Participatory management assessment in State Parks open for public visits in the state of Minas Gerais

Assessing and understanding participation effectiveness is fundamental to promote management excellence in a Conservation Unit. The central topic of this study is the Advisory Councils of State Parks open to public visits in Minas Gerais, and was written after applying a questionnaire that allowed making a participatory management self-perception diagnosis based on understanding the technically-defined duties for these councilors, as established in Federal Decree No. 4,340/2002. Through its autarchic body, Instituto Estadual de Florestas, the state of Minas Gerais is responsible for administering 42 Parks, 11 of which are the basis of this study for being considered open to the public and having adequate infrastructures to welcome and serve visitors. In this research, the counselors' strengths, difficulties, shortcomings and understanding in the “institutional”, “individual” and “functional” dimensions are evaluated through an adaptation of the technique called “Medición de la efectividad del Manejo de Áreas Protegidas”, conceived by Cifuentes, Izurieta and De Faria (2000). 127 participation instances were obtained from an overall scenario of 229 counselors. The results evidence predominance of the male gender (68%), urban areas residents (83%) and individuals with graduate studies (55%). Regarding the “institutional” and “functional” dimensions, the majority (56%) is not clear about the reasons for creating the Park in which they are advisory members. Unawareness is also verified in the fact that only 8% understand the reasons for the Conservation Unit to exist. Considering the methodology used, effectiveness of the Parks was assessed as with more than 50% of their counselors participating in this research, and their participation effectiveness was considered satisfactory. However, the need for continuous actions is reinforced as a motivating factor for greater involvement of the counselors and local communities in management of the Parks, fundamental to achieving their main creation objectives.A avaliação e a compreensão da efetividade da participação são fundamentais na promoção da excelência da gestão de uma Unidade de Conservação. Este estudo tem como tema central os Conselhos Consultivos dos Parques Estaduais abertos à visitação pública em Minas Gerais, e foi escrito após a aplicação de um questionário que permitiu realizar um diagnóstico de autopercepção da gestão participativa sobre o entendimento dos deveres tecnicamente definidos para esses conselheiros, estabelecidos no Decreto Federal 4.340/2002. O Estado de Minas Gerais, por meio de sua autarquia, o Instituto Estadual de Florestas, é responsável pela administração de 42 Parques, sendo 11 a base desse estudo por serem considerados abertos à visitação pública, possuindo infraestrutura adequada de recebimento e atendimento ao visitante. Nessa pesquisa avalia-se as potencialidades, dificuldades, carências e entendimentos dos conselheiros nas dimensões da institucionalidade, individualidade e funcionalidade por meio de uma adaptação da técnica denominada Medicion de la efectividadedel Manejo de Areas Protegidas, idealizada por Cifuentes, Izurieta e De Faria (2000). Foram obtidas, 127 participações, em um cenário total de 229 conselheiros. Os resultados evidenciaram a dominância do gênero masculino (68%), residentes em zonas urbanas (83%) e pós-graduados (55%). Nas dimensões institucional e funcional, a maior parte (56%) não possui clareza sobre os motivos da criação do Parque em que é membro conselheiro. Desconhecimento também em que, somente 8% compreendem os motivos da existência da unidade de conservação. Considerando-se a metodologia utilizada, avaliou-se a efetividade dos Parques com índice superior a 50% de seus conselheiros participando dessa pesquisa, e sua efetividade de participação foi considerada satisfatória. Entretanto, reforça-se a necessidade de ações contínuas como fator motivador para um maior envolvimento dos conselheiros e das comunidades locais na gestão dos Parques, fundamentais para que se alcancem seus principais objetivos de criação

Nebivolol Reduces Central Blood Pressure In Stage I Hypertensive Patients: Experimental Single Cohort Study.

Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. Experimental single cohort study conducted in the outpatient clinic of a university hospital. Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.132290-

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients.DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital.METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol.RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment.CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP

A Survey of Empirical Results on Program Slicing

International audienceBACKGROUND:Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS:This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS:Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION:Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding