Structural accreditation of healthcare facilities: comparison of the requirements by Italian Presidential Decree 14/01/1997 and regional regulations. A proposal for updating the minimum environmental units at national level.

BACKGROUND AND AIM: The Decree of the President of the Italian Republic 14/01/1997 is the reference norm related to the accreditation of public and private healthcare structures. This guideline establishes the minimum structural, technological and organizational requirements that each structure operating in the Italian territory must comply with. METHODS: In occasion of the project work for the postgraduate training course in healthcare management by ALTEMS School, a team of researchers conducted a survey on the state of updating of the minimum structural requirements indicated in the norm-in particular those relating to hospital facilities- with those adopted by the individual regions through the analysis of the most up-to-date regional regulations. RESULTS: Precisely starting from the comparison of regional references and from the regulations on the subject of structural accreditation which suggest strategic environmental units and which address some key-aspects relating to the contemporary design of healing environments (i.e. semi-intensive care units, hybrid operating theatres, etc.), the outcome of the project work is to define a proposal to update the national reference document, also in the light of the currently changing needs in terms of hospital design. CONCLUSIONS: The research aims to become a starting milestone for future investigations. The team investigated - in this first phase - the functional areas listed in the norm, and the next step aims to extend the analysis also to the innovative functions (i.e. buffer spaces, hybrid operating theatres, sub-intensive care units, etc.) and/or introduced only the last years which have only been regulated in some regions.

Artificial Intelligence and Public Health: Evaluating ChatGPT Responses to Vaccination Myths and Misconceptions.

Artificial intelligence (AI) tools, such as ChatGPT, are the subject of intense debate regarding their possible applications in contexts such as health care. This study evaluates the Correctness, Clarity, and Exhaustiveness of the answers provided by ChatGPT on the topic of vaccination. The World Health Organization's 11 "myths and misconceptions" about vaccinations were administered to both the free (GPT-3.5) and paid version (GPT-4.0) of ChatGPT. The AI tool's responses were evaluated qualitatively and quantitatively, in reference to those myth and misconceptions provided by WHO, independently by two expert Raters. The agreement between the Raters was significant for both versions (p of K < 0.05). Overall, ChatGPT responses were easy to understand and 85.4% accurate although one of the questions was misinterpreted. Qualitatively, the GPT-4.0 responses were superior to the GPT-3.5 responses in terms of Correctness, Clarity, and Exhaustiveness (Δ = 5.6%, 17.9%, 9.3%, respectively). The study shows that, if appropriately questioned, AI tools can represent a useful aid in the health care field. However, when consulted by non-expert users, without the support of expert medical advice, these tools are not free from the risk of eliciting misleading responses. Moreover, given the existing social divide in information access, the improved accuracy of answers from the paid version raises further ethical issues.

Quality of Life in Amyotrophic Lateral Sclerosis Patients and Care Burden of Caregivers in Sardinia during COVID-19 Pandemic.

Amyotrophic Lateral Sclerosis (ALS) is a rare neurogenerative disorder whose median survival ranges from 2 to 4 years after symptomatic onset. Therefore, the global Quality of Life (QoL) assessment in these patients should be carefully evaluated to guarantee an adequate care level, particularly during the COVID-19 pandemic period, given the increased social isolation and the pressure on healthcare services. Caregiving has been recognized as an important source of physical and psychological burden, with a possible QoL impairment. The purpose of this study was to evaluate the QoL of ALS patients and the burden of their caregivers across Sardinia, Italy. The ALS Specific QoL Instrument-Short Form (ALSSQOL-SF) and the Zarit Burden Inventory (ZBI) tools were used to assess patient's QoL and the burden on their caregivers, respectively. The questionnaires were supplemented with items specific for the COVID-19 period. Sixty-six family units of patients with advanced ALS were interviewed between June and August 2021 across Sardinia. Patients' psychological and social well-being were found to significantly affect the patients' QoL, regardless of their physical condition. In addition, the caregiver burden resulted as being inversely proportional to the patient's perceived QoL. Lack of adequate psychological support was reported among the caregivers during the emergency period. Providing adequate psychological and social support might be useful to improve QoL in middle and late stages of ALS patients and to decrease caregivers' perceived home care burden.

Gender equality in the Italian academic context. Results from the IGEA project.

The Innovation for Gender Equality in Academia (IGEA) project is focused on the analysis of the gender composition in academia, on the identification of the health needs of the academic population and on the assessment of their organizational wellbeing, in order to promote equal working conditions and opportunities. The study, focused on the identification of health needs, involved the construction of an ad hoc questionnaire in order to collect the socio-demographic characteristics and the perception of working environment of the participants. Differences between males and females were evaluated by the Mann-Whitney test, and Pearson Chi-Square or Fisher exact tests as appropriate, highlighting significant differences between genders regarding the occurrence of anxiety, panic, irritation and annoyance related to work activities. A multivariate logistic regression analysis was performed to identify factors associated with the perception of work-related anxiety/panic, showing a direct association with the difficulty in work performance and the work-related stress during the pandemic period, whereas, an indirect association was found with job satisfaction and the feeling of being appreciated by colleagues. Occupational stress can increase the risk of developing physical and mental conditions, also affecting work performance and absenteeism. It is therefore fundamental to plan targeted interventions, implement policies and specific actions, in order to avoid and reduce any differences related to gender.

Impact of the COVID-19 Pandemic on the Prevalence of HAIs and the Use of Antibiotics in an Italian University Hospital.

The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University Hospital and to investigate whether the intensification of hospital infection control measures during the COVID-19 pandemic has affected the prevalence of bacterial HAIs. A point prevalence survey was conducted according to the simplified ECDC protocol. The survey identified a local HAI prevalence of 9.0%, revealing an increase compared to pre-pandemic values (7.3%). The survey also identified an antimicrobial exposure of 40.8%, revealing a decrease in their use compared to the study carried out in the pre-pandemic era (44.6%). Among the organizational challenges experienced during the COVID-19 pandemic, despite the greater attention paid to infection prevention measures aimed at reducing SARS-CoV-2, many healthcare facilities had to contend with the controlled availability of personnel, physical space limitations and a large number of patients. Active surveillance in hospital wards and the consequent reporting by personnel specialized in infection control is fundamental for hospitals to recognize gaps in prevention and report any observed increases in HAIs.

Impact on breast cancer susceptibility and clinicopathological traits of common genetic polymorphisms in TP53, MDM2 and ATM genes in Sardinian women.

Common variants of genes involved in DNA damage correction [tumor protein p53 (TP53), murine double 2 homolog oncoprotein (MDM2) and ataxia-telengiectasia mutated (ATM)] may serve a role in cancer predisposition. The purpose of the present study was to investigate the association of five variants in these genes with breast cancer risk and clinicopathological traits in a cohort of 261 women from northern Sardinia. Polymorphic variants in TP53 (rs17878362, rs1042522 and rs1625895), MDM2 (rs2279744) and ATM (rs1799757) were determined by PCR and TaqMan single nucleotide polymorphism assay in patients with breast cancer (n=136) and healthy controls (n=125). Association with clinicopathological (e.g., age at diagnosis, lymph node involvement, clinical stage) and lifestyle factors (e.g., smoking status, alcohol intake, contraceptive use) was also evaluated. TP53 rs17878362 and rs1625895 polymorphisms were associated with decreased risk of BC diagnosis in patients older than 50 years (codominant and recessive models) and post-menopause (recessive model). Furthermore, there was a significant association between lymph node status (positive vs. negative) and ATM rs1799757-delT in dominant and additive models and between MDM2 rs2279744-allele and use of oral contraceptives. This analysis suggested that TP53 rs17878362 and rs1625895 may affect age of onset of breast cancer and ATM rs1799757 and MDM2 rs2279744 may be associated with lymph node status and prolonged use of oral contraceptives, respectively.

COVID-19: opinions and behavior of Italian general population during the first epidemic phase.

BACKGROUND AND AIM: On January 9, 2020, the World Health Organization (WHO) declared that Chinese health authorities had identified a new coronavirus strain never before isolated in humans, the 2019-nCoV later redefined SARS-CoV-2, that still today represent a public health problem. The present survey started on 10 February 2020 with the aim of a) assessing the risk perception in healthcare workers and young students, following the evolution of attitudes, perception and knowledge over time, b) provide useful information to the general population during survey. RESULTS: A study sample consisting of 4116 Italian individuals of both sexes was enrolled. High levels of risk perception, low perception of self-efficacy and low levels of knowledge scores (24.55 ± 5.76 SD) were obtained indicating the need for continuous population monitoring as well as further communication strategies carried out at institution levels. CONCLUSION: The results of the present study could help public health authorities in carrying out informative campaigns for general population and could be an important tool in evaluating public knowledge and misperceptions during the management of the COVID-19. (www.actabiomedica.it).

Experiences, Emotions, and Health Consequences among COVID-19 Survivors after Intensive Care Unit Hospitalization.

Literature suggested that COVID-19 patients experienced hospitalization as a physically and psychologically stressful event, with the risk to develop post-traumatic stress symptoms. The study aimed to understand psychological experiences of COVID-19 survivors with severe complications during and after ICU hospitalization, and any relevant health consequences. From October 2020 to January 2021, a qualitative study was conducted in Italy via semi-structured interviews by phone or video call addressed to COVID-19 survivors, randomly enrolled among people who released their stories publicly on newspapers, television, or social media. Fifteen individuals (three women and twelve men with average age of 56.4 years) were interviewed. Four main themes emerged: (i) emotion of fear; (ii) isolation and loneliness; (iii) unawareness about the gravity of the situation as a protective factor; (iv) "Long COVID" as consequences of the disease on physical and psychological health. During hospitalization, 66.7% of participants had mild or moderate values of anxiety and depression. After discharge, 86.7% moved to normal values. The results suggest that long-COVID is an important problem to manage to improve patients' quality of life. It is essential to guarantee a holistic take in charge starting before the discharge and continuing care after discharge in the community where they live.

Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors.

Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor's skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor's arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor's venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety.

Ten-Year Evaluation of Thermal Comfort in Operating Rooms.

The microclimate is a particularly important environmental aspect in operating rooms (ORs), where more than in other hospital environments, it is extremely important, and at the same time extremely difficult, to reconcile the needs of different types of occupants (patients and operators). Moreover, unsuitable microclimatic conditions may affect the onset of infection. The present study aimed to analyze the periodic monitoring of the microclimatic conditions carried out in ORs over 10 years, to verify the adequacy of the thermal comfort conditions for all occupants. The evaluation of thermal comfort was carried out using the Fanger indices and the standards required by current legislation and specific guidelines. Non-compliant values for at least one parameter were found in 98.8% of the examinations performed in the ORs. A condition of thermal discomfort was calculated for 3.6% of healthcare professionals and 98.3% of patients. The monitoring of microclimatic conditions is particularly important in the OR as an indicator of inadequate functioning of the air conditioning system, which might affect the thermal comfort of all occupants and lead to microbial contamination of the room.

The revised European Directive 2020/2184 on the quality of water intended for human consumption. A step forward in risk assessment, consumer safety and informative communication.

Water is an indispensable element for humankind and indeed all living beings; as such it is essential that it be supplied in adherence with safety and security criteria so as to fulfill its primordial role in community development. Therefore, the European Union has issued a new Directive on drinking water, updating the previous one (98/83/EC). The main new features of the updated Directive issued on January 12, 2021 include: • The adoption of a risk-based approach, in accordance with the principles of the Water Safety Plan, along the entire supply chain including the domestic system from the meter to the tap; • The updating of some quality standards, mainly related to the introduction of new parameters and the modification of parameter values for some in a more restrictive sense and for others in more permissive terms; • The identification of possible emerging pollutants present in supply sources (catchment areas); • The demand for effective and transparent communication to citizens on the quality of the water supplied, necessary to foster consumer confidence in the mains water supply. The Directive is the first European legislation adopted following a European Citizens' Initiative (ECI), a European Union participatory democracy tool launched through the "Right2Water" initiative aiming to positively affect the environment. Indeed, the increased consumer confidence in tap water resulting from the desired improvement in communication to citizens should lead to a gradual reduction in the use of plastic water bottles. In addition, the Directive confirms what WHO has been reporting for some time through its Water Safety Plans. It is not limited to monitoring activities but also reproposes and promotes a generalised safety approach based on risk identification and management along the entire drinking water supply chain (from the catchment area to extraction, treatment, storage including distribution). The revised Directive will become the reference standard for the quality of water intended for human consumption in EU countries, and its entry into force will make it possible to minimise the harmful impacts of pollution on human health.

The management of the Sars-CoV-2 pandemic in Italy, lessons earnt and reflections for the future.

BACKGROUND: Italy and especially Lombardy region was the first European Country hit by the covid 19 pandemic, without a proper preparedness plan. Italy's health-care service is a regionally based National Health Service (NHS) that provides universal coverage, largely free of charge at the point of service. Aim of this paper is to analyse the national and especially the regional strategies put in place to face the pandemic, focusing on the impact of the overlap of the political and health competences among national and regional authority. METHODS: Italian hygiene and preventive medicine society (SITI) realized a questionnaire submitted to National Institute for Health and regional stakeholder to investigate the response to the epidemic analysing the strategies and actions put in place both by the national and regional governments and the regional health authorities. RESULTS: The national survey highlighted several critical points in the management of the covid 19 pandemic in the different regional contexts such as lack of personnel in preventive departments and preparadness. CONCLUSIONS: Lessons learnt during the pandemic should shape the future of the Italian health service. (www.actabiomedica.it).

Web-based analysis on the role of Digital Media in Health Communication: the experience of VaccinarSinSardegna Website.

BACKGROUND AND AIM: Vaccinarsinsardegna.org website is a medical and scientific communication portal regarding vaccinations of Sardinia region. This article aims to present the structure of the portal, to demonstrate the actions carried out to provide accurate information for users and to analyse the website's activity from its launch until the current pandemic period in terms of dissemination and visibility. METHODS: Various metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were recorded, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with absolute (relative) frequencies and means. The statistical differences between the two periods (before and during the anti-COVID-19 vaccination campaign) were evaluated applying the Wilkoxon runk-sum test. A two-tailed p-value less than 0.01 was considered to be statistically significant. RESULTS: The metrics recorded using Google Analytics show that from its publication to date, the VaccinarSinSardegna.org portal has significantly increased its visibility: in fact, the number of users who have accessed the site, the number of sessions and individual web pages visited have grown exponentially. These findings are confirmed by the increasing number of visits to both versions of the regional website (Italian- and English-language) during the COVID-19 emergency and COVID-19 vaccination campaign. When the total values recorded over the period were compared, an overall increase in metrics was observed-the number of individual users, visits and individual pageviews rose in a statistically significant way. CONCLUSIONS: Based on the success on VaccinarSinSardegna and given its potential for expansion to include further collaborations with national and international scientific bodies, the authors affirm that similar initiatives should be implemented in the fight against vaccine hesistancy.

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018-2021) in an Italian University Hospital.

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018-2019, 2019-2020, and 2020-2021). A gap analysis was performed at the case base (2018-2019), on-site vaccination was trialled in the 2019-2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020-2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020-2021) and other variables related to the healthcare workers' characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020-2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave.

The aim of the study is to evaluate the preparedness of retirement and nursing homes in the city of Sassari at the end of the first wave of the severe acute respiratory syndrome coronavirus 2 epidemic, first by investigating the risk perception of epidemic outbreaks by the facility managers and subsequently by carrying out a field assessment of these facilities. To perform the field assessment, a checklist developed by the CDC (Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19) and adapted to the Italian context was used. Fourteen facilities took part in the survey (87.5%). The application of good practices for each survey area was expressed as a percentage with the following median values: restriction policies (87.5%), staff training (53.8%), resident training (67.6%), availability of personal protective equipment (41.7%), infection control practices (73.5%) and communication (80%). Among the facilities, considerable variability was observed in these evaluation fields: only the restriction policies and communication activities were applied uniformly. A discrepancy was found between perceived risk and real danger in the facilities, requiring targeted communication actions. At present, it is necessary to promote a new approach based on the prediction of critical events, thereby providing the means to effectively address them.

ATP Bioluminescence for Assessing the Efficacy of the Manual Cleaning Procedure during the Reprocessing of Reusable Surgical Instruments.

Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the adenosine triphosphate (ATP) bioluminescence method for assessing the efficacy of the manual cleaning procedure during the reprocessing of reusable surgical instruments. The ATP bioluminescence assay was performed on 140 surgical instruments of 12 different types, both before being cleaned (baseline) and after each of the cleaning procedures (i.e., decontamination, manual washing, drying, and visual inspection). For each instrument, two swabs were used as follows: one to sample the entire surface (test point 1) and the other to sample the most difficult part of the surface to clean (test point 2). Overall, for each type of instrument, there was a decrease in contamination ranging from 99.6 to >99.9% (log reduction from 2.40 to 3.76). Thus, in order to standardize the assessment of cleanliness, it may be useful to introduce the bioluminescence method into the daily routine or, at least, at regular time intervals as a complementary check combined with visual inspection. This would allow real-time verification of the achievement of an adequate level of cleanliness.

Pro-Environmental Behaviors: Determinants and Obstacles among Italian University Students.

The awareness of citizens concerning the health risks caused by environmental pollution is growing, but studies on determinants of pro-environmental behaviors have rarely examined health-related aspects. In this study, we investigated these determinants using data from a large survey among Italian university students (15 Universities: 4778 filled questionnaires). Besides the health-related aspects, represented by environmental health risk perception and functional health literacy, we considered social and demographic characteristics (gender, area of residence, sources of information, trust in institutional and non-institutional subjects, and students' capacity of positive actions, indicated as internal locus of control). The attitudes towards pro-environmental behaviors were positive for more than 70% of students and positively related with health risk perception, internal locus of control, and health literacy. The correspondence between the positive attitudes towards pro-environmental behaviors and the real adoption of such behaviors was approximately 20% for most behaviors, except for the separate collection of waste (60%). Such a discrepancy can be attributable to external obstacles (i.e., lack of time, costs, lack of support). The health-related aspects were linked to the pro-environmental attitudes, but to a lesser extent to pro-environmental behaviors, owing to the complexity of their determinants. However, they should be taken in account in planning education interventions.

Monitoring COVID-19 Transmission Risks by Quantitative Real-Time PCR Tracing of Droplets in Hospital and Living Environments.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination occurs through droplets and biological fluids released in the surroundings from patients or asymptomatic carriers. Surfaces and objects contaminated by saliva or nose secretions represent a risk for indirect transmission of coronavirus disease 2019 (COVID-19). We assayed surfaces from hospital and living spaces to identify the presence of viral RNA and the spread of fomites in the environment. Anthropic contamination by droplets and biological fluids was monitored by detecting the microbiota signature using multiplex quantitative real-time PCR (qPCR) on selected species and massive sequencing on 16S amplicons. A total of 92 samples (flocked swabs) were collected from critical areas during the pandemic, including indoor (three hospitals and three public buildings) and outdoor surfaces exposed to anthropic contamination (handles and handrails, playgrounds). Traces of biological fluids were frequently detected in spaces open to the public and on objects that are touched with the hands (>80%). However, viral RNA was not detected in hospital wards or other indoor and outdoor surfaces either in the air system of a COVID hospital but only in the surroundings of an infected patient, in consistent association with droplet traces and fomites. Handled objects accumulated the highest level of multiple contaminations by saliva, nose secretions, and fecal traces, further supporting the priority role of handwashing in prevention. In conclusion, anthropic contamination by droplets and biological fluids is widespread in spaces open to the public and can be traced by qPCR. Monitoring fomites can support evaluation of indirect transmission risks for coronavirus or other flu-like viruses in the environment.IMPORTANCE Several studies have evaluated the presence of SARS-CoV-2 in the environment. Saliva and nasopharyngeal droplets can land on objects and surfaces, creating fomites. A suitable indicator would allow the detection of droplets or biofluids carrying the virus. Therefore, we searched for viral RNA and droplets and fomites on at risk surfaces. We monitored by qPCR or next generation sequencing (NGS) droplets through their microbiota. Although the study was performed during the pandemic, SARS-CoV-2 was not significantly found on surfaces, with the only exception of environmental areas near infectious patients. Conversely, anthropic contamination was frequent, suggesting a role for biofluids as putative markers of indirect transmission and risk assessment. Moreover, all SARS-CoV-2-contaminated surfaces showed droplets' microbiota. Fomite monitoring by qPCR may have an impact on public health strategies, supporting prevention of indirect transmission similarly to what is done for other communicable diseases (e.g., influenza and influenza-like infections).

Characteristics of SARS-CoV-2 positive cases beyond health-care professionals or social and health-care facilities.

BACKGROUND: During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities. METHODS: The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively. RESULTS: Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia. CONCLUSIONS: This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.

Air pollutants and risk of death due to COVID-19 in Italy.

The present work aims to study the role of air pollutants in relation to the number of deaths per each Italian province affected by COVID-19. To do that, specific mortality from COVID-19 has been standardized for each Italian province and per age group (10 groups) ranging from 0 to 9 years to >90 years, based on the 2019 national population figures. The link between air pollutants and COVID-19 mortality among Italian provinces was studied implementing a linear regression model, whereas the wide set of variables were examined by means of LISA (Local Indicators of Spatial Autocorrelation), relating the spatial component of COVID-19 related data with a mix of environmental variables as explanatory variables. As results, in some provinces, namely the Western Po Valley provinces, the SMR (Standardized Mortality Ratio) is much higher than expected, and the presence of PM10 was independently associated with the case status. Furthermore, the results for LISA on SMR and PM10 demonstrate clusters of high-high values in the wide Metropolitan area of Milan and the Po Valley area respectively, with a certain level of overlap of the two distributions in the area strictly considered Milan. In conclusion, this research appears to find elements to confirm the existence of a link between pollution and the risk of death due to the disease, in particular, considering land take and air pollution, this latter referred to particulate (PM10). For this reason, we can reiterate the need to act in favour of policies aimed at reducing pollutants in the atmosphere, by means of speeding up the already existing plans and policies, targeting all sources of atmospheric pollution: industries, home heating and traffic.