Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Estudo e recomendações sobre o Sistema de Planejamento da Embrapa

174 páginasEl presente trabajo de asesoría sobre aspectos del desarrollo organizacional de EMBRAPA está restringido al área de planificación. Sin embargo, dentro de la visión sistémica del desarrollo organizacional, no se deja a un lado al que tiene una comprensión del "hacer" sustantivo (actividad final) para apreciar la relevancia de las operaciones en el área de planificación, que es el objeto más específico de tratamiento en este trabajo. . Como primer y más básico principio, se considera que dentro de un estudio en perspectiva de análisis y desarrollo organizacional, todos y cada uno de los aspectos instrumentales deben ser vistos como un objeto-medio, adecuado al objeto-fin de la institución. Dentro de esta perspectiva, y para los propósitos de este trabajo, el área de planificación en sus aspectos estructurales, procedimentales e instrumentales y considerada como un objeto-medio o "medio de actividad" de la institución. Es decir, la planificación de la investigación; de un 'sujeto' que es el investigador '; y de un "método" que es el método científico como instrumento o instrumental de un "objeto sustantivo" el de un fin que es la tecnología para el productor y el desarrollo rural

Land-use intensification trends in the Rio de la Plata region of South America: Toward specialization or recoupling crop and livestock production

The Rio de la Plata region comprises central Argentina, Uruguay, and southern Brazil. Modern agriculture developed around 1900 with recent decades being characterized by the advance of cropping areas over native grasslands. Highly specialized agriculture has decoupled crop and livestock production but has succeeded in intensifying yields. However, significant losses of ecosystem services have been reported. Thus, questions have been raised on the sustainability of this pathway. A glance at world regions that have experienced similar trends suggests that an urgent course correction is needed. A major concern has been the lack of diversity in regions with highly specialized agriculture, promoting renewed interest in integrated crop-livestock systems (ICLS), not only because ICLS are more diverse than specialized systems, but also because they are rare examples of reconciliation between agroecosystem intensification and environmental quality. Consequently, this paper discusses alternatives to redesign multifunctional landscapes based on ICLS. Recent data provide evidence that recoupling crop and animal production increases the resilience of nutrient cycling functions and economic indicators to external stressors, enabling these systems to face climate-market uncertainty and reconcile food production with the provision of diverse ecosystem services. Finally, these concepts are exemplified in case studies where this perspective has been successfully applied.Fil: De Faccio Carvalho, Paulo Cesar. Universidade Federal do Rio Grande do Sul; BrasilFil: Savian, Jean Víctor. Instituto Nacional de Investigación Agropecuaria ? Inia Uruguay; UruguayFil: Della Chiesa, Tomás. Universidad de Buenos Aires; ArgentinaFil: De Souza Filho, William. Universidade Federal do Rio Grande do Sul; BrasilFil: Terra, Jose Alfredo. Instituto Nacional de Investigación Agropecuaria. Inia; UruguayFil: Pinto, Priscila. Universidad de Buenos Aires; ArgentinaFil: Posselt Martins, Amanda. Universidade Federal do Rio Grande do Sul; BrasilFil: Villarino, Sebastián Horacio. Universidad Nacional de Mar del Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; ArgentinaFil: Da Trindade, Julio Kuhn. Livestock and Rural Development of Rio Grande do Sul; BrasilFil: De Albuquerque Nunes, Pedro Arthur. Universidade Federal do Rio Grande do Sul; BrasilFil: Piñeiro, Gervasio. Universidad de la Republica; Urugua

Intestinal microbiota regulates tryptophan metabolism following oral infection with Toxoplasma gondii

The intestinal microbiota plays an important role in modulating host immune responses. Oral Toxop/asma gondii infection can promote intestinal inflam­mation in certain mice strains. The 1DO-AhR axis may control tryptophan (Trp) me­tabolism constituting an important immune regulatory mechanism in inflammatory settings. Aims: In the present study, we investigated the role of the intestinal microbiota on Trp metabolism during oral infection with T gondii. Methods and results: Mice were treated with antibiotics for four weeks and then infected with T gondii by gavage. Histopathology and immune responses were eval­uated 8 days after infection. We found that depletion of intestinal microbiota by antibiotics contributed to resistance against T gondii infection and led to reduced expression of AhR on dendritic and Treg cells. Mice depleted of Gram-negative bac­teria presented higher levels of systemic Trp, downregulation of AhR expression and increased resistance to infection whereas depletion of Gram-positive bacteria did not affect susceptibility or expression of AhR on immune cells. Conclusion: Our findings indicate that the intestinal microbiota can control Trp avail­ability and provide a link between the AhR pathway and host-microbiota interaction in acute infection with T gondii.Fil: Santos, Liliane M.. Universidade Federal de Minas Gerais; BrasilFil: Commodaro, Alessandra G.. Universidade de Sao Paulo; BrasilFil: Vasquez, Alicia R. R.. Universidade Federal de Minas Gerais; BrasilFil: Kohlhoff, Markus. Instituto Federal de Educacao Ciencia E Tecnologia Do Sul de Minas.; BrasilFil: de Paula Guerra, Daniel A.. Universidade Federal de Minas Gerais; BrasilFil: Coimbra, Roney S.. Universidade Federal de Minas Gerais; BrasilFil: Martins Filho, Olindo A.. Universidade Federal de Minas Gerais; BrasilFil: Teixeira Carvalho, Andrea. Universidade Federal de Minas Gerais; BrasilFil: Rizzo, Luiz V.. Instituto Israelita de Pesquisa E Ensino, São Paulo; BrasilFil: Vieira, Leda Q.. Universidade Federal de Minas Gerais; BrasilFil: Serra, Horacio Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; Argentin

Intestinal microbiota regulates tryptophan metabolism following oral infection with Toxoplasma gondii

The intestinal microbiota plays an important role in modulating host immune responses. Oral Toxop/asma gondii infection can promote intestinal inflam­mation in certain mice strains. The 1DO-AhR axis may control tryptophan (Trp) me­tabolism constituting an important immune regulatory mechanism in inflammatory settings. Aims: In the present study, we investigated the role of the intestinal microbiota on Trp metabolism during oral infection with T gondii. Methods and results: Mice were treated with antibiotics for four weeks and then infected with T gondii by gavage. Histopathology and immune responses were eval­uated 8 days after infection. We found that depletion of intestinal microbiota by antibiotics contributed to resistance against T gondii infection and led to reduced expression of AhR on dendritic and Treg cells. Mice depleted of Gram-negative bac­teria presented higher levels of systemic Trp, downregulation of AhR expression and increased resistance to infection whereas depletion of Gram-positive bacteria did not affect susceptibility or expression of AhR on immune cells. Conclusion: Our findings indicate that the intestinal microbiota can control Trp avail­ability and provide a link between the AhR pathway and host-microbiota interaction in acute infection with T gondii.Fil: Santos, Liliane M.. Universidade Federal de Minas Gerais; BrasilFil: Commodaro, Alessandra G.. Universidade de Sao Paulo; BrasilFil: Vasquez, Alicia R. R.. Universidade Federal de Minas Gerais; BrasilFil: Kohlhoff, Markus. Instituto Federal de Educacao Ciencia E Tecnologia Do Sul de Minas.; BrasilFil: de Paula Guerra, Daniel A.. Universidade Federal de Minas Gerais; BrasilFil: Coimbra, Roney S.. Universidade Federal de Minas Gerais; BrasilFil: Martins Filho, Olindo A.. Universidade Federal de Minas Gerais; BrasilFil: Teixeira Carvalho, Andrea. Universidade Federal de Minas Gerais; BrasilFil: Rizzo, Luiz V.. Instituto Israelita de Pesquisa E Ensino, São Paulo; BrasilFil: Vieira, Leda Q.. Universidade Federal de Minas Gerais; BrasilFil: Serra, Horacio Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; Argentin

Educação do campo: notas para uma análise de percurso Field education: Notes for an analysis of the course

Este ensaio busca contribuir na construção de uma chave metodológica para interpretação do percurso e da situação atual da educação do campo, um fenômeno recente da realidade educacional brasileira, que tem os movimentos sociais camponeses como principais protagonistas. O texto inicia com uma análise da constituição originária da Educação do campo, identificando contexto, práticas e sujeitos. Em seguida, discute as tensões e contradições principais do seu percurso, especialmente as que se produzem na relação entre movimentos sociais e Estado, na afirmação de uma tradição pedagógica emancipatória e da luta por políticas públicas que garantam o acesso dos camponeses à educação escolar em seu próprio território. Por fim, são identificados alguns impasses e desafios principais da Educação do campo na atualidade, relacionando-os ao momento atual de crise mundial do capitalismo e como ela se materializa nas questões relacionadas ao trabalho do campo.<br>This essay seeks to contribute to building a methodological key to interpret the course and the current status of field education, a recent phenomenon in the Brazilian educational reality which has peasant social movements as its main actors. The article begins with an analysis of the original Field Education constitution, identifying its context, practices, and subjects. It then discusses the main tensions and contradictions in its course, particularly those that are produced in the relationship between the social movements and the State, in the affirmation of an emancipatory pedagogic tradition, and in the struggle for public policies that ensure peasant access to formal school education in their own territory. Finally, a few of the impasses and challenges that were singled out regarding the modern day Field education, relating them to the current global crisis of capitalism and to how it materializes itself in the issues related to work in the field

Collaborative brazilian pediatric renal transplant registry (CoBrazPed-RTx) : a report from 2004 to 2018

The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death23