Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Pyhä Teresa ja keskiajan mystiikan teoriat

In my dissertation I have studied St Teresa (1515-1582) in the light of medieval mystical theories. I have two main levels in my research: historical and theological. On the historical level I study St Teresa s personal history in the context of her family and the Spanish society. On the theological level I study both St Teresa s mysticism and her religious experience in the light of medieval mysticism. St Teresa wrote a book called Life , which is her narrative autobiography and story about her mystical spiritual formation. She reflected herself through biblical texts interpreting them in the course of the biblical hermeneutics like allegory, typology, tropology and anagogy. In addition to that she read others life stories from her period of time, but reflected herself only slightly through the sociological point of view. She used irony as a means to gain acceptance to her authority and motive to write. Her position has been described as a double bind because of writing at the request of educated men and to the non-educated women as she herself was uneducated. She used irony as a means to achieve valuation to women, to gain negative attributes connected to them and to gain authority to teach them mystical spirituality, the Bible and prayer. In this ironic tendency she was a feminist writer. In order to understand medieval mysticism I have written in the first chapter a review of the main trends in medieval mysticism in connection with the classical emotional theories. Two medieval mystical theories show an important role in St Teresa s mysticism. One is love mysticism and the other is the three partite way of mysticism (purification, illumination and union). The classic-philosophical emotional theories play a role in both patterns. The theory of love mysticism St Teresa interpreted in the traditional way stressing the spiritual meaning of love in connexion with God and neighbors. Love is an emotion, which is bound with other emotions, but all objects of love don t strengthen spiritual love. In the three partite way of mysticism purification means to find biblical values in life and to practice meditative self-knowledge theologically interpreted. In illumination human understanding has to be illuminated by God and united to mystical knowledge from God. St Teresa considered illumination a way to learn things. Illumination has also psychological aspects like recognition of many trials and pains, which come from life on earth. Theologically interpreted in illumination one should die to oneself, let oneself be transformed and renewed by God. I have also written a review of the modern philosophical discussion on personal identity where memory and mental experiences are important creators of personal identity. St Teresa bound medieval mystical teaching together with her personal religious experience. Her personal identity is by its character based on her narrative life story where mental experiences play important role. Previous researchers have labelled St Teresa as an ecstatic person whose experiences produced ecstatic phenomena to the mysticism. These phenomena combined with visions have in one respect made of her a person who has brought physical and visionary tendencies to theology. In spite of that she also represents a modern tendency trying to give words to experiences, which at first seem to be exceptional and extreme and which are easily interpreted as one-sided either physical or sexual or unsaid. In other respect I have stressed the personality of St Teresa that was represented as both strong and weak. The strong personality for her is demonstrated by religious faith and in its practice. The weak personality was for her a natural personal identity. St Teresa saw a unifying aspect in almost all. Firstly, her mysticism was aimed towards union with God and secondly, the unifying aspects and common rules in human relations in community life were central. Union with God is based on the fact that in a soul God is living in its centre, where God is present in the Trinitarian way. The picture of God in ourselves is a mirror but to get to know God better is to recognize his/her presence in us. When the soul recognizes itself as a dwelling place of God, it knows itself as God knows him/herself. There is equality between God and the soul. To be a Christian means to participate in God in his Trinitarian being. The participation to God is a process of divinization that puts a person into transformation, change and renewal. The unitive aspect concludes also knowledge of opposites between experience of community and solitude as well as community and separateness. As a founder of monasteries St Teresa practiced theology of poverty. She renewed the monastic life founding a rule called discalced that stressed ascetic tendencies. Supporters of her work were after the difficulties in the beginning both society and churchly leaders. She wrote about the monasteries including in her description at times seriousness at times humor and irony. Her stories are said to be picaresque histories that contain stories of ordinary laymen and many unexpected occasions. She exercised a kind of Bakhtinian dialogue in her letters. St Teresa stressed the virtues like sacrifice, determination and courage in the monastic life. Most of what she taught of virtues is based on biblical spirituality but there are also psychological tendencies in her writings. The theological pedagogical advice is mixed with psychology, but she herself made no distinction between different aspects in her teaching. To understand St Teresa and her mysticism is to recognize that she mixes her personal religious experience and mysticism, which widens mysticism to religious experience in a new way, although this corresponds also the very definition of mysticism. St Teresa concentrated on mental-spiritual experiences and the aim of her mystical teaching was to produce a human mind well cured like a garden that has God as its gardener.

Istoria delle guerre del Regno del Brasile : accadute tra la corona di Portogallo e la Republica di Olanda, composta, ed offerta alla sagra reale maesda di Pietro Secondo, Re di Portogallo & C. dal P. F. Gio. Gioseppe di S. Teresa Carmelitano Scalzo : Parte prima e Parte seconda

As negociações entre Portugal e Holanda a respeito da devolução dos territórios portugueses ocupados se desenvolveram ao longo de um decênio. As propostas iniciais de Portugal referiam-se aos territórios ocupados pelos holandeses na África e no Maranhão. Estão no raríssimo folheto.

Nas tramas de Itamatatiua: representações sociais, práticas de saúde e as trocas comunicativas dos filhos de Santa Teresa

No presente estudo utiliza-se a Teoria das Representações Sociais, iniciada por Serge Moscovici, ao publicar a obra La Psychanalyse son image et son public em 1961. Para o autor, as representações sociais são originadas a partir das definições de linguagem e comunicação configurando-se em uma conexão de idéias, metáforas e imagens mentais em constante dinâmica, sendo sustentadas pela comunicação. Essa perspectiva teórica se propõe a entender como os indivíduos e grupos sociais compreendem o mundo, sua realidade e as circunstâncias nas quais se comunicam, compartilham idéias, ações, crenças, ideologias e interagem entre si e com os outros. Este estudo tem como objetivo compreender como os indivíduos constroem e reconstroem os conceitos e as práticas de saúde, as relações estabelecidas entre saúde e doença e como caracterizam as práticas tradicionais de saúde existentes na comunidade negra de Itamatatiua - Maranhão. No que se refere à metodologia utilizou-se os principíos da etnometodologia aliados à etnografia, com o intuito de perceber os modos de dizer e fazer saúde na comunidade. Mediante pesquisa de campo verificou-se que os itamatatiuenses vivem um momento de transição social, política e econômica que vem se repercutindo nas práticas de saúde. A manutenção e utilização de praticas tradicionais de saúde, que envolvem chás, ervas de giraus, emplasto, garrafadas, benzimentos e curandeirismo continua a ser observada, coexistindo com as práticas institucionais do Programa de Saúde da Família. As construções simbólicas em torno da saúde estabelecem relações complexas em uma rede que envolve o momento de transmissão oral; a promessa de saúde e a fé em Santa Teresa; questões territóriais que se traduzem em título de cidadania quilombola e melhoria de qualidade de vida; cultura da cerâmica como base econômica; transição alimentar com a entrada no mercado de consumo dos alimentos industrializados; modo de vida, na maior parte das vezes, harmonioso; relações conflituosas entre os múltiplos saberes em interação, que envolve o conhecimento reificado institucionalizado e o conhecimento popular. Concluí-se que através da oralidade as experiências práticas de saúde das gerações antepassadas se consolidaram e hoje se colocam em paralelo as práticas institucionalizadas governamentais e privadas, constituindo um conjunto de representações características dessa comunidade.

A audácia de ser diferente: a escrita obsessiva de Ana Teresa Pereira

A presente tese tem como objetivo estudar a obra da escritora madeirense Ana Teresa Pereira. Partindo da leitura integral dos seus livros, que se interligam formando um todo caraterizado por uma unidade intrínseca e obsessiva, e analisando especificamente a obra publicada entre 1989 e 2008, procurámos demonstrar os tópicos que permitem classificar a sua poética como uma escrita obsessiva e audaz, sob o ponto de vista do que de mais espantoso as expressões podem ter. Estamos perante uma obra cuja indivisibilidade labiríntica se entretece com a paixão obsessiva pela Arte, em particular, pela Literatura, pelo Cinema, pela Pintura e pela Música.

Maria Teresa Cortez. Os contos de Grimm em Portugal. A recepção dos Kinder-und Hausmärchen entre 1837 e 1910, Coimbra, Minerva (Centro Interuniversitário de Estudos Germanísticos) e Universidade de Aveiro, 2001. 531 pp.

Trabalho que investiga a recepção dos Kinder - und Hausmärchen em Portugal, fruto duma aturada e minuciosa pesquisa documental. Com efeito, Teresa Cortez passa em revista os livros e publicações periódicas enquadrados entre 1837 — data do aparecimento das primeiras traduções de contos dos KHM, no periódico lisboeta Biblioteca Familiar e Recreativa — e 1910, data a que a autora estendeu a sua pesquisa. Cada incidência da presença dos contos dos Grimm em Portugal é cuidadosamente investigada, contextualisada e analisada, Assim, à medida que vemos surgir, primeiro esparsas em revistas destinadas a um público infantil, e sem indicação de autoria, traduções (do francês) dos KHM, vamo-nos inteirando sobre o epírito e motivações do seu aparecimento, quer partindo do estudo comparativo com o texto de origem, quer de um exame da publicação de chegada, alargando-se a pesquisa aos seus editores e autores. Todo o processo de recepção dos contos de Grimm vai sendo examinado pela autora à luz dos movimentos das últimas décadas do séc. XIX e primeira do séc. XX, nomeadamente o nacionalismo neo-romântico e o positivismo.

O livro encenado: escrita e representação na obra de Ana Teresa Pereira

Esta dissertação propõe uma leitura de um conjunto de obras de Ana Teresa Pereira centrada nas relações entre escrita e representação. Estas obras são: O Fim de Lizzie e outras histórias (2008), O Verão Selvagem dos Teus Olhos (2008), Inverness (2010), A Outra (2010), A Pantera (2011) e O Lago (2011). Partindo da hipótese de que aquele binómio constitui um problema teórico importante na abordagem a estas obras, interroga-se as diversas instâncias em que ele se manifesta nos textos, tendo em conta a encenação do acto de escrita e de outros actos de criação, bem como o recurso a um campo semântico do domínio do teatro, com o qual a narrativa se confunde, pondo em evidência e em diálogo diferentes acepções do conceito de “representação”. A reflexão atenta essencialmente em três eixos: o pensamento sobre arte que atravessa estas narrativas, a figuração auto-reflexiva do texto e a forma como Ana Teresa Pereira desenvolve uma noção de teatralidade na articulação entre escrever e representar. Esta noção é também a que une ideias de livro, de palco e de mundo, gerando tensões consequentes entre ficção, realidade e literatura.

O (in)dizível em Uma aventura secreta do Marquês de Bradomín de Teresa Veiga

A dissertação baseia-se numa leitura do conto “Uma aventura secreta do marquês de Bradomín”. Este texto narrativo destaca questões relacionadas com a ficção contemporânea portuguesa, como a construção da personagem com estatuto de protagonista, oscilando entre ser real e ser ficcional, a autoria feminina, a importância do dizer e do silêncio. A personagem feminina apresenta a sua história partilhada com o marquês de Bradomín e os sentidos mudam em consonância com as condições temporal e discursiva; a simbologia torna-se um acto de ideologia e de interpretação, uma vez que a expressividade humana está para além das palavras, produzindo silêncios enquanto se discursa. A personagem escreve por palavras que ocultam outras, que são apenas aludidas e, como a narradora recorre à memória, o seu texto discursivo pode apresentar-se de forma lacunar, com a desculpa do esquecimento. Neste caso, os sentidos podem ser sempre outros e o (in)dizível persiste.