Efeito do Treino de Composição (Cópia) na Aprendizagem do Conceito de Proporção

This experiment investigated the effect of training conditional relations between pictorial and numerical fractional stimuli, with and without composition training, upon the learning of the proportion concept. It was evaluated the formation of equivalence classes, expansion of classes formed, generalization to new situations, and pencil and paper problem solving with fractional stimuli. The participants were 20 students of the sixth grade of Elementary School. The QEG and TCQEC groups were exposed to training and testing of conditional relations, but the last group was exposed, additionally, to a fractional composition training before the conditional relations training; two control groups were exposed only to the initial and final tests. The results indicated the formation of equivalence classes, but did not show effects of the composition training.O presente experimento investigou o efeito do treino de relações condicionais entre estímulos fracionários pictóricos e numéricos com e sem treino de composição (cópia) sobre aprendizagem do conceito de proporção. Avaliou a formação de classes de equivalência, a expansão das classes formadas, a generalização para novas situações e a resolução de problemas do tipo lápis e papel com estímulos fracionários. Cinco alunos da sexta série fundamental passaram por treinos e testes de relações condicionais (grupo GEQ) e cinco receberam treino de composição (cópia) de frações antes dos treinos das relações condicionais (grupo GEQTC). Cada grupo teve ainda um de controle. Os resultados indicaram que o treino de composição foi uma variável facilitadora para a aprendizagem do conceito de proporção

A utilização de fluxograma orientador nas Unidades Básicas de Saúde

Visando a maior integração dos alunos com a realidade das Unidades Básicas de Saúde é proposta uma inserção nesse ambiente profissional pela Pontifícia Universidade Católica de Minas Gerais (PUC- MG) em parceria com a Prefeitura Municipal de Betim e região. No segundo semestre de 2017, pudemos vivenciar as atividades da Unidade Básica de Saúde/CAIC no bairro Capelinha. Conversando com os pacientes e com os profissionais da área, fomos informados sobre a difícil locomoção dentro da unidade de saúde, já que faltavam placas explicativas com informações básicas. Dentre tais informações, estão os documentos necessários para o atendimento e orientações de onde são as salas de vacina, curativos e farmácia. Diante de tal demanda, procurou-se uma alternativa que melhorasse a organização da UBS e otimizasse o tempo dos pacientes e dos profissionais do centro de saúde. Sendo assim, o objetivo do trabalho foi a elaboração de um fluxograma que se adequasse à dinâmica da unidade e, também, a confecção de placas que auxiliassem no fluxo de atendimento do local. Sabe-se, que a dificuldade de organização nas Unidades básicas de saúde, tanto em relação a estrutura física, quanto no sentido operacional, é uma questão recorrente em diversos municípios. Um quadro semelhante ao descrito no presente artigo foi observado em um relato de experiências de especialista da área de nutrição no Distrito Federal, em que percebeu-se que, por meio do uso de faixas e placas, houve benefícios significativos quanto ao fluxo de atendimento, à comunicação e ao deslocamento de usuários dentro da UBS. Além de redução de circulação aleatória de pessoas à procura de locais de atendimento, bem como, maior satisfação dos servidores atuantes na recepção (CORDEIRO & FREITAS, 2021

DESENVOLVIMENTO E CARACTERIZAÇÃO FÍSICO-QUÍMICA DE GELEIA COMUM E EXTRA DE GRAVIOLA COM PIMENTA

A produção de geleias é um processo bastante utilizado, porém algumas frutas com grande quantidade de nutrientes, como é o caso da graviola, são ainda pouco exploradas comercialmente nesses processos. Neste trabalho teve-se como objetivo o desenvolvimento e caracterização de geleia de graviola (Annona muricata) com pimenta “dedo de moça” tipo extra e comum em três concentrações de pectina 0,5; 1,0 e 1,5%. As análises físicas e químicas foram analisadas quanto ao seu teor de sólidos solúveis totais, umidade, vitamina C, Aw (atividade de água), acidez e pH, teste de sinérese e coloração expressa com valores de L*, a*, b*,croma e hue. A acidez e umidade foram influenciadas pela concentração de pectina e também pela concentração de açúcar na geleia extra e comum. Apenas a geleia comum com 0,5% de pectina apresentou sinérese, devido a maior acidez. Houve diferença significativa entre a geleia extra e comum na umidade e acidez e Aw e entre os parâmetros de cor na geleia extra e comum. Resultados demonstraram que a estrutura do gel é afetada pela concentração do açúcar, pectina e pela acidez

ATIVIDADE DA IVERMECTINA E DO MEBENDAZOL SOBRE HELMINTOS DA SUPERFAMÍLIA STRONGYLOIDEA EM ANIMAIS DE TRAÇÃO

Dentre as enfermidades que acometem os equinos, as parasitárias estão entre as mais importantes. Os parasitas competem pelo alimento além de causar irritação, hemorragias intestinais, quadros anêmicos e outros danos à saúde, apresentando maior severidade, conforme maior grau de infecção do animal. Entretanto, mesmo infecções leves podem afetar o desenvolvimento e desempenho dos cavalos. Objetivo: O objetivo do presente trabalho foi comparar a atividade da Ivermectina e do Mebendazol sobre os helmintos Strongyloidea em animais de tração atendidos pelo Programa Carroceiro Cidadão da FMVV. Materiais e Métodos: Foram selecionados 12 cavalos de tração, que apresentaram positividade em exame coproparasitológico. Esses animais foram divididos em dois grupos, um tratado com ivermectina, outro tratado com mebendazol. Foram realizados exames nos dias +7 e +14 visando-se verificar a eficiência dos diferentes tratamentos. Resultados: Aqueles que compuseram o grupo tratado com Ivermectina, apresentaram negatividade no exame de OPG já no 7º dia após o tratamento, mantendo-se negativos no 14º dia. Já no grupo tratado com o Mebendazol, nenhum animal apresentou negatividade nos dois dias experimentais após o tratamento. Conclusão: Embora a ivermectina tenha apresentado resultado superior ao mebendazol na redução do OPG de helmintos Strongyloidea, maiores estudos precisam ser realizados a fim de se confirmar os resultados obtidos neste estudo

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Efeito do treino de composição (cópia) na aprendizagem do conceito de proporção

Este experimento investigou o efeito do treino de relações condicionais entre estímulos fracionários na forma de figuras e numéricos, com e sem treino de composição, sobre a aprendizagem do conceito de proporção. Avaliou-se a formação de classes de equivalência, sua expansão e generalização, e a resolução de problemas, com lápis e papel, com estímulos fracionários. Participaram 20 alunos do sexto ano do Ensino Fundamental. Os grupos GEQ e GEQTC passaram por treinos e testes de relações condicionais, mas este último foi exposto, adicionalmente, ao treino de composição de frações antes dos treinos das relações condicionais; dois grupos controle fizeram apenas as avaliações inicial e final. Os resultados indicaram a formação de classes de equivalência, mas não evidenciaram efeito do treino de composição