Clinical and epidemiological characteristics associated with pneumonia at disease onset in patients admitted for COVID-19 to the Emergency Department of a large Hospital in Piedmont (North-Western Italy).

OBJECTIVES: to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN: this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS: the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS: in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS: in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.

Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018.

OBJECTIVES: Workers in the construction industry have been exposed to asbestos in various occupations. In Italy, a National Mesothelioma Registry has been implemented more than 20 years ago. Using cases selected from this registry and exploiting existing control data sets, we estimated relative risks for pleural mesothelioma (PM) among construction workers. DESIGN: Case-control study. SETTING: Cases from the National Mesothelioma Registry (2000-2018), controls from three previous case-control studies. METHODS: We selected male PM incident cases diagnosed in 2000-2018. Population controls were taken from three studies performed in six Italian regions within two periods (2002-2004 and 2012-2016). Age-adjusted and period-adjusted unconditional logistic regression models were fitted to estimate odds ratios (OR) for occupations in the construction industry. We followed two approaches, one (primary) excluding and the other (secondary) including subjects employed in other non-construction blue collar occupations for >5 years. For both approaches, we performed an overall analysis including all cases and, given the incomplete temporal and geographic overlap of cases and controls, three time or/and space restricted sensitivity analyses. RESULTS: The whole data set included 15 592 cases and 2210 controls. With the primary approach (4797 cases and 1085 controls), OR was 3.64 (2181 cases) for subjects ever employed in construction. We found elevated risks for blue-collar occupations (1993 cases, OR 4.52), including bricklayers (988 cases, OR 7.05), general construction workers (320 cases, OR 4.66), plumbers and pipe fitters (305 cases, OR 9.13), painters (104 cases, OR 2.17) and several others. Sensitivity analyses yielded very similar findings. Using the secondary approach, we observed similar patterns, but ORs were remarkably lower. CONCLUSIONS: We found markedly increased PM risks for most occupations in the construction industry. These findings are relevant for compensation of subjects affected with mesothelioma in the construction industry.

[Use of hospital discharge records to estimate the incidence of malignant mesotheliomas]. / Uso delle schede di dimissione ospedaliera per la stima dell'incidenza dei mesoteliomi maligni.

SETTING: cancer registries usually adopt strategies for active case finding. Interest in using administrative sources of data is rising OBJECTIVE: to assess the usefullness of Hospital discharge records (HDR) to supplement the traditional methods of case finding of the malignant mesothelioma (MM) Registry of the Piedmont Region. METHODS: HDRs have been used since 1996. We assessed the number of cases identified only through HDRs and their influence on MM incidence. RESULTS: cases identified through HDRs were about 10% of those with histologic confirmation of the diagnosis, 34% of those with cytologic confirmation, and 72% of those without morphologic examination. Cases diagnosed in hospitals located outside the region would have been easily (50%) missed. The age-standardised (standard: Italian pop. at the 1981 census) incidence rate of pleural MM increases from 2.2 to 2.7 per 100,000 per year among men, and from 1.1 to 1.2 among women, when including all cases identified from HDRs, irrespective of their diagnostic confirmation. Peritoneal MM incidence estimates are unaffected. Overall without access to the hospital discharge files, 179 cases out of 954 would not have been registered between 1996 and 2001. In the same calendar period 59 cases identified by means of active search by the Registry have not been found in the hospital discharge files. CONCLUSIONS: HDRs are useful in addition, but not in substitution, to active search of MM cases.

[Incidence of malignant mesothelioma in Piedmont, 1990-2001]. / Incidenza del mesotelioma maligno in Piemonte, 1990-2001.

SETTING: age-, period-, and cohort-models allowed the prediction ofan increase in mortality from malignant mesotheliomas (MM) in Western Europe, expected to peak between 2015 and 2025 in different Countries, and around 2020 in Italy. Recently, however, a deceleration in the increase has been reported. OBJECTIVE: we updated to 31 december 2001 previous estimates ofMM incidence among residents in the Piedmont region (Italy) and assessed time-trends in incidence. DESIGN: the Registry of Malignant Mesotheliomas actively searches cases in hospital wards and pathology units' records since 1990; since 1996 the database of hospital admissions and discharges is also used. Cases are registered when eligible for inclusion in the National Mesothelioma Registry. RESULTS: the average yearly incidence of pleural MM, computed across four consecutive three-year calendar periods, from 1990-1992 to 1999-2001, increased in both sexes, for histologically confirmed as well as for all cases. No changes were observed in peritoneal MM incidence. CONCLUSIONS: the rise in incidence might be due to increased diagnostic awareness for MM. An analysis by birth-cohort, however, revealed a cohort-effect, therefore it is unlikely that diagnostic bias alone could explain the observed trend. Among men residing at diagnosis in the province of Turin, but not among women nor in both sexes outside Turin province, the increase in incidence has levelled off in the most recent calendar period; for them exposures stopped on average seven years earlier than those of residents in other areas of Piedmont.