Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15072746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54•0% (95% uncertainty interval [UI] 38•1–65•8), 17•4% (7•7–28•4), and 59•5% (34•2–86•9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. Funding Bill & Melinda Gates Foundationates Foundation

Flow structure and near-field dispersion in arrays of building-like obstacles

Dispersion in the near-field region of localised releases in urban areas is difficult to predict because of the strong influence of individual buildings. Effects include upstream dispersion, trapping of material into building wakes and enhanced concentration fluctuations. As a result, concentration patterns are highly variable in time and mean profiles in the near field are strongly non-Gaussian. These aspects of near-field dispersion are documented by analysing data from direct numerical simulations in arrays of building-like obstacles and are related to the underlying flow structure. The mean flow structure around the buildings is found to exert a strong influence over the dispersion of material in the near field. Diverging streamlines around buildings enhance lateral dispersion. Entrainment of material into building wakes in the very near field gives rise to secondary sources, which then affect the subsequent dispersion pattern. High levels of concentration fluctuations are also found in this very near field; the fluctuation intensity is of order 2 to 5

Identificação de quedas d’água nos municípios de Pelotas e Arroio do Padre (Brasil) por meio da cartografia colaborativa: subsídios ao geoturismo

Geodiversity is understood as the variety of rocks, minerals, fossils, landforms and physical processes that act on these abiotic elements. The recognition of aesthetic, cultural, scientific and educational values, among others, makes it possible to inventory geodiversity and conserve the portion that has significant value, in addition to favoring geotourism activities. Therefore, the present work aims to identify the waterfalls of the municipalities of Pelotas and Arroio do Padre, in Rio Grande do Sul (Brazil), with the help of collaborative cartography, in order to subsidize the proposition of geotourism itineraries for dissemination of these elements of geodiversity. Two stages of application of online questionnaires were carried out to obtain information from collaborative cartography about the occurrence and location of waterfalls in the area under study. The results obtained allowed the identification of 21 waterfalls in Pelotas and Arroio do Padre, five of which are widely recognized and cited by collaborators: Cachoeira Imigrante, Cachoeira Arco-Íris, Cachoeira Paraíso, Cachoeira Camboatá and Pousada do Moinho. It is noteworthy that collaborative cartography reinforced the knowledge of local populations and enabled the development of a cartographic product based on the understanding that individuals have. The contributions brought by them are loaded with values and understanding of their environment, with emphasis on the abiotic elements, which validate the waterfalls as a local and regional geoheritage.A geodiversidade é compreendida como a variedade de rochas, minerais, fósseis, formas do relevo e processos físicos que agem sobre esses elementos abióticos. O reconhecimento dos valores estéticos, culturais, científicos e educativos, entre outros, possibilita a inventariação da geodiversidade e a conservação da parcela que apresenta significativo valor, além de favorecer ações de geoturismo. Diante disso, o presente trabalho possui como objetivo identificar as quedas d’água dos municípios de Pelotas e Arroio do Padre, no Rio Grande do Sul (Brasil), com o auxílio da cartografia colaborativa, a fim de subsidiar a proposição de roteiros geoturísticos para divulgação desses elementos da geodiversidade. Foram realizadas duas etapas de aplicação de questionários online, para a obtenção de informações da cartografia colaborativa acerca da ocorrência e localização das quedas d’água na área em estudo. Os resultados obtidos permitiram a identificação de 21 quedas d’água em Pelotas e Arroio do Padre, sendo cinco delas amplamente reconhecidas e citadas pelos colaboradores: Cachoeira Imigrante, Cachoeira Arco-Íris, Cachoeira Paraíso, Cachoeira Camboatá e Pousada do Moinho. Destaca-se que a cartografia colaborativa reforçou o conhecimento das populações locais e viabilizou a elaboração de um produto cartográfico a partir do entendimento que os indivíduos possuem. As contribuições trazidas pelos mesmos são carregadas de valores e compreensão sobre o seu meio, com o destaque para os elementos abióticos, que validam as quedas d'água enquanto um geopatrimônio local e regional

Análise crítica sobre a internação compulsória e os efeitos da medicalização por meio de um caso de esquizofrenia ilustrado no filme Uma Mente Brilhante

Embora a internação compulsória tenha sido combatida pela reforma psiquiátrica brasileira,ela ainda é utilizada como uma opção de tratamento para pessoas que recebem diagnóstico deesquizofrenia e outros transtornos mentais, principalmente quando estão em momentos decrise. Porém, esse tratamento pode vir acompanhado de desrespeito aos direitos e vontades doindivíduo que está sendo internado. Portanto, a elaboração deste artigo buscou analisarelementos relacionados à internação compulsória. A análise objetivou compreender quais sãoos efeitos da medicalização e a relação dos profissionais de saúde, nesse contexto direcionadoao indivíduo internado compulsoriamente. Para isso, foi realizada uma observação analíticado filme “Uma Mente Brilhante” (2001) que ilustra o caso de John Nash, matemáticobrilhante diagnosticado com esquizofrenia e internado compulsoriamente devido às suasalucinações. A metodologia escolhida foi a abordagem qualitativa de análise de conteúdocom categorias de comportamento por meio da observação e descrição de algumas cenas dofilme, que foram sintetizadas em duas categorias de comportamento, articulando com estudosselecionados e traçando um paralelo com o filme. Por meio da análise realizada, constata-seque o filme retrata bem a condição precária a que são submetidas as pessoas internadas contraa sua vontade. É possível concluir que a internação compulsória, muitas vezes, oferece umtratamento de viés coercitivo baseado na medicalização e no isolamento do indivíduo,podendo agravar ainda mais o sofrimento psíquico

Desempenho agronômico e supressão de plantas daninhas no sorgo em semeadura adensada

The dense sowing of sorghum can influence the crop yield performance. In addition, this practice can also be used in the cultural management of weeds. This study aimed to evaluate the influence of densification on sorghum sowing, agronomic crop development, and weed suppression. The experiment was conducted in the field in the randomized complete block design. The treatments were arranged in factorial arrangement 2x2x2, adopting eight replications. The first factor consisted of two row spacings, 0,50 and 0,25 m; the second factor was composed of two populations, 180,000 and 270,000 plants ha-1; finally, the third factor corresponded to the cohabitation or not with the weeds. For sorghum, the height of plants, length and panicle mass, mass of one thousand grains, and yield were evaluated. Weeds were evaluated for density and dry mass. Row spacing and plant population influenced sorghum yield components, but they did not have effect on the yield. Weed interference during the entire development cycle of sorghum reduced its yield. The densification of plants in sorghum cultivation reduced weed density and weed dry mass.A semeadura do sorgo adensado pode influenciar no manejo cultural de plantas daninhas e desempenho produtivo da cultura. Sendo assim, o objetivo deste trabalho foi avaliar a influência do adensamento na semeadura do sorgo sobre o desenvolvimento agronômico da cultura e supressão de plantas daninhas. O experimento foi conduzido a campo no delineamento blocos casualizados. Os tratamentos foram dispostos em arranjo fatorial 2x2x2, adotando oito repetições. O primeiro fator consistiu em dois espaçamentos entre linhas, 0,50 e 0,25 m; o segundo fator foi composto por duas populações, 180.000 e 270.000 plantas ha-1; por fim, o terceiro fator correspondeu à convivência ou não com a comunidade infestante. Para o sorgo, foi avaliada a altura de plantas, comprimento e massa de panícula, massa de mil grãos e produtividade. Para as plantas daninhas, avaliou-se densidade e massa seca. O espaçamento entre linhas e a população de plantas influenciou os componentes de rendimento do sorgo, sem, contudo, apresentar efeito sobre a produtividade. A interferência das plantas daninhas durante todo o ciclo de desenvolvimento do sorgo promoveu redução na produtividade. O adensamento de plantas no cultivo do sorgo proporcionou redução da densidade de infestação e massa seca de plantas daninhas

Fatores associados à utilização e reutilização de máscaras entre brasileiros durante a pandemia da COVID-19

Objetivo identificar os fatores associados à utilização e à reutilização de máscaras entre brasileiros durante a pandemia da COVID-19. Método estudo transversal desenvolvido nas cinco regiões brasileiras, entre adultos, via formulário eletrônico por meio de mídias sociais, contendo informações gerais e referentes à utilização de máscaras. Foram utilizadas análises bivariadas e regressões logísticas binárias para identificar fatores associados à utilização e à reutilização. Resultados participaram do estudo 3.981 (100%) pessoas. A utilização de máscaras totalizou 95,5%, (IC 95%: 94,8-96,1), com destaque para as de tecido (72,7%; IC 95%: 71,3-74,1) e as cirúrgicas (27,8%; IC 95%: 26,5-29,2). A porcentagem de reutilização foi de 71,1% (IC 95%: 69,7-72,5). A maioria (55,8%; IC 95%: 51,7-60,0) que usa, exclusivamente, máscara cirúrgica reutiliza-a. O sexo feminino e o contato prévio com pessoas com sintomas respiratórios aumentaram as chances de utilização (p≤0,001). Contudo, o sexo feminino diminuiu a possibilidade de reutilização da máscara cirúrgica (p≤0,001). Conclusão a quase totalidade dos participantes relatou utilizar máscaras, sendo mais recorrente a de tecido. Os achados chamam atenção para uma prática de risco, a reutilização da máscara cirúrgica e de papel. Diretrizes, políticas públicas e estratégias educativas são necessárias para o desenvolvimento de práticas assertivas no controle e prevenção da COVID-19.Objective to identify the factors associated with the use and reuse of masks among Brazilian individuals in the context of the COVID-19 pandemic. Method cross-sectional study conducted in the five Brazilian regions, among adult individuals, via an electronic form disseminated in social media, addressing general information and the use of masks. Bivariate analysis and binary logistic regression were used to identify the factors associated with the use and reuse of masks. Results 3,981 (100%) individuals participated in the study. In total, 95.5% (CI 95%: 94.8-96.1) reported using masks. Fabric masks were more frequently reported (72.7%; CI 95%: 71.3-74.1), followed by surgical masks (27.8%; CI 95%: 26.5-29.2). The percentage of reuse was 71.1% (CI 95%: 69.7-72.5). Most (55.8%; CI 95%: 51.7-60.0) of those exclusively wearing surgical masks reported its reuse. Being a woman and having had contact with individuals presenting respiratory symptoms increased the likelihood of wearing masks (p≤0.001). Additionally, being a woman decreased the likelihood of reusing surgical masks (p≤0.001). Conclusion virtually all the participants reported the use of masks, most frequently fabric masks. The findings draw attention to a risky practice, that of reusing surgical and paper masks. Therefore, guidelines, public policies, and educational strategies are needed to promote the correct use of masks to control and prevent COVID-19.Objetivo identificar los factores asociados con el uso y la reutilización de máscaras entre brasileños durante la pandemia del COVID-19. Método estudio transversal desarrollado en las cinco regiones brasileñas, entre adultos, aplicándose un formulario electrónico a través de las redes sociales, que contiene información general y relativo al uso de máscaras. Se utilizaron análisis bivariados y regresiones logísticas binarias para identificar los factores asociados con el uso y la reutilización. Resultados 3.981 (100%) personas participaron en el estudio. El uso de máscaras totalizó 95.5% (IC 95%: 94.8-96.1), particularmente las de tejido (72.7%; IC 95%: 71.3-74.1) y la quirúrgicas (27.8%; IC 95%: 26.5-29.2). El porcentaje de reutilización fue del 71,1% (IC 95%: 69,7-72,5). La mayoría (55.8%; IC 95%: 51.7-60.0) que usa exclusivamente una máscara quirúrgica la reutiliza. El género femenino y el contacto previo con personas con síntomas respiratorios aumentaron las posibilidades de uso (p≤0.001). Sin embargo, el sexo femenino disminuyó la posibilidad de reutilizar la máscara quirúrgica (p≤0.001). Conclusión casi todos los participantes informaron haber usado máscaras, siendo aquella de tejido más frecuente. Los hallazgos llaman la atención sobre una práctica arriesgada, la reutilización de la máscara quirúrgica y de papel. Las directrices, políticas públicas y estrategias educativas son necesarias para el desarrollo de prácticas asertivas en el control y la prevención del COVID-19

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years : an analysis of the Global Burden of Disease Study 2017

Background Many countries have shown marked declines in diarrhoea! disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78.4 deaths (70.1-87.1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69.6% (63.1-74.6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13.3% decrease, 11.2-15.5), childhood wasting (9.9% decrease, 9.6-10.2), and low use of oral rehydration solution (6.9% decrease, 4-8-8-4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe