45 research outputs found
Longitudinal attenuation in political polarization: evidence from COVID-19 vaccination adherence in Brazil
Background: While political polarization in policy opinions, preferences, and observance is well established, little is known about whether and how such divisions evolve, and possibly attenuate, over time. Using the COVID-19 pandemic in Brazil as the backdrop, we examine the longitudinal evolution of a highly relevant and polarizing policy: adherence to the COVID-19 vaccination.
Methods: Studies 1 (N = 3346) and 2 (N = 10,214) use nationwide surveys to document initial differences and subsequent changes in vaccination adherence between conservatives ("Bolsonaristas") and non-conservatives ("non-Bolsonaristas"). Study 3 (N = 742) uses an original dataset to investigate belief changes among conservatives and their association with asymmetric changes in vaccination adherence.
Results: Despite substantial differences at the early stages of rollout, the gap in vaccination adherence between conservatives and non-conservatives significantly decreased with the passage of time, driven essentially by a much faster uptake among the initially most skeptic—the conservatives. Study 3 demonstrates that the asymmetric changes in vaccination adherence were associated with meaningful belief changes among the conservatives, especially about the perceived effectiveness of the COVID-19 vaccines and the expected adherence of peers to the vaccination campaign.
Conclusions: Together, these studies show that, in a context where the superiority of the promoted policy becomes clear over time and individuals have the opportunity to revisit prior beliefs, even intense political polarization can be attenuated
Diversidade bioconstrutiva, edificação bioclimática, reabilitação sustentável e sua aplicação nos espaços naturais: diagnóstico biofísico, climático e da paisagem envolvente da edificação e propostas de atuação
As casas de interpretação possuem especial relevância na receção e orientação dos visitantes destes espaços protegidos. Estas casas apresentam habitualmente conteúdos de educação ambiental e de sensibilização dos visitantes, para além de albergar atividades administrativas. Para além dos que neles trabalham, estes edifícios recebem diariamente visitantes, que se deslocam preferencialmente a estes locais como um ponto de partida para obter informação e aconselhamento, que possa melhorar a sua experiência na visita aos espaços naturais.
A qualidade do contexto natural, na envolvente, e dos próprios edifícios, podem ser fatores de grande atratividade, ajudando a gerar mais visitas. Este relatório descreve as atividades de análise do contexto, pelo diagnóstico biofísico, socioeconómico e climático de diversos edifícios que foram objeto de intervenção no Projeto POCTEP BIOURB NATUR, localizados em áreas protegidas do espaço de cooperação transfronteiriça entre Portugal e Espanha, designadamente: em Espanha, a Casa do Parque das Lagoas de Villafáfila; a Casa do Parque das Arribas do Douro, em Fermoselle, a Casa do Parque do Lago de Sanabria e o Pavilhão educativo do complexo PRAE, em Valladolid; em Portugal, a escola primária de Rio de Onor e o Centro Aquícola de Castrelos.Este projeto foi desenvolvido no âmbito do Programa de Cooperação Transfronteiriça Espanha - Portugal financiado com fundos do FEDER, através do programa Interreg V-A Espanha-Portugal (POCTEP) 2014-2020.info:eu-repo/semantics/publishedVersio
Diversidad bioconstructiva, edificación bioclimática, rehabilitación sostenible y su aplicación en los espacios naturales: diagnóstico biofísico, climático y paisajístico del entorno del edificio y propuestas de actuación
Las casas de interpretación tienen especial relevancia en la recepción y orientación de los visitantes en las áreas protegidas. Estas casas generalmente cuentan con contenido de educación medioambiental y concientización para los visitantes, además de albergar actividades administrativas. Estos edificios reciben diariamente visitantes, quienes preferentemente se desplazan a estos locales como punto de partida para obtener información y consejos , que pueden mejorar su experiencia al visitar espacios naturales.
La calidad del entorno natural y de los propios edificios, pueden ser factores de gran atractivo, contribuyendo para generar más visitas. Este informe describe las actividades de análisis de contexto , a través del diagnóstico biofísico, socioeconómico y climático de varios edificios en las que ocurrieron intervención en el Proyecto POCTEP BIOURB NATUR, ubicados en áreas protegidas del espacio de cooperación transfronteriza entre Portugal y España, a saber : en España, la Casa del Parque de las Lagunas de Villafáfila; la Casa del parque das Arribas do Duero, en Fermoselle, la Casa del parque del Lago de Sanabria y el Pabellón Educativo del complejo PRAE, en Valladolid ; en Portugal, la escuela de Rio de Onor y el Centro Acuícola de Castrelos.Este proyecto se ha desarrollado en el marco del Programa de Cooperación Transfronteriza España-Portugal financiado con fondos FEDER, en el programa Interreg V-A España-Portugal (POCTEP) 2014-2020.info:eu-repo/semantics/publishedVersio
The importance of the serial primary revaluation in the management of polytrauma – case report and literature review
O estudo traz o relato de uma experiência de um paciente vítima de trauma carro versus bicicleta, que sofreu amputação traumática bilateral de membros inferiores. Para isso foram coletadas informações no banco de dados PubMed em 8 artigos, juntamente com informações da nova edição do livro ATLS®, além de informações do paciente, do atendimento pré hospitalar e hopitalar, conduta e evolução. No caso exposto foi realizada correta avaliação primária e sua reavalição seriada, permitindo precoce identificação das lesões e conduta terapêutica, com boa evolução do paciente pós operatório. Afirma-se que a implementação do protocolo ATLS® é grande responsável pela diminuição da mortalidade do paciente politraumatizado. A reavaliação seriada se mostrou imprescindível para detecção do sangramento do paciente, estabilização e tratamento definitivo.The paper presentes the report of an accident patient of car x bicycle trauma who suffered traumatic amputation of the lower limbs. Therefore informations from eight articles of Pubmed database and new edition of ATLS book were collected, besides the preexisting informations from prehospital care, hospital care, conduct and evolution of the patient. The case described was carried out correct primary assessment and its serial reassessment, allowing early identification of lesions and therapeutic approach, with favorable postoperative patient. It is stated that the implementation of ATLS® protocol is largely responsible for the decrease in mortality of polytrauma patients. Serial reassessment proved to be indispensable for detection of patient bleeding, stabilization and final treatment
UTILIZAÇÃO DE GLICEROL E ETILENOGLICOL COMO CRIOPROTETORES NA CONGELAÇÃO DO SÊMEN CAPRINO
Dez amostras de sêmen de dois reprodutores caprinos, da raça Parda-alpina, colhidas em vagina artificial, foram submetidas a quatro tratamentos para avaliação da eficiência do etilenoglicol e do glicerol, associados ou não ao EDTA, na criopreservação da célula espermática caprina. O diluente usado era à base de Tris-gema de ovo contendo 7% de glicerol (glicerol E glicerol+EDTA) ou 7% de etilenoglicol (etilenoglicol e etilenoglicol + EDTA), sendo que nos grupos glicerol+EDTA e etilenoglicol+EDTA foi associado ao diluente 0,1% de EDTA. As amostras foram mantidas por 60 minutos em geladeira a 40C, onde então era efetuada a congelação em nitrogênio (-1960C). A descongelação foi realizada em banho-maria a 370C por 30segundos. As médias obtidas para motilidade (%) a descongelação, para os grupos glicerol, glicerol+EDTA, etilenoglicol, etilenoglicol+EDTA, foram, respectivamente, 51%; 61%; 10% e 12%. Os grupos que utilizaram o glicerol como crioprotetor obtiveram melhores taxas de motilidade pós-descongelação, principalmente quando foi associado ao diluidor o EDTA (grupo glicerol+EDTA). Porém, esse resultado foi comprometido pelos maiores índices de alterações patológicas nos grupos que continham o glicerol.
PALAVRAS-CHAVE: Caprinos, criopreservação, sêmen, glicerol, etilenoglicol, EDT
The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases
This article analyzes the "Global Burden of Disease Study 2010" and examines the study's implications for neglected tropical diseases
Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017
Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Background
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.
Methods
We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
Findings
In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.
Interpretation
By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd
Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015
Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe