Análise de variância multivariada aplicada a dados com medidas repetidas

Em algumas situações, no processo de análise de dados, existe o interesse de analisar a performance de diversas variáveis conjuntamente e determinar a influência ou a importância de cada variável na presença das demais. Para isto, utilizam-se as técnicas de análise multivariada. Quando, em particular, este interesse está em identificar a existência de efeitos entre tratamentos e/ou condições de avaliação e verificar a existência de interação entre estes fatores; é apropriado o emprego de uma análise de variância multivariada, ou ainda, uma análise de perfis de médias que são métodos multivariados aplicados na análise de dados com medidas repetidas e dados longitudinais. O presente trabalho tem por objetivo desenvolver um referencial básico sobre o uso e aplicações da análise multivariada, e proporcionar instruções sobre os procedimentos operacionais necessários para a execução destas técnicas no software Statistica 9.0

O cuidado em saúde mental: narrativas de familiares de ouvidores de vozes

Ancorado numa perspectiva psicossocial, frente aos desafios da reinserção social e da composição de estratégias de cuidado em liberdade, este estudo tem por objetivo analisar as narrativas dos familiares de ouvidores de vozes sobre suas experiências como cuidadores. Foram realizadas entrevistas narrativas com familiares de participantes de um grupo de ouvidores de vozes em um Centro de Atenção Psicossocial (Caps) da cidade de Pelotas, no Rio Grande do Sul, Brasil. A partir da análise temática, produziram-se três eixos temáticos: (1) experiência de ouvir vozes e necessidade de cuidado; (1) família: práticas de cuidado; e (3) estratégias terapêuticas: tecendo redes de cuidado compartilhadas em saúde mental. As narrativas dos cuidadores reportam dificuldades na convivência com familiares que ouvem vozes, sobrecarga de trabalho relacionada ao cuidado e desafios enfrentados no cotidiano. Destaca-se a importância de espaços grupais de ajuda mútua que possam auxiliar os cuidadores.Considering the challenges of social reintegration and the composition of care strategies in a context of liberty, this study aims to analyze the narratives of family members of voice hearers regarding their experiences as caregivers from a psychosocial perspective. Narrative interviews were conducted with family members of individuals attending a group of voice hearers at a Psychosocial Care Center in the city of Pelotas, Rio Grande do Sul, Brazil. Three thematic axes were obtained from the thematic analysis of interview data: (1) experience of hearing voices and the need for care; (2) family: care practices; and (3) therapeutic strategies: weaving care networks in mental health. Caregivers report difficulties in living with family members who hear voices, carerelated work overload, and challenges faced in daily life. In this context, the results stress the importance of mutual aid groups in supporting caregivers

IN VITRO ROOTING OF THE APPLE TREE ROOTSTOCK - M9 RELATED TO SEAL,

The objective for this study was to evaluate two support and two of flask covers and the effect of sucrose on the in vitro rooting of M-9 apple rootstock. The culture medium used was MS, added of indole-3-butyric acid-IBA (5 µM). The treatments consisted of two support (agar or vermiculite); flask cover (cotton-wool or aluminum foil) and with or without addition of sucrose to the culture media. In culture medium with sucrose, it was observed higher rooting percentage with agar than that of vermiculite. The flasks covered with cotton-wool had higher average of root number per plantlet as well as higher rooting percentage in the culture medium with sucrose.Este trabalho teve como objetivo determinar o melhor material de suporte, tipo de vedação dos frascos e concentração de sacarose, visando o enraizamento in vitro do porta-enxerto de macieira M-9. O meio de cultura usado foi o MS, acrescido de ácido indolbutírico-AIB (5 mM). Os tratamentos consistiram-se no uso de dois tipos de material de suporte (ágar e vermiculita); vedação de frascos (algodão e papel alumínio) e da presença ou ausência de sacarose no meio de cultura. Constatou-se que o ágar promoveu o melhor desempenho para a percentagem de enraizamento, sendo superior à vermiculita em meio de cultivo com sacarose. A vedação dos frascos com algodão promoveu maior número médio de raízes e porcentagem de enraizamento em meio de cultivo com adição de sacarose

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