Hábitos de saúde de adolescentes beneficiários do Bolsa Família: um estudo exploratório. Health habits of adolescents benefiting from Bolsa Família: an exploratory study

Objetivo: analisar os hábitos de saúde de adolescentes beneficiários e não beneficiários do Programa Bolsa Família (PBF). Métodos: os participantes foram adolescentes com idade entre 14 a 17 anos, moradores de uma cidade do Sul de Minas Gerais, categorizados em beneficiários e não beneficiários. Foram avaliados o peso corporal, estatura, hábitos alimentares e nível de atividade física pelo International Physical Activity Questionnarie (versão longa). Foi realizado o teste “t” no programa Stata e adotado um p<0,05 para significância. Resultados: participaram 16 adolescentes beneficiários (15,4±0,8 anos) e 16 adolescentes não beneficiários (15,1±1,0 anos) de ambos os sexos, todos caracterizados com Índice de Massa Corporal normal; mas, quanto ao nível de atividade física, o grupo de beneficiários apresentou maior tempo de atividade física no transporte e total (816,5 min/semana e 1953,7 min/semana), já os não beneficiários apresentaram maior comportamento sedentário durante a semana (552,5 min/dia). Com relação aos hábitos alimentares, os não beneficiários apresentaram uma ingestão de leites e derivados nos finais de semana (5,2 vezes/dia) significativamente maior quando comparados aos beneficiários do programa (3,3 vezes/dia). Conclusão: os beneficiários apresentaram um maior nível de atividade física no transporte e no total e menor tempo de comportamento sedentário quando comparado com os não beneficiários. Entretanto, para as outras variáveis de saúde não foram verificadas diferenças entre os participantes.Palavras-chave: atividade física; estado nutricional; política pública; adolescente.AbstractObjective: to analyse the health habits of adolescent beneficiaries and non-beneficiaries of the Bolsa Família Program (PBF). Methods: participants were adolescents aged 14 to 17 years old, living in a city in the south of Minas Gerais, classified as beneficiaries and non-beneficiaries. Body weight, height, eating habits and level of physical activity were evaluated using the International Physical Activity Questionnarie (long version). The t-test was performed in the Stata program and a p<0.05 was adopted for significance. Results: 16 beneficiary adolescents (15.4 ± 0.8 years) and 16 non-beneficiary adolescents (15.1 ± 1.0 years) of both sexes participated. All of them characterized with normal Body Mass Index, but as for the level of physical activity, the group of beneficiaries had a longer time of physical activity in transportation and total (816.5 min / week and 1953.7 min / week), while non-beneficiaries, a greater sedentary behaviour during the week (552.5 min / day). Regarding eating habits, non-beneficiaries had a significantly higher intake of milk and dairy products on weekends (5.2 times / day) when compared to program beneficiaries (3.3 times / day). Conclusion: beneficiaries showed higher level of community and total physical activity and lower level of sedentary behaviour when compared with no-beneficiaries. However, for the other health variables, there was no difference between the participants.Keywords: physical activity; nutritional status; public policy; adolescent

USE OF ATHEROGENIC INDICES AS ASSESSMENT METHODS FOR CLINICAL ATHEROSCLEROTIC DISEASES

Accurate assessment of clinical atherosclerotic diseases is essential to guide effective therapeutic interventions, and atherogenic indices have emerged as valuable methods in this setting. The complexity of these pathologies demands approaches that go beyond the simple measurement of total cholesterol, requiring tools that consider the interaction between different lipoproteins and other risk factors. In this context, the use of atherogenic indices appears as a promising approach, providing a more comprehensive and refined assessment of atherosclerotic conditions. Objective: To comprehensively analyze scientific studies published in the last 10 years that investigated the use of atherogenic indices as methods of evaluating clinical atherosclerotic diseases. The review seeks to consolidate the available evidence by examining the effectiveness of these indices in early identification, risk stratification and monitoring the progress of atherosclerotic diseases. Methodology: The systematic review was conducted following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were "atherogenic indices", "atherosclerotic diseases", "clinical assessment", "lipoproteins" and "cardiovascular risk factors". Inclusion criteria considered original studies that investigated the use of atherogenic indices in clinical populations, while exclusion criteria involved studies with unrepresentative samples and inadequate atherosclerotic assessment methods. Results: The results of the review highlight the diversity of available atherogenic indices and their usefulness in evaluating different aspects of atherosclerotic diseases, including prediction of cardiovascular events, risk stratification and treatment monitoring. The analysis identified indices that proved to be particularly sensitive and specific in different clinical contexts. Conclusion: In summary, the systematic review highlights the relevance of atherogenic indices as valuable tools in the assessment of clinical atherosclerotic diseases. The diversity of these indices and their ability to provide comprehensive information highlights their importance in clinical practice, contributing to a more refined and personalized approach to the management of these conditions.Accurate assessment of clinical atherosclerotic diseases is essential to guide effective therapeutic interventions, and atherogenic indices have emerged as valuable methods in this setting. The complexity of these pathologies demands approaches that go beyond the simple measurement of total cholesterol, requiring tools that consider the interaction between different lipoproteins and other risk factors. In this context, the use of atherogenic indices appears as a promising approach, providing a more comprehensive and refined assessment of atherosclerotic conditions. Objective: To comprehensively analyze scientific studies published in the last 10 years that investigated the use of atherogenic indices as methods of evaluating clinical atherosclerotic diseases. The review seeks to consolidate the available evidence by examining the effectiveness of these indices in early identification, risk stratification and monitoring the progress of atherosclerotic diseases. Methodology: The systematic review was conducted following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were "atherogenic indices", "atherosclerotic diseases", "clinical assessment", "lipoproteins" and "cardiovascular risk factors". Inclusion criteria considered original studies that investigated the use of atherogenic indices in clinical populations, while exclusion criteria involved studies with unrepresentative samples and inadequate atherosclerotic assessment methods. Results: The results of the review highlight the diversity of available atherogenic indices and their usefulness in evaluating different aspects of atherosclerotic diseases, including prediction of cardiovascular events, risk stratification and treatment monitoring. The analysis identified indices that proved to be particularly sensitive and specific in different clinical contexts. Conclusion: In summary, the systematic review highlights the relevance of atherogenic indices as valuable tools in the assessment of clinical atherosclerotic diseases. The diversity of these indices and their ability to provide comprehensive information highlights their importance in clinical practice, contributing to a more refined and personalized approach to the management of these conditions

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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

A política de criação dos institutos federais de educação, ciência e tecnologia e a conformação do ensino superior nessas instituições

O presente estudo analisa a política pública de criação dos Institutos Federais de Educação, Ciência e Tecnologia e o ensino superior no interior dessas instituições. Para examinar a política, este estudo buscou priorizar a dimensão político-institucional, além de considerar os cenários, político e social, no qual a política foi implantada, no sentido de compreender suas finalidades e o papel que tem ocupado no cenário educacional brasileiro. Para isso, foram analisados os elementos legais e as produções referentes aos contextos sociais, históricos e ideológicos incorporados. A pesquisa desenvolvida é de natureza quanti-qualitativa uma vez que conta com levantamento dos números disponibilizados pelos censos da educação superior nas décadas de 1990 e 2000 e com as concepções e a percepções dos atores sociais envolvidos nesse processo. Esta pesquisa enfatiza as fases de formulação e implantação da política de criação dos Institutos e como se encontra o processo de conformação do ensino superior no interior dessas instituições. A dissertação foi estruturada em dois capítulos sendo o primeiro, a construção da trajetória histórica do ensino superior no país e o levantamento das políticas públicas implementadas para este nível de ensino nas décadas de 1990 e 2000. No segundo capítulo, a partir das percepções dos atores institucionais e políticos, efetivamos a análise da política de criação dos IFs e do ensino superior nessas instituições. Nas considerações finais foram recuperados os eixos de análise e as variáveis escolhidas para o presente estudo, estabelecendo uma articulação com os dados pesquisados e sinalizando os aspectos positivos, as fragilidades e os questionamentos a serem respondidos em pesquisas futuras.The present study analyzes the creation public policy from the Federal Institutes (FIs) of Education, Science and Technology and the higher education within these institutions. To examine the policy, this study sought to prioritize the political and institutional dimension, besides considering the political and social scenarios in which the policy was implemented, in order to understand their purpose and the role it has occupied in the brazilian educational scenario. For this, we analyzed the legal elements and productions related to the social, historical and ideological contexts incorporated into the work. The research has both quantitative and qualitative elements, since it counts on a survey of the numbers provided by the census of higher education in the 1990s and 2000s and the views and perceptions of social actors involved in this process. This research emphasizes the stages of formulation and implementation of creation policy of institutes and how is the forming process of the higher education within these institutions. The dissertation is structured in two chapters with the first, the construction of the historical trajectory of higher education in the country and an examination of the implemented public policies on this level of education in the 1990s and 2000. In the second chapter, from the perceptions of institutional and political actors, we conducted an analysis of the creation policy of FIs and higher education in these institutions. In the final remarks, axes of analysis and the variables chosen for this study were recovered, establishing an articulation with the researched data and signaling the positives aspects, the weaknesses and the questions to be answered in future researches

Trabalhos completos - Educação

Trabalhos completos - Educaçã

Trabalhos completos - Educação

Trabalhos completos - Educaçã