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Inherited Trauma Shapes Your Health

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Often, when I complain to my therapist about how stressed out I am by a problem I’m having, she says a variation on the same thing:

“Well, like all Ashkenazi Jews, you have a lot of intergenerational trauma. You know, because of everything that’s ... happened.”

Of course you’re anxious, she seems to say, you’re Jewish! I think it’s meant to help me feel more at peace with my emotions, but, I must admit, I find this response deeply unsatisfying.

I am, of course, grateful that my life is easier than the lives of my relatives—Jewish and otherwise—who survived World War II. At the same time, I can’t do anything about the fact that the Holocaust happened, so I don’t want to spend time thinking about its effects on my cortisol levels. I can, however, write the perfect email to get myself out of a scrape, or find a way to stop thinking about why I didn’t get some plaudit or another.

“The Jews have nothing to do with it!” I always want to say in response, as though I’m debunking some George Soros–related conspiracy.

But a growing body of evidence suggests my therapist might be right, and I’m wrong.

The most recent chapter is a new study in the Proceedings of the National Academy of Sciences this week by researchers from the National Bureau of Economic Research. They found that the sons of Union Army soldiers who endured grueling conditions as prisoners of war were more likely to die young than the sons of soldiers who were not prisoners. This is despite the fact that the sons were born after the war, so they couldn’t have experienced its horrors personally. In other words, it seemed like the stresses of war were getting passed down between generations.

[Read: Can a parent’s life experience change the genes a child inherits?]

The effects on longevity showed up for the sons of men who were imprisoned in 1863 and 1864, when conditions in POW camps were especially bad. Crowding was extreme—each man was said to have had a grave’s worth of square footage to himself—and deaths from diarrhea and scurvy were common.

Because the study authors controlled for other factors that might have influenced the sons’ longevity, like socioeconomic status and the quality of the parents’ marriages, they believe this effect on mortality is working through epigenetics, or the process by which genes are switched on and off. These epigenetic changes are inherited by later generations, setting diseases in motion.

“It’s either the stress of war or the malnutrition of war or both,” said Randy L. Jirtle, an epigenetics researcher at North Carolina State University who was not involved in the study. “The stress on the system moves the machinery to put down or not put down epigenetic markers.”

Jirtle explains the epigenome as a type of software that runs on the computer-like cell. The epigenome can affect lots of different cells, just like a software program can be run on many different computers. He thinks this study might help explain why states in the southern United States—which had more severe food shortages during and after the Civil War—have worse health outcomes today.

Epigenetic links have also been established in animal studies. For example, mice who have been taught to fear the smell of cherries when it was paired with an electric shock had children and grandchildren who also showed signs of anxiety when exposed to the odor, even though they had never “learned” the painful association.

Other research in humans has suggested there’s something beyond our genes and environment that’s affecting our health, but the Civil War study is one of the first to study the effects of war specifically. The “Hunger Winter” studies in the Netherlands in 1944 showed that people conceived during a particularly brutal winter famine, when adults were eating 400 to 800 calories per day, were more likely to have heart disease as adults compared to those who were in the womb during more prosperous times. Perhaps more surprisingly, the children of men who endured the famine while in the womb were more likely to be obese.

A 2014 study showed that sons (but not daughters) of fathers who began smoking before the age of 11, when they began to produce sperm, were fatter than those whose fathers started smoking later, after their sperm had already formed. Stress from racism might cause similar epigenetic changes: People who have experienced racial discrimination have more of a type of epigenetic change called methylation on the genes that affect schizophrenia, bipolar disorder, and asthma.

[Read: Being black in America can be hazardous to your health.]

In 2016, Rachel Yehuda, of Mount Sinai hospital, and her colleagues found that Holocaust survivors and their children both had evidence of methylation on a region of a gene associated with stress, suggesting that the survivors’ trauma was passed onto their offspring. The paper was criticized for, among other things, having a small sample size and for not looking at the third and fourth generations of descendants of the Holocaust survivors.

The current Civil War paper overcomes some of these drawbacks, since it looked at thousands of veterans and their children. But the study looked only at the statistics, not at the genes themselves, so the idea that the connection is epigenetic is more like conjecture, or a process of elimination. The authors would have to follow the sample through further generations to know for sure.

And those are only some of the uncertainties when it comes to epigenetics. We don’t yet know, for example, which genes to look at for epigenetic changes. Or how epigenetic markers might survive the powerwash-like fertilization process. Confusingly, some studies find that stressful times our grandparents experienced might actually be beneficial for future generations. One study found that people who were undernourished at age 9 had grandchildren with better mental health. Studies performed on a series of poor 19th-century harvests in Överkalix, Sweden, found that grandsons of grandfathers who had bountiful harvests during childhood actually died younger than expected, but granddaughters of women who were in the womb during a famine were also at a higher risk of death at a young age.

Lars Olov Bygren, the author of the Överkalix studies, told me this could be because it’s beneficial for our grandparents to have plenty of food before age 10, but after that age something switches, and it’s in the best interest of our own longevity for them to be slightly under-nourished. Jirtle, meanwhile, says that the contradictory findings show up because while too little food is bad, so is too much food. Ideally, our grandparents should be stressed just enough, but not too much.

In another twist, the Civil War paper shows that the sons could be protected from their fathers’ trauma if their mothers had good nutrition while they were pregnant, which is something that’s consistent with epigenetic research.

“By no means is it saying that whenever there’s trauma, that means it’s going to be transmitted,” Dora Costa, the lead author of the Civil War study and an economist at UCLA, told me. “The epigenetic story is optimistic because it allows for the possibility of reversibility through maternal nutrition.”

Jirtle, for example, has found that dietary supplements fed to a mother mouse were able to protect baby mice from exposure to a chemical called BPA. “As Hippocrates basically stated two millennia ago, food is medicine,” Jirtle told me.

I asked Jirtle if there’s anything we can do, short of demanding to see our mothers’ food diaries during pregnancy, to try to erase some of our ancestors’ traumas. Jirtle says we still need more research to figure out such answers. But he pointed out that in Costa’s study and in some others, the blow to longevity only held true for the sons of POWs, not daughters. Costa believes the epigenetics are being transmitted through the Y chromosome only.

Because of that, Jirtle suggested I might be “home free.”

Just not if you ask my therapist.

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Most of us have some insight into our personality traits, but how self-aware are we in the moment?

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Screenshot 2018-10-01 13.07.33.png
Correlations between momentary self-views and observed behaviour, from Sun and Vazire, 2018.

By guest blogger Jesse Singal

Your ability to accurately understand your own thoughts and behaviour in a given moment can have rather profound consequences. If you don’t realise you’re growing loud and domineering during a heated company meeting, that could affect your standing at work. If you react in an oversensitive manner to a fair and measured criticism levelled at you by your romantic partner, it could spark a fight.

It’s no wonder, then, that psychology researchers are interested in the question of how well people understand how they are acting and feeling in a given moment, a concept known as state self-knowledge (not to be confused with its better-studied cousin trait self-knowledge, or individuals’ ability to accurately gauge their own personality characteristics that are relatively stable over time).

In a new study available as a preprint on PsyArXiv, Jessie Sun and Simine Vazire of the University of California, Davis adopted a novel, data-heavy approach to gauging individuals’ levels of personality state self-knowledge (i.e. their personality as it manifested in the moment), and it revealed some interesting findings about the ways in which people are – and aren’t – able to accurately understand their own fleeting psychological states.

The study, provisionally titled “Do People Know What They’re Like in the Moment?” had two main components. First, 434 Washington University of St. Louis students were texted four times a day for 15 days and asked to rate themselves on four of the Big Five personality characteristics based on how they had felt and behaved during the previous hour: Extraversion, Agreeableness (only “if they reported that they were around others during the target hour”), Conscientiousness, and Neuroticism. Of these 434 participants, 311 also wore a recording device paired with an iPod touch that recorded for 30 seconds every nine and a half minutes from 7 a.m. to 2 a.m. every day, generating a huge amount of audio data. (Before researchers had full access to the recordings, students were allowed to listen to them and erase anything they didn’t want the researchers to hear, but only 99 files were deleted from a cache that became “152,592 usable recordings from 304 participants.”)

Second, a veritable small army of research assistants – more than a hundred – listened to the recordings and rated the speakers on the same four personality states they had previously rated themselves on. For a subset of the study participants, then, researchers had three useful pieces of information: recordings of them going about their lives, participants’ rating of their own personality states during those periods, and outside observers’ rating of those same states. This allowed the researchers to measure the extent to which self-ratings correlated with other-ratings – that is, did Tom’s view that he was quite extroverted during a given hour match up with how others who heard him on audio interpreted his behaviour during snippets of that period?

And measure they did, generating a pretty cool series of graphs (see above). The more acute the positive, upward slope, the more there was agreement between self- and other-ratings. So as you can see, Extraversion was, by a significant margin, the personality characteristic for which people seemed to have the most accurate self-knowledge. This shouldn’t necessarily be a surprise. For one thing, while intuition isn’t always an accurate guide on such matters, common sense would suggest that people are well aware of the extent to which they are actively and enthusiastically engaging in social activity, and that we’re all pretty good at judging others’ level of extraversion as well. Second, the authors note that this finding is “consistent with a large body of literature demonstrating high self-observer agreement on trait extraversion across a wide range of conditions.” The state with second-highest subject-observer agreement, as the graph shows, was Conscientiousness (again, perhaps because in-the-moment conscientious behaviour is pretty easy for both the self and others to discern).

What about the two other personality states, where there was significantly less subject-observer agreement? The tricky part about interpreting these findings, as the authors point out, is that there are two possible explanations: the first is that the subject really does lack insight into their temporary psychological states and that the external observers’ observations accurately captured this; and the second is that the observer was wrong because they only had access to a limited slice of audio that simply might not be enough to accurately gauge the subject’s state at that moment (remember, the raters had no visual information to go on – no body language, facial expressions, or anything else). 

So when it comes to Agreeableness and that rather flat line – meaning little agreement between subjects and observers – the authors argue that “it is plausible that people have less self-insight into their momentary agreeableness,” because Agreeableness has so much more to do with external, observable behaviours, and with other people’s perceptions of your warmth, than with internal “thoughts and feelings” (meaning that other people might naturally be better judges of this personality state). Neuroticism, on the other hand, is different – it’s a state much more characterised by internal feelings than by outward behaviour. So in that case, Sun and Vazire argue that their findings alone shouldn’t be seen as supporting the idea that people are bad at self-rating their present level of Neuroticism – rather, it’s more likely the audio just didn’t give the observers enough to go on.

As is probably clear, this is a complicated topic, and it seems likely that people are much better at understanding their present personality states in some ways than others. Sun and Vazire’s study was quite ambitious, and it offers a useful path forward for researchers hoping to learn more about an important issue. In the meantime, their general takeaway? “Our findings show that we can probably trust what people say about their momentary levels of extraversion, conscientiousness, and likely neuroticism. However, our findings also call into question people’s awareness of when they are being considerate versus rude.” Useful information – and probably not a surprise to anyone who has dealt with a bullying coworker who doesn’t seem to understand the impression he’s making on his colleagues.

Do People Know What They’re Like in the Moment? [This paper is a preprint and the final peer-reviewed version may differ from the version that this report was based on]

Post written by Jesse Singal (@JesseSingal) for the BPS Research Digest. Jesse is a contributing writer at New York Magazine. He is working on a book about why shoddy behavioral-science claims sometimes go viral, for Farrar, Straus and Giroux.

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Toddlers Want to Help and We Should Let Them

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Researchers have found that very young children innately want to help, and they will continue helping into adulthood.
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Maria Clara R. M. do Prado: A irracionalidade do mercado

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- Valor Econômico

A crise de 2008 mostrou que o mundo não consegue caminhar na direção apregoada pela corrente da liberdade econômica

Durante muito tempo, a tese do mercado racional dominou o pensamento econômico. Nasceu nos anos 70, na Universidade de Chicago, que havia se destacado uma década antes com a teoria monetarista, segundo a qual a inflação resultaria diretamente da quantidade e da velocidade da moeda em circulação na economia.

O monetarismo, como se sabe, começou a sucumbir no início dos anos 90, quando os primeiros países passaram a usar o regime de meta inflacionária, baseado no direcionamento das expectativas futuras para a estabilidade monetária. Já a hipótese da racionalidade prevê a capacidade dos preços absorverem todas as informações disponíveis, redundando, assim, no funcionamento eficiente do mercado.

Ainda nos anos 70, concomitantemente à ideia da racionalidade, surgiu a tese da economia comportamental, baseada nos escritos de dois psicólogos, advogando que as decisões do mercado nem sempre são perfeitas porque as escolhas se fazem debaixo de incertezas, influenciadas pelo contexto do momento.

As finanças comportamentais destacam não a eficiência, mas a ineficiência do mercado, cujos participantes costumam errar sistematicamente, afetando preços e retornos, muitas vezes em busca de vantagens. Operações de arbitragem e a criação de instrumentos financeiros sofisticados, demasiadamente replicados na era da globalização, são produtos da ineficiência, a mesma que também explica as bolhas e o fenômeno do "rebanho" (em que os participantes movem-se na mesma direção para diluírem a percepção das falhas de suas decisões). A ineficiência favorece, ainda, a especulação.

Para além disso, pode-se dizer que os mercados não são imunes à política, muito embora possam ser cegos ao ambiente político que os rodeia.

O comportamento atual do mercado financeiro dos Estados Unidos é um exemplo emblemático. De olho nas projeções de crescimento da economia norte-americana para 2019 e 2020, está dominado pela euforia. A expansão do crédito empresarial e as significativas altas acumuladas nos preços das ações não combinam com o discurso errático do presidente Trump, nem com as medidas intervencionistas adotadas por ele. Muito menos com os gastos públicos que têm crescido de forma expressiva, como uma bomba em construção passível de explodir no médio prazo. Também o endividamento privado tem aumentado de forma preocupante.

Mas nada daquilo parece relevante para o mercado que, de forma irracional, age com vistas a tirar proveito dos ganhos de curto prazo, sem olhar para as perspectivas sombrias que se desenham no horizonte. Não a toa, tem crescido entre os economistas o temor de que uma nova crise financeira se avizinhe, nos moldes da que estourou há exatos dez anos com a quebra do banco Lehman Brothers.

As suspeitas recaem na alavancagem de um instrumento conhecido por "covenant-lite loans" ou, em tradução grosso modo, empréstimos com cláusulas suavizadas. São créditos concedidos a empresas de baixa classificação que buscam condições financeiras menos restritivas. Esse tipo de operação tem crescido muito nos Estados Unidos desde o ano passado, levantando o receio de que os investidores naquelas companhias possam sofrer sérias perdas no caso de novo colapso. Em resumo, apesar dos riscos da política econômica de Trump, Wall Street parece viver na festa de Babette.

No Brasil, a irracionalidade do mercado tem se aprofundado neste ano eleitoral. O índice da Bolsa de Valores cai, e o dólar também, sempre que o candidato do Partido Social Liberal (PSL) sobe nas pesquisas de opinião. Os participantes do mercado financeiro não estão preocupados com o perfil de um político eivado de todo tipo de deformações morais. Não enxergam o potencial desastre que sua eleição representaria para o país nos segmentos político, econômico e social. Em linha com a tese da economia comportamental, atuam de forma ineficiente ao prestigiar um político que não apresenta condições mínimas de presidir a nação.

Nem mesmo faz sentido a justificativa de que a aposta do mercado recai sobre o economista Paulo Guedes, potencial futuro ministro da Fazenda, segundo se imagina, caso Bolsonaro seja eleito. Sem experiência em cargos executivos do setor público, Guedes é "filho" da Universidade de Chicago, onde cursou o mestrado e o doutorado em economia, e carrega a chancela de liberal que tanto agrada o mercado.

Mas o pensamento liberal radical ou a sua vertente mais amenizada, o neoliberalismo, do qual Chicago foi a maior expressão no século XX - depois de ter desenhado a política econômica adotada pelo governo do ditador Pinochet, no Chile - está defasado. Até Chicago se renova. O último economista daquela universidade laureado com o Prêmio Nobel (em 2017) é Richard Thaler, um estudioso da economia comportamental. Seus trabalhos enfatizam justamente a influência da psicologia na tomada de decisões e a ineficiência das escolhas feitas pelo mercado.

A tese da racionalidade do mercado, deve-se dizer, surgiu na academia norte-americana independente do neoliberalismo. Mas são irmãos gêmeos. A não intervenção dos governos na economia, e nos mercados, pressupõe que os agentes econômicos sejam capazes de tomar as decisões "corretas" a partir das informações captadas sem a ingerência do Estado.

A crise financeira de 2008 mostrou que o mundo não consegue caminhar na direção apregoada pela corrente da liberdade econômica. O mercado quebrou porque não funcionou de forma racional e muito menos teve interesse em se auto-regular. A ganância superou largamente a racionalidade. Vale ponderar que as políticas destinadas a estreitar a presença do Estado na economia devem ser sempre bem vindas. O setor privado sabe como alocar os recursos disponíveis com mais eficiência do que os governos. Isso tem a ver com bom senso, condição que qualquer economista pode ter, mesmo que não tenha se formado em Chicago.
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Candidatura de Jair Bolsonaro muda de patamar

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O projeto eleitoral de Bolsonaro mudou de patamar. Há uma semana, frequentava as pesquisas em situação paradoxal. No primeiro turno, era bicho-papão. Depois, era papado. Isso mudou. Na mais recente pesquisa do Ibope, Bolsonaro aparece como uma assombração competitiva também no segundo turno. Abriu cinco pontos de vantagem sobre Marina. E emparelhou com Alckmin, Haddad e Ciro.

Bolsonaro não é mais um azarão do segundo round. Hospitalizado há duas semanas, reduziu a taxa de polêmicas em que se metia. Nessa fase, também foi poupado de ataques dos rivais na primeira semana pós-facada. Seus oito segundos na propaganda eleitoral tornaram-se uma vasta exposição jornalística. Voltou às redes sociais como paciente sofrido. O timbre lacrimoso suavizou-lhe a arrogância.

No seu penúltimo vídeo, veiculado no domingo passado, Bolsonaro atiçou sua rivalidade com Lula e o petismo. Acertou no olho da mosca, pois a transferência de eleitores do presidiário de Curitiba para o seu poste avança aceleradamente. Em uma semana, Haddad deu um salto de 11 pontos, isolando-se na vice-liderança com 19%. O capitão oscilou novamente para o alto, batendo em 28%.

Mantido esse ritmo, o que vem por aí é um primeiro turno plebiscitário no qual o eleitor decidirá se o PT deve retornar ao Planalto ou ser mantido na oposição. É a mesma velha disputa entre o petismo e o antipetismo. Com uma diferença: o PSDB foi expurgado da polarização. Hoje, é Bolsonaro quem representa a maioria do voto anti-PT.

A moderação personificada em Alckmin virou mercadoria pouco valorizada. Para complicar, as opções do chamado centro pulverizaram-se em micro-candidaturas como as do ex-tucano Álvaro, de Amoêdo e de Meirelles. O que era fraco tornou-se exangue. Numa campanha curta, a apenas 18 dias da abertura das urnas do primeiro turno, a possibilidade de correção de tropeços é pequena.

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A volta do HIV

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Corria o ano de 1981. Num almoço na casa do cirurgião Fernando Gentil em homenagem a Joseph Burchenal, um dos mais destacados oncologistas americanos da época, ouvi falar, pela primeira vez, de uma doença estranha que debilitava o sistema imunológico.

O doutor Burchenal contou que, num congresso realizado em Nova York, foram descritos casos de jovens com pneumonia por Pneumocystis, fungo que causa infecções pulmonares apenas em pessoas imunodeprimidas, como as transplantadas e as portadoras de leucemias e linfomas submetidas à quimioterapia.

Ao mesmo tempo, na Califórnia, apareceram pacientes com sarcoma de Kaposi, que apresentavam manchas espalhadas pelo corpo todo, inclusive em órgãos internos. A apresentação era raríssima, uma vez que esse tipo de tumor costumava acometer gente de idade, da região do Mediterrâneo, nas quais as manchas seguiam curso indolente no decorrer de anos, geralmente limitadas aos membros inferiores.


Veja também: Uso de medicamentos no controle do HIV


Para surpresa de todos, tanto os doentes com pneumonia por Pneumocystis, quanto aqueles com as lesões disseminadas do sarcoma de Kaposi, eram jovens e homossexuais.

Estava armado o cenário para a disseminação da aids, uma das pandemias mais devastadoras do século 20.

Por sorte da humanidade, no entanto, a aids emergiu nos anos 1980, época em que o laboratório do americano Robert Gallo, no Nacional Cancer Institute, já havia identificado os primeiros retrovírus causadores de doenças humanas. Tivesse surgido 20 anos antes, não existiria tecnologia para cultivar o vírus nem para caracterizá-lo como o agente etiológico da síndrome. A tragédia atingiria proporções catastróficas.

Enquanto epidemias de tuberculose, hanseníase, malária, sífilis, varíola, peste e outras assolaram o mundo por milênios sem que os germes responsáveis por elas fossem descobertos, no caso da aids, em dois anos o HIV foi isolado e já dispúnhamos de um teste sanguíneo para identificar os portadores. Dois anos mais tarde, surgia um medicamento para combater o vírus: o AZT.

Em 1995, foram publicados os resultados obtidos com a combinação de antivirais, que ficaria conhecida como “coquetel”. Foi uma revolução que os médicos da minha geração tiveram o privilégio de viver. Guardadas as proporções, é possível compará-la à descoberta dos antibióticos para tratamento das infecções bacterianas.

Doentes caquéticos, debilitados pelas sucessivas doenças oportunistas, ganhavam peso, voltavam a andar, retornavam ao trabalho e às atividades cotidianas; a maioria deles está viva e saudável até hoje.

Em seguida, o Brasil passou a distribuir os antivirais pelo SUS, estratégia que mudaria a história da epidemia no mundo.

O Brasil que inovou ao implementar medidas ousadas de combate à aids, que serviram de exemplo aos países da África, Ásia e Américas, agora cruza os braços diante da nova onda de infecções que atinge os mais jovens.

Em 1995, a prevalência do HIV em nosso país era idêntica à da África do Sul, que não adotou a mesma política. Hoje, 10% da população adulta daquele país está infectada. Se o mesmo tivesse acontecido conosco, teríamos cerca de 18 milhões de brasileiros HIV-positivos.

Hoje, além do tratamento precoce dos infectados, o SUS oferece medicamentos para prevenir a transmissão (PrEP) e para a profilaxia pós-exposição (PEP).

Paradoxalmente, entretanto, relaxamos na educação. As campanhas públicas pelos meios de comunicação de massa desapareceram, a educação sexual nas escolas enfrenta barreiras impostas por religiosos, pelos moralistas das horas vagas e por grupos de conservadores medievais.

O Brasil que inovou ao implementar medidas ousadas de combate à aids, que serviram de exemplo aos países da África, Ásia e Américas, agora cruza os braços diante da nova onda de infecções que atinge os mais jovens.

Estudo patrocinado pelo Ministério da Saúde em 12 capitais mostra que as prevalências do HIV em homens que fazem sexo com homens, variam de 5,8% em Brasília a 24,8% em São Paulo.

São números assustadores que exigem medidas drásticas para evitar que se forme uma legião de infectados capaz de reviver os piores anos da epidemia.

Aids é uma doença crônica que exige exames laboratoriais, imagens radiológicas, internações hospitalares e tratamento medicamentoso pelo resto da vida. Na penúria em que vive o SUS, de onde virão os recursos necessários?

A influência dos que se arvoram como defensores da vontade divina, é nefasta. Impedir que a informação e intervenções educativas cheguem aos mais jovens, em nome da moral e dos bons costumes, na vigência de uma epidemia por uma doença sexualmente transmissível incurável, é crime.


The post A volta do HIV appeared first on Portal Drauzio Varella.

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