= ções

Homofobia, Cultura e Violências: a desinformação social

7

2015

Revisão de Literatura

Revista Saúde em Debate

Acolhimento na Atenção Primária a Saúde: uma revisão integrativa

8

2016

Descritivo

Caderneta Ministério da Saúde

Política Nacional de Saúde Integral de Lésbicas, Bissexuais, Travestis e Transexua= is

9

2017

Revisão de Literatura

Revista de Divulgação Científica Sena Aires

Ações da equipe de enfermagem na implementação da política de=

lésbicas, gays, bissexuais, travestis e transexuais – Revisão de Literatura.

10

2019

Quantitativo

Portal ANTRA

Dossiê Assassinatos    e

violências contra travestis e transexuais em 2019.

11

2019

Revisão Integrativa

Revista Brasileira de Medicina, Fami= lia e Comunidade

O acesso das transexuais à Atenção Primária à Saúde: uma revisão integrativ= a

12

2019

Revisão Integrativa

Revista Brasileira de Enfermagem

Assistência de Enfermagem à população trans: gêneros na perspectiva da prática profissional

13

2019

Revisão Bibliográfica

17º Congresso de Iniciação Científic= a da FASB

Atenção à saúde LGBT na atenção básica: revisão bibliográfica

14

2020

Qualitativo

Biblioteca Virtual de Saúde

Como acolher a população transexual na atenção primária à saúde?

15

2020

Qualitativo

Reserarch<= /span>, Society = and Development

A perspectiva do enfermeiro no cuidado diante da pessoa trans.

16

2020

Qualitativo

Revista Eletrônica=

Acervo Saúde

A humanização da atenção básica a saúde brasileira no atendimento de traves= tis e transexuais: uma revisão narrativa.

Legenda: Nº - número

Fonte: Elaborado pelo autor (2020).

 

Em relação ao ano de publicação dos artigos analisados, de acordo com a Tabela 02 abaixo, verifica-se que houve predomínio no ano de 2019 totalizando 25% dos artigos publicados. No entanto, houve equivalência entre os anos de 1999, 2002, 200= 9, 2012, 2015, 2016 e 2017 com 6,2% cada, no ano de 2013 foram encontrados 12,= 5% dos artigos relacionados com a temática do presente estudo e no ano de 2020= - 18,7% dos mesmos.

 

Tabela 2 – Disposiçã= o dos artigos de acordo com o ano de publicação, 1999-2020. Caxias – MA, 2020.

Ano da Publicação

N

%

1999<= /o:p>

1

6,2

2002<= /o:p>

1

6,2

2009<= /o:p>

1

6,2

2012<= /o:p>

1

6,2

2013<= /o:p>

2

12,5

2015<= /o:p>

1

6,2

2016<= /o:p>

1

6,2

2017<= /o:p>

1

6,2

2019<= /o:p>

4

25

2020<= /o:p>

3

18,7

Total=

16=

100

  Legenda: N - número; % - porcentagem.

  Fonte: Elaborado pelo autor (2020).

 

Todos os artigos pesquisados e analisados para o presente estudo são trabalhos originais, e = de acordo com a Tabela 03 abaixo, segundo a abordagem metodológica, foram encontradas 8 pesquisas com análise qualitativa, ou seja, 50% dos artigos analisados, 1 artigo com análise quantitativa dos dados (6,25%), 2 (12,5%) pesquisas com análise descritiva, 3 (18,75%) artigos são oriundos de revisão bibliográfica e 2 foram produzidos como revisão integrativa (12,5%).

 

Tabela 3 – Artigos relacionados com a temática em questão de acordo com a abordagem metodológi= ca. Caxias – MA, 2020.

Abordagem metodológica

N

%

Qualitativa

8

50

Quantitativa

1

6,25

Descritiva

2

12,5

Rev. Bbliográfica

3

18,75

Rev. Integrativa

2

12,5

Total

16

100

Legenda: N - número; % - porcentagem.

Fonte: Elaborado pelo autor (2020).

 

A Figura 2 a seguir, = diz relação à ações da enfermagem e das políticas públicas voltadas à saúde da população Trans e LGBTQIA+, ao acolhimento e APS e em relação à homofobia e= a violência contra essas populações.

 

Figura 1 – Ações de enfermagem e políticas voltadas à saúde + versus o acolhimento e APS versus homofobia e violência contra a população trans e LGBTQIA+. Caxias – MA, 202= 0.

<= /span>

Fonte: Elaborado pelo autor (2020).

 

      =      


De acordo com a Figur= a 1, segundo a temática de cada artigo, percebeu-se que 56,25% dos artigos pesquisados abordaram as ações de enfermagem e políticas de saúde voltadas à população Trans e LGBTQIA+, 31,25% abordaram sobre acolhimento e APS, e 12,= 5% abordaram sobre homofobia e violência contra a população LGBTQIA+, logo, verifica-se que as ações e as políticas de saúde voltadas à essas populações são consideradas ao mesmo tempo importantes, perante a comunidade científic= a da saúde, e da Atenção Básica.

 

DISCUSSÃO

                                          

      =       Em relação ao acolhimento na APS, reforça-se a importância do funcionamento e implementação do sistema. A Equipe de Saúde da Família acolhe populações vulneráveis e é onde eles têm como referência de assistência de saúde ou dirigem-se às UBS’s em busca de diagnósticos rotineiros(7). É na= APS que são organizados e racionalizados os recursos tanto básicos, como especi= alizados, voltados para a manutenção, prevenção e promoção de saúde(8).

      =       No que se refere à saúde da população LGBTQIA+, entende-se que houve uma grande necessidade na criação de leis para o atendimento dessa população, visto que ela possui demandas específicas. A Política Nacional de Saúde integral ao L= GBT surgiu em dezembro de 2011 no intuito de ofertar uma assistência sem ferir a orientação ou identidade de gênero do indivíduo, sendo importante ressaltar= que esse grupo sofre constantes tipos de intolerância no meio social em que está inserido(9).

      =       Em relação à mudança corporal por meio de cirurgias e hormonioterapia, nota-se que, na maioria das vezes, a mulher ou o homem transgênero possui a necessi= dade de mudança corporal para se sentir bem, o que deve ser levado em consideraç= ão no atendimento de enfermagem, sempre estando atento aos riscos que procedimentos cirúrgicos e suplementações hormonais podem trazer ao pacient= e(7,10).

      =       Quanto à capacitação do profissional enfermeiro para realizar o acolhimento do púb= lico Trans, observa-se que, durante a formação acadêmica desses profissionais, o conhecimento sobre gênero é quase zero. Nota-se também que as universidades ainda seguem um modelo moldado na heteronormatividade e no conservadorismo,= por mais que a saúde abrace os indivíduos de acordo com sua individualidade(1).

      =       Há uma grande importância no uso do nome social nos atendimentos nas unidades = de saúde e do manejo das situações típicas na vida da população LGBTQIA+, em especial às Trans. É ressaltado ainda que situações de desrespeito com o gê= nero fazem que os pacientes saiam da consulta deprimidos(as) e cabisbaixos(as). Subentende-se que o profissional enfermeiro deve trabalhar não só com a red= ução de danos físicos, mas principalmente com danos emocionais(1). Ob= serva-se a necessidade de construir um ambiente confortável para esse paciente, e is= so pode começar com uma simples pergunta: “Como você deseja ser chamado ou chamada?”

 

CONSIDERAÇÕES FINAIS<= o:p>

 

      =       Diante dos objetivos específicos, nota-se que os questionamentos em razão tiveram = uma resposta clara e coesa. Foram abordadas as análises de como ajudar no acolhimento do público Trans na APS, podendo ser citado a capacitação do profissional enfermeiro, também foi abraçada a problemática gênero e corpo, dando conceitos sobre transexualidade e travestilidade de maneira conclusa. Demonstraram-se fatores que mais interferem negativamente do que positivame= nte na consulta de enfermagem, abordando como corrigi-los e como qualificar a assistência.

      =       O estudo mostra que o enfermeiro é agente direto na promoção de saúde e preve= nção de doenças. A principal finalidade desta pesquisa é fazer com que eles conh= eçam e agucem a vontade de se capacitarem e aprenderem mais sobre gênero e fazer também com que profissionais da saúde de outras categorias se inspirem para produzirem trabalhos científicos com o tema em questão. É dever de profissionais e futuros profissionais da saúde possuírem uma visão neutra do ser humano e olharem com cuidado para suas necessidades pessoais.

      =       Percebeu-se, ainda, que há escassez de publicações a respeito da problemática, o que evidencia a importância da continuidade do estudo sobre o tema. Diante diss= o, a percepção da necessidade de mais pesquisas sobre esse público, recomenda-se= que futuros estudos abranjam temáticas plurais não menos importantes, podendo s= er citada a assistência de exame ginecológico para homens Trans e atenção do profissional urologista para/com a mulher Trans. É importante ressaltar que, mesmo frente à transição, esses indivíduos ainda possuem seus órgãos biológ= icos e merecem atenção tal qual pessoas cisgêneros (= cujas pessoas se identificam com o sexo que nasceram).

      =       Conclui-se, pois, que há um método principal para que o acolhimento seja qualificado e holístico. A capacitação do enfermeiro juntamente com a educação continuada soma para que ele ajude a mudar a realidade da vida do público Trans no âmb= ito de saúde. Sendo necessário, ainda, o engajamento dos órgãos públicos responsáveis nesse processo, fornecendo suporte técnico e recursos humanos suficientes, a fim de organizar e ofertar materiais de cunhos educativos e capacitivos.

 

REFERÊNCIAS

 

1.        &nbs= p;         Pereira LBC, Chazan ACS. O acesso das pessoas transexua= is e travestis à Atenção Primária à Saúde: uma revisão integrativa. R= evista Brasileira de Medicina de Famíl= ia e Comunidade [Internet]. 2019 [acesso em 24 ago 2020]; 14(41):1-16. Disponível em: https://rbmfc.org.br/rbmfc/articl= e/view/1795.

 

2.        &nbs= p;         Cardoso MR, Ferro LF. Saúde e População LGBT: Demandas e especificidades em questão. Revista Psicologia: Ciência e Profissão [Internet]. 2012 [aces= so em 23 ago 2020]; 32(2):552-563. Disponível em: <= span style=3D'color:windowtext;text-decoration:none;text-underline:none'>https:/= /www.scielo.br/j/pcp/a/8pg9SMjN4bhYXmYmxFwmJ8t/?lang=3Dpt.<= /o:p>

 

3.        &nbs= p;         Brasil. Ministério da Saúde. Portaria<= span style=3D'letter-spacing:.75pt'> nº 457, de 10 de agosto de 2008. [Internet]. Ministério da Saúde 2008 [acesso em 2 abr 2020].  Disponível    em: http://bvsms.saude.gov.br/bvs/saudelegis/sas/2008/prt0457_19_08_2008.= html.

 

4.        &nbs= p;         Brasil. Ministério da Saúde. Portaria nº 1.820, de 13 de agosto de 2009. [Internet]. Ministério da Saúde 2009 [acesso em 2 abr 2020]. Dis= ponível     em: https:/= /bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt1820_13_08_2009.html.

5.        &nbs= p;         Lakatos EM, Marconi, MA. Fundamen= tos de metodologia científica. 5. ed. São Paulo: Atlas; 2003.

 

6.        &nbs= p;         Minayo MCS. Pesquisa social: teoria, método e criatividade. 21. ed. Petrópolis: Editora Vozes; 2002.

 

7.        &nbs= p;         Ramos LS, Almeida MG, Ramos MVS, Machado EMC, Santos VO, Con= tarini MRF, et al. A humanização da atenção básica a saúde brasileira no atendimento de travestis e transsexu= ais: uma revisão narrativa. Rev Eletrô= nica Acervo Saúde [Internet]. 2020 [acesso em 26 ago 2020]; 44:1-7. Disponível em: https:/= /acervomais.com.br/index.php/saude/article/view/2770.

 

8.        &nbs= p;         Starfield B. Atenção primária: equilíbrio entre necessidades de saúde, serviços e tecnologia [Internet] Brasília:= UNESCO/Ministério da Saúde; 2002 [acesso em 3 abr 2020]. Disponível em: https:/= /www.nescon.medicina.ufmg.br/biblioteca/imagem/0253.pdf.

 

9.        &nbs= p;         Sousa LB. Atenção à saúde LGBT na Atenção Básica: revisão bibliográfica. 17º Congresso de Iniciação Cient= ífica da FASB [Internet]. 2019 [aces= so em 23 ago 2020]; 17(1):1-6. Disponível em: = http://= www.fasb.edu.br/revista/index.php/cic/article/view/406/348.=

 

10.        &nb= sp;     Rocon PC, Sodré F, Zamboni J, Rodrig= ues A, Roseiro MCFB. O que esperam pessoas trans do Sistema Único de Saúde? Interface - Comunicação, Saúde, Educação [Internet]. 2017 [acesso em 22 ago 2020]. Disponível em: https:/= /www.scielo.br/j/icse/a/V3t4XwP5dNGDHkcfXSfJDcj/?format=3Dhtml&lang=3Dp= t.

Autor correspondente

Kaio Germano Sousa Da Silva, Travessa São 654, Seriema, Caxias – MA, 65602= 90, telefone: +55 (99) 8817-3001, E-mail: kaiogsds@hotmail.com.

Submissão: 2021-07-16

Aprovado: 2021-11-30

 


[1] Centro Universitário Maurício de Nassau, Parnaíba, Brasi= l, ORCID: https://orcid.org/0000-0002-4221-8310. =

[2]= Faculdade do Vale Elvira Dayrell, Virginópol= is, Brasil, ORCID: https://orcid.org/0000-0003-4236-6230

[3] Universidade Estadual do Maranhão, Florianópolis, B= rasil, ORCID: https://orcid.org/0000-0002-2054-959X.

[4] Centro Universitário de Ciências e Tecnologia do Maranhão, Caxias, Brasil, = ORCID: https://orcid.org/0000-0002-8571-7806.

[5]= Centro Universitário de Ciências e Tecnologia do Maranhão, Caxias, Brasil, = ORCID: https://orcid.org/0000-0002-3525-6394

[6]= Centro Universitá= rio de Ciências e Tecnologia do Maranhão, Caxias, Brasil, ORCID: https://orcid.org/0000-0002-6512-1212

[7]= Centro Universitário de Ciências e Tecnologia do Maranhão, Caxias, Brasil, = ORCID: https://orcid.org/0000-0001-9894-090

[8]= Universidade Estadual do Maranhão, Caxias, Brasil, = ORCID: https://orcid.org/0000-0002-5521-5258

[9]= Faculdade Evangélica do Meio Norte, Caxias, Brasil, ORCID: https://orcid.org/0000-0001-7134-049X

[10] Faculdade Evangélica do Meio Norte, Caxias, Brasil,= Orcid: https://orcid.org/0000-0003-0003-7404.

[11] Universidade Estadual do Maranhão, Caxias, Brasil, = Orcid: https://orcid.org/0000-0002-2249-1440

[12] Centro Universi= tário de Ciências e Tecnologia do Maranhão, Caxias, Brasil, ORCID: https://orcid.org/0000-0003-1819-9540

[13] Centro Universitário de Ciências e Tecnologia do Maranhão, Caxias, Brasil, ORCID: https://orcid.org/0000-0003-3400-0570

[14] Universidade Federal do Ceará, Fortaleza, Brasil, <= span class=3DSpellE>Orcid: https://orcid.org/0000-0003-0531-1388

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https://doi.org/10.31011/reaid-2021-v.95-n.36-art.1179  Rev Enferm Atual In Derme  v. 95, n. 36, 2021  e-021177         =                     1

 

 

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