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1.
Proc Natl Acad Sci U S A ; 118(4)2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33414277

RESUMEN

After the national lockdown imposed on March 11, 2020, the Italian government has gradually resumed the suspended economic and social activities since May 4, while maintaining the closure of schools until September 14. We use a model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to estimate the health impact of different exit strategies. The strategy adopted in Italy kept the reproduction number Rt at values close to one until the end of September, with marginal regional differences. Based on the estimated postlockdown transmissibility, reopening of workplaces in selected industrial activities might have had a minor impact on the transmissibility. Reopening educational levels in May up to secondary schools might have influenced SARS-CoV-2 transmissibility only marginally; however, including high schools might have resulted in a marked increase of the disease burden. Earlier reopening would have resulted in disproportionately higher hospitalization incidence. Given community contacts in September, we project a large second wave associated with school reopening in the fall.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/métodos , Cuarentena/métodos , /epidemiología , /virología , Hospitalización , Humanos , Italia/epidemiología , Modelos Teóricos , Pandemias , Estudios Retrospectivos , Instituciones Académicas
2.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33414391

RESUMEN

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Pandemias , Cuarentena , Telemedicina/tendencias , Adulto , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea , Femenino , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-33430022

RESUMEN

The COVID-19 pandemic put the Italian health system under great stress. The sudden reorganization of work practices and the emotional impact of the large number of the victims had many consequences on the well-being of the healthcare professionals (HCPs) involved in managing the crisis. In the available literature, most studies have focused on the risk aspects while only few studies also take into account protective factors. For this reason, it was decided to conduct, within psycho-sociological perspective, a qualitative study with the aim to explore in depth the protective and risk factors as experienced by HCPs who worked in the Italian healthcare system during the COVID-19 outbreak. A total of 19 semi-structured interviews were conducted with HCPs-9 nurses and 10 physicians (7M and 12F) with an average age of 43 (SD = 13.4)-selected using snowball sampling. Considering three different levels of analysis the results highlight the protective and risk factors: personal history level (intrinsic/ethical motivation and flexible role versus extrinsic motivation and static role), interpersonal level (perception of supportive relationships with colleagues, patients, and family versus bad relationships), and organizational level (good leadership and sustainable work purpose versus absence of support from management and undefined or confused tasks).


Asunto(s)
/psicología , Personal de Salud/psicología , Pandemias , Adulto , Prestación de Atención de Salud , Humanos , Entrevistas como Asunto , Italia/epidemiología , Liderazgo , Motivación , Factores de Riesgo , Apoyo Social
4.
Artículo en Inglés | MEDLINE | ID: mdl-33430024

RESUMEN

Early known cases of COVID-19 emerged in late 2019 in the city of Wuhan (China) and in a relatively short time, it has reached more than 200 countries up to July 2020. In Italy, from 21 February 2020, (first official Italian positive case of COVID-19) until 27 July 2020, 246,286 confirmed cases were observed of which over 68,150 (28%) needed hospitalization and 35,112 died. In recent scientific research, it has been shown that the severity of symptoms and mortality rates were different not only among the various countries of the world but also in different regions of the same country. This research investigates whether and by how much air environmental conditions (such as exposure to fine particulate matter-PM2.5, sea air masses and altitude) influences the risk of hospitalization due to COVID-19 in Italy, once the spreading of the virus and the percentage of the elderly in the population have been accounted for. A log-linear multiple regression model was estimated where the log of the ratio of hospitalized patients per inhabitant, since the beginning of the epidemic up to July 27, has been considered as a dependent variable. Among the independent variables, the ones that have been taken into account are the spreading of the virus, the rate of people over 50 years of age, the concentration of PM2.5, the rate of population living by the sea, the rate of green public space for each resident and the ratio of population living at a high altitude. The results showed an increase in the hospitalization rate in terms of the percentage of people over 50 and the average concentration of PM2.5. If average limits of PM2.5 concentration allowed by the current European regulations (25 µg/m3) were respected in all Italian provinces, that would have led to 7339 less hospitalizations for COVID-19 (-11%). On the contrary, near the coast there were lower hospitalized cases in the referred period. In the hypothetical case that no Italians lived near the sea, about 1363 (+2%) more hospitalizations would have been recorded in the analysis period in addition to the effect of a lower PM concentration. This paper wanted to investigate which are the areas with a higher risk of hospitalization in Italy, so as to help the Italian Government to strengthen Health System measures, predicting the most suffering areas and health care systems. According to the results, this is directly related to the severity of symptoms which decreased with the long-time exposure to the sea.


Asunto(s)
Contaminación del Aire/efectos adversos , Altitud , Hospitalización/estadística & datos numéricos , Océanos y Mares , China , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Italia/epidemiología , Material Particulado/efectos adversos
5.
Artículo en Inglés | MEDLINE | ID: mdl-33430353

RESUMEN

The COVID-19 pandemic, with the consequent lockdown of about 3 months, can be viewed as an experimental model to observe the impact of the depletion of environmental factors that stimulate gambling, particularly electronic gambling machines (EGMs) that were set to zero. The effects of some structural characteristics of gambling activities that increase gambling behavior were studied among disordered gamblers in treatment in this unique scenario. In fact, studies investigating the effects of the lockdown on problem gamblers (PGs) under treatment are missing. The aims of this study were to analyze patients' gambling behavior and craving during the lockdown and to conduct a comparison between gambling disorder (GD) symptoms at the beginning of the treatment and during lockdown. The study was conducted in Italy, the European country with the largest gambling market and the first to be affected by the virus. Data were collected through a semi-structured telephone interview conducted by healthcare professionals. Participants were 135 PGs under treatment (109 males, mean age = 50.07). Results showed that most PGs achieved a significant improvement in their quality of life, with less gambling behavior, GD symptoms, and lower craving. No shift toward online gambling and very limited shift towards other potential addictive and excessive behaviors occurred. The longer the treatment, the more monitoring is present and the better the results in terms of symptoms reduction. Individual and environmental characteristics during the lockdown favored the reduction in symptoms. Consideration for prevention and treatment are discussed.


Asunto(s)
Conducta Adictiva/epidemiología , Juego de Azar/epidemiología , Control de Enfermedades Transmisibles , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Calidad de Vida , Encuestas y Cuestionarios
7.
Artículo en Inglés | MEDLINE | ID: mdl-33406588

RESUMEN

The restrictions enacted during lockdown to limit the spread of the novel coronavirus (SARS-CoV-2) have led to changes in people's lifestyle habits. In Italy, these restrictions have dramatically changed the way people work and spend their leisure time, also with repercussions on diet and physical activity. An anonymous survey was disseminated via websites and social media to a convenience sample of the Italian population during and immediately after the first lockdown (10 March-18 May 2020). Data collected on 1826 individuals show that lockdown might have worsened the quality of sleep of almost half of the participants in this cross-sectional study. This worsening was associated with a deterioration in crucial determinants of health, such as physical activity and diet (OR 1.68; 95% CI 1.18-2.40 and OR 4.19; 95% CI 2.51-6.96, respectively), with symptoms of psychological distress, such as tension (OR 3.88; 95% CI 2.74-5.52) and loneliness (OR 3.27; 95% CI 2.23-4.79), and with the presence of financial problems (some OR 1.86; 95% CI 1.27-2.72; many OR 7.27; 95% CI 3.59-14.73). The multivariate regression analysis models confirmed these associations. This impact on sleep quality was seen especially among females, those with low education level, and those who experienced financial problems.


Asunto(s)
/epidemiología , Pandemias , Sueño , Control de Enfermedades Transmisibles , Estudios Transversales , Dieta , Ejercicio Físico , Femenino , Humanos , Italia/epidemiología , Soledad , Masculino , Cuarentena , Estrés Psicológico , Encuestas y Cuestionarios
8.
PLoS One ; 16(1): e0244173, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33411744

RESUMEN

The novel coronavirus (COVID-19) is an emergent disease that initially had no historical data to guide scientists on predicting/ forecasting its global or national impact over time. The ability to predict the progress of this pandemic has been crucial for decision making aimed at fighting this pandemic and controlling its spread. In this work we considered four different statistical/time series models that are readily available from the 'forecast' package in R. We performed novel applications with these models, forecasting the number of infected cases (confirmed cases and similarly the number of deaths and recovery) along with the corresponding 90% prediction interval to estimate uncertainty around pointwise forecasts. Since the future may not repeat the past for this pandemic, no prediction model is certain. However, any prediction tool with acceptable prediction performance (or prediction error) could still be very useful for public-health planning to handle spread of the pandemic, and could policy decision-making and facilitate transition to normality. These four models were applied to publicly available data of the COVID-19 pandemic for both the USA and Italy. We observed that all models reasonably predicted the future numbers of confirmed cases, deaths, and recoveries of COVID-19. However, for the majority of the analyses, the time series model with autoregressive integrated moving average (ARIMA) and cubic smoothing spline models both had smaller prediction errors and narrower prediction intervals, compared to the Holt and Trigonometric Exponential smoothing state space model with Box-Cox transformation (TBATS) models. Therefore, the former two models were preferable to the latter models. Given similarities in performance of the models in the USA and Italy, the corresponding prediction tools can be applied to other countries grappling with the COVID-19 pandemic, and to any pandemics that can occur in future.


Asunto(s)
/epidemiología , Predicción/métodos , Modelos Biológicos , /mortalidad , Control de Enfermedades Transmisibles , Simulación por Computador , Toma de Decisiones , Humanos , Italia/epidemiología , Estados Unidos/epidemiología
9.
BMC Psychiatry ; 21(1): 20, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33419391

RESUMEN

BACKGROUND: Quarantine as a preventive action to reduce people's exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic. METHODS: From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI). RESULTS: In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18-50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (rs = + 0.83, p = < 0.0001), and between responder rate and region latitude (rs = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km. CONCLUSIONS: Policy makers and mental health professionals should be aware of quarantine's adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.


Asunto(s)
Coronavirus , Adolescente , Adulto , Ansiedad , Depresión , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Distrés Psicológico , Cuarentena , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto Joven
10.
J Cardiovasc Med (Hagerstown) ; 22(1): 29-35, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33186239

RESUMEN

INTRODUCTION: During the coronavirus disease-19 (COVID-19) outbreak in spring 2020, people may have been reluctant to seek medical care fearing infection. We aimed to assess the number, characteristics and in-hospital course of patients admitted for acute cardiovascular diseases during the COVID-19 outbreak. METHODS: We enrolled all consecutive patients admitted urgently for acute myocardial infarction, heart failure or arrhythmias from 1 March to 31 May 2020 (outbreak period) and 2019 (control period). We evaluated the time from symptoms onset to presentation, clinical conditions at admission, length of hospitalization, in-hospital medical procedures and outcome. The combined primary end point included in-hospital death for cardiovascular causes, urgent heart transplant or discharge with a ventricular assist device. RESULTS: A similar number of admissions were observed in 2020 (N = 210) compared with 2019 (N = 207). Baseline characteristics of patients were also similar. In 2020, a significantly higher number of patients presented more than 6 h after symptoms onset (57 versus 38%, P < 0.001) and with signs of heart failure (33 versus 20%, P = 0.018), required urgent surgery (13 versus 5%, P = 0.004) and ventilatory support (26 versus 13%, P < 0.001). Hospitalization duration was longer in 2020 (median 10 versus 8 days, P = 0.03). The primary end point was met by 19 (9.0%) patients in 2020 versus 10 (4.8%) in 2019 (P = 0.09). CONCLUSION: Despite the similar number and types of unplanned admissions for acute cardiac conditions during the 2020 COVID-19 outbreak compared with the same period in 2019, we observed a higher number of patients presenting late after symptoms onset as well as longer and more complicated clinical courses.


Asunto(s)
Arritmias Cardíacas/epidemiología , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Hospitales de Enseñanza , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias
11.
J Affect Disord ; 280(Pt B): 1-6, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33220632

RESUMEN

BACKGROUND: The COVID-19 pandemic is exposing health workers (HW) worldwide to extreme burden and risk of developing post-traumatic stress disorder (PTSD). This problem emerged in Lombardy, the Italian region where the pandemic exacted the heaviest toll. Study aims were to assess mental health of HW in Lombardy after the peak of COVID-19 related hospitalizations, through the joint evaluation of PTSD and positive mental health; and to explore the potential role of positive mental health in PTSD development. METHODS: HW completed an online survey including demographic and work-related information; PTSD Checklist for DSM-5; Mental Health Continuum Short-Form. Analyses comprised calculation of percentages of participants meeting a provisional PTSD and mental health diagnosis (flourishing, moderate, languishing); a binary logistic regression with demographics, work-related features, and positive mental health as predictors, and provisional PTSD diagnosis as outcome. RESULTS: Out of 653 participants, 39.8% received a provisional PTSD diagnosis; 33.4% reported flourishing, 57.7% moderate, and 8.9% languishing mental health. Regression analysis highlighted that women vs. men, nurses vs. technical/rehabilitation HW, frontline vs. second-line workers and languishing vs. moderately mentally healthy HW were more likely to receive a provisional PTSD diagnosis, whereas flourishing participants were more likely not to receive it. No role emerged for job seniority. LIMITATIONS: Self-reported PTSD scores, stress symptoms related to COVID-19 considered as a global stressor, cross-sectional study design. CONCLUSIONS: Findings suggest the potential usefulness of supporting vulnerable HW categories during massive disease outbreaks through emergency-focused professional training and psychological intervention addressing both positive mental health promotion and PTSD prevention.


Asunto(s)
/psicología , Personal de Salud/psicología , Salud Mental/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Encuestas y Cuestionarios
14.
Exp Appl Acarol ; 83(1): 147-164, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33206312

RESUMEN

The role of resident or migratory birds in dispersal of tick species and tick-borne pathogens is still poorly known in Italy. We report here the results of a 3-year project based on sampling ticks from migratory birds, as well as from the vegetation at three stop-over sites for migrants, namely the islands of Ventotene (Latium), Asinara (Sardinia) and Ustica (Sicily). During the spring seasons from 2017-2019, in total 2681 ticks were collected, 2344 of which were sampled from migratory birds and 337 from the vegetation. Ticks were identified by morphology or by molecular tools when necessary. In total, 16 tick species were identified among which the following were exclusively found on birds: Hyalomma rufipes (43.3%), Hy. truncatum (0.1%), Ixodes frontalis (11.8%), Ix. inopinatus (0.2%), Ix. ricinus (3%), Haemaphysalis punctata (0.08%), Hae. erinacei (0.1%), Amblyomma variegatum (0.08%) and Argas vulgaris 0.1%), whereas five species were exclusively collected from the vegetation: Rhipicephalus bursa (10.5%), Rh. turanicus (5.9%), Rh. sanguineus sensu lato (2%), Rh. pusillus (2.4%), Hae. sulcata (0.08%). Hy. marginatum (10.3%) and Ix. ventalloi (9.3%) were found both on birds and on the vegetation on the island Ustica. It is worth noting that the search for ticks on the vegetation did not detect allochthonous tick species. Although we found several interesting local species and allochthonous ticks like Hy. rufipes, Am. variegatum and Ar. vulgaris on birds, further investigations are needed to better define the possible role of migratory birds in the introduction of ticks and tick-borne diseases in Italy, above all after the evidence of imported ticks positive to Crimean Congo hemorrhagic fever (CCHF) virus in several European countries.


Asunto(s)
Virus de la Fiebre Hemorrágica de Crimea-Congo , Fiebre Hemorrágica de Crimea , Infestaciones por Garrapatas , Garrapatas , África/epidemiología , Animales , Aves , Europa (Continente) , Italia/epidemiología , Infestaciones por Garrapatas/epidemiología , Infestaciones por Garrapatas/veterinaria
16.
Clin Microbiol Infect ; 27(1): 130.e5-130.e8, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33007476

RESUMEN

OBJECTIVES: Investigation whether in depth characterization of virus variant patterns can be used for epidemiological analysis of the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection clusters in Hamburg, Germany. METHODS: Metagenomic RNA-sequencing and amplicon-sequencing and subsequent variant calling in 25 respiratory samples from SARS-CoV-2 infected patients involved in the earliest infection clusters in Hamburg. RESULTS: Amplikon sequencing and cluster analyses of these SARS-CoV-2 sequences allowed the identification of the first infection cluster and five non-related infection clusters occurring at the beginning of the viral entry of SARS-CoV-2 in the Hamburg metropolitan region. Viral genomics together with epidemiological analyses revealed that the index patient acquired the infection in northern Italy and transmitted it to two out of 134 contacts. Single nucleotide polymorphisms clearly distinguished the virus variants of the index and other clusters and allowed us to track in which sequences worldwide these mutations were first described. Minor variant analyses identified the transmission of intra-host variants in the index cluster and household clusters. CONCLUSIONS: SARS-CoV-2 variant tracing allows the identification of infection clusters and the follow up of infection chains occurring in the population. Furthermore, the follow up of minor viral variants in infection clusters can provide further resolution on transmission events indistinguishable at a consensus sequence level.


Asunto(s)
/genética , /transmisión , Genoma Viral , Pandemias/prevención & control , /genética , Adulto , /biosíntesis , Trazado de Contacto/estadística & datos numéricos , Evolución Molecular , Femenino , Alemania/epidemiología , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Italia/epidemiología , Masculino , Familia de Multigenes , Filogenia , Polimorfismo de Nucleótido Simple , /patogenicidad , Viaje
17.
Clin Microbiol Infect ; 27(1): 131.e1-131.e3, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33059091

RESUMEN

OBJECTIVES: In Italy the burden of patients with coronavirus disease 2019 (COVID-19) gradually decreased from March to the end of May. In this work we aimed to evaluate a possible association between the severity of clinical manifestations and viral load over time during the epidemiological transition from high-to low-transmission settings. METHODS: We reviewed the cases of COVID-19 diagnosed at the emergency room of our hospital, retrieving the proportion of patients admitted to the intensive care unit. A raw estimation of the viral load was done evaluating the Ct (cycle threshold) trend obtained from our diagnostic reverse transcriptase real-time PCR test. RESULTS: The proportion of patients requiring intensive care significantly decreased from 6.7% (19/281) in March to 1.1% (1/86) in April, and to none in May (Fisher's test p 0.0067). As for viral load, we observed a trend of Ct increasing from a median value of 24 (IQR 19-29) to 34 (IQR 29-37) between March and May, with a statistically significant difference between March and April (pairwise Wilcoxon test with stepdown Bonferroni adjustment for multiple testing, p 0.0003). CONCLUSIONS: We observed a reduction over time in the proportion of patients with COVID-19 requiring intensive care, along with decreasing median values of viral load. As the epidemiological context changes from high-to low-transmission settings, people are presumably exposed to a lower viral load which has been previously associated with less severe clinical manifestations.


Asunto(s)
/epidemiología , Pandemias , /genética , Anciano , Anciano de 80 o más Años , /transmisión , Servicio de Urgencia en Hospital , Femenino , Hospitales , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Índice de Severidad de la Enfermedad , Carga Viral
18.
Sci Total Environ ; 755(Pt 1): 142523, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33022464

RESUMEN

The Italian government has been one of the most responsive to COVID-2019 emergency, through the adoption of quick and increasingly stringent measures to contain the outbreak. Despite this, Italy has suffered a huge human and social cost, especially in Lombardy. The aim of this paper is dual: i) first, to investigate the reasons of the case fatality rate (CFR) differences across Italian 20 regions and 107 provinces, using a multivariate OLS regression approach; and ii) second, to build a "taxonomy" of provinces with similar mortality risk of COVID-19, by using the Ward's hierarchical agglomerative clustering method. I considered health system metrics, environmental pollution, climatic conditions, demographic variables, and three ad hoc indexes that represent the health system saturation. The results showed that overall health care efficiency, physician density, and average temperature helped to reduce the CFR. By the contrary, population aged 70 and above, car and firm density, air pollutants concentrations (NO2, O3, PM10, and PM2.5), relative average humidity, COVID-19 prevalence, and all three indexes of health system saturation were positively associated with the CFR. Population density, social vertical integration, and altitude were not statistically significant. In particular, the risk of dying increases with age, as 90 years old and above had a three-fold greater risk than the 80-to-89 years old and four-fold greater risk than 70-to-79 years old. Moreover, the cluster analysis showed that the highest mortality risk was concentrated in the north of the country, while the lowest risk was associated with southern provinces. Finally, since prevalence and health system saturation indexes played the most important role in explaining the CFR variability, a significant part of the latter may have been caused by the massive stress of the Italian health system.


Asunto(s)
Contaminación del Aire , Anciano , Anciano de 80 o más Años , Prestación de Atención de Salud , Humanos , Italia/epidemiología , Mortalidad/tendencias
19.
Emerg Infect Dis ; 27(1)2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33261716

RESUMEN

We used random sampling to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 infection in Verona, Italy. Of 1,515 participants, 2.6% tested positive by serologic assay and 0.7% by reverse transcription PCR. We used latent class analysis to estimate a 3.0% probability of infection and 2.0% death rate.


Asunto(s)
/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Pruebas Serológicas , Adulto , Anciano , /virología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia
20.
Support Care Cancer ; 29(1): 255-261, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32346798

RESUMEN

PURPOSE: The purpose of this study is to evaluate the prevalence over time of the measured side effects using a self-assessment questionnaire in normal clinical practice. METHODS: The prevalence of symptoms reported by patients on the questionnaire was evaluated over two 1-year periods: from 1 June 2006 to 31 May 2007 and from 1 July 2013 to 30 June 2014. Descriptive statistics were used to describe population. The 2006-2007 and 2013-2014 datasets were compared with each other using the chi-squared test for equality of proportion, Pearson's chi-squared test, and chi-squared test for trend in proportion. RESULTS: We analyzed 1974 questionnaires from 283 patients in 2006-2007 and 2619 questionnaires from 403 patients in 2013-2014. The most frequently encountered symptom in both periods was fatigue; nausea and constipation decreased in 2013-2014 compared with 2006-2007, while alopecia increased. CONCLUSIONS: Using the self-assessment questionnaire in normal clinical practice has allowed us to carry out an accurate prevalence survey on symptoms in patients receiving chemotherapy that takes into account not only reports of the presence of symptoms but also of their absence. Between 2006-2007 and 2013-2014, there was an increase in patients treated at the Oncological Day Hospital of the Biella Hospital, whose characteristics were comparable in the two periods, except for the type of therapies carried out. Some symptoms were in decline: fatigue, nausea, and constipation.


Asunto(s)
Antineoplásicos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Neoplasias/tratamiento farmacológico , Autoevaluación , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/inducido químicamente , Alopecia/epidemiología , Antineoplásicos/uso terapéutico , Estreñimiento/inducido químicamente , Estreñimiento/epidemiología , Fatiga/inducido químicamente , Fatiga/epidemiología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Pacientes , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
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