Morphology, Physical and Chemical Characteristics of Mangrove Soil under Riverine and Marine Influence: A Case Study on Subaé River Basin, Bahia, Brazil

The preservation of mangrove ecosystem requires knowledge on soil Morphology, Physical and Chemical Characteristics, for understanding the requirements for their sustainability and preservation. Seven pedons of mangrove soil, five under fluvial and two under marine influence, located in the Subaé River basin were described and classified. Samples of horizons were collected for physical and chemical analyses, including Pb and Cd. The moist soils were suboxidic, with Eh below 350 mV. The pH of the pedons under fluvial influence ranged from moderately acid to alkaline, and pedons under marine influence was around 7.0. Mangrove soils under fluvial influence were characterized with the highest Pb and Cd concentrations in the pedons, which could be perhaps due to it closeness to the mining company Plumbum, while the lowest Pb concentrations was registered in the pedon furthest from the factory. Because the pedons had at least one metal above the reference level they were considered potentially toxic. The soils were classified as Gleissolos Tiomórficos Órticos (sálicos) sódico neofluvissólico, according to the Brazilian Soil Classification System and as Thiomorphic orthic Gleysol (salic) sodicluvissol (potentially toxic, very poorly drained) according with FAO. The pedon under marine influence was classified in the same subgroup, but the metal concentrations met the acceptable standard

Care coordination in PMAQ-AB: an Item Response Theory-based analysis

OBJETIVO Analisar a qualidade das variáveis do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica para avaliar a coordenação na atenção básica do cuidado. MÉTODOS Estudo transversal baseado em dados de 17.202 equipes de atenção básica que participaram do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica em 2012. Baseado na Teoria de Resposta ao Item, o Modelo de Resposta Gradual de Samejima foi utilizado para estimação do escore relacionado ao nível de coordenação. Os coeficientes alfa de Cronbach, Spearman e ponto bisserial foram utilizados para análise da consistência interna e da correlação entre os itens e de itens com o escore total. Foram avaliadas as suposições de unidimensionalidade e de independência local dos itens. Gráficos do tipo nuvem de palavras auxiliaram na interpretação dos níveis de coordenação. RESULTADOS Os itens do Programa com maior discriminação do nível de coordenação foram: existência de telefone/internet, fluxos institucionais de comunicação e ações de apoio matricial. A frequência de contato de especialistas com a atenção básica e prontuário eletrônico integrado exigiram maior nível de coordenação das equipes. O coeficiente alfa de Cronbach total 0,8018. Os itens fluxos institucional de comunicação e telefone/internet tiveram maior correlação com o escore total. Os escores de coordenação variaram entre -2,67 (mínimo) e 2,83 (máximo). Maior grau de comunicação, troca de informações, apoio matricial, cuidado no território e domicílio tiveram peso relevante nos níveis de coordenação. CONCLUSÕES A capacidade de disponibilizar a informação e a frequência de contato entre os profissionais são elementos importantes para o cuidado abrangente, contínuo e de qualidade.OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care. METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels. RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination. CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care

Associação entre internações por condições sensíveis e qualidade da atenção primária

OBJECTIVE: To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019. METHOD: Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman’s test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years. RESULTS: A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations. CONCLUSIONS: The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.OBJETIVO: Analisar a associação entre taxas municipais de internações por condições sensíveis à atenção primária (ICSAP), com a qualidade da atenção primária à saúde (APS), variáveis socioeconômicas, demográficas e relacionadas a características locais do sistema de saúde, de 2010 a 2019. MÉTODOS: Estudo ecológico de séries temporais nos municípios brasileiros analisando a correlação das taxas de ICSAP, com a qualidade da APS medida pelos três ciclos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foram incluídos municípios que participaram com 80% ou mais de suas equipes em, ao menos, dois ciclos do PMAQ-AB. Foi analisada a correlação entre as taxas de ICSAP padronizadas com a qualidade da APS e demais variáveis. Empregou-se o teste de Spearman entre a variável resposta e as variáveis explicativas numéricas. Foi usado o generalized equations estimating como modelo multivariado associando as taxas de ICSAP e as demais variáveis ao longo dos anos. RESULTADOS: Foram incluídos 3.500 municípios nos modelos. A qualidade da APS (nota do PMAQ-AB) apresentou associação inversa com a variação das taxas de ICSAP. As taxas de internação tiveram queda de -2% ao ano a cada aumento de dez pontos na nota do PMAQAB, ajustado pelas demais variáveis. O aumento de uma unidade na variável leitos por mil habitantes impactou em uma elevação de aproximadamente +6,4% nas taxas de ICSAP. Quanto ao porte populacional, municípios maiores tiveram menores taxas de ICSAP. Também se associaram à redução das internações o aumento da cobertura da APS e a menor desigualdade socioeconômica. CONCLUSÕES: A redução das taxas de ICSAP ao longo do tempo mostrou-se associada com o aumento da qualidade da APS. Além disso, esteve associada com diminuição do número de leitos hospitalares e a municípios com melhores indicadores socioeconômicos

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.</sec

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Integração da atenção básica à rede assistencial: análise de componentes da avaliação externa do PMAQ-AB

Estudo transversal que avalia a integração entre a atenção básica e a rede assistencial do Sistema Único de Saúde (SUS), por meio do Modelo de Resposta Gradual da Teoria de Resposta ao Item. Com base nos dados de 17.202 equipes que participaram do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), 2012, foram mensurados gradientes de integração para identificar o perfil das equipes por nível de integração. Os resultados demonstram que os itens referentes às ações de apoio matricial - consultas médicas; discussão de caso; ação clínica compartilhada; construção conjunta de projetos terapêuticos; atividade de educação permanente; discussão processo trabalho; intervenções no território e realização de visita com profissionais de atenção básica - melhoram o desempenho das equipes de atenção básica. Dispositivos de comunicação entre as equipes reforçam esse entendimento. Contudo, a frequência em torno de 50% de respostas associadas ao pior cenário para alguns itens do estudo, evidenciou a necessidade de qualificação da integração entre as ações de atenção básica e especializada para a consolidação de uma atenção primária à saúde abrangente

Association between hospitalizations for sensitive conditions and quality of primary care

ABSTRACT OBJECTIVE To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019. METHOD Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman’s test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years. RESULTS A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations. CONCLUSIONS The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators