Unidade básica de saúde infraestrutura e equipamentos para o trabalho / Basic health unit, infrastructure and equipment for work

Introdução: O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica amplia a oferta qualificada dos serviços de saúde no âmbito do SUS ¹. Objetivo (s): Avaliar e conhecer a estrutura e os equipamentos baseados no PMAQ, que são ofertados em uma unidade básica de saúde. Método: Trata-se de um estudo do tipo relato de experiência. A coleta de dados foi realizada entre setembro e outubro de 2018, através de uma unidade básica de saúde do norte de Minas Gerais. Com as etapas: 1) Entendimento do instrumento AMAQ e a sub-dimensão H. 2) Levantamentos dos equipamentos da infraestrutura da unidade. 3) Análise com categorias que são indicadas a cada escala e foram avaliadas em pontuações mínimas e máximas. Resultados: Sugere- se melhorias como, rampas com barras de apoio, placas de identificação imprescindivelmente em braile e de formas visuais. Melhoria dos equipamentos de urgências e emergências. Conclusões/Considerações Finais: A gestão em saúde é responsável pelo gerenciamento e desenvolvimento das ações, porém, obstáculos são encontrados, gerando fragilidades. É necessária mudança nos processos de trabalhos na assistência aos usuários e na gestão dos recursos em saúde, a fim de que a APS seja qualificada e equiparada em todo território nacional. Nesse sentido, o PMAQ-AB tem sido importante com potencial de melhoria dos serviços e processos de trabalho. Foi possível perceber que o PMAQ-AB foi positivo, mas existem dificuldades de adequação dos padrões de qualidade relacionados à infraestrutura dos equipamentos

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events