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

Avaliação das ações de controle da leishmaniose visceral (calazar) em uma área endêmica do Estado da Bahia, Brasil (1995-2000) Evaluation of control measures for visceral leishmaniasis (kala azar) in an endemic area in Bahia, Brazil (1995-2000)

Este estudo objetivou avaliar as ações do Programa de Controle da Leishmaniose Visceral no Município de Feira de Santana, Bahia, Brasil. Foram coletadas informações das ações no período de 1995 a junho de 2000, considerando-se a periodicidade e cobertura, e a evolução da incidência nas áreas trabalhadas. A variável dependente foi a incidência de casos humanos e as variáveis independentes foram: percentual de prédios trabalhados para inquérito canino e prédios borrifados, número de ciclos de inquérito canino e borrifação e prevalência canina. Para avaliar a correlação entre as ações e a incidência de casos humanos calculou-se os coeficientes de correlação de Pearson e procedeu-se à analise de regressão linear. Não foi observada associação entre a prevalência de cães com sorologia positiva e a incidência de casos humanos. As variáveis que permaneceram no modelo final e que tiveram efetividade mais destacada no controle da doença foram: percentual de prédios trabalhados para inquérito e borrifação e número de ciclos de inquérito canino, capazes de explicar 40% da incidência de casos humanos. Os achados constituem material relevante para discussão da efetividade das ações de controle da leishmaniose visceral.<br>This study evaluated the Control Program for Visceral Leishmaniasis in the city of Feira de Santana, Bahia, Brazil. Information was collected on control measures from 1995 to June 2000, and focused on periodicity, coverage, and incidence trends in the target areas. The dependent variable was the incidence rate for human cases, and independent variables were: percentage of buildings visited in the canine survey and buildings sprayed, number of cycles in the canine survey and spraying, and canine prevalence rate. To evaluate the correlation between control measures and the human visceral leishmaniasis incidence rate, we calculated the Pearson’s correlations coefficients and performed linear regression analysis. No association was observed between the prevalence of dogs with positive serology and the incidence rate of human cases. The variables that remained in the final model and that proved most effective in controlling the disease were: percentage of buildings visited during the survey and spraying and number of cycles in the canine survey, capable of explaining 40% of the incidence of human cases. The findings constitute relevant material for the discussion of effectiveness in control measures for visceral leishmaniasis