AUTISMO E INTERVENÇÕES PRECOCES - O PAPEL DETERMINANTE NA VIDA DA CRIANÇA

O impacto das intervenções precoces no autismo é de suma importância para o desenvolvimento e qualidade de vida das crianças afetadas. A intervenção precoce oferece oportunidades significativas para melhorar as habilidades sociais, comunicativas e comportamentais, além de reduzir possíveis desafios no futuro. Estudos demonstram que o diagnóstico e intervenção precoces, idealmente antes dos três anos de idade, proporcionam uma base fundamental para um progresso mais significativo. As abordagens terapêuticas, especialmente aquelas baseadas na Análise do Comportamento Aplicada (ABA), têm se mostrado altamente eficazes.     As intervenções precoces na ABA geralmente se concentram na criação de um ambiente estruturado, na identificação e reforço de comportamentos desejáveis, na redução de comportamentos problemáticos e no estímulo ao desenvolvimento de habilidades adaptativas. Isso inclui foco na comunicação, interação social, autonomia e habilidades acadêmicas. Os resultados mostram que crianças submetidas a intervenções precoces têm maior probabilidade de melhorar suas habilidades sociais e de comunicação, o que, por sua vez, melhora suas interações sociais e qualidade de vida. Além disso, a intervenção precoce muitas vezes reduz a necessidade de suporte intensivo no futuro, reduzindo potencialmente custos sociais e econômicos. Entretanto, é crucial ressaltar a importância de personalizar a intervenção de acordo com as necessidades individuais de cada criança, levando em consideração a diversidade dentro do espectro do autismo. Também é essencial fornecer suporte e educação aos pais e cuidadores para que possam continuar a promover o progresso da criança em casa e em ambientes sociais. Em resumo, as intervenções precoces, particularmente aquelas fundamentadas na ABA, desempenham um papel crucial no desenvolvimento e na qualidade de vida das crianças com autismo, destacando a importância de identificar, diagnosticar e intervir o mais cedo possível para melhorar os resultados a longo prazo

SAÚDE MENTAL: INTERVENÇÕES MULTIDISCIPLINAR NO TRATAMENTO E DIAGNÓSTICO.

Multidisciplinary disciplines in mental health treatment and diagnosis represent a comprehensive and collaborative approach to dealing with psychological and emotional issues. This model involves the synergy of professionals from different areas, such as psychologists, psychiatrists, social workers, occupational therapists and nurses, working together to diagnose and treat mental disorders. The main advantage of this approach is the ability to offer a broad, holistic view of an individual's mental health challenges. A multidisciplinary team is capable of carrying out more comprehensive assessments, taking into account not only symptoms, but also the social, emotional and physical aspects that can influence a person's mental health. By combining specialties, the team can create personalized treatment plans, combining different therapies and approaches to meet patients' individual needs. This collaboration allows the application of varied methods, such as cognitive-behavioral therapy, medication disciplines, occupational therapy and counseling. Furthermore, this approach is not limited to treatment; it also seeks prevention and education, evolves to reduce the stigma surrounding mental illnesses and promote awareness. Communication and cooperation between professionals is essential, ensuring that everyone is aligned and updated on the patient's progress. This integration facilitates continuous adjustments to treatment, adapting it according to evolving needs. In summary, multidisciplinary interventions in mental health represent a collaborative and comprehensive approach that detects the complexity of mental disorders, promoting more complete and personalized care, evolving towards the patient's recovery and overall well-being.  As disciplinas multidisciplinares no tratamento e diagnóstico de saúde mental representam uma abordagem abrangente e colaborativa para lidar com questões psicológicas e emocionais. Esse modelo envolve a sinergia de profissionais de diversas áreas, como psicólogos, psiquiatras, assistentes sociais, terapeutas ocupacionais e enfermeiros, trabalhando juntos para diagnosticar e tratar distúrbios mentais. A principal vantagem dessa abordagem é a capacidade de oferecer uma visão ampla e holística dos desafios de saúde mental de um indivíduo. Uma equipe multidisciplinar é capaz de realizar avaliações mais abrangentes, levando em consideração não apenas os sintomas, mas também os aspectos sociais, emocionais e físicos que podem influenciar a saúde mental de uma pessoa. Ao unir especialidades, a equipe pode elaborar planos de tratamento personalizados, combinando diversas terapias e abordagens para atender às necessidades individuais dos pacientes. Essa colaboração permite a aplicação de métodos variados, como terapia cognitivo-comportamental, disciplinas medicamentosas, terapia ocupacional e aconselhamento. Além disso, essa abordagem não se limita ao tratamento; também busca a prevenção e educação, evolui para reduzir o estigma em torno das doenças mentais e promover a conscientização. A comunicação e a cooperação entre os profissionais são essenciais, garantindo que todos estejam alinhados e atualizados sobre o progresso do paciente. Essa integração facilita ajustes contínuos no tratamento, adaptando-o de acordo com as necessidades em evolução. Em resumo, as intervenções multidisciplinares em saúde mental representam uma abordagem colaborativa e abrangente que detecta a complexidade dos distúrbios mentais, promovendo um cuidado mais completo e personalizado, evoluindo para a recuperação e o bem-estar global do paciente

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

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

BackgroundRegular, 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.MethodsThe 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.FindingsThe 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.InterpretationLong-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