Dedalo Vola project: The effect of choral singing on physiological and psychosocial measures. An Italian pilot study.

Several studies have been conducted that show the crucial role of active participation in music in health promotion (e.g. Dingle et al., 2021; Sheppard & Broughton, 2020); however, little research has focused on the biopsychosocial effects of choral singing. The present study aims to evaluate the effectiveness, in terms of improving physiological and psychosocial factors, of a choral program for middle-aged and older individuals. We integrated our study with qualitative observations of the atmosphere and flow state experienced by the choristers. The data were collected before and after 12 weeks of training, with 23 participants took part in the study. They experienced significant improvements in weight, oxygen saturation, heart rate, and satisfaction of psychological needs. A beneficial trend, although not statistically significant, were observed for blood pressure, cholesterol, triglycerides, stress, psychological needs, and mental health. The observations progressively revealed a more cohesive and focused group. Our findings support the potential for cross-disciplinary collaboration between healthcare and arts policy to promote and enhance health and well-being throughout the lifespan.

The role of music in promoting health and wellbeing: a systematic review and meta-analysis.

BACKGROUND: The higher disease burden and related costs due to an increasing aging population have placed tremendous pressure on the healthcare systems worldwide. Given that music, both listened and actively performed, promotes and maintains good health and wellbeing among the population, we sought to perform a systematic review that would assess its biopsychosocial effects on a population over 40 years of age. METHODS: A comprehensive search of peer-reviewed articles up to April 2021 was conducted on six electronic databases (i.e. Cochrane, MEDLINE, PubMed, PsycINFO, Web of Science and Scopus). Our study population only included healthy adults of 40 years and older. A total of 11 randomized controlled trials (RCTs) matched the inclusion criteria and were therefore analyzed. RESULTS: Despite the heterogeneity of the methodologies used in the selected studies, our findings suggest that active musical participation can lead to beneficial effects on both cognitive and psychosocial functioning, whereas the positive impact of listening to music seems to be predominantly restricted to the cognitive domain. CONCLUSIONS: Although our results are consistent with both active and passive music activities favouring health and wellbeing in individuals 40 years old and over, future prospective RCTs, employing more uniformed and sensitive measurements, should allow us to better gauge the role of music participation in healthy aging and longevity, especially in countries with a high population density of elderly people.

Estimate of the prevalence of subjects with chronic diseases in a province of Northern Italy: a retrospective study based on administrative databases.

OBJECTIVE: To find a definition of chronic disease based on literature review and to estimate the population-based prevalence rate of chronicity in a province in Northern Italy. DESIGN: Retrospective observational study based on administrative databases. DATA SOURCES/SETTING: Archives of the National Health Service that contain demographic and administrative information linked with the archives of ticket exemptions (2000-2019), the hospital discharge and drug prescriptions (2016-2019). PARTICIPANTS: Subjects who lived in Vercelli Local Health Authority, a Northern Italian province (Piedmont region), and were alive in December 2019. MAIN OUTCOME MEASURES: Prevalence of subjects with at least one chronic disease identified by administrative sources and stratification of population according to the number of comorbidities. The pathologies considered were: chronic ischaemic heart disease, congestive heart failure, cardiac arrhythmias, hypertension, stroke, neoplasm, asthma, chronic obstructive pulmonary disease, diabetes, thyroid disorders, osteoporosis, rheumatoid arthritis, chronic kidney disease, dementia, autism spectrum disorder, depression, schizophrenia, hepatitis, HIV and substance use disorders. RESULTS: Our target population was about 164 344 subjects. The overall prevalence of subjects with at least one chronic condition was 21.43% (n=35 212): 19 541 were female and 15 671 were male with a raw prevalence of 22.96% and 19.77%, respectively. The overall prevalence increases with age until 85 years old, then a decrease is observed. Moreover, 16.39% had only one pathology, 4.30% two diseases and 0.74% had a more complex clinical condition (more than three diseases). CONCLUSIONS: Despite the difficulty of having a unique definition of chronic disease, the prevalence obtained was coherent with the estimates reported by other national surveillance systems such as Passi and Passi d'Argento. Underestimates were observed when international comparisons were done; however, when we used less stringent definitions of chronic diseases, similar results were obtained.

A Quantitative Benefit-Risk Analysis of ChAdOx1 nCoV-19 Vaccine among People under 60 in Italy.

The Oxford-AstraZeneca ChAdOx1 nCoV-19 is a vaccine against the COVID-19 infection that was granted a conditional marketing authorization by the European Commission in January 2021. However, following a report from the Pharmacovigilance Risk Assessment Committee (PRAC) of European Medicines Agency, which reported an association with thrombo-embolic events (TEE), in particular disseminated intravascular coagulation (DIC) and cerebral venous sinus thrombosis (CVST), many European countries either limited it to individuals older than 55-60 years or suspended its use. We used publicly available data to carry out a quantitative benefit-risk analysis of the vaccine among people under 60 in Italy. Specifically, we used data from PRAC, Eudravigilance and ECDC to estimate the excess number of deaths for TEE, DIC and CVST expected in vaccine users, stratified by age groups. We then used data from the National Institute of Health to calculate age-specific COVID-19 mortality rates in Italy. Preventable deaths were calculated assuming a 72% vaccine efficacy over an eight-month period. Finally, the benefit-risk ratio of ChAdOx1 nCoV-19 vaccination was calculated as the ratio of preventable COVID-19 deaths to vaccine-related deaths, using Monte-Carlo simulations. We found that among subjects aged 20-29 years the benefit-risk (B-R) ratio was not clearly favorable (0.70; 95% Uncertainty Interval (UI): 0.27-2.11). However, in the other age groups the benefits of vaccination largely exceeded the risks (for age 30-49, B-R ratio: 22.9: 95%UI: 10.1-186.4). For age 50-59, B-R ratio: 1577.1: 95%UI: 1176.9-2121.5). Although many countries have limited the use of the ChAdOx1 nCoV-19 vaccine, the benefits of using this vaccine clearly outweigh the risks in people older than 30 years. Study limitations included risk of underreporting and that we did not provide age-specific estimates. The use of this vaccine should be a strategic and fundamental part of the immunization campaign considering its safety and efficacy in preventing COVID-19 and its complications.

Role of time-normalized laboratory findings in predicting COVID-19 outcome.

Objectives The pandemic COVID-19 currently reached 213 countries worldwide with nearly 9 million infected people and more than 460,000 deaths. Although several Chinese studies, describing the laboratory findings characteristics of this illness have been reported, European data are still scarce. Furthermore, previous studies often analyzed the averaged laboratory findings collected during the entire hospitalization period, whereas monitoring their time-dependent variations should give more reliable prognostic information. Methods We analyzed the time-dependent variations of 14 laboratory parameters in two groups of COVID-19 patients with, respectively, a positive (40 patients) or a poor (42 patients) outcome, admitted to the San Raffaele Hospital (Milan, Italy). We focused mainly on laboratory parameters that are routinely tested, thus, prognostic information would be readily available even in low-resource settings. Results Statistically significant differences between the two groups were observed for most of the laboratory findings analyzed. We showed that some parameters can be considered as early prognostic indicators whereas others exhibit statistically significant differences only at a later stage of the disease. Among them, earliest indicators were: platelets, lymphocytes, lactate dehydrogenase, creatinine, alanine aminotransferase, C-reactive protein, white blood cells and neutrophils. Conclusions This longitudinal study represents, to the best of our knowledge, the first study describing the laboratory characteristics of Italian COVID-19 patients on a normalized time-scale. The time-dependent prognostic value of the laboratory parameters analyzed in this study can be used by clinicians for the effective treatment of the patients and for the proper management of intensive care beds, which becomes a critical issue during the pandemic peaks.

Development, evaluation, and validation of machine learning models for COVID-19 detection based on routine blood tests.

Objectives: The rRT-PCR test, the current gold standard for the detection of coronavirus disease (COVID-19), presents with known shortcomings, such as long turnaround time, potential shortage of reagents, false-negative rates around 15-20%, and expensive equipment. The hematochemical values of routine blood exams could represent a faster and less expensive alternative. Methods: Three different training data set of hematochemical values from 1,624 patients (52% COVID-19 positive), admitted at San Raphael Hospital (OSR) from February to May 2020, were used for developing machine learning (ML) models: the complete OSR dataset (72 features: complete blood count (CBC), biochemical, coagulation, hemogasanalysis and CO-Oxymetry values, age, sex and specific symptoms at triage) and two sub-datasets (COVID-specific and CBC dataset, 32 and 21 features respectively). 58 cases (50% COVID-19 positive) from another hospital, and 54 negative patients collected in 2018 at OSR, were used for internal-external and external validation. Results: We developed five ML models: for the complete OSR dataset, the area under the receiver operating characteristic curve (AUC) for the algorithms ranged from 0.83 to 0.90; for the COVID-specific dataset from 0.83 to 0.87; and for the CBC dataset from 0.74 to 0.86. The validations also achieved good results: respectively, AUC from 0.75 to 0.78; and specificity from 0.92 to 0.96. Conclusions: ML can be applied to blood tests as both an adjunct and alternative method to rRT-PCR for the fast and cost-effective identification of COVID-19-positive patients. This is especially useful in developing countries, or in countries facing an increase in contagions.

Routine blood analysis greatly reduces the false-negative rate of RT-PCR testing for Covid-19.

BACKGROUND: The COVID-19 outbreak is now a pandemic disease reaching as much as 210 countries worldwide with more than 2.5 million infected people and nearly 200.000 deaths. Amplification of viral RNA by RT-PCR represents the gold standard for confirmation of infection, yet it showed false-negative rates as large as 15-20% which may jeopardize the effect of the restrictive measures taken by governments. We previously showed that several hematological parameters were significantly different between COVID-19 positive and negative patients. Among them aspartate aminotransferase and lactate dehydrogenase had predictive values as large as 90%. Thus a combination of RT-PCR and blood tests could reduce the false-negative rate of the genetic test. METHODS: We retrospectively analyzed 24 patients showing multiple and inconsistent RT-PCR, test during their first hospitalization period, and compared the genetic tests results with their AST and LDH levels. RESULTS: We showed that when considering the hematological parameters, the RT-PCR false-negative rates were reduced by almost 4-fold. CONCLUSIONS: The study represents a preliminary work aiming at the development of strategies that, by combining RT-PCR tests with routine blood tests, will lower or even abolish the rate of RT-PCR false-negative results and thus will identify, with high accuracy, patients infected by COVID-19.

Evidence of significant difference in key COVID-19 biomarkers during the Italian lockdown strategy. A retrospective study on patients admitted to a hospital emergency department in Northern Italy.

BACKGROUND: The Lombardy region, Italy, has been severely affected by COVID-19. During the epidemic peak, in March 2020, patients needing intensive care unit treatments were approximately 10% of those infected. This fraction decreased to approximately 2% in the second part of April, and to 0.4% at the beginning of July. COVID-19 is characterized by several biochemical abnormalities whose discrepancy from normal values was associated to the severity of the disease. The aim of this retrospective study was to compare the biochemical patterns of patients during and after the pandemic peak in order to verify whether later patients were experiencing a milder COVID-19 course, as anecdotally observed by several clinicians of the same Hospital. MATERIAL AND METHODS: The laboratory findings of two equivalent groups of 84 patients each, admitted at the emergency department of the San Raffaele Hospital (Milan, Italy), during March and April respectively, were analyzed and compared.  Results. White blood cell, platelets, lymphocytes and lactate dehydrogenase showed a statistically significant improvement (i.e. closer or within the normal clinical range) in the April group compared to March. Creatinine, C-reactive protein, Calcium and liver enzymes, were also pointing in that direction, although the differences were not significant. DISCUSSION: The laboratory findings analyzed in this study were consistent with a milder COVID-19 course in the April group. After excluding several hypotheses, we concluded that our observation was likely the consequence of the lockdown strategy enforcement, which, by imposing social distancing and the use of respiratory protective devices, reduced viral loads upon infection.