NOGUEIRA, Carlos Alberto de Sousa. BRANDÃO, Fernando Barbosa. Mortality of young adults due to external causes in the municipality of Imperatriz – MA, in the biennium (2017 – 2018). Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 09, Vol. 05, pp. 31-58. September 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/saude/mortalidade-de-adultos, DOI: 10.32749/nucleodoconhecimento.com.br/saude/mortality-of-adults
Mortality from external causes has been highlighted today due to the number of registered cases and their consequences in society. In the case of Brazil, young adults aged 20 to 39 years, male, are the group most affected by these causes. Local studies that seek to address the consequences of external causes of death in the male juvenile population can greatly contribute to actions to reduce the current high numbers. The aim of this study was to identify the differences in mortality of young adults, due to external causes, in the municipality of Imperatriz – MA, in the biennium (2017 and 2018). The work consisted of a retrospective, descriptive documentary study, with quantitative approach, carried out in the municipality of Imperatriz – MA, using the database of the Legal Medical Institute (IML). The sampling consisted of the occurrences that entered the institution in the years 2017 and 2018, through the evaluation of cadaveric reports and death certificates. The variables used were the cause of death, age, gender, educational level, ethnicity and marital status. Population estimates were obtained from census data from the Brazilian Institute of Geography and Statistics (IBGE). Mortality rates (TM) were calculated per 100,000 inhabitants according to the specific cause. The present study was able to conclude that the mortality rate in the municipality was high, higher than the Brazilian average in the two years studied, being the main external causes, firearm projectiles, followed by traffic accidents and aggression by sharp-cutting instrument. The main victims of external causes were young adults, male with low educational level, brown and single.
Keywords: external causes, mortality rate, young adults.
Mortality from external causes has been highlighted today due to the number of registered cases and their consequences in society. Thus, it has become a public health problem, reaching the majority of the young population of productive age, with serious consequences involving high social, emotional and economic costs for treatment and rehabilitation, besides bringing incalculable damage to the victim and families (SOUSA et al., 2016).
External causes may be defined as injury, trauma or any other damage to health, intentional or not, at a sudden beginning and as an immediate consequence of violence or other exogenous cause, including injuries caused in traffic and transportation, homicides, assaults, suicides, falls, drownings, poisonings, burns, injuries by slip or flood, and other occurrences caused by environmental disasters, whether mechanical, chemical, thermal, electrical energy and/or radiation (OLIVEIRA et al., 2019; SETTERVALL et al., 2012).
Data from the World Health Organization (WHO) show that accidents and violence are the causes of more than 5 million deaths annually, accounting for approximately 9% of global mortality. It is estimated that 16% of these deaths result from suicides, 10%, homicides, 24%, traffic accidents, 14%, falls, with the remainder distributed among other causes (CORASSA et al., 2017). For each death, there are dozens of hospitalizations, hundreds of visits to emergency care units and thousands of medical consultations (COSTA et al., 2013).
Deaths from external causes in Brazil since the 1980s correspond to the second cause of death, surpassed only by diseases of the circulatory system (GONSAGA et al., 2012; TREVISOL et al., 2011).
Violence and accidents, which are a significant group of external causes, are constituted by traffic accidents, homicides, suicides, intoxications, work accidents, burns, falls, drownings, are important factors of morbidity and mortality of young adults (SILVA et al., 2010).
In Brazil, homicides are no longer concentrated only in large cities, spreading more generally in recent decades, also affecting medium-sized cities in the interior (COSTA, et al., 2014).
The increase in mortality from external causes in Brazil occurred mainly from the 1980s, from fourth to second place in the ordering of groups of causes of death, between the beginning and the end of that decade (TRISTÃO et al., 2012).
External causes do not affect the population uniformly. Several studies have shown that there are more predisposed population groups, which can be perceived by the unequal distribution of deaths from external causes (LIMA et al., 2013).
In relation to the causes associated with violent deaths, there is still no consensus. Biological and multicausatofactors are involved: socioeconomic factors; the family constitution; the home environment; age and personality characteristics; the sex of the victim; the ethnicity of the victim; the use of alcoholic beverages and chemicals (AMADOR et al., 2018).
In the case of Brazil, young adults aged 20 to 39 years, male, are the group most affected by external causes, and these are considered as the major responsible for the potential years lost. Most of the times the occurrences are fatal, as a consequence, male mortality is five times higher than that of female mortality, in the age group of 20 to 25 years (IBGE, 2009).
From adolescence, the behavior adopted by most young people makes them more exposed and vulnerable to the risks of being victims of violence (CAVALCANTE; MONTEIRO, 2008). Violence is among the main causes of mortality in the country (WAISELFISZ, 2013).
Knowledge about deaths from external causes provides support for the implementation of prevention actions and the development of comprehensive coping strategies. For this reason, it is important to mention that Brazil has a wide territorial extension and a great cultural, demographic and socioeconomic diversity, which justifies the need to identify regional contrasts that affect the life and health of the population, supporting planning and decision-making on actions directed at the most at-risk groups (PREIS et al., 2018).
The high number of deaths and sequelae/disabilities caused by external causes constitute an important demand for public safety and health policies to be elaborated, implemented and followed in Brazil (BATISTA et al., 2018).
In 2001, the Ministry of Health launched the National Policy for the Reduction of Morbidity and Mortality in Accidents and Violence (PNRMAV), approved by Ordinance No. 737/GM on May 16, 2001, which highlights the importance and role of the health sector in coping with accidents and violence in the country, through the development of a set of articulated and systematized actions, in accordance with the guidelines of the PNRMAV (MATOS; MARTIGNS, 2013).
A study conducted in the state of Maranhão, from 2001 to 2010, showed an increase in deaths in all age groups, especially between 20-35 years, which ranged from 6.1% in 2001 to 15.6% in 2010 (LIMA et al., 2013). However, the state still lacks more detailed studies on the external causes of deaths.
The studies conducted in the state are more general, and there are no more accurate evaluations of reality in their municipalities. For this reason, the present study aims to identify the differences in mortality of young adults, due to external causes, in the municipality of Imperatriz – MA, in the biennium (2017 and 2018).
2.1 OVERALL OBJECTIVE
To identify the differences in mortality of young adults, due to external causes, in the municipality of Imperatriz – MA, in the biennium (2017 and 2018).
2.2 SPECIFIC OBJECTIVES
– Determine the overall mortality rates and by external cause group and compare the groups with each other.
– Classify the total number of victims into groups, according to the cause of death, identified by the coroner's assessment.
– Identify, quantify and classify, by age group, the main external causes of death in the period evaluated.
– To compare the victims of external causes of death, of the group of young adults, in relation to gender, educational level, ethnicity and marital status.
3.1 STUDY AREA
The study was carried out in the municipality of Imperatriz, located in the southwest of the State of Maranhão, in the microregion of Imperatriz. It concentrates the second largest population of the state, totaling 258,016 inhabitants of which 48.16% are male and 52.84% female, according to an estimate by the Brazilian Institute of Geography and Statistics (IBGE) for the year 2018 (IBGE, 2018) and an area of 1,367.901 km², of which 15,480 km² correspond to the urban area.
The city extends along the right bank of the Tocantins River and is crossed by the Belém-Brasília Highway (BR-010). It is the largest commercial, energy and economic junction of Maranhão and has a strategic geographical positioning not only to the state, but also to the entire north of the country.
Most of the municipality's active workforce is absorbed by the tertiary sector (trade in goods and services). Construction also plays a very important role in the local economy. More recently, industrial activity has gained expression with the installation of large industry, attracting other associated companies and this enterprise.
3.2 TYPE OF STUDY
The work consisted of a retrospective, descriptive documentary study, with quantitative approach, carried out in the municipality of Imperatriz – MA, using the database of the Legal Medical Institute (IML), where victims of deaths from external causes are sent to perform legal procedures and necropsy.
3.3 SAMPLE AND DATA COLLECTION
The sampling was composed of the occurrences that were admitted to the Legal Medical Institute (IML) of Imperatriz, from January 2017 to December 2018, through the evaluation of cadaveric reports and death certificates. The data used were the cause of death, age, gender, educational level, ethnicity and marital status.
External causes were classified according to Chapter XX of the 10th International Classification of Diseases ( ICD10: accidents are contained in chapters V01-Y98 in which traffic accidents are in categories V01- V99 and other external causes of accidental injuries W00-X59.
Homicides were intentionally caused, classified by iCD-10, as "Aggressions" (X85 to Y09) and "Legal Interventions" (Y35 to Y36): they include assaults by firearm (AAF) (X93-X95), assaults by sharp-cutting instrument (AIP) (X99) and other violence. Legal interventions (Y35) include trauma inflicted by police or other law enforcement officers, including military personnel on duty, during the arrest or attempted arrest of law offenders, repressing riots, maintaining order or other legal action. Intentional self-inflicted suicides/injuries are in X60-X84.
3.4 INCLUSION AND EXCLUSION CRITERIA
The inclusion criteria of the study were: (1) cadaveric reports and death certificates related to necropsies performed from January 2017 to December 2018; (2) cadaveric reports and death certificates of individuals living in the municipality of Imperatriz – MA; (3) deaths declared as external causes.
Exclusion criteria were: (1) cadaveric reports and death certificates prior to January 2017 and after December 2018; (2) cadaveric reports and death certificates of individuals who did not reside in the municipality of Imperatriz – MA; (3) deaths not declared as external causes; (4) individuals not identified on death certificate.
3.5 ETHICAL ASPECTS
Because it is the use of secondary data obtained from a database (IML) it is necessary to dispense with the FREE AND INFORMED CONSENT TERM to carry out this project, because researchers will have access only necropsy data.
The rights were guaranteed, among others guaranteed by resolution 466/2012 of the National Health Council:
1) Ensuring confidentiality, anonymity and non-use of information to the detriment of others;
2) That there will be no risks to the research subject;
3) Use of the data only for the purposes provided for in this research;
4) Return of the benefits obtained through this study to the people and the community where it was carried out.
The research will only be initiated after the approval of the Research Ethics Committee – CEP, to guarantee all those involved the basic references of bioethics, that is, autonomy, non-maleficence, benevolence and justice.
3.6 DATA ANALYSIS
Population estimates were obtained from census data from the Brazilian Institute of Geography and Statistics (IBGE). Mortality rates (TM), general and by different external causes, were calculated per 100,000 inhabitants according to the formula:
TM =(number of deaths per cause group/estimated population) x 100,000
The results obtained with the use of the above formula were used to compare the overall mortality rate with the results of studies in other municipalities and to compare, among themselves, the main external causes of deaths in the municipality surveyed.
Table 1 – Data organized for statistical analysis.
|Ac. transit||drowning||Electric shock||AIP||Aaf||suicide||burn||Falls||Physical aggression||other|
Source: search result.
The mortality data per cause group were analyzed using the Biostat program. For statistical analysis of these data, transformations in the data set were necessary. First, for repetition, the data had to be analyzed with the two reference years (2017 and 2018), representing blocks. The treatments consisted of the causes of mortality (traffic accident, aggression by firearm…) (Table 1).
As the data came from counting (discrete variable), it was necessary to perform a transformation, using for this the relativization of the values over the annual total, making the variable continuous.With the homogenization and transformation of the data, the analysis of data variance was calculated, using a DBC (randomized block design), in order to answer the following hypothesis:
To compare the different means of the causes of mortality, the Tukey test was applied to 95%.
The variables age group, gender, educational level, ethnicity and marital status were individually subdivided into classes and data transformed into percentage for comparison purposes. For the analysis by gender, educational level, ethnicity and marital status, we used only data from the group classified as young adults, determined in the evaluation by age group.
4. RESULTS AND DISCUSSION
4.1 GENERAL MORTALITY AND FOR DIFFERENT CAUSES
The analysis of the obtained data identified that the number of deaths from external causes in the municipality of Imperatriz – MA, was 199 and 204, respectively in the years 2017 and 2018.
The mortality rates due to external causes in the municipality of Imperatriz – MA, in the years 2017 and 2018, were, respectively, 80.4 and 82.42 deaths per 100 thousand inhabitants, demonstrating that they presented close values in the two years studied. These results indicate the relevance of these causes of death on the overall mortality of the population studied.
The mortality rate from external causes in Brazil in 2014 was 75.5 deaths per 100,000 inhabitants, ranging from 26.4 deaths per 100,000 women to 125.5 deaths per 100,000 men (BRASIL, 2015). In Brazil, external causes represent the first position in the population of young adults and occupy the third position among the population over 50 years (BRASIL, 2017).
In the municipality of Diamantina – MG, an evaluation on external causes of mortality identified, in the period from 2001 to 2012, a total of 233 deaths from these causes (7.6% of the total), with an average annual mortality coefficient of 44.3/100,000 inhabitants (CORASSA et al., 2017), a figure well below that found in the two years of the present study.
The results obtained in the present study proved that the mortality rate due to external causes in the municipality of Imperatriz – MA, in the two years evaluated, can be considered high, because it presents rates higher than the Brazilian average and other cities where similar studies were conducted.
The evaluation of mortality rates due to the different external causes identified showed that the three main ones were, respectively: 1) aggression by firearm; 2) traffic accident and 3) aggression by sharp-cutting instrument (Table 2).
Table 2 – Mortality rates due to different external causes in the municipality of Imperatriz – MA, in the years 2017 and 2018.
|Causes||2017 TM||2018 TM|
|Assault by firearm||29,49||41,21|
|Aggression by sharp-cutting instrument||7,27||12,93|
Source: search result.
From 2017 to 2018, the mortality rate from firearm assault increased from 29.49 to 41.21. By traffic accident, it decreased from 22.63 to 13.74. By aggression by sharp-cutting instrument increased from 7.27 to 12.93. These results are similar to those obtained in previous studies conducted in other cities, which also identified the use of firearms and traffic accidents as the two main external causes of deaths in their populations.
In the state of Maranhão, from 2001 to 2010, it was observed that aggressions of various types (35.5%) followed by occupants of a traumatized vehicle (16.6%), were the two largest external causes of death (LIMA et al., 2013).
In the northeast region, on average, 30% of deaths from external causes were caused by land transport accidents (BRASIL, 2015).
Traffic accidents cause high rates of mortality and morbidity, thus causing social impacts for individuals, their families and society as a whole, also associated with high costs for the health system (GONSAGA et al., 2012).
Regarding the external causes of death, through the analysis of variance, it was evident that there is no statistical difference in the sum of deaths between 2017 and 2018 (H0) (Table 3). However, a highly significant difference was found between the causes of mortality (H 0 isrejected).
Table 3 – Analysis of variance of external causes of mortality in the years 2017 and 2018, in the municipality of Imperatriz – MA.
|Source of variation||Sq||Gl||MQ||F||Critical F (95%)|
In which: SQ: sum of squares; gl: degrees of freedom; MQ: medium square; F: calculated value; Critical F: F value tabled p>99%
Source: search result.
To compare the percentages of external causes of mortality, the Tukey test was applied to 95%. The test results are in table 4.
Table 4 – Comparison of mortality percentages from external causes by the Tukey Test at 95%.
|Assault by firearm||43,3||a*|
|Aggression by sharp-cutting instrument||12,4||b|
*averages followed by the same letter do not differ by the Tukey test at 95%
Source: search result.
The 95% Tukey test showed a statistically significant difference in deaths from firearm projectiles, when compared to other causes, except for traffic accidents, which were the second largest external cause of death in the two years evaluated.
Traffic accidents and homicides caused mainly by the use of firearms are among the main causes of death that contribute to the high rates of deaths from external causes (PALMEIRA et al., 2009), which demonstrates that the results found are compatible with those obtained in previous studies.
In Brazil, on average, 71% of homicides involve the use of firearms, legal or illegal. Because they are highly lethal and usually easily accessible, when associated with a violent society, they potentiate the risk that conflicts of a different order end in deaths (AMADOR et al., 2018).
4.2 DEATHS BY AGE GROUP
The group of young adults presented the highest mortality due to external causes in the two years evaluated, corresponding to 51.76 and 62.25%, respectively for the years 2017 and 2018, showing that in the period evaluated, more than half of the deaths from external causes occurred with individuals in this age group (Figures 1 and 2).
Figures 1 and 2 – Percentages of mortality from external causes in the municipality of Imperatriz – MA, according to the age group, in the years 2017 and 2018.
In the period from 2001 to 2011, the majority of deaths from external causes in Teresina – PI, occurred in the age group 20 to 29 years (64.8%) in the age group of 30-39 years, mortality from external causes was 35.2% (SOUSA et al., 2016). Research indicates that vulnerability to external causes of people aged 20 to 35 years is also related to certain risk behaviors, such as the search for emotions, the pleasure of experiencing risk situations, impulsivity and the abuse of psychoactive substances (SOUZA et al., 2007).
In 2015, in Brazil, homicides corresponded to 47.8% of the total number of deaths of the male population, aged 15 to 29 years, bringing implications for health, demographic dynamics and, consequently, the process of economic and social development (AMADOR et al., 2018).
The results obtained in the present study are corroborated by other studies, such as those mentioned above, which also indicated a high percentage of mortality from external causes among young adults. These results demonstrate the impact of external causes for the group of young adults, directly reflecting on the dynamics of society as a whole, because they are people who are starting or are already at the peak of intellectual and work productive age.
The two age groups with the highest mortality rates (TM) from external causes in 2017 and 2018 were: 1) young adults; 2) mature adults (Table 5).
Table 5 – Mortality rates due to external causes, by age group, in the municipality of Imperatriz – MA, in the years 2017 and 2018.
|AGE GROUP||TM 2017||TM 2018|
|TM Young Adults||41,62||51,31|
|TM Mature Adults||22,63||14,55|
Source: search result.
In the two years evaluated, the sum of the rates of these two groups was higher than 60% of the total deaths occurred, demonstrating that they are the main groups victimized by external causes in the municipality, in the biennium studied.
4.3 DEATHS BY GENDER
In the two years evaluated, males represented the highest number of deaths from external causes of young adults, corresponding to 86.93 and 88.24%, respectively for the years 2017 and 2018 (Figures 3 and 4), demonstrating that external causes reach men with a largefrequency, similarly to other studies that evaluated deaths from external causes by gender.
Figures 3 and 4 – Percentages of mortality of young adults due to external causes, according to gender, in the municipality of Imperatriz – MA, in the years 2017 and 2018.
The high rates of male mortality from external causes in the age group 15 to 39 years have contributed to the increase in the differential of years lost compared to the female sex (DANTAS, 2014).
In 2013, in Brazil, external causes were responsible for 151,683 deaths recorded in the Mortality Information System (SIM), most of them men (82.2%) and people aged 20 to 39 years (43.8%). Regarding race/skin color, there was a predominance of browns (50.1%), followed by whites (37.3%) (BRAZIL, 2015).
In 2010, external causes were the second leading cause of death among men in 26 Brazilian capitals, with the city of Rio de Janeiro being the only capital to register this group as the third cause of death (DANTAS, 2014). The average rate of mortality from violence in Brazil in the last 15 years has increased, both for males and females, and the ratio between the sexes is approximately 12:1 (AMADOR et al., 2018).
In 2012, in the city of Itabuna – BA, the percentage of homicide deaths recorded among men aged 15 to 29 years was 56 times higher than among women in the same age group (COSTA et al., 2014).
Other studies comparing the number of deaths by sex, in addition to those mentioned above, found results similar to the present study, indicating that males are largely more affected by external causes of mortality. The premature loss of these men has negative repercussions on family dynamics, as these would be important components for the economic support of families, usually low-income, as well as in general family relationships, such as the education of children and organization of household chores, in the case of married individuals.
4.4 DEATHS BY LEVEL OF EDUCATION
In the evaluation of the level of education of young adults victimized by external causes, it was found that the most significant groups had incomplete elementary level and incomplete mean skilled in the two years evaluated (Figures 5 and 6).
From 2017 to 2018, the percentage of mortality in the group with incomplete fundamental level ranged from 38.69 to 56.86%. For the group with incomplete mean level, it ranged from 30.65 to 23.04%. These two groups were comprised more than 65% of deaths from external causes in the two years studied.
Figures 5 and 6 – Percentages of mortality of young adults, due to external causes, according to schooling, in the municipality of Imperatriz – MA, in the years 2017 and 2018.
A study conducted in 2006 in the city of Cuiabá – MT, identified that the vast majority of deaths from external causes involved individuals with schooling between 4 and 7 years followed from 1 to 3 years (OLIVEIRA, 2006).
The evaluation of external causes of mortality in the municipality of Teresina – PI, in the period from 2001 to 2011, verified for the variable schooling, that the majority remained in school between 4 and 7 years (35.82%) followed by schooling from 8 to 11 years (22.63%) (SOUSA et al., 2016). A study on mortality from external causes in the state of Maranhão, conducted from 2001 to 2010, identified that the most frequent schooling time was 4 to 7 years, followed by 1 to 3 years (LIMA et al., 2013).
The results found in the present study are similar to those of previous studies, indicating that people with a lower level of education are the main ones affected by the external causes of death, reinforcing that individuals with lower schooling are more likely to be involved in violent events, which often have death as an outcome. These results demonstrate the need for initiatives to keep young people in school as a strategy to assist in the protection of these individuals.
4.5 DEATHS BY ETHNICITY
The ethnic group with the highest number of young adults victimized by external causes was the brown group, with 77.89 and 75.98% of the cases, respectively in the years 2017 and 2018. The black group had 15.58% of the cases in 2017 and 14.22% in 2018. These two groups together represented more than 90% of the cases of deaths from external causes in the two years studied (Figures 7 and 8).
Figures 7 and 8 – Percentages of mortality of young adults, due to external causes, according to ethnicity, in the municipality of Imperatriz – MA, in the years 2017 and 2018.
A study conducted in the state of Paraíba identified that the brown race represented 66% of deaths from external causes in 2000 and 84% in 2010 (MELO; DIOGENES, 2018).
The evaluation of mortality from external causes in the municipality of Campina Grande – PB, in 2015, identified that males with a percentage of 93.97% and mixed color or race with a percentage of 73.5% are the main affected by these causes (COSTA, 2016). The results of mortality by ethnic group are similar to those found in a study in the municipality of Teresina – PI, in the period from 2001 to 2011, which verified in relation to race, the prevalence of brown (70.67%) followed by white (12.82%) (SOUSA et al., 2016).
A study conducted in the microregion of São Mateus – ES, identified that mortality from external causes in relation to skin color or race presented the highest rates for browns and blacks (TRISTÃO et al., 2012).
The results obtained in the present study are compatible with previous studies conducted in other municipalities, demonstrating that brown/black ethnic groups are commonly the most affected by external causes of death, representing the vast majority of cases. Even in the city of Imperatriz, where brown/black ethnic groups represent the majority of the population, the percentages of deaths from external causes in individuals of these ethnic groups are higher than their percentages in the population.
4.6 DEATHS BY MARITAL STATUS
In the two years evaluated, the majority of young adults who were victims of external causes were single individuals, corresponding to 62.81% in 2017 and 74.02% in 2018, demonstrating that external causes reach people in this group with a large frequency. Then married individuals with 26.13 and 18.14%, respectively in 2017 and 2018. The other groups individually were below 10% in the two years evaluated (Figures 9 and 10).
Figures 9 and 10 – Percentages of mortality of young adults due to external causes, according to marital status, in the municipality of Imperatriz – MA, in the years 2017 and 2018.
A study conducted in the city of Teresina – PI, covering the period from 2001 to 2011, identified that in relation to marital status prevailed single (71.74%), then married (21.89%) (SOUSA et al., 2016), corroborating the results found in the present study.
In southern Brazil, from 2004 to 2013, the marital status of victims of external causes was 57.81% of singles, 29.75% of married, 7.08% of widowers and 5.36% of legally separated victims (PREIS, et al., 2018).
The results found in the present study are corroborated by other studies, evidencing that single individuals are the most affected by external causes of mortality. These results are directly related to the age of those involved, considering that the vast majority corresponds to young adults, according to the results of other studies, in addition to those obtained in the present study.
- The three main external causes of death in 2017 and 2018 were, respectively: 1) aggression by firearm; 2) traffic accident and 3) assault by sharp cutting instrument.
- Regarding age, the group of young adults presented the highest mortality due to external causes, representing more than half of all deaths from these causes in the two years evaluated.
- Regarding gender, in the two years evaluated, males represented the vast majority of deaths from external causes.
- In the evaluation of schooling, it was found that the highest rates of death from external causes occurred with people who had incomplete elementary level, followed by those with incomplete mean in the two years evaluated.
- In the evaluation of ethnicity, it was found that brown and black individuals combined, represented the majority of cases of deaths from external causes in the two years studied.
- In the assessment of marital status, it was found that in the two years evaluated, most of the victims of external causes were single individuals.
- The main victims of external causes were young adults, male with low educational level, brown and single.
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 Acadêmico do 8o período do curso de Medicina.
 Advisor. PhD in Dental Clinics. Master's degree in Health Sciences. Specialization in progress in specialization course in endodontics. Specialization in Dental Radiology and Imaging. Graduation in Dentistry.
Submitted: August, 2020.
Approved: September, 2020.