COVID-19 mortality risk assessment: An international multi-center study.

Timely identification of COVID-19 patients at high risk of mortality can significantly improve patient management and resource allocation within hospitals. This study seeks to develop and validate a data-driven personalized mortality risk calculator for hospitalized COVID-19 patients. De-identified data was obtained for 3,927 COVID-19 positive patients from six independent centers, comprising 33 different hospitals. Demographic, clinical, and laboratory variables were collected at hospital admission. The COVID-19 Mortality Risk (CMR) tool was developed using the XGBoost algorithm to predict mortality. Its discrimination performance was subsequently evaluated on three validation cohorts. The derivation cohort of 3,062 patients has an observed mortality rate of 26.84%. Increased age, decreased oxygen saturation (≤ 93%), elevated levels of C-reactive protein (≥ 130 mg/L), blood urea nitrogen (≥ 18 mg/dL), and blood creatinine (≥ 1.2 mg/dL) were identified as primary risk factors, validating clinical findings. The model obtains out-of-sample AUCs of 0.90 (95% CI, 0.87-0.94) on the derivation cohort. In the validation cohorts, the model obtains AUCs of 0.92 (95% CI, 0.88-0.95) on Seville patients, 0.87 (95% CI, 0.84-0.91) on Hellenic COVID-19 Study Group patients, and 0.81 (95% CI, 0.76-0.85) on Hartford Hospital patients. The CMR tool is available as an online application at covidanalytics.io/mortality_calculator and is currently in clinical use. The CMR model leverages machine learning to generate accurate mortality predictions using commonly available clinical features. This is the first risk score trained and validated on a cohort of COVID-19 patients from Europe and the United States.

Back and neck pain disability and upper limb symptoms of home healthcare workers: A case-control study from Northern Italy.

OBJECTIVES: Work-related musculoskeletal disorders (MSD) are quite frequent in healthcare workers (HCWs), but data about MSD in home-based healthcare workers (HHWs) are lacking. In this study we describe the prevalence of MSD among Italian HHWs. MATERIAL AND METHODS: A case-control study was carried out among 300 random-selected female HCWs, the sample comprising 100 HHWs, 100 HCWs with a low exposure to patient handling (MAPO - Movimentazione e Assistenza Pazienti Ospedalizzati - Movement and Assistance of Hospital Patients index 0-5) and 100 HCWs with high exposure to patient handling (MAPO index ≥ 5.01). As a negative control group, 200 visual display unit workers were also randomly selected. Musculoskeletal disorder cases were collected using a standardized case definition. A multivariate logistic regression analysis was performed comparing the MSD prevalence in the 4 groups. RESULTS: The overall prevalence of MSD was 17% in the reference group and 28.3% for HCWs. HHWs and HCWs with MAPO index ≥ 5.01 had similar prevalence of neck pain (9% and 11%, respectively), whereas lumbosacral pain prevalence was higher in the HHWs group (31%), with similar results in residential HCWs groups (21% in MAPO index 0-5 group and 25% in MAPO index ≥ 5.01 group). HCWs of group MAPO index ≥ 5.01 and HHWs showed the higher prevalence of upper limb complaints, with a prevalence of 20% and 10%, respectively. In multivariate regression analysis, prevalence of MSD complaints was quite similar in HHWs (adjusted odds ratio (ORadj) = 2.335, 95% confidence interval (CI): 1.318-4.138) and in HCWs of the group MAPO ≥ 5.01 (ORadj = 2.729, 95% CI: 1.552-4.797). CONCLUSIONS: The prevalence of MSD in the examined HCWs was relatively high, with HHWs appearing as a particularly high-risk group for lumbosacral back pain. In higher exposed HCWs, upper-limb symptoms were particularly frequent, probably reflecting the different tasks required to manage residential and homebased patients. In conclusion, this study reaffirms the high prevalence of MSD in HHWs, seemly similar to high-risk residential groups. Int J Occup Med Environ Health 2017;30(2):291-304.

[Re-organization of health services in Italy and the role of medical directors of hospitals and local health units]. / Il Direttore sanitario aziendale e il processo di riorganizzazione dei servizi ospedalieri e territoriali.

Health authorities, medical directors and managers are called to face increasing and inter-related challenges regarding the ongoing financial crisis, aging of the population and the need to acquire innovative medical technologies. These challenges need to be tackled in order to ensure sustainability of the healthcare systems and appropriateness and quality of healthcare services. In Italy, the role of medical directors has progressively evolved over the years and now requires strengthened managerial skills and additional professional expertise and skills to plan, implement and evaluate the new systems of government. We performed an extensive literature review and a qualitative study involving six semi-structured interviews with key actors (health managers) in order to explore and clarify the possible future role of medical directors in Italy and what training should be provided to residents in Hygiene and Preventive Medicine.

Assessing the impact of defining a global priority research agenda to address HIV-associated tuberculosis.

OBJECTIVES: In 2010, the WHO issued 77 priority research questions (PRQs) to address HIV-associated TB. Objective of the this study was to assess the impact of defining the research agenda in stimulating and directing research around priority research questions. METHODS: We used number and type of scientific publications as a proxy to quantitatively assess the impact of research agenda setting. We conducted 77 single systematic reviews - one for every PRQ - building 77 different search strategies using PRQs' keywords. Multivariate logistic regression models were applied to assess the quantity and quality of research produced over time and accounting for selected covariates. RESULTS: In 2009-2015, PRQs were addressed by 1631 publications (median: 11 studies published per PRQ, range 1-96). The most published area was 'Intensified TB case finding' (median: 23 studies/PRQ, range: 2-74). The majority (62.1%, n = 1013) were published as original studies, and more than half (58%, n = 585) were conducted in the African region. Original studies' publication increased over the study period (P trend = <0.001). They focused more on the 'Intensified TB case finding' (OR = 2.17, 95% CI: 1.56-2.93) and 'Drug-resistant TB and HIV infection' (OR = 2.12, 95% CI: 1.47-3.06) areas than non-original studies. Original studies were published in journals of lower impact factor and received a smaller number of citations than non-original studies (OR = 0.54, 95% CI: 0.42-0.69). CONCLUSION: The generation of evidence to address PRQs has increased over time particularly in selected fields. Setting a priority research agenda for HIV-associated TB might have positively influenced the direction and the conduct of research and contributed to the global response to such a major threat to health.

[Human Papillomavirus infection and vaccination: knowledge and attitudes of Italian general practitioners]. / Infezione da Papillomavirus umano e vaccinazione: conoscenze e ruolo dei medici di medicina generale.

OBJECTIVE: To assess General Pratictioner's (GPs) knowledge and attitudes about HPV infection and prevention. DESIGN AND PARTICIPANTS: A semi-structured survey was conducted from November to December 2013 among Italian GPs. Descriptive and univariate analyses were carried out. MAIN OUTCOME MEASURES AND RESULTS: 938 GPs were included in the study. 15% participated in continuing medical education courses focusing on HPV. GPs identified as HPV transmission routes: sexual (100%), cutaneous (15%), transplacental (13%), haematic (9%) and by air (2%); they considered HPV-related diseases: cervical (98%), vulvar and vaginal (42%), anal (39%), penile (38%) and oral (38%) cancer, genital warts (79%) and respiratory papillomatosis (12%). They knew HPV vaccination is to prevent HPV-associated cancer (60%), in particular cervical cancer (35%), genital warts (3%) and sexually transmitted diseases (2%). A total of 73% were aware of the existence of both available vaccines, 69% believed that immunization target population should be females before initiation of sexual activity, 87% knew the age of vaccine administration. No significant difference in knowledge was retrieved by age, gender, level of education or region of origin. CONCLUSION: We report a lack of knowledge on HPV infection and vaccination in GPs. GPs have a key role in the Italian health system. Although 12-year old patients are a small percentage of their patients, it is of fundamental importance to promote medical education and training among GPs in order to meet HPV coverage targets and control HPV-associated diseases.