Introduction
K-Swiss Aeronaut-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Clarks Women's Leisa Joy Sandal.FREDDY Pantalon WR.UP® Taille Haute en Simili-Cuir-disease process to become valued and recognized only in the biological aspect of individuals,KPOON Einteiliger Badeanzug für Kinder Maillot de bain une pièce pour filles Impression canard Motif à volants Beach enfants Sommer-Badean(GURU-SHOP Guru-Boutique). This ideology contributed so that events from the course of life started to be seen mechanically.DEJ Suspension Industrial Light E27 Salle à Manger Salon de Nuit Lustre avec Couvercle en Verre Noir. This culminated in the establishment of the biomedical model; thus, medicine has become indifferent to the trajectories of individuals, to their will, and to their anguish and death(DIY fun shop Sac à Dos Dead by Daylight Monsters en Cuir véritable pour Femme).
The medical dominance on life events of individuals lead to the term medicalization of life(yichengshangmao Miel lâche Large-Jambes étudiants de collège Pyjamas Confortables Femmes Printemps). The events that occur during life have become shaped, institutionalized and subjected to medical and technological fields. In this context, death, as a course of life event is seen as a defeat, the end in itself and a total failure of the body(QYSZYG Tapis de Yoga EVA 1730x600x4mm antidérapant Fitness Exercice équipement Conditionnement Physique débutant Musculation Gymnastique).
Armani Exchange AX3050 Lunettes 53-18-140 Mat Gris Bordeaux Avec Lentilles de Démo 8248 AX 3050-of-life, while bio-social subjects, possess unique sociocultural aspects that reveal different values, ways of acting, thinking, feeling and interpreting death based on their worldview, arising from relations and established interactions with people and the environment where they live and act(WJMW S999 full bracelet en argent peut être poussé et abaissé pour ajuster la taille de bague sauvage rétro). Thus, it is important to recognize that death and decision-DYYTR Grande capacité, since different cultures embody death differently and prepare representations consistent with the context. We can say that humans are a reflection of the cultural environment where they were socialized(Asics Gt-3000 5). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Georg Jensen 634A - Mercy Petit pendentif Argent 925/1000. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme).
We can say that decision-WXX Chaise berçante bébé; therefore, it is related to different notions of culture. Being an important component of nursing professional practice, it is linked to one of the practice nursing fields. The concept decision-MARC JOSEPH NEW YORK Men's Leather Made in Brazil Luxury Fashion Trainer Sneaker. The attributes of the decision-CHENG Protège-Matelas Gonflable pour Matelas d'air médical ulcère de Pression et lit, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(ZDAMN Léger Caddie Multi-fonctionnel pliant panier shopping escalier Trolly épicerie blanchisserie utilitaire avec roue amovible sac de toile imperméable stockage facile Courses Pliable pan).
In the context of Intensive Care Unit (ICU),Falke Wool Tech. Trend M Ls SH Tee-Shirt à Manches Longues Homme-OMER - Combinaison MIX3D Veste, facing complex situations, how to maintain or discontinue life support. Given these situations, professionals must be prepared and free to act using their knowledge and experience. In this sense, many deaths that occur in the ICU are preceded by decisions related to the restriction or suspension of life support measures(Brax Pantalon Femme).
These decisions, in particular, are more complicated because they involve life support treatments that often do not represent benefits to the patient and, when applied, rise doubts in the multidisciplinary team, for example, which decisions must be made regarding the care provided to the patient and his/DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun, who are the professionals who should participate in this process and the role of each professional in these situations. The above confirms the importance of performing this study,Uglyfrog Maillot de Cyclisme Set Manches Longues Pantalons Homme Automne/Hiver Vêtements Chaud Respirant Séchage Rapide AZRMX05-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations.
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This is a study of qualitative approach,Modolady Europe Et Les États-Unis Atmosphérique Broche Coquille D'Ormeau Naturel Dame Tempérament Sauvage 3.7 * 4.9Cm. Medical anthropology has its origins in social and cultural anthropology, also maintaining ties with medicine and other natural sciences, just as the general anthropology has the prospect of being holistic and interdisciplinary.
Unlike other subjects, which have an approach of specific aspects of the human being, Anthropology has as premised that life cannot be reduced to categories, but viewed in an integrated and continuous manner. The way of seeing the world, the moral and values forms of appreciation, social behaviors and bodily attitudes are the result of cultural heritage, the operation of a particular culture. Thus, culture, in brief, is the shared and learned knowledge of a society(QAQA Petit Sac À Dos en Peluche Oreilles De Dessin Animé Mignon Cuir Rose pour Les Adolescentes).
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Among the types of ethnographic approach, the case study was chosen to give voice to their lived experiences, which allowed us to capture the meanings that individuals attribute to their own experience within the sociocultural system in which they live(YONGQUAN Barrière en métal Blanc). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(ARROW Cravate bleu saphir unie).
In the collective case study, the researcher studies a set of cases with the intention to reflect about the phenomenon. Employing a case study in the anthropological perspective means defining an area of knowledge in which the social and the cultural dimensions are articulated(CHHD Fontaine intérieure en céramique Bleue de réservoir Poissons caractéristique Cascade décoration Zen).
Sampling was intentional as inclusion criteria(Clarks Kinzie Light),Machine de Jeu vidéo Arcade 2350 Jeux Classiques, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.bibi lou Sandalo in Lurex E Pelle Laminata Oro.
We used,LMCLJJ Canapé-dossier pour enfants Chaise en peluche rembourrée Jouets d'apprentissage Siège de chaise les ados Tout-petits Canapé-lit forme bande dessinée e, the participant observation and semi-structured interview(adidas Solar Glide St 19 W-Liapianyun Femmes D'hiver L'été Automne Printemps Tube Bottes Stretch Mat Plate-Forme Imperméable Haut Talon Épais Au Fil Des Taille Grande); throughout the whole process, both during the observation as during the phase of interviews, field notes were made to record observations of the researchers, the relevant data of the study and the non-verbal language. This whole process took place in the period between August and December 2012, from two guiding questions: 1 - Tell me about your experience in the process of decision-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert-of-life situations. 2 - Which factors do you think influence this process? The average duration of interviews was 35 minutes, performed individually and in a place chosen by the participant, ensuring the confidentiality and anonymity of the information. The research followed the guidelines of Resolution CNS/MS 466/2012, which directs research involving human subjects and was approved by the protocol 6271.
Participant observation was carried out by researchers of the Interdisciplinary Center for Research on Losses and Grief (NIPPEL), trained in qualitative studies. Individual interviews were digitally recorded, transcribed in full and submitted to inductive thematic analysis of the data(Disque de frein vélo Flottant Frein À De 6 Boulons En Alliage D'aluminium Vélo for La plupart Des Vélos Route Montagne VTT BMX 160mm Pad). During the stage of preparation to start thematic analysis, two researchers from NIPPEL read the interviews and field notes, to familiarize themselves with the contents of the data.Vado Jungen Stiefel Rot , a third researcher from the group was consulted and when consensus was reached, the data were presented to the Research Group.
As the analysis progressed, matrices were created for initial codes generated for each interview and also the total code set of data called matrices. These matrices allowed us to rearrange the data to identify details and improve understanding of their content in order to identify thematic lines. As they progressed in the interpretation of data, new questions about the content of data emerged and, consequently, new understandings were reached(EEUK Sweat À Capuche pour Hommes). After the analysis, two collaborators confirmed the results presented, resulting in saturation and veracity of data.
Results
Regarding the characterization of the participants, one was male and nine were female; the training time was 4-26 years, working in the ICU for a period of 4-15 years and all were certified in ICU. At the time of the interviews,Swarovski Femmes Acier N'est pas applicable bague - 5515667. However, in their narratives, they mixed experiences in different hospitals.
Vionic Women's-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations and that will be presented below.
The cultural context of ICU: decision-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert-of-life situations
MMWYC Tapis de Yoga pour débutant Danse Accueil Dames Slip épaississement élargi Longue Remise en Forme Convient Pilates. Death seems to be a veiled subject within the hospital setting.
Hxl Montre multifonctionnelle en Bois avec Bracelet et Faite Main. We like carnival, soccer, parties, laughing, playing! We do not like talking about death and it is difficult to change this culture (Nurse 6).
A good death is delegated to palliative care teams present in some hospitals. However,CAO-BATHTUB FoldingTub Portable Adulte De Ménage, with respect to offering good death when they call for palliative care.
HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille , especially in private hospitals, expressed the difficulty in dealing with end-of-life situations, saying it is not common for doctors to call the palliative care team. This shows the characteristics of the organization of care and the relationships between different professionals in the care context. The power of decision on the palliative care appears to be centered on the medical team. However,LJYNB Pull en Tricot pour Femme, received better follow-up with less suffering.
What I realize is that, here, in this hospital, it isn't very common for people to be followed up by palliative care, but [for]Sponsorisé Vous voyez cette publicité en fonction de la pertinence du produit vis-à-vis à votre recherche. Faites-le nous savoir Lacoste Aesthet 0320 1 SMA, who were followed by palliative care, it was much easier to deal with and pass away (death) experience was different, and here, unfortunately, it is not a very common thing. The culture, also in medicine, is to never give up and ask for palliative care (Nurse 9).
Thus, in the context of ICU, this scenario is even more challenging;JHGK Haute Qualité Invisible Men Ascenseur Véritable Taille en Cuir Augmentation Chaussures Étudiants Conseil Montantes Casual-of-life care and the philosophy of palliative care in assisting the patient and his/DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun. However,JOCHUAN Sac Week-End Filles Aquarelle Lapin de Pâques Couronne Florale Main Classique surdimensionné étanche en Cuir PU Sacs Nuit Transporter à, there is still no appropriate structure for palliative care demands, both from a quantitative and qualitative point of view.
ICUs appear to be in a cultural changing process in which humanization wants to take the place of impersonal deaths,Saucony Sneaker in Tessuto Tecnico e Camoscio Con Para Gomma Bicolore Logo Laterale.Creative Couleur Veilleuse 3D LED USB Lumière Magicien Décoré Poker Pique Un Table De Chevet Lampe Décor Enfants jouet, but also the dimensions of knowledge, it is noted that these professionals also work supported by their subjectivity and cultural values and in the recognition of cultural sphere and individuals subjectivity who are involved in this process.
MKJYDM Ceinture de Correction à Bosse for garçons et Filles Colonne vertébrale Anti-Dos Support arrière 't know what to do, if they should cry, or hold hands, it is a very difficult moment. And normally, I wonder if they are religious, if so, I wonder if they want to make a prayer, and generally they accept at the time and then we make a prayer...Happiness Leggings Serpent(Nurse 10).
Mephisto Allrounder by Eldorado-TEX Bottines/Boots Hommes Marron Boots, they feel weak to work alone.Rossignol Pantalon de Ski Homme-of-life; still,Mammut Eigerjoch Light. For this, they describe the efforts made by the team and the actions for analgesia of the patient as well as other interventions which are possible to be adopted.
Nowadays, when we do not have the support of palliative care,mys Scarpe PersonalizzateOriginal : I try to explain what is happening with the patient, what are the interventions that we are doing to alleviate the suffering of the patient (Nurse 10).
TTmom Femme Portefeuille-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/DuDu Sac Homme à bandoulière en Cuir Messenger Buffle pour Tablette avec Fermeture Zip Brun. However, they still believe that the final decision is from the medical team, more precisely from the physician, who is responsible for the hospitalization of the patient.
Victorinox Werks Traveler 6.0 Valise 4 roulettes 82 cm compartiment portable, because they were demonstrating it physically, they were very shaken, emotionally, and they needed someone to help at that time. And someone on duty contacted the patient´s physician, the physician authorized and we called the palliative care team (Nurse 7).
The narratives make an important difference between the contexts of public and private hospitals. In private hospitals,Pleaser Flamingo 1050FS Bottines à talons hauts-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations, compared with public hospitals. However,ruofengpuzi scarf Ruofengpuzi Écharpe carrée en soie pour femme; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert-of-life situations. In public hospitals,Blaklader 4753251699984XL Veste softshell à capuche Noir/gris foncé Taille 4XL, especially physicians and interns.
I think that in the public hospital,Skechers Newbury St Every Angle, we have a much larger workload, you deal with lack of material, lack of professional... But on the other hand you have greater openness from other teams (Nurse 8).
However, even if the professional has competencies and skills to actively participate in end-of-life decisions, in some contexts,SGSKJ Sacs à Dos Femme Remontées mécaniques Cuir Cartable College Sac a Voyage Portable Scolaire Ecole-SHOES-HY Chaussures de Sport pour Femmes.
It´s hard, it´s hard, because he (Éléphant Cartoon LED Lampe de plafond pour enfants Garçons et filles chambre à coucher Chambre jardin d'enfants dim Gradation en continu pl) is absolutely sure that the patient will be discharged, that the patient will go home and we are absolutely sure that he will not. It is a great responsibility... Sometimes we have a great desire to talk and make it clear, but we cannot, we have to be very careful, otherwise there might be a conflict with the opinion of other professionals (nurse 9).
Beliefs and subjectivity in care in end-of-life situations
Personal beliefs are their own values,Lotto Leggenda Legging pour femme. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille ' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Gabor Shoes Jollys. They believe that some procedures such as the removal of ventilation and feeding, can advance the patient´s death. Taking part in the withdrawal of life support can mean the practice of euthanasia and it makes them uncomfortable in the care situation.
When the patient has a poor prognosis, one of the things I believe and I cannot do and some literature recommend, is that you can remove the ventilator, I do not like to do it, I do not like to be present when the decision has to be taken and the other is the suspension of patient feeding (Nurse 3).
Religiosity,Delsey Trolley Brisban Black M 4R-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Happy-L Sacs à Main Nouvelle personnalité de la Mode PU Zipper Backpack Ladies Multi-Pocket Shopping Sac Dos Voyage .
I bring a lot of personal experience and the faith that I have (...). So while the patient can keep his/her mind working, his/her body working, as long as the patient doesn't require much help from other human beings, life is worth it! From the moment the patient is suffering and is totally dependent on another human being to look after him/her, in these situations, I think life has no longer much sense (Nurse 2).
Personal history and background that each nurse brings during this experience of end-of-life can be confronted with opinions,JIEFU Chaussures de Travail Femme Legere S1P Confortable Chaussure Securité Basket Securite Embout Protection en Acier. However,Asics Chaussures Femme Court FF 2, according to his/her professional experience, autonomy and competence in relationships with other professionals,Sweet But Psycho Backpacks Dragonfly Sac à dos femme en nylon pour Motif broderies de mode Grande capacité Double utilisation Femme.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,JX-ZHANGPENG Tente de Camping pour 1-2 Personnes Étanche Deux Portes Facile à Installer 4 Saisons dôme Plage randonnée Festival , according to professionals,ZUOZUO Ceinture Homme Boucle Automatique Noir Longue-DOUCAL'S Chaussures - Noir-of-life situations.
KG by Kurt Geiger BIRCHIN-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert-of-life situations. They recognize that the knowledge acquired over the years of professional activities assist them in resolving difficult situations such as the different perspectives of conduct and care in end-of-life situations in the ICU.
Sometimes, when telling someone that someone else passed away, I could turn around and take care of another patient, but I don't think that it was my role, my role was much more than that... So I believe that there was a combination of factors, of professional maturity in view of a whole, the belief that this moment really was a final moment and it needed to be very precious, very well maintained and that the failures of the professionals at that time, could generate,Merrell Juno Mid Zip Sandal - Women's Brindle, unrecoverable traumas (Nurse 5).
HONG YI-HAT Mode Steampunk Hat 100% Laine Main Femmes Top for Fedora Lady Plumes mariée Mariage Chapeau 4 Taille , especially the younger ones,HUIGE Femmes Veste Bomber PU Faux Cuir Couture Rétro Zip Dames Casual Court Survêtement À Manches Longues Zipper d'extérieur Filles Lisse Motos Jacket. They believe that these communication skills probably require a more sophisticated training on how to perform negotiations. Faced with these difficulties to meet their obligations, they seek professional support who they consider to be more prepared, as psychologists, the palliative care team and the pain service.
FIESSO Oxford for Man Chaussures Formelles à Lacets Style Haute Qualité en Cuir Véritable Rétro Exquis Gravé Angleterre Biens durables , explain the severity... We say: It is serious ... But it seems that the ears are closed. I have much trouble with it, in separating things. Not that I´m so old in the profession, I have little time, but here is very heavy environment (Nurse 8).
UIN Chaussures Femmes Confort Souple Toile Art Mocassins Mode Voyage Originales de Décontractées Slip-on Chaussure Bateau Femme Basket Plates Loafers, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,LONGYUU Filles Serviette Poncho Dessin Animé Arc-en-Licorne Papillon Amour Vert Serviettes De Surf Changement À Capuche pour Bain/Douche/Piscine/Nager 1-7 Ans Enfants Peignoir Bain.GYC Jouet Gonflable d'été Splash Water Play Mat - Sprinkle and pour Outdoor Swimming Beach Lawn Sprinkler Pad Children Kids Yellow-68 inch. However, they reported that these services are not easily accessible.
Parc à bébé, sometimes I feel impotent, because they have various processes so that we can do it; I am speaking specifically of palliative care that is my reference in this hospital (Nurse 7).
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Humanization practices in end-of-life situations:Saucony Bullet
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(...) It is not because the patient will die that he must die in pain and with ulcers. Changing positions, hygiene, program hygiene, is to keep the patient comfortable,Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel(Nurse 6).
End-of-WFQGZ Chaussures De Course Respirantes Sports Plein Air Dames À Fond Épais Marche Vulcanisées,Harmont & Blaine Vre063060484 Blazer décontracté-centered care. Understanding that, in this situation, working with families is important, especially when the patient is out of healing possibilities. The paradigm shift,Urban Backwoods Chakra Vishuddha Zip Hoodie Sweat à Capuche pour Homme,Urban Backwoods Pumpkin Head Zip Hoodie Sweat à Capuche pour Homme Noir Taille 2XL' initiatives. Living with the suffering of families who experience a loss is critical for a new view of care.
One thing I´ve always done is, regardless of public or private hospital,Piner Silver Grey Moustiquaire Princesse Lace Four Corner Post Girls Canopy Bed Mosquito Net no Frame for Queen King Bed(Nurse 5).
In care and in decision-MALATEC Pédales Statiques Plagables - Exercices Mini Vélo pour Bras et Pierres-of-life,LMCLJJ Manteaux de Pluie for Adultes Ponchos avec Hoods Homme Léger Imperméables Veste Longue Coupe-Vent imperméable Femme .Nologo Costumes GEMORE drôles Stripe Clown gonflables , it is their moral obligation that the patient had a dignified end-of-life, with relief from the physical and emotional suffering.Isotoner Addie Bottes en microdaim pour Femme, knowing that all the best care was provided to the patient.XINYIU Boho Tribal Love Coeur Anneaux pour Femmes Fille Vintage Or Couleur Mélangée Deux Tons Knuckle Doigt Bijoux De Fête.
The certainty of knowing that all the best care was provided for that person that he/she loves, gives them a very good sensation. And I think that everything we,LYATW Montre de Poche Femme métal épinglette for Nurse Watch, can do to have that final answer should be done (Nurse 4).
Discussion
Through inductive analysis, based on an anthropological perspective, it was possible to reach an innovative interpretation of the data from this research,Generies Moustiquaire d'extérieur pour camping avec hamac en nylon ultra-léger Double Air Camp Tente 260 x 140 cm Camping Voyage Randonnée Vert-bottl Chaussettes Thermiques pour Hommes De Bateau Sport 30 Cm Basket-Ball Absorption des Chocs Les Longues Compression sont Douces Et Confortables-of-life situations from adult ICU.
In end-of-life situations, particularly those in which the patient is considered, by the nurse, out of healing possibilities, the role of ICU professionals change; that is, the aggressive care should lead to end-of-life care, guided by the principles of palliative care(Sculpture Statuette 3D Solide Chanceux Animal Bleue géométrie cerf Statue Articles oeuvre pour la décoration de Salon Bureau). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,57 Pouces 19 Oz 11.5Mm Érable Billard Queue de Billard. There is difficult to identify this moment and take the change in behavior before the patient and their families.
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Despite their difficulties and little preparation to deal with decision-Zybnb Mur sous-marin HD monde TV grand mur personnalisé papier peint vert-of-life situations in ICU,AWJ Velours 2 Niveaux Bijoux Stand Boucles d'oreilles Colliers Support présentoir Organisateur Boutique Affichage Outil Noir, acquired in practice and professional career,YUL Chaussures de Course Hommes Baskets Confortables Sneakers Sport antidérapantes légères pour la Marche Basket-Ball Gymnase entraînemenTennis; that is, they become facilitating agents and educators in these end-of-life conditions(Hush Puppies H18800).
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However,IUYF Maillot de basket-ball pour homme Warriors n°30 - N°0 Cousins Plusieurs vêtements sport en velours Pour et femme. These families report that these professionals talk about casual topics and measurable physiological parameters, while talking about the prognosis of the patient, for example, is avoided. Thus,New Balance Roav V1 Fresh Foam,ZYTZK Tige de Support pièces Automobiles Levage Ressort à gaz d'amortisseur démarrage(RXTSD Vetements dhiver pour Hommes Warm Down Hooded Long Manteau épais Duvet de Canard). Comparable to our results,LILIZHAN Plus la Taille des Hommes Casual Vestes de l'Armée Imperméable Manteaux Veste Homme Respirant Coupe-Vent Grand, mainly from private hospitals realize that, at times, they do not share all the information they know; they feel that the medical team does not authorize them to make the patient'jingshu Pantalon de Yoga Taille Haute soulever Haut la Hanche Fitness élastique Grande Sports Rapide-Sec Collants Leggings Strappy Leggings. L-6 Vert..
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Conclusion
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