Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy.

PURPOSE: Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention. METHODS: To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories. FINDINGS: We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas. CONCLUSIONS: Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.

Effects of climatic and environmental factors on mosquito population inferred from West Nile virus surveillance in Greece.

Mosquito-borne diseases' impact on human health is among the most prominent of all communicable diseases. With limited pool of tools to contrast these diseases, public health focus remains preventing mosquito-human contacts. Applying a hierarchical spatio-temporal Bayesian model on West Nile virus (WNV) surveillance data from Greece, we aimed to investigate the impact of climatic and environmental factors on Culex mosquitoes' population. Our spatio-temporal analysis confirmed climatic factors as major drivers of WNV-transmitting-Culex mosquitoes population dynamics, with temperature and long periods of moderate-to-warm climate having the strongest positive effect on mosquito abundance. Conversely, rainfall, high humidity, and wind showed a negative impact. The results suggest the presence of statistically significant differences in the effect of regional and seasonal characteristics, highlighting the complex interplay between climatic, geographical and environmental factors in the dynamics of mosquito populations. This study may represent a relevant tool to inform public health policymakers in planning preventive measures.

Demographic characteristics associated with West Nile virus neuroinvasive disease - A retrospective study on the wider European area 2006-2021.

BACKGROUND: With a case-fatality-risk ranging from 3.0 to >20.0% and life-long sequelae, West Nile neuroinvasive disease (WNND) is the most dangerous outcome of West Nile virus (WNV) infection in humans. As no specific prophylaxis nor therapy is available for these infections, focus is on preventive strategies. We aimed to find variables associated with WNND diagnosis, hospitalisation or death, to identify high-risk sub-groups of the population, on whom to concentrate these strategies. METHODS: We used data from The European Surveillance System-TESSy, provided by National Public Health Authorities, and released by the European Centre for Disease Prevention and Control (ECDC). In two Firth-penalised logistic regression models, we considered age, sex, clinical criteria, epidemiological link to other cases (epi-link), calendar year, and season as potential associated variables. In one model we considered also the rural/urban classification of the place of infection (RUC), while in the other the specific reporting country. FINDINGS: Among confirmed West Nile Virus cases, 2,916 WNND cases were registered, of which 2,081 (71.4%), and 383 (13.1%) resulted in the hospitalisation and death of the patient, respectively. Calendar year, RUC/country, age, sex, clinical criteria, and epi-link were associated with WNND diagnosis. Hospitalisation was associated with calendar year and RUC/country; whereas death was associated with age, sex and country. INTERPRETATION: Our results support previous findings on WNND associated variables (most notably age and sex); while by observing the whole population of WNND cases in the considered area and period, they also allow for stronger generalizations, conversely to the majority of previous studies, which used sample populations.

Awareness and use of psychosocial care among cancer patients and their relatives-a comparison of people with and without a migration background in Germany.

PURPOSE: We examined how migration background is associated with awareness and usage of psycho-oncology services. METHODS: Oncologists in community-based practices and outpatient clinics asked their patients and their relatives to complete a questionnaire. Migrants were purposely over-sampled. The questionnaire was provided in Arabic, English, Farsi, French, German, Hindi, Kurdish, Pashto, Russian, Somali, Turkish, Urdu, and Vietnamese. RESULTS: From 9 collaborators, 177 participants were enrolled (130 with and 47 without migration background). The existence of outpatient cancer counselling centres was known to 38% of the participants without and 32% with migration background, self-help groups to 32 vs. 12%, and psychotherapy to 43 vs. 25%. Respondents from the Near and Middle East were less likely to know about psychotherapy (odds ratio (OR) 0.1, p = 0.01); those from the Commonwealth of the Independent States or former Yugoslavia were less often informed about self-help groups (OR 0.1, p = 0.06). Migrants retrieved information less frequently from the internet than non-migrants (10 vs. 25%). At least one service had been used by 27% of migrants and 42% of non-migrants (OR 0.5, p = 0.06). After adjusting for gender, age, education, and patient-relative status, there was no evidence for an association between migration background and service use. CONCLUSIONS: Migrants should be better informed about psychotherapy and self-help groups, in particular the ones coming from the Near or Middle East and the Commonwealth of the Independent States or former Yugoslavia. The under-use of psychosocial services can largely be explained by confounding factors. Therefore, these factors must always be taken into account when analysing the use of psychosocial services in the aforementioned populations.

Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany.

PURPOSE: We compared the perception of office-based haematologists and oncologists regarding the availability of outpatient psycho-social support services (PSSS) for patients with cancer and a migration background, as well as their different experiences with these services. METHODS: Data were collected via an online survey addressing the doctors' socio-demographic characteristics and their perception of-and experience with PSSS. The association between socio-demographic characteristics of the doctors and their experiences with PSSS was tested using Pearson's chi-squared test and Kruskal-Wallis test. RESULTS: A total of 55 doctors were included in this study. More than three doctors in four reported non-sufficient presence of PSSS in foreign languages in their region; one in two reported that the services for patients with migration background should be improved. Most doctors reported missing PSSS in Turkish and Arabic in their region. Doctors with less experience referred patients more often to PSSS hosted in patients' associations (75% vs 25%; p = 0.02), than doctors with more experience. Doctors working in larger cities referred patients less often to PSSS in cancer counselling centres (12% vs 88%; p = 0.01), than doctors working in small or middle-large cities. Male doctors were more satisfied with the network of PSSS' providers, than female doctors (mean score = 2.8 vs 2.2; p = 0.05). CONCLUSIONS: Our results suggest that efforts should be made for a higher regional availability of overall and specific PSSS for non-German speaking patients (especially for Turkish- and Arabic-speaking patients). The experience with PSSS was associated with the doctors' work experience and gender, as well as the location of the practice.

An epidemiological model for mosquito host selection and temperature-dependent transmission of West Nile virus.

We extend a previously developed epidemiological model for West Nile virus (WNV) infection in humans in Greece, employing laboratory-confirmed WNV cases and mosquito-specific characteristics of transmission, such as host selection and temperature-dependent transmission of the virus. Host selection was defined by bird host selection and human host selection, the latter accounting only for the fraction of humans that develop symptoms after the virus is acquired. To model the role of temperature on virus transmission, we considered five temperature intervals (≤ 19.25 °C; > 19.25 and < 21.75 °C; ≥ 21.75 and < 24.25 °C; ≥ 24.25 and < 26.75 °C; and > 26.75 °C). The capacity of the new model to fit human cases and the week of first case occurrence was compared with the original model and showed improved performance. The model was also used to infer further quantities of interest, such as the force of infection for different temperatures as well as mosquito and bird abundances. Our results indicate that the inclusion of mosquito-specific characteristics in epidemiological models of mosquito-borne diseases leads to improved modelling capacity.

Host selection and forage ratio in West Nile virus-transmitting Culex mosquitoes: Challenges and knowledge gaps.

BACKGROUND: To date, no specific therapy or vaccination is available for West Nile virus (WNV) infections in humans; preventive strategies represent the only possibility to control transmission. To focus these strategies, detailed knowledge of the virus dynamics is of paramount importance. However, several aspects of WNV transmission are still unclear, especially regarding the role of potential vertebrate host species. Whereas mosquitoes' intrinsic characteristics cause them to favour certain hosts (host preference), absolute selection is impossible in natural settings. Conversely, the selection carried out among available hosts and influenced from hosts' availability and other ecological/environmental factors is defined as host selection. METHODOLOGY/PRINCIPAL FINDINGS: In July 2022, we searched PubMed database for original articles exploring host selection among WNV-transmitting Culex mosquitoes, the main WNV vector. We considered only original field studies estimating and reporting forage ratio. This index results from the ratio between the proportion of blood meals taken by mosquitoes on potential host species and the hosts' relative abundance. From the originally retrieved 585 articles, 9 matched the inclusion criteria and were included in this review. All but one of the included studies were conducted in the Americas, six in the United States, and one each in Mexico and Colombia. The remaining study was conducted in Italy. American Robin, Northern Cardinal, and House Finch were the most significantly preferred birds in the Americas, Common Blackbird in Italy. CONCLUSIONS/SIGNIFICANCE: Although ornithophilic, all observed WNV-transmitting mosquitoes presented opportunistic feeding behaviour. All the observed species showed potential to act as bridges for zoonotic diseases, feeding also on humans. All the observed mosquitoes presented host selection patterns and did not feed on hosts as expected by chance alone. The articles observe different species of mosquitoes in different environments. In addition, the way the relative host abundance was determined differed. Finally, this review is not systematic. Therefore, the translation of our results to different settings should be conducted cautiously.

Quality of life in lung cancer survivors treated with tyrosine-kinase inhibitors (TKI): results from the multi-centre cross-sectional German study LARIS.

PURPOSE: We aimed at exploring the quality of life (QOL) of lung cancer survivors with proven tyrosine-kinase receptor (RTK) genetic alterations and targeted tyrosine-kinase inhibitors (TKI) therapy, compared to lung cancer survivors with no-RTK alterations and no-TKI therapy. METHODS: Data were collected in a cross-sectional multi-centre study. Primary lung cancer survivors were asked about their socio-demographic and clinical information, QOL, symptom burden, and distress. QOL and symptom burden were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), and distress with the Patient Health Questionnaire-4 (PHQ-4). Demographic and clinical characteristics were reported in absolute and relative frequencies, QOL, and symptom burden using mean scores. Differences in mean scores with relative 95% confidence intervals were used for comparison. RESULTS: Three groups of survivors were defined: group A with proven RTK alterations, TKI therapy at any time during therapy, and stage IV lung cancer at diagnosis (n = 49); group B: non-TKI therapy and stage IV lung cancer (n = 121); group C: non-TKI therapy and stage I-III lung cancer (n = 495). Survivors in group A reported lower QOL (mean score difference = -11.7 vs. group B) and symptom burden for dyspnoea (difference = -11.5 vs. group C), and higher symptom burden for appetite loss (difference = + 11.4 vs. group C), diarrhoea and rash (differences = + 25.6, + 19.6 and + 13.2, + 13.0, respectively, vs. both groups). CONCLUSIONS: Our results suggest that the specific side effects of TKI therapy can impair QOL among lung cancer survivors. Therefore, specific focus towards the optimal management of these side effects should be considered.

Health-related quality of life in patients with COVID-19; international development of a patient-reported outcome measure.

BACKGROUND: We aimed to create a questionnaire to assess the health-related quality of life including functioning, symptoms, and general health status of adult patients with current or previous COVID-19. Here, we report on Phase I and II of the development. METHODS: Internationally recognized methodology for questionnaire development was followed. In Phase I, a comprehensive literature review was performed to identify relevant COVID-19 issues. Decisions for inclusion, exclusion, and data extraction were completed independently in teams of two and then compared. The resulting issues were discussed with health care professionals (HCPs) and current and former COVID-19 patients. The input of HCPs and patients was carefully considered, and the list of issues updated. In Phase II, this updated list was operationalized into items/questions. RESULTS: The literature review yielded 3342 publications, 339 of which were selected for full-text review, and 75 issues were identified. Discussions with 44 HCPs from seven countries and 52 patients from six countries showed that psychological symptoms, worries, and reduced functioning lasted the longest for patients, and there were considerable discrepancies between HCPs and patients concerning the importance of some of the symptoms. The final list included 73 issues, which were operationalized into an 80-item questionnaire. CONCLUSION: The resulting COVID-19 questionnaire covers health-related quality of life issues relevant to COVID-19 patients and is available in several languages. The next steps include testing of the applicability and patients' acceptability of the questionnaire (Phase IIIA) and preliminary psychometric testing (Phase IIIB).

["We knew it was going to be tough, but we didn't expect this!" Experiences with the inclusion of cancer patients with a migrant background and their relatives in the field of psycho-oncology]. / "Wir wussten, dass es schwierig wird, doch damit haben wir nicht gerechnet!" Erfahrungen beim Studieneinschluss von Krebspatient*innen mit Migrationshintergrund und Angehörigen im Bereich der Psychoonkologie.

BACKGROUND: The process of enrolling participants is an important component and often a time-consuming step in scientific research projects. Due to different financial, organisational and ethical framework conditions, the enrolment of participants is often a challenge. In this article, we report our experiences of enrolling patients in clinical trials made in the project "Psycho-oncological care of cancer patients with a migration background - a mixed methods study" (POM). METHODS: Participants were recruited through outpatient haemato-oncology practices. Patients and relatives were primarily made aware of the project by the treating physicians and recruited to participate in qualitative interviews. RESULTS: Nine patients and relatives were interviewed nationwide in individual qualitative interviews. In addition to the COVID-19 pandemic, there were other patient enrolment challenges. In many cases, participation was refused. The reasons included: "not interested", the use of the terms "psycho-oncology" or "person with a migration background", family denying permission to participate, no face-to-face interview due to the COVID-19 pandemic as well as too much emotional distress and deterioration of health after prior consent. DISCUSSION: Enrolling study participants from vulnerable groups for a sensitive topic such as psycho-oncology entails multiple challenges. In order to achieve successful study inclusion, regular telephone and written exchanges with the respective practice staff proved to be helpful, allowing an overview of challenges to be gained and study inclusion to be evaluated and adjusted in a timely manner. CONCLUSION: In research projects with vulnerable groups and on sensitive topics, both a target-group-specific, sensitive approach in plain language (layman's terms) and regular consultations with the persons responsible for study inclusion in care facilities should take place in order to adapt the existing procedure during the study inclusion process, if necessary.

[Psycho-Oncological Care for People with a Migration Background and their Relatives - Results of Semi-Structured Interviews with Physicians]. / Psychoonkologische Versorgung von Menschen mit Migrationshintergrund und ihren Angehörigen ­ Ergebnisse aus leitfadengestützten Einzelinterviews mit Ärztinnen und Ärzten.

BACKGROUND: People with a migration background represent a heterogeneous population group with different ethnic, cultural, and religious views and experiences. Cancer diagnosis and treatment are associated with a variety of psychosocial burdens. OBJECTIVE: The aim of this study was to investigate the current perspective of physicians regarding barriers in psycho-oncological care of people with a migration background and to analyse the assistance they need. In addition, the study also aimed to determine the need for as well as structures and processes of psycho-oncological care in order to develop recommendations for improvements in this area of medical care. METHODS: Eight physicians in private practices from the field of hematological-oncological care across Germany were interviewed individually in qualitative interviews that were digitally recorded and transcribed. The evaluation was carried out using content analysis with the software program MAXQDA 2020. RESULTS: 255 codes were identified in the main categories "Definition of people with a migration background", "Communication", "Cultural differences", "Psycho-oncological care", "Coordination and referral to psycho-oncological care services", and "Optimal psycho-oncological care". The results provided insight into daily and practical issues that arise while caring for this group of people, such as transcultural communication, barriers regarding the identification of needs, psycho-oncological continuing care, or translation by relatives. DISCUSSION: Even the identification of needs during medical treatment is associated with barriers. Screening instruments for people with a migration background in different languages and for different cultures could help the identification. In addition, networks would have to be created in order to provide psycho-oncological care to patients afterwards.

Air pollution and airport apron workers: A neglected occupational setting in epidemiological research.

INTRODUCTION: Airport apron workers are occupationally exposed to jet exhaust and major concern is related to the exposure to ultrafine particles (UFP) from aircrafts. To date, little attention has been given to occupational exposures to aircraft-related UFP, although aircraft engines have high emissions of ultrafine particles, which are orders of magnitude higher than residential exposure. UFP could possibly contribute to the development of cancer, heart disease, mental illness, and respiratory symptoms. In addition to particulate matter, apron workers are exposed to other polluting substances associated with vehicles, aircraft exhaust or direct fuel emissions. METHODS: We performed a scoping review on occupational health hazards due to air pollution among apron workers. RESULTS: Only three epidemiological studies were identified: two cross-sectional studies are of limited relevance due to a small sample size and a lack of quantitative exposure data. One sizeable cohort study performed an individual exposure measurement for UFP and considered relevant confounders. However, current studies are not numerous enough to evaluate an association of occupational air pollution with potential health effects among airport workers. CONCLUSIONS: The results suggest that current scientific evidence on this topic is sparse. Further observational studies in this occupational work force is highly recommended. For a better understanding of adverse health effects due to air pollution and especially UFP, studies in different countries are essential, since working environments, medical monitoring of workers or safety standards might differ internationally.

Epidemiological Measures in the Context of the COVID-19 Pandemic.

BACKGROUND: The various epidemiological indicators used to communicate the impact of COVID-19 have different strengths and limitations. METHODS: We conducted a selective literature review to identify the indicators used and to derive appropriate definitions. We calculated crude and age-adjusted indicators for selected countries. RESULTS: The proportion of deaths (case fatality proportion [CFP]; number of deaths/ total number of cases) is commonly used to estimate the severity of a disease. If the CFP is used for purposes of comparison, the existence of heterogeneity in the detection and registration of cases and deaths has to be taken into account. In the early phase of an epidemic, when case numbers rise rapidly, the CFP suffers from bias. For these reasons, variants have been proposed: the "confirmed CFP" (number of deaths/total number of confirmed cases), and the "delay-adjusted CFP," which considers the delay between infection with the disease and death from the disease. The indicator mortality (number of deaths/total population) has at first sight the advantage of being based on a defined denominator, the total population. During the outbreak of a disease, however, the cumulative deaths rise while the total population remains stable. The phase of the epidemic therefore has to be considered when using this indicator. In this context, R0 and R(t) are important indicators. R0 estimates the maximum rate of spread of a disease in a population, while R(t) describes the dynamics of the epidemic at a given time. Age-adjusted analysis of the CFP shows that the differences between countries decrease but do not dis - appear completely. If the test strategies depend on age or symptom severity, however, the bias cannot be entirely eliminated. CONCLUSION: Various indicators of the impact of the COVID-19 epidemic at population level are used in daily communication. Considering the relevance of the pandemic and the importance of relevant communications, however, the strengths and the limitations of each parameter must be considered carefully.