ANÁLISIS DE LA SERIE HISTÓRICA DEL VOLUMEN DE AGUA EN LA REPRESA ENGENHEIRO ÁVIDOS EN PARAÍBA

A região Nordeste do Brasil possui um clima diferenciado das demais regiões do país, sendo influenciada por diversos fatores climáticos que contribuem diretamente para longos períodos de estiagem na região. Além disso, devido à escassez de recursos hídricos, costuma-se construir barragens para garantir o abastecimento de água aos mais diversos setores em períodos críticos. Nesse sentido, o presente trabalho analisou a série temporal da barragem Engenheiro Ávidos, localizada no sertão da Paraíba, entre janeiro de 2000 e dezembro de 2022 com dados disponíveis no portal AESA. Foi utilizado o software R 4.1.2 através do pacote “forecast” utilizando a função “auto.arima” para tratamento dos dados. O modelo que apresentou maior precisão foi o ARIMA (1,1,0), onde foi possível encontrar possíveis estimativas para os valores das séries futuras até junho de 2023.The Northeast region of Brazil has a climate that is different from other regions of the country, being influenced by several climatic factors that directly contribute to long periods of drought in the region. Furthermore, due to the scarcity of water resources, it is customary to build dams to guarantee water supply to the most varied sectors during critical periods. In this sense, the present work analyzed the time series of the Engenheiro Ávidos dam, located in the hinterland of Paraíba, between January 2000 and December 2022 with data available on the AESA portal. The R 4.1.2 software was used through the "forecast" package using the "auto. arima" function for data processing. The model that showed the highest accuracy was ARIMA (1,1,0), where it was possible to find possible estimates for future series values until June 2023. La región del Nordeste de Brasil tiene un clima que es diferente de otras regiones del país, siendo influenciado por varios factores climáticos que contribuyen directamente a los largos períodos de sequía en la región. Además, debido a la escasez de recursos hídricos, es costumbre construir represas para garantizar el abastecimiento de agua a los más variados sectores en períodos críticos. En ese sentido, el presente trabajo analizó la serie temporal de la represa Engenheiro Ávidos, ubicada en el interior de Paraíba, entre enero de 2000 y diciembre de 2022 con datos disponibles en el portal AESA. Se utilizó el software R 4.1.2 a través del paquete “forecast” utilizando la función “auto. arima” para el procesamiento de datos. El modelo que mostró mayor precisión fue ARIMA (1,1,0), donde fue posible encontrar posibles estimaciones para valores de series futuras hasta junio de 2023.A região Nordeste do Brasil possui um clima diferenciado das demais regiões do país, sendo influenciada por diversos fatores climáticos que contribuem diretamente para longos períodos de estiagem na região. Além disso, devido à escassez de recursos hídricos, costuma-se construir barragens para garantir o abastecimento de água aos mais diversos setores em períodos críticos. Nesse sentido, o presente trabalho analisou a série temporal da barragem Engenheiro Ávidos, localizada no sertão da Paraíba, entre janeiro de 2000 e dezembro de 2022 com dados disponíveis no portal AESA. Foi utilizado o software R 4.1.2 através do pacote “forecast” utilizando a função “auto.arima” para tratamento dos dados. O modelo que apresentou maior precisão foi o ARIMA (1,1,0), onde foi possível encontrar possíveis estimativas para os valores das séries futuras até junho de 2023

The impact of social drivers, conditional cash transfers and their mechanisms on the mental health of the young; an integrated retrospective and forecasting approach using the 100 million Brazilian Cohort: A study protocol.

BackgroundPhysical, emotional, and social changes, including exposure to poverty, abuse, or violence, increases youth vulnerability to mental illness. These factors interfere with development, limit opportunities, and hamper achievement of a fulfilling life as adults. Addressing these issues can lead to improved outcomes at the population level and better cost-effectiveness for health services. Cash transfer programs have been a promising way to address social drivers for poor mental health. However, it is still unclear which pathways and mechanisms explain the association between socioeconomic support and lower mental illness among youth. Therefore, we will evaluate the effect of social drivers on youth mental health-related hospitalizations and suicide, test mechanisms and pathways of a countrywide socioeconomic intervention, and examine the timing of the intervention during the life course.MethodsWe will combine individual-level data from youth national hospitalization, mental health disorders and attempted suicide, suicide registries and notifications of violence, with large-scale databases, including "The 100 Million Brazilian Cohort", over an 18-year period (2001-2018). Several approaches will be used for the retrospective quasi-experimental impact evaluations, such as Regression Discontinuity Designs, Propensity Score Matching and difference-in-differences, combined with multivariable regressions for cohort analyses. We will run multivariate regressions based on hierarchical analysis approach to evaluate the association between important social drivers (mental health care, demographic and economic aspects) on mental health-related hospitalizations and suicide among youth. Furthermore, we will perform microsimulations to generate projections regarding how mental health-related hospitalizations and suicide trends will be in the future based on the current state, and how BFP implementation scenarios will affect these trends.DiscussionThe results of this project will be of vital importance to guide policies and programs to improve mental health and reduce mental health-related hospitalizations and suicide in youth. It will provide information to improve the effectiveness of these programs worldwide. If cash transfers can decrease mental health problems among youth and reduce suicide

Integrated microsimulation model (MS).

Integrated microsimulation model (MS).</p

Summary of the dataset’s description, from 2001 to 2018.

Summary of the dataset’s description, from 2001 to 2018.</p

Flowchart of non-beneficiary (non-BFP) and beneficiary of the Bolsa Familia Program (BFP) to test the association between BFP and youth mental health-related hospitalizations and suicide.

Flowchart of non-beneficiary (non-BFP) and beneficiary of the Bolsa Familia Program (BFP) to test the association between BFP and youth mental health-related hospitalizations and suicide.</p

Potential mechanisms and pathways through which Bolsa Familia Program (BFP) may affect mental health-related hospitalizations and suicide among children and youth.

Potential mechanisms and pathways through which Bolsa Familia Program (BFP) may affect mental health-related hospitalizations and suicide among children and youth.</p

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research