Arterial lactate as a risk factor for death in respiratory failure related to coronavirus disease 2019: an observational study.

BACKGROUND: Arterial lactate is a recognized biomarker associated with death in critically ill patients. The prognostic role of arterial lactate in acute respiratory failure due to the novel coronavirus disease 2019 (COVID-19) is unclear. OBJECTIVES: We aimed to investigate the prognostic role of arterial lactate levels at admission in patients with COVID-19-related acute respiratory failure. DESIGN AND METHODS: Cohorts of consecutive patients admitted to nonintensive care units (ICU) at study centers for COVID-19-related respiratory failure were merged into a collaborative database. The prognostic role of lactate levels at admission was assessed for continuous values and values ⩾2.0 mmol/l, and lactate clearance at 24 h through delta-lactate (ΔLac). The study outcome was 30-day in-hospital death. Cox proportional regression model was used to assess independent predictors of the study outcome. RESULTS: At admission, 14.6% of patients had lactate levels ⩾2 mmol/l. In-hospital death at 30 days occurred in 57 out of 206 patients; 22.3% and 56.7% with normal or ⩾ 2 mmol/l lactate at admission, respectively. The median lactate level was 1.0 [interquartile range (IQR) 0.8-1.3] mmol/l and 1.3 (IQR 1.0-2.1) mmol/l in survivors and nonsurvivors, respectively (p-value < 0.001). After adjusting for age, relevant comorbidities, acidemia, and the severity of respiratory failure, lactate ⩾2.0 mmol/l was associated with in-hospital death (HR 2.53, 95% CI 1.29-4.95, p-value 0.0066), while Δ Lac ⩾0 was not (HR 1.37, 95% CI 0.42-4.49). These results were confirmed in patients with a pO2/FiO2-ratio (P/F ratio) ⩽300 mmHg. CONCLUSIONS: In our study, increased arterial lactate at admission was independently associated with in-hospital death at 30 days in non-ICU patients with acute respiratory failure related to COVID-19.

Are Bank Employees Stressed? Job Perception and Positivity in the Banking Sector: An Italian Observational Study.

Background: The epidemiology of stress on bank workers in Europe is only at the introductory stages. This study investigated for the first time the association between occupational stress level in bank-employees using the BEST8, Karasek-Model and socio-demographic and working factors in Italy. Methods: The observational pilot study involved 384 employees. Three questionnaires were adopted to collect data: Karasek-Model, BEST8 (p < 0.001) and Positivity-Scale. Results: 25% of the sample belonged to high stress group. The workers more stressed were older with a commercial role and consumer of antidepressants/sedatives. Women were much more likely to agree with the perception of feeling unsafe in a possible robbery (OR = 2.42; 95% CI: 1.50-3.91) and with that sales requests were in conflict with one's own personal moral code (OR = 2.31; 95% CI: 1.38-3.87). Older employees declared feeling inadequate in the workplace (OR = 1.97; 95% CI: 1.07-3.65) and younger employees referred to be anxious about meeting financial budget goals. Workers who had a low positivity had a lower probability of adaptation (OR = 0.88; 95% CI: 0.83-0.93). Conclusions: The occupational stress level in the banking sector involves many aspects: gender, type of bank, role, personal morals, high job-demands, low level of decision-making. This study recommended that banks should implement strategic interventions for well-being of employees, and consequently for their productivity.

The Multidisciplinary Issue of Obesity: Epidemiological Studies, Company Strategies and Policy Actions: A Systematic and Methodological Review of the Research Approaches.

BACKGROUND: The work is a review of studies carried out in recent years on the epidemic of obesity. The issue of obesity includes several disciplines: medical-health, socio-economic impacts and policy actions. METHODS: This review focuses on the three main areas of study: the first area is about patent epidemiological researches, the second one analyzes the companies that focus on research and development towards less obesogenic foods and the third one investigates on the policies actions adopted by European governments to address the problem of obesity. RESULTS: This study underlined a more strong scientific production relative to US and UK countries compared with the southern countries of the world where the attention of scientists and politicians to the obesity is lower due to the problems of food security rather than to those of inappropriate lifestyle. CONCLUSION: The study of the cause and effects of this phenomenon through epidemiological researches is a good tool to counteract obesity. However, the development of policies controlling and contrasting obesogenic food production is fundamental like greater communication to consumers on the risks of obesity and foods processing.

[Urban air pollution and children respiratory hospital admissions in Pisa (Italy): a time series and a case-crossover approach]. / Inquinamento urbano e ricoveri per cause respiratorie nei bambini a Pisa: confronto tra serie temporali e case-crossover.

OBJECTIVES: we evaluated the association of daily pollutants' concentrations with daily hospital admissions for respiratory causes in children residents in Pisa during 1998-2002. We compared the results obtained with two methods of statistical analyses. A total of 657 children under ten years and admitted to local hospitals for respiratory diseases (ICD 9: 460-469, 480- 519) were included in the study. DESIGN: both time-series and case-crossover analysis were applied, controlling for temperature, holidays, influenza epidemics,rain and relative humidity. Pollutants' effects are expressed as percentage increase (and 95% CI) of hospital admissions for an increase of 10 µg/m³ of pollutants (1 mg/m³ for CO). RESULTS: with both analyses, children's hospital admissions for respiratory conditions were significantly associated to increasing daily levels of PM10 and CO at different time lags, while no association was found for NO2 and O3. In the case-crossover analysis, for a daily increase of 10 µg/m³ in PM10, a significant increment of 8.5% (CI 95% 0.02; 17.6) in children respiratory admissions was observed at lag 0-3. Results were stronger for males and during the warm season. A 1 mg/m³ increment in daily CO levels was associated with an increase of respiratory admissions at lag 0 (20.2%, CI 95% 5.3; 37.2) and at all cumulative lags: the maximum value was observed at lag 0-3 (32.6%, CI 95%8.3; 62.2). Time series analyses provides similar results, although the estimates were lower than with the other method, in terms of percentage increment and length of confidence intervals. CONCLUSIONS: this study indicates adverse effects of air pollution on respiratory health of children living in urban environment. The results of both analyses were consistent.

[Road accidents in piedmont (Italy): factors affecting mortality among drivers]. / Incidenti stradali in piemonte: i fattori che influenzano la mortalità tra i conducenti.

OBJECTIVES: Italy is one of the industrialized countries with the highest mortality from road accidents. The mortality index of road accidents in Piemonte is one of the highest in Italy. This study assesses the main factors affecting the mortality among drivers. DESIGN: Police reports of 95,944 road traffic accidents occurred between 1999 and 2004 in Piemonte, involving 178,230 drivers, were analysed. Multivariate logistic regression models were used to estimate the association of drivers' and accidents' characteristics with mortality among drivers. Analyses were stratified for car, truck and two-wheel vehicle drivers. RESULTS: Mortality is affected by age and gender. In addition, the main risk factors are night-time, extra-urban roads, mountain areas and two wheel vehicles. The drivers license penalty point regulation law introduced in Italy on July 2003 seems to have had a protective effect on mortality during the early months of application. CONCLUSIONS: Official data are useful for estimating potential determinants of road injuries' outcome. Factors affecting the occurrence of accidents are not necessarily predictors of outcome severity. An effective prevention policy of frequency of accidents, mortality and disability should be based on drivers'safety education, structural interventions, targeted road controls and law enforcement.