Rev Paul Pediatr. 2014;32(3)î
REVISTA PAULISTA DE PEDIATRIA www.spsp.org.br
$57,*225,*,1$/
3HUÀOGHFULDQoDVHDGROHVFHQWHVLQWHUQDGRVHP8QLGDGHGH 7UDWDPHQWRGH4XHLPDGRVGRLQWHULRUGRHVWDGRGH6mR3DXOR☆ 7HUH]LQKD6RDUHV%LVFHJOLD /DULVVD'HOi]DUL%HQDWLD5DIDHOD6SHUDQGLR)DULDD 7DtV5RPDQR%RHLUDD)HOLSH%LVFHJOL&LGb5LFDUGR$OHVVDQGUR7HL[HLUD*RQVDJDD a b
Faculdades Integradas Padre Albino (FIPA), Catanduva, SP, Brasil Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brasil
5HFHELGRHPGHGH]HPEURGHDFHLWRHPGHIHYHUHLURGH
PALAVRAS-CHAVE 4XHLPDGXUDV HSLGHPLRORJLD &DXVDVH[WHUQDV &ULDQoD $GROHVFHQWH
Resumo Objetivo:'HVFUHYHURSHUILOGHFULDQoDVHDGROHVFHQWHVYtWLPDVGHTXHLPDGXUDLQWHUQDGRV QR+RVSLWDO(VFROD3DGUH$OELQR+(3$ HP&DWDQGXYD63 Métodos: (VWXGR WUDQVYHUVDO UHWURVSHFWLYR TXH UHYLVRX SURQWXiULRV GH SDFLHQWHV PHQRUHVGHDQRVLQWHUQDGRVQD8QLGDGHGH7HUDSLDGH4XHLPDGRVGR+(3$GHD )RUDPDQRWDGRVHPILFKDVLQGLYLGXDLVGDGRVGHPRJUiILFRVDJHQWHVFDXVDGRUHVGD TXHLPDGXUDFDUDFWHUtVWLFDVGDVOHV}HVFRPSOLFDo}HVLQWHUYHQo}HVFLU~UJLFDVWHPSRGH LQWHUQDomRHGHVIHFKRGRVFDVRV$HVWDWtVWLFDIRLGHVFULWLYD Resultados:)RUDPLQFOXtGRVQRHVWXGRSDFLHQWHVFRPSURQWXiULRVFRPSOHWRV2VH[R SUHYDOHQWHIRLRPDVFXOLQR HDIDL[DHWiULDSUHGRPLQDQWHIRLDGHPHQRUHVGH DQRV 2GRPLFtOLRIRLRORFDOGHGRVDFLGHQWHVHGHOHVDFRQWHFHUDP FRP OtTXLGRV DTXHFLGRV$ PpGLD GD VXSHUItFLH FRUSyUHD TXHLPDGD IRL H DV UHJL}HV PDLV OHVDGDV IRUDP R WyUD[ H RV PHPEURV 4XHLPDGXUDV GH SULPHLUR H VHJXQGR JUDXV DFRQWHFHUDPHPGRVFDVRV,QIHFomRVHFXQGiULDRFRUUHXHPGRVSDFLHQWHVH HPSURFHGLPHQWRVFLU~UJLFRV2WHPSRPpGLRGHLQWHUQDomRIRLGLDV$PRUWDOLGDGH IRLGH Conclusões:$ FRQVWDWDomR GH TXH DV FULDQoDV HP LGDGH SUpHVFRODU IRUDP DV SULQFLSDLV YtWLPDV GDV TXHLPDGXUDV RULJLQDGDV HP GRPLFtOLR UHSUHVHQWDQGR D PDLRU SDUWH GR FRQWLQJHQWH GH KRVSLWDOL]Do}HV LQIDQWRMXYHQLV SRU HVWD FDXVD GHPRQVWUD D QHFHVVLGDGH GHGHVHQYROYHUDo}HVGHVHQVLELOL]DomRHRULHQWDomRDRVSDLVHjSRSXODomRHPJHUDOSRU PHLRGHSURJUDPDVHGXFDWLYRVHFDPSDQKDVGHSUHYHQomR 6RFLHGDGHGH3HGLDWULDGH6mR3DXOR3XEOLFDGRSRU(OVHYLHU(GLWRUD/WGD Este é um artigo Open Access sob a licença de CC BY-NC-ND
(VWXGRFRQGX]LGRQDV)DFXOGDGHV,QWHJUDGDV3DGUH$OELQR&DWDQGXYD63%UDVLO
$XWRUSDUDFRUUHVSRQGrQFLD E-mailWHUH]LQKDELVFHJOL#\DKRRFRPEU76%LVFHJOL
☆
6RFLHGDGH GH 3HGLDWULD GH 6mR 3DXOR 3XEOLFDGR SRU (OVHYLHU (GLWRUD /WGD Este é um artigo Open Access sob a licença de CC BY-NC-ND KWWSG[GRLRUJ
.( 60%
Área corporal queimada
)LJXUD 'LVWULEXLomRGDVFULDQoDVHDGROHVFHQWHVLQWHUQDGRV QR+RVSLWDO(VFROD3DGUH$OELQRGH&DWDQGXYD63QRSHUtRGR GHDGHDFRUGRFRPDH[WHQVmRGDiUHDFRUSRUDO TXHLPDGD
LUmRDyELWRGLUHWDRXLQGLUHWDPHQWHSRUVXDVOHV}HV (QWUHWDQWRRVGDGRVHVWDWtVWLFRVQDFLRQDLVVREUHDVOHV}HV SRU TXHLPDGXUDV VmR HVFDVVRV GHPRQVWUDQGR LPSRUWDQWH VXEQRWLILFDomR /LWHUDWXUD HVSHFLDOL]DGD VREUH R WHPD UHODWD TXH DV FULDQoDV FRPS}HP XP JUXSR GH SDFLHQWHV GLIHUHQFLDGRV KDMD YLVWD DSUHVHQWDUHP HSLGHPLRORJLD SUySULD TXDQGR FRPSDUDGDV DRV DGXOWRV ILVLRORJLD UHVSRVWDV LPXQH H LQIODPDWyULD HVSHFtILFDV H QHFHVVLWDUHP GH FXLGDGRV HVSHFLDLV HP UHODomR DR WUDWDPHQWR H j UHLQWHJUDomR DR FRQYtYLRVRFLDO13 $DQiOLVHGRVUHVXOWDGRVGRSUHVHQWHHVWXGRDSRQWRXSUHGRPtQLR GRV DFLGHQWHV QR VH[R PDVFXOLQR (VWXGR UHDOL]DGR QXP +RVSLWDO 8QLYHUVLWiULR GH &XULWLED 35 QR SHUtRGR GH MXOKR GH D IHYHUHLUR GH FRP SDFLHQWHVPHQRUHVGHDQRV1UHYHORXSUHYDOrQFLDVHPH OKDQWH GH PHQLQRV 'D PHVPD IRUPD 0DUWLQV H $QGUDGH14 TXH DQDOLVDUDP FDVRV GH PHQRUHV GH DQRV YtWLPDV GH TXHLPDGXUD DWHQGLGRV HP FLQFR KRVSLWDLV GH /RQGULQD 35 HP GHPRQVWUDUDP IUHTXrQFLD VLPLODU QR VH[R PDVFXOLQR -i$OPHLGD et al15 HP HVWXGR GHVFULWLYR TXDQWLWDWLYR GH FULDQoDV TXHLPDGDV H LQWHUQDGDV QR &HQWUR GH 7UDWDPHQWR GH 4XHLPDGRV GH XPLQVWLWXWRGH)RUWDOH]D&( QRVPHVHVGHDEULOHPDLR GH REVHUYDUDP SUHGRPtQLR GH PHQLQDV (VWD ~OWLPD REVHUYDomR FRP SHUILO GLYHUVR GRV GHPDLV HVWXGRV FLWDGRV SRGH VHU H[SOLFDGD GHYLGR j FDVXtVWLFD UHGX]LGD 2 PDLRU Q~PHUR GH FDVRV HP LQGLYtGXRV GR VH[R PDVFXOLQRSRGHVHUH[SOLFDGRSRUPDLRUH[SRVLomRRFXSDFLRQDOH GRPpVWLFDSHORGLIHUHQWHFRPSRUWDPHQWRGRVVH[RVHSRU IDWRUHV FXOWXUDLV TXH SURSRUFLRQDP PDLRU OLEHUGDGH DRV KRPHQVHPDLVYLJLOkQFLDjVPXOKHUHV17 5HODWLYR j IDL[D HWiULD D DWXDO LQYHVWLJDomR REVHUYRX PDLRU Q~PHUR GH FDVRV HP FULDQoDV PHQRUHV GH DQRV 3UHYDOrQFLD VHPHOKDQWH HP PHQRUHV GH TXDWUR DQRV IRLGHVFULWDSRU9LDQDHWDODQDOLVDQGRSURQWXiULRVGHFULDQoDVGHDDQRVLQWHUQDGDVQR3URQWR 6RFRUURSDUD4XHLPDGXUDVGH*RLkQLD*2 QRSHUtRGRGH D3XEOLFDomRUHFHQWHGH)HUQDQGHVHWDO2TXH WUDWDGHFULDQoDVHDGROHVFHQWHVYtWLPDVGHTXHLPDGXUDV DGPLWLGDV QXP +RVSLWDO GH 5HIHUrQFLD GH -RmR 3HVVRD 3% GHMDQHLURGHDGH]HPEURGHUHYHORXTXH DSUR[LPDGDPHQWH GRV LQGLYtGXRV HVWXGDGRV WLQKDP LGDGH LQIHULRU D VHWH DQRV R TXH WDPEpP IRL FRQVWDWDGR SRU1LJURHWDOQR3DUDQi12VIDWRUHVTXHSRGHPMXVWLILFDU D PDLRU SUHYDOrQFLD GH DFLGHQWHV QHVVD IDVH SUHFRFH GD YLGD HVWmR UHODFLRQDGRV jV FDUDFWHUtVWLFDV GR GHVHQYROYLPHQWR LQIDQWLO SRLV DV FULDQoDV VmR LPDWXUDV H FXULRVDV FRP UHODomR DR PHLR DPELHQWH ILFDQGR PDLV H[SRVWDV jV VLWXDo}HVGHSHULJRRTXHpSRWHQFLDOL]DGRSHODVXSHUYLVmR LQDGHTXDGD14 $ 8QLGDGH GH 4XHLPDGRV GR +(3$ p XPD UHIHUrQFLD GH DWHQGLPHQWRHVSHFLDOL]DGRQDUHJLmRQRURHVWHGRHVWDGRGH 6mR 3DXOR DWHQGHQGR WDQWR DGXOWRV TXDQWR FULDQoDV YtWLPDVGHTXHLPDGXUD&RQWDFRPOHLWRVTXDWURGRVTXDLV HPHVTXHPDGH87,DOpPGHGXDVVDODVGHFXUDWLYRFRP HTXLSDPHQWRVFRPRPRQLWRUPXOWLSDUDPpWULFRFRPSUHVVmR DUWHULDO QmR LQYDVLYD HOHWURFDUGLRJUDPD H R[LPHWULD GH SXOVRPRQRFURPiWLFDERPEDVGHLQIXVmRFDUGLRFRQYHUVRU GHVILEULODGRUFRPR[LPHWULDGHSXOVRUHVSLUDGRUHOHWU{QLFR PLFURSURFHVVDGR VLVWHPDV SQHXPiWLFRV GH SURILOD[LD GH
%LVFHJOL76et al. WURPERVH YHQRVD SURIXQGD FDPDV FRP VLVWHPD GH PRQLWRUDPHQWR GH SHVR PHVDV HVSHFLDLV SDUD EDOQHRWHUDSLD H HTXLSHPXOWLSURILVVLRQDOFRPSHWHQWH3RUVHWUDWDUGHFHQWUR GH UHIHUrQFLD UHFHEH SDFLHQWHV GH XPD PLFURUUHJLmR FRPSRVWD GH PXQLFtSLRV KDMD YLVWD D JUDQGH GHPDQGD GH SDFLHQWHV SURYHQLHQWHV GH FLGDGHV YL]LQKDV D &DWDQGXYD 3HUILO VHPHOKDQWH IRL YHULILFDGR QD FLGDGH GH *RLkQLD TXH DFXVRX GRV SDUWLFLSDQWHV RULXQGRV GH RXWUDVFLGDGHVHDWpGHRXWURVHVWDGRV $LQYHVWLJDomRUHDOL]DGDVREUHRORFDOGRDFLGHQWHTXH YLWLPRX RV SDUWLFLSDQWHV GHVWH HVWXGR GHPRQVWURX SUHGRPtQLRGHDFLGHQWHVGRPLFLOLDUHV RTXHWDPEpP IRLYHULILFDGRHPRXWUDVSHVTXLVDV2H (VWXGR EDVWDQWHFLWDGRQDiUHDHFRQGX]LGRSRUPHLRGHHQWUH YLVWDVFRPRVUHVSRQViYHLVSRUFULDQoDVHDGROHVFHQWHVTXHGHUDPHQWUDGDQXPKRVSLWDOGH0LQDV*HUDLVHP LQGLFDWD[DVVHPHOKDQWHVGHDFLGHQWHVGRPLFLOLDUHV FRP GHOHV VLWLDGRV QD FR]LQKD (VVH PDLRU Q~PHUR GH DFLGHQWHV GHQWUR GRV ODUHV p SHUIHLWDPHQWH FRPSDWtYHO FRP R SHUtRGR GD YLGD GHVVDV FULDQoDV ODFWHQWHV RX SUpHVFRODUHV &RPR DLQGD QmR VH HQFRQWUDP HP LGDGH HVFRODU SHUPDQHFHP FRQILQDGDV DR DPELHQWH IDPLOLDUHPXLWDVYH]HVVRERVFXLGDGRVGHLUPmRVTXH PHVPRPDLVYHOKRVDLQGDVmRLPDWXURVHOHJDOPHQWHLUUHVSRQViYHLV (QWUH RV DJHQWHV FDXVDGRUHV GDV TXHLPDGXUDV RV OtTXLGRV DTXHFLGRV UHSUHVHQWDUDP DSUR[LPDGDPHQWH PHWDGH GRVDJHQWHVHWLROyJLFRV$UDJmRet al20HPHVWXGR UHWURVSHFWLYRGHFULDQoDVLQWHUQDGDVQXPD8QLGDGHGH 7UDWDPHQWR GH 4XHLPDGRV GH 6HUJLSH QR SHUtRGR GH D REVHUYDUDP SUHYDOrQFLD EHP PDLRU GHVVH DJHQWH R TXH WDPEpP IRL QRWDGR SRU 0DUWLQV H$QGUDGH 14(VVDPDLRUSUHYDOrQFLDGRVGRLV~OWLPRVHVWXGRV SRGH VHU MXVWLILFDGD SHOD FDVXtVWLFD TXH DEUDQJHX DSHQDV SDFLHQWHV PHQRUHV GH H DQRV UHVSHFWLYDPHQWH -i 0DFKDGR et al21 HP HVWXGR UHWURVSHFWLYR GH FDVRV GHTXHLPDGXUDVHPFULDQoDVPHQRUHVGHDQRVDWHQGLGDV QR&HQWURGH7UDWDPHQWRGH4XHLPDGRV&74 GR+RVSLWDO GR$QGDUDtQR5LRGH-DQHLURQRSHUtRGRGHD GHVFUHYHUDP SRUFHQWDJHP GH VLPLODU j GHVWD DYD OLDomR 2FXSDQGR R VHJXQGR OXJDU GRV DJHQWHV FDXVDGRUHV GD SHVTXLVD HP IRFR HQFRQWUDPVH DV TXHLPDGXUDV RFDVLR QDGDVSRUiOFRRORXJDVROLQD 6HUUDet al22HPHVWXGRGHVHQYROYLGRQR&74GR+RVSLWDOGR$QGDUDtDYDOLDUDP DGROHVFHQWHV HQWUH H DQRV QR SHUtRGR GH D H REVHUYDUDP SUHYDOrQFLD OLJHLUDPHQWH VXSHULRU GH OtTXLGRVLQIODPiYHLV RTXHSRGHVHUFRQVHTXrQFLDGD IDL[D HWiULD DEUDQJLGD FRPSRVWD H[FOXVLYDPHQWH GH DGROHVFHQWHV-i2OLYHLUDet al23HPUHYLVmRGHSURQWXiULRV PpGLFRV GH FULDQoDV GH D DQRV LQWHUQDGDV HP QXPDXQLGDGHSDUDTXHLPDGRVGH7HUHVLQD3, UHJLVWUDUDP RiOFRROFRPRDJHQWHFDXVDGRUHPDSHQDVGRVFDVRV 2XWUR DJHQWH HWLROyJLFR LPSRUWDQWH GDV TXHLPDGXUDV p UHSUHVHQWDGR SHOR IRJR H SHODV VXSHUItFLHV TXHQWHV $QGUHWWDet al24DQDOLVDQGRSURQWXiULRVGHLQGLYtGXRVHQWUH HDQRVLQWHUQDGRVQRVHWRUSHGLiWULFRGHXP+RVSLWDO GH 7XEDUmR 6& QXP SHUtRGR GH DQRV D REVHUYDUDP TXH GRV DFLGHQWHV IRUDP RFDVLRQDGRV SRUIRJRHFRQWDWRFRPVXSHUItFLHVTXHQWHVYDORUHVVHPHOKDQWHVjSHVTXLVDGH9LDQDet al e superiores aos
3HUÀOGHFULDQoDVHDGROHVFHQWHVLQWHUQDGRVHP8QLGDGHGH7UDWDPHQWRGH4XHLPDGRV HQFRQWUDGRV QR SUHVHQWH HVWXGR 2 DJHQWH OHVLYR PHQRVIUHTXHQWHQHVWDLQYHVWLJDomRIRLDFRUUHQWHHOpWULFD TXHFRQWULEXLXFRPGDVTXHLPDGXUDVVLPLODUDRXWUDV SXEOLFDo}HV14H $DQiOLVHGRVUHVXOWDGRVGHVWDSHVTXLVDUHODWLYDjVOHV}HV GH SHOH GHPRQVWURX TXH HP PpGLD D 6&4 IRL TXDWURTXLQWRVGRVSDUWLFLSDQWHVWLYHUDPQRPi[LPR GRFRUSROHVDGR VHQGRTXHDVUHJL}HVPDLVFRPSURPHWLGDVIRUDPWyUD[HPHPEURV'DVVLHH$OYHV25SRUPHLRGH DQiOLVHGRVSURQWXiULRVGHFULDQoDVFRPLGDGHGHD DQRVLQWHUQDGDVHPKRVSLWDOXQLYHUVLWiULRGH/RQGULQD 35 QR SHUtRGR GH DJRVWR GH DWp PDLR GH REVHUYDUDP SUHGRPtQLR GH OHV}HV HP WURQFR PHPEURVVXSHULRUHV HFDEHoD FRP HPPpGLDGD6&41LJURet al1PRVWUDUDP6&4GH 2OLYHLUDet al23SRUVXDYH]LQGLFDPTXHGRVYLWLPDGRVDSUHVHQWDUDPDWpGH6&4HQWUHH H! 4XDQWRDRJUDXGHSURIXQGLGDGHGDVTXHLPDGXUDVHVWD DYDOLDomRLGHQWLILFRXTXHSUDWLFDPHQWHGRLVWHUoRVGDVYtWLPDVWLYHUDPTXHLPDGXUDVDSHQDVGHHJUDXVHQTXDQWR R UHVWDQWH DSUHVHQWRX TXHLPDGXUDV GH JUDX 2XWURV DXWRUHV FLWDGRV DQWHULRUPHQWH HYLGHQFLDUDP UHVXOWDGRV VLPLODUHV202H17GHTXHLPDGRVGHJUDX 2V SDUWLFLSDQWHV GD SHVTXLVD SHUPDQHFHUDP HP PpGLD GH]GLDVLQWHUQDGRVHDWD[DGHPRUWDOLGDGHIRLGH $ LQIHFomR VHFXQGiULD IRL GHWHFWDGD HP GRV FDVRV H SURFHGLPHQWRV FLU~UJLFRV TXH DX[LOLDP QR SURFHVVR GH UHHSLWHOL]DomR FRPR GHVEULGDPHQWRV H HQ[HUWRV FRPXQV QDV TXHLPDGXUDV GH PDLRU JUDYLGDGH IRUDP QHFHVViULRV HP DSUR[LPDGDPHQWH GR WRWDO GH LQWHUQDGRV 1LJUR et al1GHVFUHYHUDPUHVXOWDGRVVHPHOKDQWHVFRPPpGLDGH LQWHUQDomRGHGLDVPRUWDOLGDGHGHHQHFHVVLGDGH GHHQ[HUWRVHP-i'DVVLHH$OYHV25HPERUDWHQKDP UHODWDGR D PHVPD PpGLD GH GLDV GH LQWHUQDomR GLDV UHJLVWUDUDPWD[DVEHPPDLVDOWDVGHSURFHGLPHQWRVFLU~UJLFRV H PRUWDOLGDGH 2XWURV HVWXGRV YHULILFDUDPWD[DVGHPRUWDOLGDGHDLQGDPDLVHOHYDGDV21 e 22 1HVWD SHVTXLVD R FULWpULR GH H[FOXVmR GRV FDVRV FXMRV SURQWXiULRV HVWDYDP LQFRPSOHWRV SURFXURX PLQLPL]DU XPD GDV PXLWDV OLPLWDo}HV GH XP HVWXGR UHWURVSHFWLYR PDV FDEH UHVVDOWDU RXWUDV WDQWDV D IDOWD GH SDGURQL]DomR GH IRUPXOiULRV UHJLVWURV LQFRPSOHWRV HRX LOHJtYHLV UHJLVWURVUHSHWLGRV HRX GLYHUJHQWHV DQRWDo}HV UHDOL]DGRV SRU SURILVVLRQDLVGHYiULDViUHDVGLILFXOGDGHGHORFDOL]DUHWHU DFHVVRDRVSURQWXiULRVHWFTXHSURYDYHOPHQWHLQWHUIHUHP GH PRGR QHJDWLYR QD TXDOLGDGH PHWRGROyJLFD GR HVWXGR $OpPGLVVRDOJXQVGDGRVIXQGDPHQWDLVQDDQiOLVHGHFDVRV GH TXHLPDGRV FRPR RV DJHQWHV HWLROyJLFRV UHVSRQViYHLV SHORV TXDGURV GH LQIHFomR VHFXQGiULD D TXDOLGDGH H D TXDQWLGDGH GD VROXomR GH UHSRVLomR YROrPLFD XWLOL]DGDV D QHFHVVLGDGH RX QmR GH YHQWLODomR PHFkQLFD QmR IRUDP REMHWRV GHVWD DYDOLDomR R TXH SRGH WHU SUHMXGLFDGR D DEUDQJrQFLDGDSHVTXLVD $ GHVSHLWR GDV OLPLWDo}HV DFLPD FLWDGDV R SUHVHQWH HVWXGR SHUPLWLX FRQFOXLU TXH DV FULDQoDV HP LGDGH SUp HVFRODUIRUDPDVSULQFLSDLVYtWLPDVGDVTXHLPDGXUDVRULJLQDGDVHPGRPLFtOLRHUHSUHVHQWDUDPDPDLRUSDUWHGRFRQWLQJHQWHGHKRVSLWDOL]Do}HVLQIDQWRMXYHQLVSRUHVWDFDXVD 2V UHVXOWDGRV VHPHOKDQWHV DRV GHVFULWRV HP OLWHUDWXUD
HVSHFtILFD DX[LOLDUDP QR FRQKHFLPHQWR HSLGHPLROyJLFR GDSRSXODomRDWHQGLGDSHOD874GR+(3$GH&DWDQGXYDH GHPRQVWUDPDQHFHVVLGDGHGHGHVHQYROYHUDo}HVGHVHQVLELOL]DomRHRULHQWDomRDRVSDLVHjSRSXODomRHPJHUDO SRU PHLR GH SURJUDPDV HGXFDWLYRV H FDPSDQKDV GH SUHYHQomR 1mR IRVVHP DSHQDV RV SUHMXt]RV ELRSVLFRVVRFLDLV GHFRUUHQWHV GDV TXHLPDGXUDV HP FULDQoDV H DGROHVFHQWHVTXDQGRVHFRQVLGHUDPRVDVSHFWRVpWLFRVGDTXHVWmR D UHSHUFXVVmR GR WHPD WRUQDVH PDLV UHOHYDQWH SRLV D PDLRU SDUWH GRV DFLGHQWHV SRU TXHLPDGXUDV SRGHULD VHU SUHYHQLGDHPXLWDVYLGDVSRGHULDPVHUSRXSDGDVDOpPGD TXDOLGDGH GH YLGD GRV VREUHYLYHQWHV 1HVVH SURFHVVR DIDPtOLDHDHVFRODUHVSRQViYHLVSHODIRUPDomRGDVFULDQoDVHGRVDGROHVFHQWHVGHYHULDPUHSUHVHQWDUXPSDSHO LPSRUWDQWH QD SURPRomR H QD SUHYHQomR GH DFLGHQWHV LQIDQWRMXYHQLV2
&RQÁLWRVGHLQWHUHVVH 2VDXWRUHVGHFODUDPQmRKDYHUFRQIOLWRVGHLQWHUHVVH
5HIHUrQFLDV 1. 1LJUR 09 )UHLWDV (7 /RSHV -XQLRU 6& 'DOFXPXQH ) %XHQR 1HWWR5)6DQFKHV0(et al3HUÀOHSLGHPLROyJLFRGDVFULDQoDV LQWHUQDGDVSRUTXHLPDGXUDQR+RVSLWDO8QLYHUVLWiULR(YDQJpOLFR GH&XULWLED+8(& QRSHUtRGRGHMXOKRGHDIHYHUHLURGH $UT&DWDU0HG 2. )HUQDQGHV )0 7RUTXDWR ,0 'DQWDV 0$ 3RQWHV -~QLRU )$ )HUUHLUD-$&ROOHW14XHLPDGXUDVHPFULDQoDVHDGROHVFHQWHV FDUDFWHUL]DomR FOtQLFD H HSLGHPLROyJLFD 5HY *DXFKD (QIHUP 2012;33:133-41. 3. 5RVVL/$%DUUXIÀQL5&*DUFLD75&KLDQFD7&4XHLPDGXUDV FDUDFWHUtVWLFDV GRV FDVRV WUDWDGRV HP XP KRVSLWDO HVFROD HP 5LEHLUmR3UHWR63 %UDVLO5HY3DQDP6DOXG3XEOLFD>VHULDORQ WKH ,QWHUQHW@ 'HF >FLWHG 'HF @ $YDLODEOH IURP KWWSZZZVFLHORVSRUJVFLHORSKS"VFULSW VFLBDUWWH[W SLG 6 OQJ HQ KWWS G[GRLRUJ6 4. %UDVLO ² 0LQLVWpULR GD 6D~GH '$7$686 >KRPHSDJH RQ WKH ,QWHUQHW@,QIRUPDo}HVGH6D~GH7$%1(7 ²(SLGHPLROyJLFDVH 0RUELGDGH0RUELGDGH+RVSLWDODUGR686&DXVDV([WHUQDVSRU ORFDO GH LQWHUQDomR ² GH D >FLWHG 2FW @ $YDLODEOH IURP KWWSZZZGDWDVXVJRYEU'$7$686LQGH[ SKS"DUHD 92EM KWWSWDEQHWGDWDVXVJRYEUFJL GHIWRKWPH[H"VLKFQYHL 5. %UDVLO ² 0LQLVWpULR GD 6D~GH '$7$686 >KRPHSDJH RQ WKH ,QWHUQHW@,QIRUPDo}HVGH6D~GH7$%1(7 ²(SLGHPLROyJLFDVH 0RUELGDGH0RUELGDGH+RVSLWDODUGR686&DXVDV([WHUQDVSRU ORFDO GH LQWHUQDomR ² D SDUWLU GH >FLWHG 2FW @ $YDLODEOH IURP KWWSZZZGDWDVXVJRYEU'$7$686LQGH[ SKS"DUHD 92EM KWWSWDEQHWGDWDVXVJRYEUFJL GHIWRKWPH[H"VLKFQYÀ %UDVLO ² 0LQLVWpULR GD 6D~GH '$7$686 >KRPHSDJH RQ WKH ,QWHUQHW@,QIRUPDo}HVGH6D~GH7$%1(7 ²(VWDWtVWLFDVYLWDLV 0RUWDOLGDGH JHUDO D SHOD &,' ² 0RUWDOLGDGH JHUDO >FLWHG 2FW @ $YDLODEOH IURP KWWSZZZ GDWDVXVJRYEU'$7$686LQGH[SKS"DUHD 92EM KWWS WDEQHWGDWDVXVJRYEUFJLGHIWRKWPH[H"VLPFQYREW 7. &ULDQoD6HJXUD%UDVLO>KRPHSDJHRQWKH,QWHUQHW@'DGRVVREUH DFLGHQWHV0RUWHV4XHLPDGXUDV>FLWHG2FW@$YDLODEOH IURPKWWSFULDQFDVHJXUDRUJEUSDJHTXHLPDGXUDV
5RVVL /$ )HUUHLUD ( &RVWD (& %HUJDPDVFR (& &DPDUJR & 3UHYHQomRGHTXHLPDGXUDVSHUFHSomRGHSDFLHQWHVHGHVHXV IDPLOLDUHV5HY/DWLQR$P(QIHUP :HUQHFN*/5HLFKHQKHLP0(3HGLDWULFVEXUQVDQGDVVRFLDWHG ULVNIDFWRUVLQ5LRGH-DQHLUR%XUQV 10. 9DOH(&3ULPHLURDWHQGLPHQWRHPTXHLPDGXUDVDDERUGDJHP GRGHUPDWRORJLVWD$Q%UDV'HUPDWRO 11. %HVVD')5LEHLUR$/%DUURV6(0HQGRQoD0&%HVVD,)$OYHV 0$ et al 3HUÀO HSLGHPLROyJLFR GRV SDFLHQWHV TXHLPDGRV QR KRVSLWDOUHJLRQDOGHXUJrQFLDHHPHUJrQFLDGH&DPSLQD*UDQGH 3DUDtED%UDVLO5HY%UDV&LHQF6DXGH 12. 5RVD-XQLRU-0$QiOLVHHSLGHPLROyJLFDGHFULDQoDVTXHLPDGDV LQWHUQDGDVQR+RVSLWDO,QIDQWLO-RDQDGH*XVPmR)ORULDQySROLV 6&>PRQRJUDÀD@)ORULDQySROLV6& 8)6& 13. /,$7²+*&5²8)6&>KRPHSDJHRQWKH,QWHUQHW@4XHLPDGXUDV SDUWLFXODULGDGHV HP FULDQoDV >FLWHG 2FW @ $YDLODEOH IURPKWWSOLDWXIVFEUDUTXLYRSGI 14. 0DUWLQV &% $QGUDGH 60 4XHLPDGXUDV HP FULDQoDV H DGROHVFHQWHVDQiOLVHGDPRUELGDGHKRVSLWDODUHPRUWDOLGDGH $FWD3DXO(QIHUP 15. $OPHLGD $& 2OLYHLUD 50 9LHLUD /- )URWD 0$ 3HUÀO VyFLR GHPRJUiÀFRGHFULDQoDVLQWHUQDGDVHPXPFHQWURGHWUDWDPHQWR GHTXHLPDGRV1XUVLQJ6mR3DXOR &RXWLQKR%%$%DOEXHQD0%$QEDU5$$QEDU5$$OPHLGD.* $OPHLGD3