A State-of-the-Art Review on the Role of Cognitive and Motor Reserve on Quality of Life: A Focus on Cardiovascular Patients in a Lifespan Perspective.

Cardiovascular diseases (CVDs) reflect a huge and diversified condition that influences patient quality of life (QoL) both in the physical and mental aspects, especially in older adults who often present comorbidities and may be affected by cognitive decline. The concept of cognitive reserve (CR), which is built through life course experiences, has widely been considered a protective factor against cognitive decline, while the results of QoL in the field of CVDs are still controversial. In particular, there is a lack of evidence that explicitly explores the effects of CR on the QoL in CVD cases since studies have considered only single CR proxies (e.g., education) or specific cardiovascular conditions. Moreover, none of them have considered the motor reserve (MR), another recent concept that considers the amount of physical activity carried out during a lifespan. Its potential role in preventing age-related diseases has been observed, but more clarification is needed given the importance of the physical component in CVDs. The present state-of-the-art review aims to (i) examine how the literature conceives CR and its proxies in CVDs relating to QoL and (ii) integrate the concept of MR in this framework. Implications for clinical practice will also be discussed.

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review.

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Quality of Life and Its Psychosocial Predictors among Patients with Disorders of Gut-Brain Interaction: A Comparison with Age- and Sex-Matched Controls.

The disorders of gut-brain interaction (DGBIs) are a heterogeneous group of chronic conditions that greatly reduce patients' quality of life (QoL). To date, biopsychosocial factors (such as gastrointestinal symptoms, alexithymia, and interpersonal problems) are believed to contribute to the development and maintenance of DGBIs, but their role in affecting patients' QoL is still under investigation. Out of 141 patients seeking treatment for their gastrointestinal symptoms, 71 were diagnosed with a DGBI (47 females, 66.2%; Mage: 41.49 ± 17.23 years) and were age- and sex-matched to 71 healthy controls (47 females, 66.2%; Mage: 40.45 ± 16.38 years) without any current gastrointestinal symptom or diagnosis. Participants completed a sociodemographic and clinical questionnaire and a survey investigating several psychosocial risk factors. We found greater symptom severity and difficulties in identifying feelings among patients compared to controls. Further, multiple linear regression analyses evidenced that, among patients, higher expressive suppression of emotions, difficulties in identifying feelings and interpersonal problems, and a lower cognitive reappraisal of emotions predicted lower QoL. Data suggest that the QoL of patients with DGBIs is affected not only by common risk factors (e.g., interpersonal problems) but also by specific difficulties in processing and regulating emotions. The implications of these findings are discussed.

Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes.

OBJECTIVE: An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. RESULTS: Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. CONCLUSION: Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

Predictors of Psychological Well-Being and Quality of Life in Patients with Hypertension: A Longitudinal Study.

Previous research has highlighted the positive impact of greater health-related quality of life (Hr-QoL) and subjective well-being (SWB) on chronic diseases' severity and progression. There is a paucity of studies investigating the long-term trajectories of these variables among hypertensive patients. The present study aims to investigate the relationships between psychological variables (Type A and D personality, locus of control-LoC, self-esteem, and trait anxiety) with SWB and Hr-QoL in patients with hypertension and comorbid metabolic syndrome. A total of 185 volunteer patients (130 males, 70.3%; mean age 54 ± 10.93) were enrolled. Patients filled out measures of Hr-QoL and SWB, LoC, and self-esteem at three time points-Type A and D behaviors and anxiety measures only at baseline. Analyses were run through two-level hierarchical mixed models with repeated measures (Level 1) nested within participants (Level 2), controlling for sociodemographic and clinical confounders. Neither Hr-QoL nor SWB changed over time. Patients with greater self-esteem and internal LoC (and lower external LoC) increased their SWB and Hr-QoL up to 1-year follow-up. A greater Type A behavior and trait anxiety at baseline predicted a longitudinal increase in most of the dependent variables. Results suggest that it could be useful to tailor interventions targeting specific variables to increase Hr-QoL and SWB among hypertensive patients.

The self and our perception of its synchrony - Beyond internal and external cognition.

The self is the core of our mental life which connects one's inner mental life with the external perception. Since synchrony is a key feature of the biological world and its various species, what role does it play for humans? We conducted a large-scale psychological study (n = 1072) combining newly developed visual analogue scales (VAS) for the perception of synchrony and internal and external cognition complemented by several psychological questionnaires. Overall, our findings showed close connection of the perception of synchrony of the self with both internal (i.e., body and cognition) and external (i.e., others, environment/nature) synchrony being associated positively with adaptive and negatively with maladaptive traits of self. Moreover, we have demonstrated how external (i.e., life events like the COVID-19 pandemic) variables modulate the perception of the self's internal-external synchrony. These findings suggest how synchrony with self plays a central role during times of uncertainty.

PsyCARE study: assessing impact, cost-effectiveness, and transdiagnostic factors of the Italian ministry of health's "psychological bonus" policy.

BACKGROUND: The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the "Psychological Bonus" (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy's effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants' psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust. METHODS: The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data. DISCUSSION: We anticipate the study's findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy's cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study's findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public. STUDY REGISTRATION: https://osf.io/6zk2j.

Catastrophizing moderates the relationship between pain severity and depressive symptomatology among women with endometriosis.

The link between pain severity, depressive symptomatology and catastrophizing among women with endometriosis is still under-investigated. The aim of this study was to (i) evaluate differences in depressive symptomatology between women with and without endometriosis; (ii) investigate if pain severity is associated with depressive symptoms; and (iii) test if catastrophizing moderates the link between these two variables. A total of 172 women with a diagnosis of endometriosis and 62 healthy controls volunteered for this cross-sectional study. Depressive symptomatology, pain severity, and catastrophizing were assessed.Compared to healthy controls, women with endometriosis were more likely to score above the cutoff for depressive symptomatology, with 60.5% of the latter being classified as having a subthreshold depression or minor depression and 15.7% as having moderate or severe major depression. Pain severity was significantly associated with depressive symptoms even after controlling for several covariates. Finally, the moderation model suggested that among patients with endometriosis, the relationship between pain severity and depressive symptomatology depended on the level of catastrophizing, with this association being stronger for high levels of the moderator.Mental health practitioners working with women with endometriosis may consider those who report high levels of pain severity and of catastrophizing at high risk of depression and are advised to promote adaptive coping strategies among patients to foster a better adaptation to this chronic disease.

Single task-level, 2SD-based cutoffs for the Italian version of the Edinburgh Cognitive and Behavioral ALS screen (ECAS).

The present study aimed at deriving, by means of a traditional "2 standard deviation-based" (2SD) approach, single task-level cutoffs for the Italian version of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). Cutoffs were derived - as M-2*SD - from the sample of healthy participants (HPs) included within 2016 Poletti et al.'s normative study - N = 248; 104 males; age: 57.8 ± 10.6; education: 14.1 ± 4.6 - separately for the four, original demographic classes: 1) education <14 years and age ≤60 years; 2) education <14 years and age >60 years; 3) education ≥14 years and age ≤60 years; 4) education ≥14 years and age >60 years. The prevalence of deficits on each task was then estimated within a cohort of N = 377 amyotrophic lateral sclerosis (ALS) patients without dementia. The distribution of abnormal performance prevalences was overall consistent with the cognitive phenotype of ALS. In conclusion, the single task-level cutoffs herewith provided for the Italian version of the ECAS, which complement those already available within Poletti et al.'s normative framework, will help better profile Italian ALS patients' cognitive phenotype within both clinical and research settings.

Italian validation of the Clinical Outcomes in Routine Evaluation-10 (CORE-10): a short measure for routine outcome monitoring in clinical practice.

The customization of the intervention using patient feedback is an evidence-based practice aimed at the continuous evaluation, during treatment, of the patient's change at a clinical level. There are few easy-to-use tools for common assessment of psychological distress, designed to be used for screening and during treatment to monitor progress. The Clinical Outcomes in Routine Evaluation-10 (CORE-10) is definitely one of them. Thus, the aim of the present study was to examine the psychometric properties of the Italian version of the CORE-10. A sample of 548 participants (females, N=463, 84.5%; mean age 23.29±7.21 years) was recruited in the study and filled out a battery of measures. The internal validity of the CORE-10 was investigated through a confirmatory factor analysis which evidenced a good fit to the data, suggesting a unidimensional factorial structure of the measure. Further, the scale had a good internal reliability and was significantly associated with other measures of distress, interpersonal problems, well-being, and insecure attachment. Finally, it showed excellent diagnostic accuracy, as well as intrinsic and post-test diagnostics. Given its validity and reliability, the CORE-10 may be adopted by Italian-speaking psychotherapists and researchers to evaluate the outcomes of mental health interventions as well as to track the session-to-session changes over time in psychological distress among patients.

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study.

OBJECTIVE: This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later. METHODS: The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions. RESULTS: Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes. CONCLUSION: These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

Perfectionistic self-presentation, coping, and affective response during laboratory performance.

BACKGROUND AND OBJECTIVES: The impact of trait perfectionism on coping and affective response has been well-documented in laboratory performances, and yet little is known about the role played by perfectionistic self-presentation in performances beyond the effects of trait perfectionism. DESIGN: We aimed to address this knowledge gap by examining the relationships between perfectionistic self-presentation, maladaptive emotion-focused coping, and affective response to laboratory problem-solving tasks. METHODS: A group of 130 undergraduates attempted challenging, time-limited arithmetic and anagram tasks. Upon task completion, participants' scores were announced along with their mistakes. Additionally, participants completed measures assessing their positive and negative affect before and after lab performance, as well as coping strategies utilized during performance. RESULTS: Participants with elevated perfectionistic self-presentation experienced greater levels of negative affect and maladaptive emotion-focused coping. Moreover, nondisclosure of imperfection emerged as a significant predictor of lowered positive affect from pre- to post-performance after controlling for self-oriented perfectionism and socially prescribed perfectionism. Path analysis indicated that both nondisplay of imperfection and nondisclosure of imperfection exerted an indirect effect on post-performance negative affect via maladaptive emotion-focused coping. CONCLUSIONS: Our findings highlight the unique contribution of perfectionistic self-presentation beyond trait perfectionism in performance settings and suggest a need for future research.

Clinimetrics of the cognitive section of the Italian ALS Cognitive Behavioral Screen (ALS-CBS™).

BACKGROUND: The present study aimed at (1) providing further validity and reliability evidence for the Italian version of the cognitive section of the ALS Cognitive Behavioral Screen (ALS-CBS™) and (2) testing its diagnostics within an Italian ALS cohort, as well as at (3) exploring its capability to discriminate patients from healthy controls (HCs). METHODS: N = 293 non-demented ALS patients were administered the cognitive sections of the ALS-CBS™ and Edinburgh Cognitive and Behavioural ALS Screen (ECAS). N = 96 HCs demographically matched with N = 96 patients were also administered the cognitive section of the ALS-CBS™. In patients, factorial and construct validity, internal reliability, and diagnostics against a defective score on the cognitive section of the ECAS were tested. Case-control discrimination was assessed via a logistic regression. RESULTS: ALS-CBS™ cognitive subscales were underpinned by a simple, unidimensional structure, internally reliable (McDonald's ω = 0.74), and mostly related with ECAS executive and fluency scores (rs = 0.54-0.71). Both raw and age- and education-adjusted scores on the cognitive section of the ALS-CBS™ accurately detected ECAS-defined cognitive impairment (AUC = 0.80 and .88, respectively), yielding optimal error-based, information-based and unitary diagnostics. A cut-off of < 15.374 was identified on adjusted scores. The test was able to discriminate patients from HCs (p < 0.001). DISCUSSION: The cognitive section of the Italian ALS-CBS™ is a valid, reliable, and diagnostically sound ALS-specific screener for detecting frontotemporal, executive-/attentive-based cognitive inefficiency in non-demented ALS patients, being also able to discriminate them from normotypical individuals.

Development and Validation of a Short Form of the Geriatric Anxiety Scale (GAS-12) among Italian Older Adults.

OBJECTIVES: We developed a new Italian short version of the Geriatric Anxiety Scale (GAS-12) and evaluated its psychometric properties. The GAS-12 specifically screens for anxiety symptoms in the Italian older adult population by identifying items that best discriminate anxiety in this population. METHODS: In Study 1, we administered the full-length Italian translation of the GAS to 517 older adults and used item response theory to identify the most discriminating items and to develop the short form used in Study 2. In Study 2, we evaluated the functioning of the new short form of the questionnaire in a new sample of 427 older adults using Confirmatory factor analysis. RESULTS: Analyses indicated 12 items that discriminated well between anxious and non-anxious participants and distributed along the latent continuum of each trait. The GAS-12 fits a three-factor structure. There was also evidence for convergent and divergent validity. CONCLUSIONS: The Italian GAS-12 appears to be a useful instrument for the quantitative screening of anxiety in Italian older adults. CLINICAL IMPLICATIONS: Anxiety imposes significant impairment thus making imperative the screening and assessment of anxiety symptoms. The GAS-12 is particularly indicated with limited time and many scales in a clinical assessment or research protocols.

Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study.

The goal of this study was to test the efficacy of training community-based psychotherapists who were part of a practice research network to be more attuned to their patients' experiences of the therapeutic relationship. We were particularly interested in the effect of therapist training on the congruence of alliance ratings with their patients. Forty psychotherapists who treated 117 patients were randomly assigned to receive either no training or training, whose learning objectives were to help therapists to develop and maintain a therapeutic alliance. The training included workshops and ongoing consultations to help the clinician to strengthen the therapeutic relationship with the use of mentalizing, attachment theory, countertransference management, and metacommunication. Therapeutic alliance and well-being outcomes were measured at each of six consecutive early psychotherapy sessions. We used the truth and bias model and response surface analysis within a multilevel modeling context to test hypotheses. There was a significantly faster rate of alliance growth in the training versus the no training condition when the alliance was rated by therapists, but not when rated by patients. Trained therapists experienced greater temporal congruence in alliance ratings with their patients compared to untrained therapists. Patient well-being outcomes improved in a session when trained therapists and their patients agreed in their positive alliance ratings in a previous session. This association not significant among untrained therapists. Training therapists in key interpersonally focused skills may lead them to be better attuned to their patients' experiences of the therapeutic relationship. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Going beyond the surface: a mixed-method exploration of infertility-related quality of life of women with endometriosis.

Literature about the impact of infertility and endometriosis on Quality of Life (QoL) is scarce and needs further investigation. Our aim was to deeply investigate the QoL of women with diagnoses of both endometriosis and infertility with failed Assisted Reproductive Treatments (ART). We conducted a concurrent mixed-method study composed of both quantitative and qualitative surveys. The quantitative survey included 22 women who completed the FertiQoL. The qualitative survey included 15 of them who provided written answers to open-ended questions aimed at deeply exploring their QoL. Data were initially analyzed separately and then combined in a meta-matrix. From the quantitative survey emerged that women at higher risk for low QoL were those who have experienced previous spontaneous miscarriages and that the domains of the FertiQoL related to fertility treatment (i.e. increased pain severity, disturbed daily life routine, and dissatisfaction with services) were the most critical. From the Interpretative Phenomenological Analysis (IPA) of qualitative survey, narrations about the physical, relational, social, emotional-cognitive, and behavioural impact of the diseases emerged. Mixed findings showed that the QoL of this population was scarce and that different levels (the inner world, the behaviours, the relational context, and the environmental context) are strictly connected and interact between them in influencing QoL. Multi-level preventive or supportive programs (with specific attention to pain experience, coping strategies, quality of services and governmental support) are required for this population.

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic.

Introduction: While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

Psychological covariates of blood pressure among patients with hypertension and metabolic syndrome.

OBJECTIVE: Previous research provides support for the role of psychosocial variables in the progression of hypertension. However, few studies have rigorously tested the longitudinal interplay between blood pressure and depressive symptoms, quality of life, and well-being. Fewer still disaggregate the effects of changes of these psychological variables within patients over time from the effects of differences between patients on essential hypertension. METHOD: A total of 185 patients with hypertension and metabolic syndrome (130 males, 70.3%; mean age 54 ± 10.93 years) volunteered for this multicentre study. We analyzed the longitudinal associations between office or daytime ambulatory blood pressure with depressive symptoms, well-being, and quality of life, measured at the same three time points (baseline and 36- and 48-week follow-up), through multilevel models and controlling for several sociodemographic and clinical factors. RESULTS: Within-person increases in depressive symptoms were significant, positive time-varying covariates of both office and daytime blood pressure, even after controlling for several potential confounders (e.g., age, sex, changes over time in risk factors for metabolic syndrome). Within-person increases in well-being and mental health components of quality of life had similar negative associations with the level of blood pressure over time. Between-person differences in these variables tended not to predict blood pressure. CONCLUSIONS: Our findings provide a deeper insight on the relationship between variability of psychological variables within individuals and their levels of blood pressure. The findings support the need for health services to implement evidence-based psychological interventions that can foster a better management of the hypertensive disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behind the Scenes of COVID-19 Vaccine Hesitancy: Psychological Predictors in an Italian Community Sample.

Psychological variables may be crucial in favoring or discouraging health-related behaviors, including vaccine acceptance. This study aimed to extend the previous literature by outlining the psychological profile associated with COVID-19 vaccine hesitancy in a sample of Italian citizens. Between April and May 2021, 1122 Italian volunteers completed a web survey on COVID-19 vaccine acceptance, also including several self-reported psychological measures. A multiple hierarchical logistic regression analysis was performed to identify the psychological variables associated with vaccine hesitancy. Low confidence in COVID-19 vaccine efficacy and safety, low collective responsibility, high complacency, and high calculation (i.e., extensive information searching, and costs-benefit estimates) predicted higher hesitancy. Our results suggest that to be effective, vaccine-related communications should be as clear, understandable, and sound as possible, preventing the spreading of misunderstandings, or even fake information, that may foster people's insecurities and distrust. Furthermore, the advantages and necessity of vaccination, both at the individual and community-level, should be clearly emphasized. Efficacious vaccine-related communications may be crucial, not only to maintain an adequate immunity rate for COVID-19, but also to inform policymakers and public authorities in the case of possible future infectious outbreaks.