Social, health and lifestyle-related determinants of older adults' preferences for place of death in South Tyrol, Italy - a cross-sectional survey study.

BACKGROUND: As the global aging population expands, understanding older adults' preferences for place of death becomes pivotal in ensuring person-centered end-of-life care. OBJECTIVE: This study aimed to investigate the influence of sociodemographic, health, and lifestyle-related factors on end-of-life care preferences of older adults in South Tyrol, Italy. METHODS: Employing a cross-sectional design, a population-based survey was conducted with a stratified probabilistic sample of adults aged ≥ 75 years in South Tyrol (Autonomous Province of Bolzano/Bozen, Italy). From a randomly selected sample of 3,600 older adults, participants were invited to respond to a questionnaire that included items on older adults' preferences for place of death and socio-demographic and health- and lifestyle-related factors, including frailty (e.g., PRISMA-7). Descriptive and multinomial logistic regression analyses were performed. RESULTS: The majority (55.3%) of the 1,695 older adults (participation rate: 47%) expressed a preference for dying at home and 12.7% indicated a desire for specialized end-of-life care in a healthcare facility. However, 27.9% refrained from disclosing their end-of-life care preferences. The factors influencing these preferences concerning the place of death included age, native language, educational level, living situation, and community. Compared to the preference of dying at own home or home of family or friends, older adults aged ≥ 85 years (OR = 0.57, P = 0.002) and living in an urban area (OR = 0.40, P < 0.001) were less likely to prefer dying at a hospital, palliative care unit, or hospice. Older adults living alone (OR = 1.90, P < 0.001), Italian-speaking (OR = 1.46, P = 0.03), and those with an educational level above high school (OR = 1.69, P = 0.002) were more likely to prefer dying at a hospital, palliative care unit, or hospice. CONCLUSIONS: End-of-life care preferences among older adults in South Tyrol were associated with socio-demographic, yet not health- and lifestyle-related factors. Recognizing and integrating these preferences is essential for developing, implementing, and evaluating interventions to promote advance care planning and provide effective, patient-centered end-of-life care.

Albumin in Normovolemic Fluid Management for Severe Traumatic Brain Injury: Controversies and Research Gaps.

Traumatic brain injury (TBI) is a significant public health issue characterized by high mortality rates and long-term complications. This commentary examines the controversial role of the use of albumin in the fluid management of patients with severe TBI. Despite its physiological benefits, the clinical use of albumin remains controversial due to the fact that various studies have yielded mixed results. Serum albumin is important for maintaining normovolemia, primarily through its contribution to colloid osmotic pressure, which helps to retain fluid in the circulatory system. This review highlights the existing evidence, examines inconsistencies in guideline recommendations, and suggests future research directions to clarify the efficacy and safety of the use of albumin in maintaining normovolemia in patients with TBI. The review also discusses the potential benefits of small-volume resuscitation strategies for the management of acute kidney injury in TBI patients, drawing parallels with the management of septic acute kidney injury. The need for further well-designed randomized controlled trials and ethical considerations in studies regarding the use of hyperoncotic albumin in TBI management is emphasized.

Parental Mental Health, Gender, and Lifestyle Effects on Post-Pandemic Child and Adolescent Psychosocial Problems: A Cross-Sectional Survey in Northern Italy.

BACKGROUND: The exacerbation of psychosocial problems among children and adolescents during the coronavirus disease 2019 (COVID-19) pandemic necessitates an assessment of the long-term mental health impact of pandemic interventions. Focusing on both pandemic-related factors and demographic variables, such as gender and daily habits, an analysis was conducted to understand how these elements continue to affect young populations in the post-pandemic era. METHODS: In April 2023, a comprehensive online survey was administered to families in South Tyrol, Italy, with children aged 7-19 years, to ensure age and gender representation. The survey included parent ratings and adolescent (11-19 years) self-reports using standardized instruments to measure the symptoms of mental health problems (Strengths and Difficulties Questionnaire, SDQ), anxiety (Screen for Child Anxiety Related Emotional Disorders, SCARED), and depression (Patient Health Questionnaire-2, PHQ-2). Statistical analyses included descriptive statistics, chi-square tests, and unadjusted odds ratios (ORs). RESULTS: Of the 4525 valid responses, 1831 were self-reported by adolescents. Notable gender differences in mental health outcomes were identified, along with significant demographic predictors, such as age, single parenthood, parental mental health problems, and immigrant background. Negative effects were associated with reduced family climate and increased screen time, whereas physical activity showed beneficial effects. Proxy reports overestimated adolescents' mental health problems, whereas self-reports tended to underestimate them. CONCLUSIONS: Persistent mental health problems and gender disparities highlight the need for a public health approach. This should include accessible support services, resilience building, targeted support for vulnerable families and gender-specific interventions.

Integrating a Strategic Framework to Improve Health Education in Schools in South Tyrol, Italy.

This narrative review addresses the integration of health education into school curricula in South Tyrol, an Italian province with significant cultural and linguistic diversity. This review's objective is to analyze current health education initiatives and propose a strategic framework to enhance school-based health education, aiming to improve student well-being post-pandemic. The review synthesizes global examples and recent local studies, highlighting the importance of comprehensive teacher training, mindfulness-based interventions, culturally sensitive health education, and community engagement. The key findings indicate that current health education programs in South Tyrol are insufficient to meet immediate public health needs, such as low vaccine uptake and mental health challenges exacerbated by the COVID-19 pandemic. The proposed strategic framework seeks to align educational strategies with the diverse needs of South Tyrol's student population, thereby improving health literacy and behavior and strengthening the region's public health infrastructure.

Impact of Digital Media, School Problems, and Lifestyle Factors on Youth Psychosomatic Health: A Cross-Sectional Survey.

BACKGROUND: Post-pandemic psychosomatic complaints in children and adolescents have been underreported. This study investigated psychosomatic complaints in children and adolescents in Northern Italy in 2023, with the aim of identifying changes in predictors and vulnerable subgroups. METHODS: Cross-sectional data representative of scholars from a northern Italian province were analyzed using the Health Behavior in School-aged Children (HBSC) checklist. The sum scores, count data, and dichotomized data were examined, and predictor effects were expressed using a linear regression model for the sum scores. RESULTS: Data from 4525 participants (aged 7-19 years, 50.5% girls) were analyzed. Psychosomatic symptoms remained unchanged after the pandemic. Significant gender differences were noted, especially in older age groups, with girls reporting more complaints. Factors such as children's health, digital media use, and school problems significantly influence psychosomatic outcomes. While migration background negatively affected girls' psychosomatic well-being, boys showed improvement through sports. CONCLUSION: The psychosomatic well-being of children and adolescents did not improve after the pandemic. These findings indicate the need for targeted interventions, improved health literacy, and ongoing monitoring to support the mental well-being of this vulnerable population. Reducing screen time remains a critical strategy for enhancing youth well-being.

Evolving Altruistic Attitudes towards Vaccination Post COVID-19 Pandemic: A Comparative Analysis across Age Groups.

Altruism plays an essential role in promoting vaccine uptake, an issue that came to the fore during the COVID-19 pandemic through discussions of herd immunity and altruistic motivations. In response, the primary objective of this cross-sectional survey was to explore how altruistic attitudes have evolved in the post-pandemic era and to assess their effectiveness in motivating vaccination behavior in different age groups. The study aimed to elucidate changes in altruistic motivations for vaccination and their implications for public health strategies. Using a representative sample of the adult population of South Tyrol, Italy, including 1388 participants, altruism was assessed in 2023 with the scales of the Elderly Care Research Center (ECRC) and the International Personality Item Pool (IPIP) subscale of the version 5F30F-R1. Its association with demographic variables, vaccination attitudes and personal beliefs in two age groups (18-69 years, 70+ years) was analyzed. The results reveal distinct predictors of altruism across these scales and age groups, suggesting a shift in altruistic attitudes towards vaccination when comparing data from a similar survey conducted in 2021 with the 2023 results. Consequently, the use of altruism scales for different age groups is warranted. This study highlights the need for further research in this field. It concludes that while promoting altruistic behavior to increase vaccine uptake appears to be effective primarily among the younger population, emphasizing personal safety is more appropriate for encouraging vaccination among older individuals.

Impact of Relational Coordination on Job Satisfaction and Willingness to Stay: A Cross-Sectional Survey of Healthcare Professionals in South Tyrol, Italy.

Job satisfaction and willingness to stay are critical for workforce stability in a challenging healthcare environment. This study examined how relational coordination, a key factor in teamwork and communication, influences outcomes among healthcare professionals in a bilingual, culturally mixed region of Italy. This cross-sectional survey included general practitioners, hospital physicians, nurses, and administrators from the South Tyrol Health Service, using the 'Relational Coordination Survey' and additional measures of job satisfaction and willingness to stay. The analytical methods used included descriptive statistics, correlations, and regression analyses. This study applied path analysis, including mediation and moderation techniques, to investigate the roles of relational coordination and job satisfaction in influencing the willingness to stay. It employs Conditional Process Analysis with the PROCESS macro in SPSS, focusing on models for moderated mediation analysis. The results indicated a critical influence of relational coordination on both job satisfaction and willingness to stay among the 525 healthcare professionals. Job satisfaction varied by health district and years of service, with midcareer professionals being the least satisfied. The findings highlight the central role of relational coordination in job satisfaction and willingness to stay and confirm that low job satisfaction increases turnover intentions. Relational coordination directly enhanced job satisfaction and willingness to stay, while also serving as a mediating factor that amplifies the impact of job satisfaction on retention intentions. This study reinforces the need for strong teamwork and communication to stabilize the healthcare workforce. Targeted interventions aimed at improving relational coordination could significantly enhance job satisfaction and retention among healthcare professionals, particularly in culturally diverse settings such as South Tyrol.

The Role of Homogeneous Waiting Group Criteria in Patient Referrals: Views of General Practitioners and Specialists in South Tyrol, Italy.

Homogeneous waiting group (HWG) criteria are central to the patient referral process, guiding primary care physicians and hospitalists in directing patient care to specialists. This cross-sectional observational study, conducted in South Tyrol, Italy, in 2023, aimed to assess the implementation and impact of HWG criteria on healthcare from the perspective of general practitioners and hospital physicians. A questionnaire was developed to gain knowledge about referral practices as perceived by general practitioners and specialists. The survey included 313 participants (82 general practitioners and 231 hospital physicians) and was designed to capture a range of factors influencing the application of HWG criteria, including communication and collaboration practices. The results showed moderate levels of familiarity with HWG criteria and opinions about the need for criteria refinement among hospitalists, indicating that further education and refinement of these criteria are warranted. Both general practitioners and hospital physicians expressed dissatisfaction with the current specialist referral system, highlighting the significant gaps in effective communication and collaboration. The survey also demonstrated the influence of patient demands and waiting times on referral practices, and the need for streamlined and accessible specialist care. This study highlights the need for improvement and adaptation of HWG criteria to better meet the needs of healthcare providers and patients in South Tyrol. By addressing the identified gaps in communication, collaboration, and education related to the HWG system, the efficiency, effectiveness, and patient-centeredness of the referral process can be improved, ultimately leading to better health outcomes.

Relational Coordination at the Primary-Secondary Care Interface: Insights from a Cross-Sectional Survey in the South Tyrolean Healthcare System.

Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. This suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

A cluster-randomized study to evaluate the effectiveness and cost-effectiveness of the Assessment of Burden of Chronic Conditions (ABCC) tool in South Tyrolean primary care for patients with COPD, asthma, type 2 diabetes, and heart failure: the ABCC South Tyrol study.

BACKGROUND: Chronic diseases, such as chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, and heart failure, often coexist and contribute to a significant burden on individuals and health systems. The Assessment of Burden of Chronic Conditions (ABCC) tool, already in routine clinical use in the Netherlands, aims to comprehensively assess and visualize disease burden, stimulate self-management, and encourage shared decision-making. This study aims to validate the German and Italian versions of the ABCC tool and evaluate its effectiveness and cost-effectiveness in the South Tyrolean Primary Care setting. METHODS: This is a cluster-randomized study involving approximately 400 patients with COPD, asthma, type 2 diabetes, and heart failure who received care from the South Tyrolean General Practices. Initially, the ABCC tool will be translated into German and Italian and validated. Subsequently, half of the participants will use the validated ABCC tool for patient-reported outcome measurement assessments, while the other half will receive usual care. The primary outcome measure is the change in the patients' perception of the quality of care after 18 months. The secondary outcomes included changes in quality of life, self-management behavior, and healthcare utilization. The missing data will be managed using multiple imputations. Additionally, a cost-effectiveness analysis that considers the direct medical costs reimbursed by the National Health Service will be conducted. DISCUSSION: This study provides insights into the application, validation, and efficacy of the ABCC tool in the South Tyrolean healthcare context. The tool's potential to enhance person-centered care, improve the quality of life, and possibly reduce healthcare costs could greatly contribute to sustainable healthcare. The challenges of implementation, such as software integration and the use of an EU data platform, will provide lessons for future international patient care data management. TRIAL REGISTRATION: ISRCTN registry, ISRCTN13531607. Registered on August 23, 2023.

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria.

BACKGROUND: The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear. METHODS: This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice. RESULTS: The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes. CONCLUSIONS: According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services. TRIAL REGISTRATION: The study has not been registered as it did not include a direct medical intervention on human participants.

Vaccine hesitancy in South Tyrol: a narrative review of insights and strategies for public health improvement.

Introduction: This review examines vaccine hesitancy in South Tyrol, Italy, a region characterized by cultural and linguistic diversity. The critical need for vaccination to control infectious diseases contrasts with the region's low vaccination rates, which pose a significant public health challenge. Methods: Based on literature, reports, and studies, we used PubMed, Embase, and Google Scholar to explore vaccine hesitancy in South Tyrol. It emphasizes the analysis of historical, cultural, and socioeconomic factors, and focuses on quantitative surveys and qualitative interviews to understand the roots of vaccine hesitancy. Results: In two studies with four reports, mistrust in health policies and institutions, misinformation, and cultural and linguistic barriers were identified as key factors contributing to vaccine hesitancy in South Tyrol. These factors are accentuated by the region's unique sociopolitical landscape, which influences public health policies and vaccination initiatives. Conclusions: These findings highlight the need for public health strategies specifically tailored to South Tyrol. Recommended actions include developing culturally sensitive and multilingual communication campaigns, increasing community involvement, and rebuilding trust in healthcare systems. These approaches are essential for addressing the specific challenges in South Tyrol, thereby improving vaccine uptake and overall public health outcomes.

Clinical value of the red blood cell distribution width to albumin ratio in the assessment of prognosis in critically ill patients with sepsis: a retrospective analysis.

Background: Red blood cell (RBC) distribution width (RDW) to albumin ratio is a novel biomarker and its prognostic effect on critically ill patients with sepsis has not been extensively investigated. The objective of this study was to identify the prognostic value of the RDW to albumin ratio in these patients. Methods: Data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. A Cox proportional hazards model and restricted cubic spline model were used to determine the association of RDW to albumin ratio with mortality. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were applied, and the area under the curve (AUC) was used to compare the predictive value. Results: A total of 3,969 eligible patients were enrolled. The median RDW to albumin ratio was significantly higher in non-survivors than in survivors at 30 and 90 days. Patients were divided into groups according to the RDW to albumin ratio, and the risk of 30- and 90-day mortality markedly increased in the group with a higher ratio. The relationship between the RDW to albumin ratio as a continuous variable and 30-day mortality also showed an upward trend in the restricted cubic spline. The AUC of the RDW to albumin ratio was 0.633 in discriminating 30-day mortality which was similar to that of the lactate to albumin ratio (AUC =0.617; P=0.133) and higher than that of the neutrophil percentage to albumin ratio (AUC =0.559; P<0.001). Conclusions: The RDW to albumin ratio is a promising biomarker for assessing the prognosis of critically ill patients with sepsis. Its predictive value in determining mortality was found to be similar to that of the lactate to albumin ratio and superior to that of the neutrophil percentage to albumin ratio.

Vaccine Hesitancy and Public Mistrust during Pandemic Decline: Findings from 2021 and 2023 Cross-Sectional Surveys in Northern Italy.

This study examines vaccine agreements in South Tyrol, Italy, within distinct socio-cultural and linguistic contexts. Using data from the 2021 and 2023 "COVID-19 Snapshot Monitoring" extended surveys, we assessed changes in attitudes towards COVID-19 and other vaccinations during the second and final years of the pandemic. Multivariate logistic regression analysis was used to examine factors such as trust in institutions, language groups, and the use of complementary and alternative medicine. The representativeness of the study is supported by good participation rates, ensuring a comprehensive view of attitudes towards vaccination in the region. The results show a shift in public agreement with the national vaccination plan to 64% by 2023, from a rate of about 73% agreement in 2021 (p < 0.001). A significant decrease in trust in health authorities and a negative correlation with complementary and alternative medicine consultations were observed. The results highlight the complex nature of vaccine hesitancy in diverse regions such as South Tyrol and underline the need for targeted communication strategies and trust-building initiatives to effectively reduce hesitancy. This study provides critical insights for the formulation of public health strategies in diverse sociocultural settings.

Trust in Conventional Healthcare and Utilization of Complementary and Alternative Medicine in South Tyrol, Italy: A Population-Based Cross-Sectional Survey.

Background: This study explored the link between trust in conventional healthcare and consultations with complementary and alternative medicine (CAM) providers in South Tyrol, Italy's linguistically diverse region. Methods: A representative cross-sectional survey of 1,388 South Tyrolean adults assessed trust in conventional healthcare, general practitioners, and complementary and alternative medicine consultation frequencies and their determinants using chi-square tests and Kendall-Tau-b correlations. Results: Seventy percent trusted the traditional healthcare system, with general practitioners as the primary trusted professionals. Trust is correlated with higher education and linguistic compatibility. A 5% subgroup, mostly women and multilinguals with lower education levels, showed uncertain trust. Over 80% had seen a general practitioner in the last year, while distrust was correlated with complementary and alternative medicine consultations. German and Ladin speakers, with higher education levels, were notably inclined towards complementary and alternative medicine consultations. Conclusions: Trust in South Tyrolean healthcare varied according to education level and language. While general practitioners remain central, there is a marked shift towards complementary and alternative medicine among specific groups.

Controversies Surrounding Albumin Use in Sepsis: Lessons from Cirrhosis.

This narrative review critically examines the role of albumin in sepsis management and compares it to its well-established application in liver cirrhosis. Albumin, a key plasma protein, is effective in the management of fluid imbalance, circulatory dysfunction, and inflammation-related complications. However, its role in sepsis is more intricate and characterized by ongoing debate and varied results from clinical studies. In sepsis, the potential benefits of albumin include maintaining vascular integrity and modulating inflammation, yet its consistent clinical efficacy is not as definitive as that in cirrhosis. This review evaluated various clinical trials and evidence, highlighting their limitations and providing practical insights for clinicians. It emphasizes identifying sepsis patient subgroups that are most likely to benefit from albumin therapy, particularly exploring the correction of hypoalbuminemia. This condition, which is significantly corrected in patients with cirrhosis, may have similar therapeutic advantages in sepsis. The potential effectiveness of albumin in the low-volume resuscitation and deresuscitation phases of sepsis management was noted. Given the safety concerns observed in cirrhosis, such as pulmonary edema and hypervolemia associated with albumin therapy, cautious integration of albumin into sepsis treatment is mandatory. Personalized albumin therapy is advocated for tailoring strategies to the specific needs of each patient, based on their clinical presentation and underlying conditions. The need for further research to delineate the role of albumin in sepsis pathophysiology is underscored. The review emphasizes the importance of conducting trials to assess the effectiveness of albumin in correcting hypoalbuminemia in sepsis, its impact on patient outcomes, and the establishment of appropriate dosing and administration methods. This approach to albumin use in sepsis management is posited as a way to potentially improve patient outcomes in this complex clinical scenario while being mindful of the lessons learned from its use in cirrhosis.

Comparative study of children's mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic.

PURPOSE: This study aimed to compare the mental health outcomes of children in North Tyrol, Austria, and South Tyrol, Italy, during the coronavirus disease 2019 (COVID-19) pandemic, considering the sociocultural and contextual differences between the two regions. METHODS: The Tyrolean COVID-19 Children's Study (TCCS: n = 401; June 2021 to July 2021) and the Corona and Psyche in South Tyrol 2021 Study (COP­S; n = 3402; May 2021 to June 2021) were used for data analyses. Both studies employed cross-sectional designs and collected data through online questionnaires completed by children aged 7-13 years and their parents. Various psychosocial assessment tools including the Child and Adolescent Trauma Screening, Children Anxiety Test, Child Behavior Check List, Screen for Child Anxiety Related Emotional Disorders, and Health Behaviour in School-Aged Children were used in the surveys. RESULTS: The comparison between North Tyrol and South Tyrol revealed no significant differences in perceived threats, trauma, or anxiety among children. Similarly, there were no substantial disparities in psychosomatic complaints, indicating similar manifestations of emotional distress across the two regions. CONCLUSION: The comparative analysis of children's mental health outcomes in North Tyrol and South Tyrol during the COVID-19 pandemic confirmed the analogous influence of sociocultural and contextual factors on their wellbeing. Despite presumable variations in pandemic events, management strategies, and healthcare systems, the study suggests comparable resilience among children and highlights the importance of sociocultural factors in shaping their wellbeing. The findings emphasize the need for comprehensive understanding and targeted interventions to support children's mental health during challenging times.

Distinct smell and taste disorder phenotype of post-acute COVID-19 sequelae.

PURPOSE: Olfactory dysfunction (OD) commonly accompanies coronavirus disease 2019 (COVID-19). We investigated the kinetics of OD resolution following SARS-CoV-2 infection (wild-type and alpha variant) and its impact on quality of life, physical and mental health. METHODS: OD prevalence was assessed in an ambulatory COVID-19 survey (n = 906, ≥ 90 days follow-up) and an observational cohort of ambulatory and hospitalized individuals (n = 108, 360 days follow-up). Co-occurrence of OD with other symptoms and effects on quality of life, physical and mental health were analyzed by multi-dimensional scaling, association rule mining and semi-supervised clustering. RESULTS: Both in the ambulatory COVID-19 survey study (72%) and the observational ambulatory and hospitalized cohort (41%) self-reported OD was frequent during acute COVID-19. Recovery from self-reported OD was slow (survey: median 28 days, observational cohort: 90 days). By clustering of the survey data, we identified a predominantly young, female, comorbidity-free group of convalescents with persistent OD and taste disorders (median recovery: 90 days) but low frequency of post-acute fatigue, respiratory or neurocognitive symptoms. This smell and taste disorder cluster was characterized by a high rating of physical performance, mental health, and quality of life as compared with convalescents affected by prolonged fatigue or neurocognitive complaints. CONCLUSION: Our results underline the heterogeneity of post-acute COVID-19 sequelae calling for tailored management strategies. The persistent smell and taste disorder phenotype is characterized by good clinical, physical, and mental recovery and may pose a minor challenge for public health. STUDY REGISTRATION: ClinicalTrials.gov: NCT04661462 (survey study), NCT04416100 (observational cohort).

Redesigning Primary Care: The Emergence of Artificial-Intelligence-Driven Symptom Diagnostic Tools.

Modern healthcare is facing a juxtaposition of increasing patient demands owing to an aging population and a decreasing general practitioner workforce, leading to strained access to primary care. The coronavirus disease 2019 pandemic has emphasized the potential for alternative consultation methods, highlighting opportunities to minimize unnecessary care. This article discusses the role of artificial-intelligence-driven symptom checkers, particularly their efficiency, utility, and challenges in primary care. Based on a study conducted in Italian general practices, insights from both physicians and patients were gathered regarding this emergent technology, highlighting differences in perceived utility, user satisfaction, and potential challenges. While symptom checkers are seen as potential tools for addressing healthcare challenges, concerns regarding their accuracy and the potential for misdiagnosis persist. Patients generally viewed them positively, valuing their ease of use and the empowerment they provide in managing health. However, some general practitioners perceive these tools as challenges to their expertise. This article proposes that artificial-intelligence-based symptom checkers can optimize medical-history taking for the benefit of both general practitioners and patients, with potential enhancements in complex diagnostic tasks rather than routine diagnoses. It underscores the importance of carefully integrating digital innovations while preserving the essential human touch in healthcare. Symptom checkers offer promising solutions; ensuring their accuracy, reliability, and effective integration into primary care requires rigorous research, clinical guidance, and an understanding of varied user perceptions. Collaboration among technologists, clinicians, and patients is paramount for the successful evolution of digital tools in healthcare.