An evaluation of the impact of mitigation policies on health and the economy by managing social distancing during outbreaks.

The COVID-19 pandemic has necessitated various unavoidable social restrictions, leading to questions about the effectiveness of public emergency interventions and their impact economic growth. Block et al. (2020) conducted a notably study using an agent-based model to evaluate policies for reducing contact and demonstrated how choices in contact behavior can influence the rate and spread of the virus. However, their approach did not consider the economic consequences of these social restrictions. In response, we propose a set of strategies for governments to plan and evaluate policies during emergencies, aiming to contain infections while minimizing negative economic consequences. Our results indicate that there is no trade-off between containment strategies and economic output loss, making containment measures necessary policy instruments. However, potential trade-offs do emerge when selecting the most effective strategy. In this context, we propose and evaluate various policy alternatives to extreme "social distancing" measures, which can partially restore essential social interactions while preventing economic disasters induced by productivity losses.

Lifespan variation among people with a given disease or condition.

In addition to fundamental mortality metrics such as mortality rates and mortality rate ratios, life expectancy is also commonly used to investigate excess mortality among a group of individuals diagnosed with specific diseases or conditions. However, as an average measure, life expectancy ignores the heterogeneity in lifespan. Interestingly, the variation in lifespan-a measure commonly used in the field of demography-has not been estimated for people with a specific condition. Based on recent advances in methodology in research within epidemiology and demography, we discuss two metrics, namely, the average life disparity and average lifetable entropy after diagnosis, which estimate the variation in lifespan for time-varying conditions in both absolute and relative aspects. These metrics are further decomposed into early and late components, separated by their threshold ages. We use mortality data for women with mental disorders from Danish registers to design a population-based study and measure such metrics. Compared with women from the general population, women with a mental disorder had a shorter average remaining life expectancy after diagnosis (37.6 years vs. 44.9 years). In addition, women with mental disorders also experienced a larger average lifespan variation, illustrated by larger average life disparity (9.5 years vs 9.1 years) and larger average lifetable entropy (0.33 vs 0.27). More specifically, we found that women with a mental disorder had a larger early average life disparity but a smaller late average life disparity. Unlike the average life disparity, both early and late average lifetable entropy were higher for women with mental disorders compared to the general population. In conclusion, the metric proposed in our study complements the current research focusing merely on life expectancy and further provides a new perspective into the assessment of people's health associated with time-varying conditions.

Multi-country clustering-based forecasting of healthy life expectancy.

Healthy life expectancy (HLE) is an indicator that measures the number of years individuals at a given age are expected to live free of disease or disability. HLE forecasting is essential for planning the provision of health care to elderly populations and appropriately pricing Long Term Care insurance products. In this paper, we propose a methodology that simultaneously forecasts HLE for groups of countries and allows for investigating similarities in their HLE patterns. We firstly apply a functional data clustering to the multivariate time series of HLE at birth of different countries for the years 1990-2019 provided by the Global Burden of Disease Study. Three clusters are identified for both genders. Then, we carry out the HLE simultaneous forecasting of the populations within each cluster by a multivariate random walk with drift. Numerical results and the statistical significance of the parameters of the identified multivariate processes are shown. Demographic evidences on the different evolution of HLE between countries are commented.

Evaluation of age-specific causes of death in the context of the Italian longevity transition.

In many low-mortality countries, life expectancy at birth increased steadily over the last century. In particular, both Italian females and males benefited from faster improvements in mortality compared to other high-income countries, especially from the 1960s, leading to an exceptional increase in life expectancy. However, Italy has not become the leader in longevity. Here, we investigate life expectancy trends in Italy during the period 1960-2015 for both sexes. Additionally, we contribute to the existing literature by complementing life expectancy with an indicator of dispersion in ages at death, also known as lifespan inequality. Lifespan inequality underlies heterogeneity over age in populating health improvements and is a marker of uncertainty in the timing of death. We further quantify the contributions of different age groups and causes of death to recent trends in life expectancy and lifespan inequality. Our findings highlight the contributions of cardiovascular diseases and neoplasms to the recent increase in life expectancy but not necessarily to the decrease in lifespan inequality. Our results also uncover a more recent challenge across Italy: worsening mortality from infectious diseases and mortality at older age.

The relay for human longevity: country-specific contributions to the increase of the best-practice life expectancy.

This study investigates the long-term dynamics of longevity by taking into account the specific contribution of each country, and how this has changed over time, thus highlighting different timing and speeds of the evolution of life expectancy among the low-lowest mortality countries. Leveraging on quantile regression, we analyze the specific position of countries that have recorded the maximum (BPLE) and second-best life expectancy value at least once in the period 1960-2014, both at ages 0 and 65. Moving in this direction, the purpose of our contribution is to provide new perspectives on the untracked behavior that may be overshadowed by the maximum longevity levels. Our results provide a comprehensive picture of the different phases and transitions experienced by developed countries in the evolution of life expectancy that has led to a continuous increase in the BPLE. This study is a prominent practice in detecting untracked behaviors, providing imminent onsets on the maximum and sub-maximum values, thus contributing to new clues for future longevity.

Causes-of-Death Specific Estimates from Synthetic Health Measure: A Methodological Framework.

Life expectancy at birth has attracted interest in various fields, as a health indicator that measures the quality of life. Its appeal relies on the ability to enclose and summarize all the factors affecting longevity. However, more granular information, provided by social indicators such as cause-of-death mortality rates, plays a crucial role in defining appropriate policies for governments to achieve well-being and sustainability goals. Unfortunately, their availability is not always guaranteed. Exploiting the relationship between life expectancy at birth and cause-of-death mortality rates, in this paper we propose an indirect model to produce estimates of death rates due to specific causes using the summary indicator of life expectancy at birth, thus the general levels of the observed mortality. By leveraging on a constrained optimization procedure, we ensure a robust framework where the cause-specific mortality rates are coherent to the aggregate mortality. The main advantage is that indirect estimations allow us to overcome the data availability problem: very often the cause-specific mortality data are incomplete, whereas data on the aggregate mortality are not. Using data from the Human Cause-of-Death Database, we show a numerical application of our model to two different countries, Russia and Spain, which have experienced a different evolution of life expectancy and different leading causes of death. In Spain, we detected the impact of several public health policies on the lowered levels of cancer deaths and related life expectancy increases. As regards the Russia, our results catch the effects of the anti-alcohol campaign of 1985-1988 on longevity changes.

Covid-19 pandemic: the impact of Italian lockdown on maxillofacial trauma incidence in southern Tuscany.

The outbreak of the Covid-19 pandemic has seriously affected our society. Governments have difficult situations by adopting strict and severe mitigation measures in order to contain the pandemic spreading. These decisions influenced significatively people's behavior changing their habits and routines. This study offers a statistical analysis of the incidence of the Maxillo-Facial traumas in Tuscany southern area, during the pandemic lockdown. The statistical analyzed has been obtained comparing the maxillo-facial trauma occurrence during the Italian lockdown between the 9th of March and the 18th of May 2020 in comparison with same period of the five previous years. KEY WORDS: Covid-19, Italian covid-19, Maxillofacial surgery, Maxillofacial trauma, Pandemic, Surgery management, Trauma incidence in Italy.

Comparison of indocyanine green fluorescence lymphangiography and magnetic resonance lymphangiography to investigate lymphedema of the extremities.

PURPOSE: The aim of this study is to compare two dynamic imaging modalities employed to study peripheral lymphatic system, Magnetic Resonance Lymphangiography (MRL) and Indocyanine Green Lymphangiography (ICGL), evaluating their role for planning lymphaticovenular anastomosis (LVA) or other surgical-nonsurgical treatments in patients with lymphedema of the extremities. MATERIALS AND METHODS: We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied. RESULTS: All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p < 0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen. CONCLUSIONS: Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system. KEY WORDS: Indocyanine green, MR lymphangiography.

Gastric Cancer Maximum Tumour Diameter Reduction Rate at CT Examination as a Radiological Index for Predicting Histopathological Regression after Neoadjuvant Treatment: A Multicentre GIRCG Study.

AIM: To investigate the role of maximum tumour diameter (D-max) reduction rate at CT examination in predicting histopathological tumour regression grade (TRG according to the Becker grade), after neoadjuvant chemotherapy (NAC), in patients with resectable advanced gastric cancer (AGC). MATERIALS AND METHODS: Eighty-six patients (53 M, mean age 62.1 years) with resectable AGC (≥T3 or N+), treated with NAC and radical surgery, were enrolled from 5 centres of the Italian Research Group for Gastric Cancer (GIRCG). Staging and restaging CT and histological results were retrospectively reviewed. CT examinations were contrast enhanced, and the stomach was previously distended. The D-max was measured using 2D software and compared with Becker TRG. Statistical data were obtained using "R" software. RESULTS: The interobserver agreement was good/very good. Becker TRG was predicted by CT with a sensitivity and specificity, respectively, of 97.3% and 90.9% for Becker 1 (D-max reduction rate > 65.1%), 76.4% and 80% for Becker 3 (D-max reduction rate < 29.9%), and 70.8% and 83.9% for Becker 2. Correlation between radiological and histological D-max measurements was strongly confirmed by the correlation index (c.i.= 0.829). CONCLUSIONS: D-max reduction rate in AGC patients may be helpful as a simple and reproducible radiological index in predicting TRG after NAC.

High-resolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience.

PURPOSE: This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment. MATERIALS AND METHODS: We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured. RESULTS: A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment. CONCLUSIONS: MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.