Programs and methodologies of sustainability indicators: comparative analysis as a subsidy for urban environmental management / Programas e metodologias de indicadores de sustentabilidade: análise comparativa como subsídio para a gestão ambiental urbana

Neste trabalho foram analisados alguns programas e metodologias de indicadores de sustentabilidade utilizados por diversos municípios para subsidiar a gestão ambiental urbana. A metodologia utilizada foi descritiva e exploratória, analisando cada programa e metodologia comparativamente com o uso do conceito de sustentabilidade no meio urbano. Os programas e metodologias estudados foram: IDS – Indicadores de Desenvolvimento Sustentável do IBGE (Nacional – Brasil), Pegada Ecológica (Mundial), Programa Cidades Sustentáveis (Nacional – Brasil), Programa Município Verde Azul (Estado de São Paulo – Brasil), Observatório Cidadão de Piracicaba (Municipal – Piracicaba/ SP, Brasil) e Instituto IPPLAP (Municipal – Piracicaba/ SP, Brasil). Na análise foi possível gerar um quadro comparativo, onde foram considerados abrangência, objetivo, as dimensões da sustentabilidade presentes nestes (ambiental, social, econômica, institucional, política e cultural), os pontos positivos e pontos de melhorias em cada um dos casos. Dentre os programas e metodologias estudados neste trabalho, cita-se resumidamente, que a Pegada Ecológica, tem um foco mais ambiental e pontual, o Município Verde Azul apresenta um enfoque ambiental, porém se destaca com suas diretivas envolvendo demais aspectos sociais, econômicos e políticos que serão notados no ato de aplicação de suas ações. Já o Observatório Cidadão de Piracicaba aborda dimensões ambiental, social e política, sendo o eixo político e participativo da comunidade muito forte neste programa. O IDS IBGE e o Instituto IPPLAP abordam diversas dimensões, porém não são muito utilizados pelos municípios por gerarem dados mais difíceis para aplicação no uso na gestão pública. O Programa Cidades Sustentáveis aborda diversos eixos, porém com uma quantidade bem significativa de indicadores, o que pode dificultar o uso do gestor, caso não tenha o foco nos indicadores que deverão ser mais trabalhados, porém também sendo de grande oportunidade como instrumento de indicadores de sustentabilidade para gestão ambiental urbana. Por fim, todos os programas e metodologias estudados tem sua importância e aplicabilidade, mesmo com diretivas e eixos diferenciados, mas todos com função principal atrelada aos indicadores de sustentabilidade. A partir da análise comparativa fica claro que cada município deve buscar o que mais se enquadra nas suas expectativas e necessidades para o poder público e a comunidade, e em especial, possam melhorar a gestão ambiental municipal. 

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

Contribuição dos indicadores de sustentabilidade na gestão urbano ambiental

Recently in Brazil cities have been suffering strong influence concerning concepts of sustainable development and urban-environmental management in order to implement public policies. These approaches combined, subsidize fair democratic construction, along with citizen participation and transparency regarding the use of resources. This study was meant to address the evaluation of performance and environmental quality through the use of sustainability indicators as a tool for planning and management of municipal urban-environmental, its advantages, disadvantages and contributions to the effectiveness in the implementation of policies aimed at local sustainable development. The main objective of the study was to do a comparative analysis of the indicators used in Piracicaba, to the national indicator system and other municipal programs, and also, its application in urban and environmental planning. To achieve this goal, initially a topic selection was made based on a bibliographic analysis in order to discuss the use of management tools and municipal evaluation systems from the perspective of sustainability, showing the management tools such as laws, agreements, documents and mainly, sustainability indicators. It was then, prepared the case study carried out in Piracicaba, São Paulo municipality. With the obtained results, it was possible to provide a model which shows strengths and weaknesses of public actions and policies for the environment, such as project suggestions that could be applied aiming greater sustainability and continuous improvement of municipal environmental performanceRecentemente no Brasil os municípios têm recebido forte influência dos conceitos de desenvolvimento sustentável e gestão urbano-ambiental para a aplicação de políticas públicas. Aliadas, essas abordagens subsidiam a construção democrática justa, juntamente com a participação civil e a transparência no uso dos recursos. Este estudo procurou abordar a avaliação do desempenho e qualidade ambiental com o uso de indicadores de sustentabilidade como instrumento para o planejamento e gestão urbano-ambiental municipal, suas vantagens, desvantagens e contribuições para a eficácia na implantação de políticas que visam o desenvolvimento sustentável municipal. O principal objetivo do estudo foi analisar comparativamente os indicadores utilizados no município de Piracicaba ao sistema de indicadores nacionais e outros programas municipais, e sua aplicabilidade no planejamento urbano-ambiental. Para alcançar esse objetivo, foi realizado inicialmente um levantamento bibliográfico em que foram selecionados temas relevantes para a discussão do uso de ferramentas de gestão e sistemas de avaliação municipal sob a ótica da sustentabilidade, evidenciando os instrumentos de gestão como leis, acordos, documentos e principalmente, indicadores de sustentabilidade. Em seguida foi elaborado o estudo de caso realizado em Piracicaba, município paulista. Com os resultados obtidos a partir da comparação dos sistemas de indicadores locais (Observatório Cidadão de Piracicaba e IPPLAP) com outros sistemas (Indicadores de sustentabilidade - IBGE, Programa cidades sustentáveis, Município Verde Azul), foi possível fornecer um modelo sobre os pontos fracos e fortes de ações e políticas públicas para o meio ambiente e sugestões de projetos que podem ser aplicados visando uma maior sustentabilidade e melhoria continua do desempenho ambiental municipa

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology