Assessment of an organizational model during the first wave of COVID -19 in the South-Eastern Tuscany Health Unit: intensifying community services as prescribed by Ministerial Decree 77 of 2022.

Introduction: At the end of 2019 a new virus, called SARS-CoV-2, emerged in Wuhan, China. The aim of the present study was to assess the impact of the first wave of the COVID-19 pandemic on the health system of the Tuscany Region and the response implemented by the South-Eastern Local Health Unit, also in view of the new reform of territorial healthcare established by Ministerial Decree No. 77 of 2022. Methods: Data were taken from the "OpenToscana" database beginning when the first case was recorded in Italy (18 February 2020) until July 2020. We analyzed infections and deaths in each Local Heal.th Unit in the Tuscany Region and calculated the fatality rate (number of deaths/cases x 100) following COVID-19 infection. We subsequently compared the fatality rates among the Local Health Units by means of the Kruskal Wallis test. Results: During the first wave, the South-Eastern Local Health Unit had fewer infections (a total of 1,532 by July) and fewer deaths (total: 107 by July) than the other Local Health Units. In the South-Eastern Local Health Unit, the fatality rate in July was 6.98%. The comparison of the fatality rates among the various LHUs and the whole Region showed statistically significant differences (p<0.001). Conclusions: The organizational models promptly implemented by the South-Eastern Local Health Unit for good territorial care and the management of COVID-19-positive patients limited the spread of infection, and consequently the deaths, thus reducing the fatality rate in the first wave of the pandemic.

Hepatitis C Virus (HCV) genotypes distribution in South-Eastern Tuscany: a ten-year retrospective study.

Italy is recognized as having the highest Hepatitis C virus (HCV) prevalence in Europe. The Tuscany region, where the prevalence of HCV infection is approximately 0.8%, implemented two programs for the control of chronic hepatitis C in Tuscany from 2018 to 2022. This retrospective study aims to investigate the incidence of HCV in a population screened in Southeastern Tuscany from 2013 to 2022. The study population included 246,137 patients from the provincial area of Arezzo and Grosseto, Tuscany, spanning from January 2013 to October 2022. Among the subjects included in the study, 3,190 (1.29%) tested positive for anti-HCV antibodies. Of this population, 2,119 patients (66.43%) also tested positive for HCV-RNA quantification, leading to their enrolment for subsequent viral genotyping. 1,106 patients had genotype (GT) 1 (52.2%), 484 had GT 3 (22.8%), 371 had GT 2 (17.5%), and 158 had GT 4 (7.5%). Our study underscores the prevalence of HCV GTs 1 and 3 as the most predominant GTs in the Southeast Tuscany region. We also observe a correlation between age, sex and HCV genotypic distribution.

BL-MOL-AR Project, Preliminary Results about Liquid Biopsy: Molecular Approach Experience and Research Activity in Oncological Settings.

Background Liquid biopsy is mainly used to identify tumor cells in pulmonary neoplasms. It is more often used in research than in clinical practice. The BL-MOL-AR study aims to investigate the efficacy of next-generation sequencing (NGS) and clinical interpretation of the circulating free DNA (cfDNA) levels. This study reports the preliminary results from the first samples analyzed from patients affected by various neoplasms: lung, intestinal, mammary, gastric, biliary, and cutaneous. Methods The Biopsia Liquida-Molecolare-Arezzo study aims to enroll cancer patients affected by various malignancies, including pulmonary, intestinal, advanced urothelial, biliary, breast, cutaneous, and gastric malignancies. Thirty-nine patients were included in this preliminary report. At time zero, a liquid biopsy is executed, and two types of NGS panels are performed, comprising 17 genes in panel 1, which is already used in the routine tissue setting, and 52 genes in panel 2. From the 7th month after enrollment, 10 sequential liquid biopsies are performed up to the 17th month. The variant allele frequency (%) and cfDNA levels (ng/mL) are measured in every plasmatic sample. Results The NGS results obtained by different panels are similar even though the number of mutations is more concordant for lung pathologies. There are no significant differences in the actionability levels of the identified variants. Most of the molecular profiles of liquid biopsies reflect tissue data. Conclusions Preliminary data from this study confirm the need to clarify the limitations and potential of liquid biopsy beyond the lung setting. Overall, parameters related to cfDNA levels and variant allele frequency could provide important indications for prognosis and disease monitoring.

Comparison of serologic and molecular SARS-CoV 2 results in a large cohort in Southern Tuscany demonstrates a role for serologic testing to increase diagnostic sensitivity.

BACKGROUND: Since February 2020, Italian hospitals registered COVID-19 (COronaVIrus Disease 19) cases more often than the rest of the Europe. During this epidemic, health authorities requested swab tests, while seeking new patient paths. METHODS: A dual laboratory approach was evaluated, consisting of patient care reports for viral RNA detection on swabs and rapid serological tests in 516 patients (192 symptomatic or paucisymptomatic and 324 asymptomatic). RESULTS: We found the molecular positive fraction equal to 12% (23/192) among symptomatic/paucisymptomatic (S/P) and 15.4% (50/324) in asymptomatic (As) sets. Among subsets, we observed serologically positive results, corresponding to 35% (8/23) for S/P and 38% (19/50) for As. Among molecular negative cases, we detected specific Immunoglobulin G or M (Ig G or Ig M) positivity in the S/P cohort equal to 6.6% (11/167) and 6% (15/246) in As cases. For indeterminate molecular results, we found S/P serological positivity equal to 100% (1/1) and 54% (13/24) in As patients. We found higher (p < 0.05) seropositivity in older patients (n = 8) among symptomatic and positives for viral RNA (n.23). CONCLUSIONS: It has been observed that a dual approach of serological and molecular tests detects a higher absolute number of disease cases in a pandemic context,which could improve monitoring and health surveillance efficacy. The age-related seropositivity frequency in this study, if confirmed, could enhance the validity of serological tests, especially in older patients.In these subjects, molecular positivity accompanied by serological positivity (distinct for M and G immunoglobulins) should help determine disease status and support decisions related to patient management.

A New Standardization of the Bells Test: An Italian Multi-Center Normative Study.

Objective: The Bells Test is a cancelation task that is widely used for the diagnosis of unilateral spatial neglect (USN). With the aim of fostering more reliable use of this instrument, we set out to develop new norms adjusted for the possible influence of age, gender and education. We worked on the original version of the test. Methods: Normative data were collected from 401 healthy participants aged between 20 and 80 years. Individual factors that could affect performance (i.e., gender, age, and years of education) were considered. We computed several indices on the Bells Test including an asymmetry score, an accuracy score and execution time. Multiple regression analyses (for time measures) and generalized linear models (for accuracy measures) were used to check for the influence of individual predictors of performance on the Bells Test. Results: Data indicated a significant influence of age on the accuracy score and execution time variables and a marginally significant effect of education on the accuracy score variable. Wherever appropriate, cut-offs are provided for the three dependent scores on the Bells Test corrected for age and education. Conclusion: Based on a large normative sample, the present study provides new normative data on the Bells Test, which could lead to its reliable use in the diagnosis of USN.

[Accidents among postmen using motorbikes for mail deliveries in Tuscany in the period 2007-2009]. / Gli infortuni negli addetti ai recapiti postali in servizio con il motomezzo in Toscana negli anni 2007-2009.

BACKGROUND: Health risks for postmen using motorbikes for mail delivery may be influenced by stability, weight and ease of handling of the vehicle, traffic and slippery or irregular road surface. OBJECTIVES: To describe accidents that occurred among postmen in Tuscany and evaluate how many of these would have been prevented using the UNI EN 13595/2004 safety jacket. METHODS: Record linkage of data obtained from the employer--the main mail delivery company in Italy--and from the Italian Workers Compensation Authority on accidents that occurred in postmen in Tuscany who used motorbikes for deliveries during the period 2007-2009. Accident rates (with CI 95%) by age, sex, year and province were calculated; the differences were evaluated using chi2 test. RESULTS: 1,342 accidents requiring at least 3 days' sick absence were recorded in postmen in Tuscany in the period 2007-2009, with an increasing trend in young men. The average accident rate was 17.6 per 100 workers, with 42,419 sick absence days. The female rate was higher compared to men (19.4%, CI 95% 18.03-20.79 in women vs 15.5%, CI 95%: 14.15-16.89 in men). 68% of accidents occurred driving a motorbike. The index of severity was 6.79, which was higher than that calculated by INAIL for the whole Tuscan transport and communication work sector (5.31). 309 accidents (11,021 sick absence days) could have been mitigated or avoided using UNI EN 13595/2004 safety jackets (47% spinal, 30% shoulder, 23% elbow, arm and forearm). CONCLUSIONS: The frequency of accidents in postmen using motorbikes is extremely high. Several serious accidents could have been prevented using the UNI EN 13595/2004 safety jackets, suggesting the need to make their use obligatory by these workers.

[A new model of integrated care: Ospedale di Continuità]. / La continuità di cura: un nuovo modello.

The "Continuity of Care Hospital", which is now realized in the Santa Verdiana Hospital, Castelfiorentino (Italy), is aimed at solving the existing gap between hospitalists and primary care physicians. This new model of care could represent an effective tool for solving the emerging medical and teaching needs of a population characterized by advanced age and comorbidities.