Cancer mortality predictions for 2024 in selected Asian countries and Australia with focus on stomach cancer.

INTRODUCTION: We estimated cancer mortality figures in five major Asian countries and Australia for 2024, focusing on stomach cancer, a leading cause of cancer-related deaths in Eastern Asia. METHODS: We computed country- and sex-specific annual age-standardized rates (ASRs) for total cancers and the 10 most common cancer sites, using WHO and the United Nations Population Division databases from 1970 to 2021 or the latest available year. We predicted figures for 2024 and estimated the number of avoided cancer deaths in 1994-2024. RESULTS: All cancers combined ASR declined between 2015-2019 and 2024 across considered countries and sexes. In 2024, the lowest predicted male rate is in the Philippines (75.0/100 000) and the highest in Australia (94.2/100 000). The Republic of Korea is predicted to have the lowest female ASR (42.1/100 000) while the Philippines the highest (74.5/100 000). Over the last three decades, 121 300 deaths were estimated to be avoided in Hong Kong SAR, 69 500 in Israel, 1 246 300 in Japan, 653 300 in the Republic of Korea, 303 300 in Australia, and 89 700 among Philippine men. Mortality from stomach cancer has been decreasing since 1970 in all considered countries and both sexes. Significant decreases are at all age groups Male rates remain, however, high in Japan (8.7/100 000) and the Republic of Korea (6.2/100 000). CONCLUSION: Declining cancer mortality is predicted in the considered countries, notably reducing stomach cancer burden. Stomach cancer, however, remains a major public health issue in East Asia.

Human Papillomavirus (HPV) Vaccine Coverage and Confidence in Italy: A Nationwide Cross-Sectional Study, the OBVIOUS Project.

BACKGROUND: Human Papillomavirus (HPV) vaccination rates are still below the target due to vaccine refusal or delay, lack of knowledge, and logistical challenges. Understanding these barriers is crucial for developing strategies to improve HPV vaccination rates. METHODS: This cross-sectional study used a questionnaire to investigate social and behavioral factors influencing decision making about the HPV vaccine. The survey was conducted from 11 April to 29 May 2022 and involved 10,000 Italian citizens aged ≥ 18 years. The sample was stratified based on region of residence, gender, and age group. RESULTS: 3160 participants were surveyed about themselves, while 1266 respondents were surveyed about their children's vaccine uptake. Among females aged ≥ 26 years, the national average HPV vaccine uptake was 21.7%, with variations across different regions. In the 18-25 age group, females had a vaccine uptake (80.8%) twice as much as males (38.1%), while vaccine uptake among male and female children aged 9-11 was similar. CONCLUSIONS: The OBVIOUS study in Italy reveals factors influencing low HPV vaccine uptake, suggesting targeted approaches, tailored information campaigns, heightened awareness of eligibility, promoting early vaccination, addressing low-risk perception among males, addressing safety concerns, and enhancing perceived accessibility to improve vaccine uptake and mitigate health risks.

"Leo&Giulia standing for public health": an animated series to promote the values of public health among school-aged children. Best practices and field-trial protocol.

Background: The "Leo&Giulia standing for public health" project is an innovative digital health education model targeting primary school children. The project, developed during the COVID-19 pandemic, aims to educate primary school-aged children about public health issues through an animated cartoon series. It highlights the importance of early-life health promotion and the potential role of educational settings in shaping health behaviours. Study design: A 2-year school-based cluster-randomized controlled community trial will be conducted among 8-10-year-old pupils in the province of Pavia, Northern Italy. Methods: The intervention group will receive an educational programme via a new episode of "Leo&Giulia" animated series, focusing on smoking prevention. The study will assess changes in knowledge, attitudes towards smoking, and communication about smoking risks among peers and parents. The trial involves baseline and follow-up assessments through questionnaires targeting both children and parents. Results (expected): We assume that children in the intervention group will demonstrate increased knowledge and awareness of smoking-related health risks and develop negative attitudes towards tobacco use compared to the control group. Enhanced communication about tobacco harms among peers and between children and parents, as well as increased parental involvement in anti-smoking socialization practices, are expected secondary outcomes. Discussion and Conclusions: "Leo&Giulia" integrates health education into the school curriculum, leveraging the appeal of animated content to engage children in public health topics. The project is expected to contribute to the field of health education by demonstrating the effectiveness of digital health interventions in childhood, foreseeing potential long-term impacts on health behaviors and in shaping future public health strategies.

Efficacy and Safety of Endovascular Fenestrated and Branched Grafts vs open Surgery in Thoracoabdominal Aortic Aneurysm Repair: An Updated Systematic Review, Meta-analysis and Meta-regression.

OBJECTIVE: To provide an updated systematic review and meta-analysis with meta-regression of safety and efficacy of fenestrated/branched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) compared with open repair. SUMMARY BACKGROUND DATA: Endovascular repair of TAAAs may be a promising alternative to open surgery by reducing invasiveness and expanding the eligible population, but evidence remains limited. METHODS: We applied PRISMA to retrieve, quantitatively pool, and critically evaluate the efficacy and safety (including 30-day mortality, reintervention, spinal cord injury, SCI, and renal injury) of both approaches. Original studies were retrieved from PubMed, Embase and Cochrane Library until 20 April 2022, excluding papers reporting less than 10 patients. Pooled proportions and means were determined using a random-effects model. Heterogeneity between studies was evaluated with I2 statistics. RESULTS: Sixty-four studies met the pre-defined inclusion criteria. Endovascular cohort patients were older and had higher rates of comorbidities. Endovascular repair was associated with similar proportions of mortality (0.07, 95% confidence interval, CI, 0.06-0.08) compared with open repair (0.09, 95%CI 0.08-0.12; P-value=0.22), higher proportions of reintervention (0.19, 95%CI 0.13-0.26, vs. 0.06, 95%CI 0.04-0.10; P-value<0.01), similar proportions of transient SCI (0.07, 95%CI 0.05-0.09, vs. 0.06, 95%CI 0.05-0.08; P-value=0.28), lower proportions of permanent SCI (0.04, 95%CI 0.03-0.05, vs. 0.06, 95%CI 0.05-0.07; P-value<0.01) and renal injury (0.08, 95%CI 0.06-0.10, vs. 0.13, 95%CI 0.09-0.17; P-value=0.02). Results were affected by high heterogeneity and potential publication bias. CONCLUSIONS: Despite these limitations and the lack of randomised trials, this meta-analysis suggests that endovascular TAAA repair could be a safer alternative to the open approach.

Who are the superheroes? A cross-sectional study on the determinants of good health among Italian older adults.

BACKGROUND: People who reach old age enjoying good physical and mental health can be defined as (health) "superheroes", given their relatively low impact on healthcare expenditure and the desirable model they represent. AIM: To evaluate prevalence and possible determinants of being "physical superheroes" (i.e., free from the ten major chronic conditions, plus obesity), "mental superheroes" (i.e., free from major mental symptoms), and "superheroes" (i.e., both mental and physical superheroes). METHODS: A telephone-based cross-sectional study (LOST in Lombardia) was conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥ 65 years from Lombardy region, northern Italy. All participants provided both current data and data referring to one year before. RESULTS: Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men, and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥ 80 years. Multivariable analysis showed that female sex, higher age, disadvantaged socio-economic status, and physical inactivity (p for trend < 0.001) were inversely related to being superheroes. People not smoking (adjusted odds ratio, aOR = 1.40), alcohol abstainers (aOR = 1.30), and those free from feelings of hopelessness (aOR = 5.92) more frequently met the definition of superheroes. During COVID-19 pandemic, the proportion of superheroes decreased by 16.3%. CONCLUSIONS: Differences in the older adults' health status are largely attributable to their lifestyles but are also likely due to gender, educational, and socio-economic disparities, which should be properly addressed by public health policies.

European trends in ovarian cancer mortality, 1990-2020 and predictions to 2025.

INTRODUCTION: Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990-2020 and predicted the number of deaths and rates by 2025. METHODS: We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025. RESULTS: Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010-2014 to 2015-2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (-7.0%) compared to Transitional countries (-2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27. CONCLUSIONS: Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role.

Population-based breast cancer screening in Pavia (northern Italy) in 2016-2018: Key performance indicators and sensitivity estimate.

BACKGROUND AND AIM: This study aims to assess the quality of the population-based breast cancer screening programme in Pavia, northern Italy computing its key performance indicators and estimating its sensitivity for the years 2016-2018. METHODS: Invitation and examination coverage, participation rate, recall rate, detection rate and positive predictive values were computed on the basis of data provided yearly to the Italian Ministry of Health. Sensitivity was estimated identifying interval cancers in the local Cancer Registry and computed with the proportional incidence method. RESULTS: In 2016-2018 the adjusted invitation coverage was 90%, and the adjusted participation rate was 62%. Recall rate was 8.4% for first screenings and 3.9% for subsequent ones. The number of screen-detected cases was 268, corresponding to a detection rate of 6.6‰ for first screenings and 4.6‰ for subsequent screenings. The number of interval cancers observed was 110 over the study period; the proportional incidence was 22% for the first interval year and 50% for the second interval. The overall sensitivity of the screening program was 64%. CONCLUSIONS: The analysis of performance indicators and sensitivity estimates for the Pavia programme indicates that the programme performance is in line with the quality standards set by the European Union and the Italian reference scientific society (GISMa).

Smoking intensity changes during the COVID-19 pandemic waves in a cohort of smokers in Italy.

INTRODUCTION: COVID-19 lockdown in Italy resulted in increased smoking consumption, mainly associated with mental distress. This study aims to update previous findings investigating changes in smoking intensity during the whole COVID-19 pandemic. METHODS: This analysis was carried out within the "LOST IN ITALY" ("LOckdown and lifeSTyle IN ITALY") and "LOST IN TOSCANA" studies on 880 smokers with information collected during main pandemic peaks. Changes in cigarettes/day were investigated in association with survey-periods, socio-demographic and psychological characteristics through a linear mixed-model. RESULTS: Net of psychological distress and socio-demographic variables, in comparison to pre-pandemic period cigarettes/day increased by 1.16 during lockdown, and remained over half higher subsequently. In the overall period, an increase of >1 cigarette/day was also associated to lower education, older age, male gender and psychotropics drugs use. CONCLUSIONS: After 2 years of pandemic, cigarettes/day have not yet returned to the pre-pandemic levels, mainly due to socio-demographic factors, but also to nicotine addiction, that tends to stabilize consumption.

Participants' satisfaction with colorectal cancer screening programs: A systematic review.

INTRODUCTION: Since satisfaction with cancer screening experience can increase adherence to programs and contribute to reduce morbidity and mortality, its assessment is crucial for programs´ effectiveness. Our aim was to conduct a systematic review about satisfaction of participants with organized colorectal cancer screening. METHODS: We searched relevant scientific databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) from inception to May 2022. We selected cross-sectional studies and clinical trials reporting a quantitative survey-based measure of satisfaction towards CRC screening. RESULTS: A total of 15 studies were included, being published from 1992 to 2019 for an overall number of 21 surveys. Of those, 16 (76%) investigated satisfaction with screening tests (fecal occult blood test, fecal immunochemical test, sigmoidoscopy, colonoscopy, computed tomographic colonography), 4 (19%) with colonoscopy as assessment test after suspicious findings, and 2 (10%) with both the screening and assessment phase. None of the included surveys used a validated questionnaire. Most surveys reported a high level of satisfaction for both screening and further assessment phases. Temporary pain, discomfort, embarrassment, and anxiety while waiting for results were the commonest negative aspects perceived, with some variability across studies and considered procedures. CONCLUSIONS: Satisfaction with the information and communication about screening was generally good, but some authors reported participants' sub-optimal understanding of informative material. Satisfaction with CRC screening is generally high, but its evaluation is performed using non-validated instruments, which limits the interpretation of results and prevents comparability of the current body of evidence.

Cannabis use in repeated representative cross-sectional studies on Italian adults after the COVID-19 pandemic.

Lockdown measures in response to the COVID-19 pandemic in 2020 yielded dramatic changes in drug consumption. A cross-sectional study was conducted on a representative sample of 6003 Italian adults (18-74 years) in April-May 2020 - reporting information before lockdown and at the time of interview - and two years later (i.e., in February-March 2022). Italian adults using cannabis decreased from 7.0% in pre-pandemic to 5.9% during lockdown (percent change -15.7%) and to 6.7% in 2022 (-4.3%). The reduction was particularly evident among adults aged 55-74 years, whereas cannabis use strongly increased among those aged 18-34 years. In the last period considered (2022), cannabis use was significantly more frequent in men (adjusted odds ratio, OR = 1.43), adults aged 18-34 years (p-trend <0.001), individuals with a low or high level of education (OR = 1.42 and 1.46, respectively), those from Central or Southern Italy/islands (OR = 1.50 and 1.38, respectively), and those with an economic status above the average (OR = 3.07). In 2022, cannabis use was also more frequently reported in current smokers (OR = 3.52), current e-cigarette and heated tobacco product users (OR = 6.09 and 2.94, respectively), individuals with a risky alcohol consumption (OR = 4.60), gamblers (OR = 3.76), those with anxiety and depression (OR = 2.50 and 2.80, respectively), those using psychotropic drugs (OR = 8.96), those with a low quality of life (OR = 1.91), and those sleeping less (OR = 1.42). After the COVID-19 pandemic, cannabis use was more frequent in individuals with other addictive behaviours, and with anxiety and depressive symptoms.

The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality in Pavia, Northern Italy: Updated Estimates for the Year 2021.

Excess mortality estimates are considered relevant indicators of direct and indirect pandemic effects on the population. Scant data have been published on cause-specific excess mortality. Using individual-level administrative data covering the Pavia province of Italian northern Lombardy region, we provided all-cause and cause-specific raw (RMR) and age-standardized (ASMR) mortality rates in 2021 and 2015-2019, the rate ratio, and 95% confidence intervals, overall and by sex. We obtained the excess deaths in 2021 as the difference between the number of observed and expected deaths from all causes and the two leading causes of death (all neoplasms and circulatory system diseases) by fitting over-dispersed quasi-Poisson regression models, accounting for temporal, seasonal and demographic changes. The total ASMR in 2021 was 972.4/100,000 (6836 certified deaths), with the highest ASMRs for circulatory system diseases (272.6/100,000) and all neoplasms (270.3/100,000), followed by COVID-19 (94.8/100,000 and 662 deaths). Compared to the expected, we estimated a total of 6.2% excess deaths in 2021 (7.2% in males and 5.4% in females), with no excess deaths from all neoplasms and a 6.2% reduction from circulatory system diseases. COVID-19 continued to affect total mortality in 2021, albeit to a lesser extent than in 2020, consistently with national patterns.

In-hospital cost-effectiveness analysis of open versus staged fenestrated/branched endovascular elective repair of thoracoabdominal aneurysms.

OBJECTIVE: To compare costs and effectiveness of elective open (OR) vs fenestrated/branched endovascular (ER) repair of thoracoabdominal aneurysms (TAAAs) in a high-volume center. METHODS: This single-center retrospective observational study (PRO-ENDO TAAA Study, NCT05266781) was designed as part of a larger health technology assessment analysis. All electively treated TAAAs between 2013 and 2021 were analyzed and propensity-matched. End points were clinical success, major adverse events (MAEs), hospital direct costs, and freedom from all causes and aneurysm-related mortality and reinterventions. Risk factors and outcomes were homogeneously classified according to the Society of Vascular Surgery reporting standards. Cost-effectiveness value and incremental cost-effectiveness ratio were calculated, considering the absence of MAEs as a measure of effectiveness. RESULTS: Propensity matching identified 102 pairs of patients out of 789 TAAAs. Mortality, MAE, permanent spinal cord ischemia rates, respiratory complications, cardiac complications, and renal injury were higher for OR (13% vs 5%, P = .048; 60% vs 17%, P < .001; 10% vs 3%, P = .045; 91% vs 18%, P < .001; 16% vs 6%, P = .024; 27% vs 6%, P < .001, respectively). Access complication rate (6% vs 27%; P < .001) was higher in the ER group. Intensive care unit stay was longer (P < .001) for OR, and ER patients were discharged home more frequently (3% vs 94%; P < .001). No differences in midterm end points were observed at 2 years. Despite ER reducing all the hospital cost items (-42% to -88%, P < .001), the higher expenses (P < .001) of the endovascular devices increased the overall cost of ER by 80%. Cost-effectiveness value for ER was favorable to OR (56,365 vs 64,903 €/patient) with an incremental cost-effectiveness ratio of 48,409 € per MAE saved. CONCLUSIONS: ER of TAAA reduces perioperative mortality and morbidity compared with OR, with no differences in reinterventions and survival rates at midterm follow-up. Despite the expenses for endovascular grafts, ER was found to be more cost-effective in preventing MAEs.

Transition to retirement impact on smoking habit: results from a longitudinal analysis within the Survey of Health, Ageing and Retirement in Europe (SHARE) project.

BACKGROUND: In an ageing society, retirement impacts on behavioural risk factors and health outcomes should be carefully assessed. Scant evidence exists from longitudinal studies on the short- and long-term consequences of the transition to retirement on smoking habit. METHODS: We conducted a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 27 European countries plus Israel collected in 2004-2020. To estimate relative risks (RR) and corresponding 95% confidence intervals (CI) for smoking status and intensity at seven time periods before and after retirement, we fitted adjusted generalised estimating equation (GEE) models for repeated measures. RESULTS: We selected a cohort of 8998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). As compared to the year of retirement, the RR of smoking was 1.59 (95% CI 1.44-1.76) at 10 years or more before retirement, 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking steadily decreased after retirement, being 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46-0.74) 10 years or more after retirement. In smokers, the estimated number of cigarettes smoked/day decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p trend < 0.001). CONCLUSION: Longitudinal data suggest that lifestyles might favourably change with retirement. Further studies are needed to direct healthy ageing promotion policies better.

Electronic Cigarette Use in 12 European Countries: Results From the TackSHS Survey.

BACKGROUND: Limited data on electronic cigarette prevalence, patterns, and settings of use are available from several European countries. METHODS: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ⩾15 years in each country, provided information on electronic cigarette. RESULTS: 2.4% (95% confidence interval [CI], 2.2-2.7%) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (ie, users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden; in particular, at workplaces (34.9%) and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (P for trend <0.001) and higher among individuals with high level of education (P for trend = 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI, 1.80-7.30). CONCLUSION: Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine, and consumed electronic cigarettes in smoke-free indoor areas.

Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic.

OBJECTIVE: Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy. METHODS: 3185 Italian participants aged 18-74 years provided baseline (April-May) and follow-up (November-December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs. RESULTS: Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20). Among ex-smokers, relapse (17.2%) at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37). Among current smokers at baseline, those who had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users). CONCLUSIONS: Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.

Prevention, diagnosis and treatment of cervical cancer: A systematic review of the impact of COVID-19 on patient care.

Worldwide, the COVID-19 pandemic disrupted healthcare services, including cervical cancer management, and an increased burden for this condition is expected. This systematic review synthetizes the available evidence on the impact of the pandemic on prevention, diagnosis and treatment of cervical cancer. Searches were performed on PubMed, Embase, and Scopus for relevant studies on these topics with the purpose of comparing service access and care delivery before and during COVID-19 pandemic. Due to the methodological heterogeneity among the studies, findings were narratively discussed. Of the 715 screened titles and abstracts, 33 articles were included, corresponding to 42 reports that covered the outcomes of interest: vaccination against human papillomavirus (HPV) (6 reports), cancer screening (19), diagnosis (8), and treatment (8). Seven studies observed reductions in HPV vaccination uptake and coverage during COVID-19. Reports on cervical screening and cancer diagnosis activities showed a substantial impact of the pandemic on access to screening services and diagnostic procedures. All but one study that investigated cervical cancer treatment reported changes in the number of women with cervical lesions who received treatments, as well as treatment delay and interruption. With a major impact during the first wave in 2020, COVID-19 and restriction measures resulted in a substantial disruption in cervical cancer prevention and management, with declines in screening and delays in treatment. Taken together, findings from this systematic review calls for urgent policy interventions for recovering cervical cancer prevention and care.

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region.

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Overall, in 2017-2019 there were a mean of 374,855 older adults with  ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run.

Clinical Characteristics and Potential Risk Factors Associated with the SARS-CoV-2 Infection: Survey on a Health Care Workers (HCWs) Population in Northern Italy.

During the two years of the COVID-19 pandemic, more than 400 million cases all over the world have been identified. Health care workers were among the first to deal with this virus and consequently a high incidence of infection was reported in this population. The aim of the survey was to investigate health care workers' (HCWs) clinical characteristics and potential risk factors associated with the SARS-CoV-2 infection in a referral hospital in Northern Italy after the first and second waves of the pandemic. We administered a questionnaire during the flu vaccination campaign that took place at the end of 2020; among 1386 vaccinated HCWs, data was collected and analyzed for 1065 subjects. 182 HCWs (17%) declared that they had tested positive on at least a molecular or a serological test since the beginning of the pandemic. Comparing the infected vs. not infected HCWs, median age, BMI, smoking habit, presence of hypertension or other comorbidities were not significantly different, while having worked in a COVID ward was associated with the infection (ORadj = 1.54, 95% CI: 1.07-2.20). Respondents declared that more than 70% of contacts occurred in the hospital with patients or colleagues, while about 15% in domestic environments. Among the infected, the most reported symptoms were fever (62.1%), asthenia (60.3%), anosmia/ageusia (53.5%), arthralgia/myalgia (48.3%), headache or other neurological symptoms (46.6%), cough (43.1%) and flu-like syndrome (41.4%). The percentage of subjects who have been infected with SARS-CoV-2 seems to be higher in HCWs than in the general population; hence, in hospitals, protective measures and preventive strategies to avoid the spreading of the contagion remain crucial.