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Casotto V, Amidei CB, Saia M, Gregori D, Zanetto A, Fedeli U, Russo FP. Mortality related to HCV and other chronic liver diseases in Veneto (Italy), 2008-2021: Changes in trends and age-period-cohort effects. Liver Int 2024; 44:559-565. [PMID: 38031995 DOI: 10.1111/liv.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS The objective of this study was to assess the impact of the COVID-19 pandemic and direct-acting antiviral (DAA) agents on mortality related to chronic liver diseases (CLD). METHODS Age-standardized mortality rates were computed based on CLD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple causes of death-MCOD). Time trends in age-standardized mortality rates were investigated using generalized estimation equation models. Additionally, we conducted age, period, and birth cohort (APC) analyses on CLD-related mortality associated with alcohol and hepatitis C virus (HCV). RESULTS Between 2008 and 2021, among residents in the Veneto region (Northeastern Italy) aged ≥35 years, there were 20 409 deaths based on the UCOD and 30 069 deaths based on MCOD from all CLD. We observed a 4% annual decline in age-standardized MCOD-based mortality throughout 2008-2021, with minor peaks corresponding to COVID-19 epidemic waves. Starting in 2016, the decline in HCV-related mortality accelerated further (p < .001). A peak in HCV-related mortality in the 1963-1967 birth cohort was observed, which levelled off by the end of the study period. Mortality related to alcoholic liver disease declined at a slower pace, becoming the most common aetiology mentioned in death certificates. CONCLUSIONS The study demonstrates a significant decrease in HCV-related mortality at the population level in Italy with the introduction of DAAs. Continuous monitoring of MCOD data is warranted to determine if this favourable trend will continue. Further studies utilizing additional health records are needed to clarify the role of other CLD etiologies.
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Affiliation(s)
| | | | - Mario Saia
- Clinical Governance, Azienda Zero, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Alberto Zanetto
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
| | - Francesco P Russo
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova, Italy
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Wahsheh MA, Hassan ZM. Association between mortality risk levels and AIFELL triage scores for suspected COVID-19 patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:454. [PMID: 38464647 PMCID: PMC10920775 DOI: 10.4103/jehp.jehp_604_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND It is crucial to examine and classify patients as soon as possible to save their lives when they display Coronavirus Disease of 2019 (COVID-19) symptoms. The Altered sense of smell/taste, Inflammation, Fever, Elevated Lactate dehydrogenase, and Lymphocytopenia (AIFELL) evaluation tool is quick, easy, and simple for medical professionals. OBJECTIVES Determine the relationship between the COVID-19 patient confirmation and the AIFELL score. Examine any relationships between the AIFELL score and the degree of mortality. MATERIALS AND METHODS A retrospective study was conducted on 970 hospitalized (18 years or older) with a COVID-19 diagnosis in 2021. Patients admitted to the intensive care unit (ICU) as critical cases and moderate cases. The Chi-square test was utilized. RESULTS The scores of the AIFELL tool ranged from 0 to 6 points; the AIFELL score for COVID-19 symptoms with a high score (4-6) made up 41.5% of the patients. More than half of the patients (58.7%) were men; the oldest age group ranged from 40 to 50 years. A very high risk of dying due to a positive COVID-19 virus exists in more than a fifth of patients (21.5%). The ICU (37.5%) received around a third of the patients. The findings showed significant associations between levels of mortality risk and gender and age. There were significant associations between AIFELL scores and mortality risk levels. AIFELL scores, mortality risk levels, and patient admissions to the critical care unit were strongly associated. CONCLUSION The AIFELL scores were excellent for predicting COVID-19 mortality risk levels and ICU admission.
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Affiliation(s)
- Moayad A. Wahsheh
- Department of Sport Rehabilitation, Faculty of Physical Education and Sport Sciences, The Hashemite University, Zarqa, Jordan
| | - Zeinab M. Hassan
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Fedeli U, Amidei CB, Casotto V, Schievano E, Zoppini G. Excess diabetes-related deaths: The role of comorbidities through different phases of the COVID-19 pandemic. Nutr Metab Cardiovasc Dis 2023; 33:1709-1715. [PMID: 37407311 PMCID: PMC10228157 DOI: 10.1016/j.numecd.2023.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIMS Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study were to update multiple causes of death data on diabetes-related mortality during the pandemic and to estimate the impact of common diabetic comorbidities on excess mortality. METHODS AND RESULTS Diabetes-related deaths in 2020-2021 were compared with the 2018-2019 average; furthermore, age-standardized rates observed during the pandemic were compared with expected figures obtained from the 2008-2019 time series through generalized estimating equation models. Changes in diabetes mortality associated with specific comorbidities were also computed. Excess diabetes-related mortality was +26% in 2020 and +18% in 2021, after the initiation of the vaccination campaign. The presence of diabetes and hypertensive diseases was associated with the highest mortality increase, especially in subjects aged 40-79 years, +41% in 2020 and +30% in 2021. CONCLUSION The increase in diabetes-related deaths exceeded that observed for all-cause mortality, and the risk was higher when diabetes was associated with hypertensive diseases. Notably, the excess mortality decreased in 2021, after the implementation of vaccination against COVID-19.
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Affiliation(s)
- Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | | | - Veronica Casotto
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Barbiellini Amidei C, Fedeli U, Gennaro N, Cestari L, Schievano E, Zorzi M, Girardi P, Casotto V. Estimating Overall and Cause-Specific Excess Mortality during the COVID-19 Pandemic: Methodological Approaches Compared. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5941. [PMID: 37297545 PMCID: PMC10252246 DOI: 10.3390/ijerph20115941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different methods, focusing on specific causes of death with different pre-pandemic trends. Monthly mortality figures observed in 2020 in the Veneto Region (Italy) were compared with those forecasted using: (1) 2018-2019 monthly average number of deaths; (2) 2015-2019 monthly average age-standardized mortality rates; (3) Seasonal Autoregressive Integrated Moving Average (SARIMA) models; (4) Generalized Estimating Equations (GEE) models. We analyzed deaths due to all-causes, circulatory diseases, cancer, and neurologic/mental disorders. Excess all-cause mortality estimates in 2020 across the four approaches were: +17.2% (2018-2019 average number of deaths), +9.5% (five-year average age-standardized rates), +15.2% (SARIMA), and +15.7% (GEE). For circulatory diseases (strong pre-pandemic decreasing trend), estimates were +7.1%, -4.4%, +8.4%, and +7.2%, respectively. Cancer mortality showed no relevant variations (ranging from -1.6% to -0.1%), except for the simple comparison of age-standardized mortality rates (-5.5%). The neurologic/mental disorders (with a pre-pandemic growing trend) estimated excess corresponded to +4.0%/+5.1% based on the first two approaches, while no major change could be detected based on the SARIMA and GEE models (-1.3%/+0.3%). The magnitude of excess mortality varied largely based on the methods applied to forecast mortality figures. The comparison with average age-standardized mortality rates in the previous five years diverged from the other approaches due to the lack of control over pre-existing trends. Differences across other methods were more limited, with GEE models probably representing the most versatile option.
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Affiliation(s)
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Nicola Gennaro
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Laura Cestari
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, 30172 Venice, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
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Basso C, Barbiellini Amidei C, Casotto V, Schievano E, Dotto M, Tiozzo Netti S, Zorzi M, Fedeli U. Veneto Region dementia-related mortality during the COVID-19 pandemic: multiple causes of death and time series analysis. Eur J Public Health 2023; 33:190-195. [PMID: 36847686 PMCID: PMC10066484 DOI: 10.1093/eurpub/ckad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Older individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) approaches. The objective of this study was to determine the impact of the COVID-19 pandemic on dementia-related deaths considering comorbidities and the place of death. METHODS This retrospective, population-based study was conducted in Veneto, Italy. All the death certificates of individuals aged ≥65 years issued from 2008 to 2020 were analyzed for dementia-related mortality using age-standardized sex-stratified rates of dementia as UCOD and MCOD. Excess in monthly dementia-related mortality in 2020 was estimated by applying Seasonal Autoregressive Integrated Moving Average (SARIMA) model. RESULTS Overall, 70 301 death certificates reported dementia (MCOD proportional mortality: 12.9%), and 37 604 cases identified it as UCOD (proportional mortality: 6.9%). In 2020, the MCOD proportional mortality increased to 14.3% whereas that of UCOD remained static (7.0%). Compared to the SARIMA prediction, MCOD increased by 15.5% in males and 18.3% in females in 2020. Compared to the 2018-19 average, deaths in nursing homes increased by 32% in 2020, at home by 26% and in hospitals by 12%. CONCLUSIONS An increase in dementia-related mortality during the first months of the COVID-19 pandemic could only be detected using the MCOD approach. MCOD proved to be more robust, and hence, should be included in future analyses. Nursing homes appeared to be the most critical setting which should guide establishing protective measures for similar situations.
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Affiliation(s)
- Cristina Basso
- Correspondence: C. Basso, Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo Avanzo 35, 35132 Padova, Italy, Tel: +39 049 8778330, e-mail:
| | | | | | | | - Matilde Dotto
- Epidemiological Department, Azienda Zero, Padova, Italy
| | | | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
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Rugge M, Zorzi M, Guzzinati S, Stocco C, Avossa F, Del Zotto S, Clagnan E, Bricca L, Dal Maso L, Serraino D. Outcomes of SARS-CoV-2 infection in cancer versus non-cancer-patients: a population-based study in northeastern Italy. TUMORI JOURNAL 2023; 109:38-46. [PMID: 35130777 PMCID: PMC9895302 DOI: 10.1177/03008916211073771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study assesses the risk of infection and clinical outcomes in a large consecutive population of cancer and non-cancer patients tested for SARS-CoV-2 status. METHODS Study patients underwent SARS-CoV-2 molecular-testing between 22 February 2020 and 31 July 2020, and were found infected (CoV2+ve) or uninfected. History of malignancy was obtained from regional population-based cancer registries. Cancer-patients were distinguished by time between cancer diagnosis and SARS-CoV-2 testing (<12/⩾12 months). Comorbidities, hospitalization, and death at 15 September 2020 were retrieved from regional population-based databases. The impact of cancer history on SARS-CoV-2 infection and clinical outcomes was calculated by fitting a multivariable logistic regression model, adjusting for sex, age, and comorbidities. RESULTS Among 552,362 individuals tested for SARS-CoV-2, 55,206 (10.0%) were cancer-patients and 22,564 (4.1%) tested CoV2+ve. Irrespective of time since cancer diagnosis, SARS-CoV-2 infection was significantly lower among cancer patients (1,787; 3.2%) than non-cancer individuals (20,777; 4.2% - Odds Ratio (OR)=0.60; 0.57-0.63). CoV2+ve cancer-patients were older than non-cancer individuals (median age: 77 versus 57 years; p<0.0001), were more frequently men and with comorbidities. Hospitalizations (39.9% versus 22.5%; OR=1.61; 1.44-1.80) and deaths (24.3% versus 9.7%; OR=1.51; 1.32-1.72) were more frequent in cancer-patients. CoV2+ve cancer-patients were at higher risk of death (lung OR=2.90; 1.58-5.24, blood OR=2.73; 1.88-3.93, breast OR=1.77; 1.32-2.35). CONCLUSIONS The risks of hospitalization and death are significantly higher in CoV2+ve individuals with past or present cancer (particularly malignancies of the lung, hematologic or breast) than in those with no history of cancer.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine - DIMED,
Surgical Pathology and Cytopathology Unit, Università degli Studi di Padova, Padova,
Italy,Veneto Tumour Registry, Azienda Zero,
Padova, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero,
Padova, Italy
| | | | | | - Francesco Avossa
- Regional Epidemiological Service Unit,
Azienda Zero, Padova, Italy
| | | | - Elena Clagnan
- Friuli Venezia Giulia Regional Health
Coordination Agency, Udine, Italy
| | - Ludovica Bricca
- Department of Medicine - DIMED,
Surgical Pathology and Cytopathology Unit, Università degli Studi di Padova, Padova,
Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di
Riferimento Oncologico, IRCCS, Aviano, Italy,Luigino Dal Maso, Cancer Epidemiology,
Centro di Riferimento Oncologico (CRO) Aviano, via Gallini, 2, Aviano (PN),
33081, Italy.
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di
Riferimento Oncologico, IRCCS, Aviano, Italy
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Bandyopadhyay A, Schips M, Mitra T, Khailaie S, Binder SC, Meyer-Hermann M. Testing and isolation to prevent overloaded healthcare facilities and reduce death rates in the SARS-CoV-2 pandemic in Italy. COMMUNICATIONS MEDICINE 2022; 2:75. [PMID: 35774529 PMCID: PMC9237078 DOI: 10.1038/s43856-022-00139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background During the first wave of COVID-19, hospital and intensive care unit beds got overwhelmed in Italy leading to an increased death burden. Based on data from Italian regions, we disentangled the impact of various factors contributing to the bottleneck situation of healthcare facilities, not well addressed in classical SEIR-like models. A particular emphasis was set on the undetected fraction (dark figure), on the dynamically changing hospital capacity, and on different testing, contact tracing, quarantine strategies. Methods We first estimated the dark figure for different Italian regions. Using parameter estimates from literature and, alternatively, with parameters derived from a fit to the initial phase of COVID-19 spread, the model was optimized to fit data (infected, hospitalized, ICU, dead) published by the Italian Civil Protection. Results We show that testing influenced the infection dynamics by isolation of newly detected cases and subsequent interruption of infection chains. The time-varying reproduction number (Rt) in high testing regions decreased to <1 earlier compared to the low testing regions. While an early test and isolate (TI) scenario resulted in up to ~31% peak reduction of hospital occupancy, the late TI scenario resulted in an overwhelmed healthcare system. Conclusions An early TI strategy would have decreased the overall hospital usage drastically and, hence, death toll (∼34% reduction in Lombardia) and could have mitigated the lack of healthcare facilities in the course of the pandemic, but it would not have kept the hospitalization amount within the pre-pandemic hospital limit. Italy was heavily affected early in the COVID-19 pandemic, with healthcare facilities becoming overloaded. We use mathematical models to study COVID-19 transmission, and factors contributing to this, on a regional basis in Italy. We show that testing and lockdowns were effective in controlling disease spread. We use regional pre- and post-pandemic hospital/ICU bed occupancy to quantify the impact of the overwhelmed healthcare system upon the number of deaths. We find that increased isolation of cases could have reduced the effect of limited healthcare facilities but would not have kept hospitalizations within the pre-pandemic limit, and an improvement of hospital facilities would still have been required. We show that contact tracing and quarantine without testing could also be efficient strategies when test capacities are limited. Our findings help us to understand how to manage COVID-19 or other disease outbreaks in future. Bandyopadhyay, Schips et al. model the factors contributing to overloading of healthcare facilities during the first COVID-19 wave in Italy. They predict that an early test and isolate intervention could have reduced healthcare usage and death rates but would not have kept hospitalizations within pre-pandemic hospital limits.
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Riccò M, Zaniboni A, Satta E, Baldassarre A, Cerviere MP, Marchesi F, Peruzzi S. Management and Prevention of Traveler's Diarrhea: A Cross-Sectional Study on Knowledge, Attitudes, and Practices in Italian Occupational Physicians (2019 and 2022). Trop Med Infect Dis 2022; 7:370. [PMID: 36422921 PMCID: PMC9692574 DOI: 10.3390/tropicalmed7110370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 07/29/2023] Open
Abstract
Even though Italian Occupational Physicians (OP) are increasingly involved in the managing of overseas workers, their knowledge, attitudes, and practices (KAP) in travel medicine are mostly undefined. We, therefore, permed a KAP study specifically targeting the management of travelers' diarrhea (TD) by OP. A total of 371 professionals (43.4% males; mean age 40.8 ± 10.9 years) completed in 2 rounds (2019 and 2022) a specifically designed web questionnaire that inquired participating OP on their knowledge status (KS), risk perception, and management of TD through pre- and post-travel advice and interventions. Multivariable odds ratios (aOR) for predictors of a better knowledge status were calculated through regression analysis. Eventually, the majority of participants (53.4%) had participated in the management of cases of TD in the previous months, but only 26.4% were reportedly involved in pre-travel consultations. The overall knowledge status was unsatisfying (potential range: 0-100%, actual average of the sample 59.6% ± 14.6), with substantial uncertainties in the management of antimicrobial treatment. Interestingly, only a small subset of participants had previously prescribed antimicrobial prophylaxis or treatment (3.5% and 1.9%, respectively). Main effectors of a better knowledge status were: having a background qualification in Hygiene and Public Health (aOR 14.769, 95%CI 5.582 to 39.073), having previously managed any case of (aOR 3.107, 95%CI 1.484 to 6.506), and having higher concern on TD, reported by acknowledging high frequency (aOR 8.579, 95%CI 3.383 to 21.756) and severity (aOR 3.386; 95%CI 1.741 to 6.585) of this disorder. As the adherence of participating OP to official recommendations for TD management was unsatisfying, continuous Education on Travel Medicine should be improved by sharing up-to-date official recommendations on appropriate treatment options for TD.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Elia Satta
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, I-50134 Florence, Italy
| | | | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, I-42016 Guastalla, Italy
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Epidemiological Analysis of COVID-19 Outbreaks in Wuhu, China, from January to March 2020. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-130499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: COVID-19, caused by SARS-CoV-2, has spread worldwide and become a global pandemic. Objectives: Studies of the earliest events of the COVID-19 pandemic are critical in understanding how the pandemic started and providing insight into the spread of SARS-CoV-2 and its infection in humans. Methods: In this report, we studied the epidemiological characteristics of all 34 confirmed COVID-19 cases in Wuhu, China, from January 3 to March 19, 2020. Results: Our study indicated that cases in male patients (61.76%, 21/34) outnumbered those in female patients (38.24%, 13/34). Studies of the age distribution among the confirmed cases revealed that most COVID-19 patients were 15 to 59 years of age (26/34, 76%), while more than 14% (5/34) were ≥ 60 years old, and less than 9% (3/34) were ≤ 14 years old. Notably, 32 of the 34 confirmed cases were (a) people who had recently resided in or traveled to Wuhan or had close contact with Wuhan residents or visitors (22 cases); and (b) people who had close contact with these 22 confirmed COVID-19 patients (10 cases). Conclusions: This study revealed the epidemiological characteristics of COVID-19 outbreaks in Wuhu between January and March 2020 and provided insight into the earliest events of the COVID-19 pandemic in China. Our analyses suggested that the COVID-19 cases confirmed in Wuhu in 2020 were directly related to or originated from the outbreaks in Wuhan.
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Fedeli U, Barbiellini Amidei C, Marcon A, Casotto V, Grippo F, Grande E, Gaisl T, Barco S. Mortality Related to Chronic Obstructive Pulmonary Disease during the COVID-19 Pandemic: An Analysis of Multiple Causes of Death through Different Epidemic Waves in Veneto, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912844. [PMID: 36232144 PMCID: PMC9565127 DOI: 10.3390/ijerph191912844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/12/2023]
Abstract
Mortality related to chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic is possibly underestimated by sparse available data. The study aimed to assess the impact of the pandemic on COPD-related mortality by means of time series analyses of causes of death data. We analyzed the death certificates of residents in Veneto (Italy) aged ≥40 years from 2008 to 2020. The age-standardized rates were computed for COPD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple cause of death-MCOD). The annual percent change (APC) in the rates was estimated for the pre-pandemic period. Excess COPD-related mortality in 2020 was estimated by means of Seasonal Autoregressive Integrated Moving Average models. Overall, COPD was mentioned in 7.2% (43,780) of all deaths. From 2008 to 2019, the APC for COPD-related mortality was -4.9% (95% CI -5.5%, -4.2%) in men and -3.1% in women (95% CI -3.8%, -2.5%). In 2020 compared to the 2018-2019 average, the number of deaths from COPD (UCOD) declined by 8%, while COPD-related deaths (MCOD) increased by 14% (95% CI 10-18%), with peaks corresponding to the COVID-19 epidemic waves. Time series analyses confirmed that in 2020, COPD-related mortality increased by 16%. Patients with COPD experienced significant excess mortality during the first year of the pandemic. The decline in COPD mortality as the UCOD is explained by COVID-19 acting as a competing cause, highlighting how an MCOD approach is needed.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | | | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Fedeli U, Casotto V, Schievano E, Bonora E, Zoppini G. Diabetes as a cause of death across different COVID-19 epidemic waves. Diabetes Res Clin Pract 2022; 190:109984. [PMID: 35803315 PMCID: PMC9258691 DOI: 10.1016/j.diabres.2022.109984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this study is to assess the role of diabetes as a cause of death through different epidemic waves of COVID-19. METHODS The annual percentage change in age-standardized rates (APC) was estimated for diabetes as the underlying (UCOD) and as multiple causes of death (MCOD) in 2008-2019. Diabetes-related deaths in 2020 were compared to the 2018-2019 average. SARIMA models were applied to monthly excess in mortality considering seasonality and long-term trends. RESULTS 2018-2019-Age-standardized mortality rates decreased, especially among females (MCOD: APC -2.49, 95%CI -3.01/-1.97%). In 2020, deaths increased by 19% (95%CI 13-25%) for UCOD, and by 27% (95%CI 24-30%) for MCOD. Diabetes and COVID-19 accounted for 74% of such excess. During the first epidemic wave, the increase in observed rates vs predicted by the model was larger in males (March +39%, April +46%) than in females (+30% and +32%). In the second wave, a huge excess of similar magnitude was observed in the two sexes; rates in December exceeded those predicted by more than 100%. CONCLUSIONS The COVID-19 pandemic abruptly interrupted a long-term declining trend in mortality associated to diabetes. MCOD analyses are warranted to fully estimate the impact of epidemic waves on diabetes-related mortality.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Enzo Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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12
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Alteri C, Scutari R, Costabile V, Colagrossi L, Yu La Rosa K, Agolini E, Lanari V, Chiurchiù S, Romani L, Markowich AH, Bernaschi P, Russo C, Novelli A, Bernardi S, Campana A, Villani A, Perno CF. Epidemiological characterization of SARS-CoV-2 variants in children over the four COVID-19 waves and correlation with clinical presentation. Sci Rep 2022; 12:10194. [PMID: 35715488 PMCID: PMC9204374 DOI: 10.1038/s41598-022-14426-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
Since the start of SARS-CoV-2 pandemic, children aged ≤ 12 years have always been defined as underrepresented in terms of SARS-CoV-2 infections' frequency and severity. By correlating SARS-CoV-2 transmission dynamics with clinical and virological features in 612 SARS-CoV-2 positive patients aged ≤ 12 years, we demonstrated a sizeable circulation of different SARS-CoV-2 lineages over the four pandemic waves in paediatric population, sustained by local transmission chains. Age < 5 years, highest viral load, gamma and delta clades positively influence this local transmission. No correlations between COVID-19 manifestations and lineages or transmission chains are seen, except for a negative correlation between B.1.1.7 and hospitalization.
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Affiliation(s)
- Claudia Alteri
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Rossana Scutari
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Luna Colagrossi
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Katia Yu La Rosa
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Valentina Lanari
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Sara Chiurchiù
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenza Romani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paola Bernaschi
- Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Cristina Russo
- Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy. .,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy.
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13
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Voci D, Fedeli U, Farmakis IT, Hobohm L, Keller K, Valerio L, Schievano E, Barbiellini Amidei C, Konstantinides SV, Kucher N, Barco S. Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area. Thromb Res 2022; 212:44-50. [PMID: 35219931 PMCID: PMC8858636 DOI: 10.1016/j.thromres.2022.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary embolism is a known complication of coronavirus disease 2019 (COVID-19). Epidemiological population data focusing on pulmonary embolism-related mortality is limited. METHODS Veneto is a region in Northern Italy counting 4,879,133 inhabitants in 2020. All ICD-10 codes from death certificates (1st January 2018 to 31st December 2020) were examined. Comparisons were made between 2020 (COVID-19 outbreak) and the average of the two-year period 2018-2019. All-cause, COVID-19-related and the following cardiovascular deaths have been studied: pulmonary embolism, hypertensive disease, ischemic heart disease, atrial fibrillation/flutter, and cerebrovascular diseases. RESULTS In 2020, a total of 56,412 deaths were recorded, corresponding to a 16% (n = 7806) increase compared to the period 2018-2019. The relative percentage increase during the so-called first and second waves was 19% and 44%, respectively. Of 7806 excess deaths, COVID-19 codes were reported in 90% of death certificates. The percentage increase in pulmonary embolism-related deaths was 27% (95%CI 19-35%), 1018 deaths during the year 2020, compared to 804 mean annual deaths in the period 2018-2019. This was more evident among men, who experience an absolute increase of 147 deaths (+45%), than in women (+67 deaths; +14%). The increase was primarily driven by deaths recorded during the second wave (+91% in October-December). An excess of deaths, particularly among men and during the second wave, was also observed for other cardiovascular diseases, notably hypertensive disease, atrial fibrillation, cerebrovascular disease, and ischemic heart disease. CONCLUSIONS We observed a considerable increase of all-cause mortality during the year 2020. This was mainly driven by COVID-19 and its complications. The relative increase in the number of pulmonary embolism-related deaths was more prominent during the second wave, suggesting a possible underdiagnosis during the first wave.
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Affiliation(s)
- Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Democritus University of Thrace, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Corresponding author at: Department of Angiology, University Hospital Zurich, Raemistrasse 100, RAE C 19, 8091 Zurich, Switzerland
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14
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Riccò M, Ferraro P, Peruzzi S, Zaniboni A, Ranzieri S. SARS-CoV-2-Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020-2021). Microorganisms 2022; 10:499. [PMID: 35336074 PMCID: PMC8951730 DOI: 10.3390/microorganisms10030499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Legionnaires' Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129-0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2-Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Servizio di Medicina del Lavoro, ASL di Foggia, 71121 Foggia, Italy;
| | - Simona Peruzzi
- AUSL–IRCCS di Reggio Emilia, Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, 42016 Guastalla, Italy;
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
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15
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Cocchio S, Zabeo F, Facchin G, Piva N, Furlan P, Nicoletti M, Saia M, Tonon M, Mongillo M, Russo F, Baldo V. The Effectiveness of a Diverse COVID-19 Vaccine Portfolio and Its Impact on the Persistence of Positivity and Length of Hospital Stays: The Veneto Region's Experience. Vaccines (Basel) 2022; 10:vaccines10010107. [PMID: 35062767 PMCID: PMC8777781 DOI: 10.3390/vaccines10010107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The vaccination campaign for the Veneto region (northeastern Italy) started on 27 December 2020. As of early December 2021, 75.1% of the whole Veneto population has been fully vaccinated. Vaccine efficacy has been demonstrated in many clinical trials, but reports on real-world contexts are still necessary. We conducted a retrospective cohort study on 2,233,399 residents in the Veneto region to assess the reduction in the COVID-19 burden, taking different outcomes into consideration. First, we adopted a non-brand-specific approach borrowed from survival analysis to estimate the effectiveness of vaccination against SARS-CoV-2 in preventing infections, hospitalizations, and deaths. We used t-tests and multivariate regressions to examine vaccine impact on breakthrough infections, in terms of the persistence of positivity and the length of hospital stays. Evidence emerging from this study suggests that unvaccinated individuals are significantly more likely to become infected, need hospitalization, and are at a higher risk of death from COVID-19 than those given at least one dose of vaccine. Cox models indicate that the effectiveness of full vaccination is 88% against infection, 94% against hospitalization, and 95% against death. Multivariate regressions suggest that vaccination is significantly correlated with a shorter period of positivity and shorter hospital stays, with each step toward completion of the vaccination cycle coinciding with a reduction of 3.3 days in the persistence of positivity and 2.3 days in the length of hospital stay.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Federico Zabeo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Giacomo Facchin
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Nicolò Piva
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Patrizia Furlan
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Michele Nicoletti
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Mario Saia
- Azienda Zero of Veneto Region, 35100 Padua, Italy;
| | - Michele Tonon
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Michele Mongillo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
- Correspondence: ; Tel.: +39-049-8275381
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16
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Epidemiological study in a small rural area of Veneto (Italian region) during Sars-Cov-2 Pandemia. Sci Rep 2021; 11:23247. [PMID: 34853349 PMCID: PMC8636493 DOI: 10.1038/s41598-021-02654-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/17/2021] [Indexed: 01/09/2023] Open
Abstract
The emergence of severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2) and its complications have demonstrated the devastating impact of a new infectious pathogen. The organisational change promulgated by the isolation of affected communities is of extreme importance to achieve effective containment of the contagion and good patient care. The epidemiological study of the population of a small rural community in the North East of Italy revealed how much the virus had circulated during Spring, 2020, and how contagion has evolved after a prolonged lockdown. In the 1st phase, NAAT (Nucleic Acid Amplification Testing) was performed in cases with more or less severe symptoms and a study was performed to trace the infection of family members. Only 0.2% of the population tested positive on NAAT, via nasopharyngeal swab during this 1st phase. In the 2nd phase a random sample of the general population were tested for circulating anti-Sars-Cov-2 immunoglobulins. This showed that approximately 97.9% of the population were negative, while 2.1% (with positive IgG at a distance) of the population had contracted the virus in a mildly symptomatic or asymptomatic form. The main symptom in subjects who developed immunity was fever. Antibodies were found in subjects with forced coexistence with quarantined or infected subjects. The mutual spatial distance by categories has shown higher relative prevalence of IgG positive and IgM negative cases in close proximity but also far from the infected, with respect to an intermediate distance. This suggests that subjects living in thinly populated areas could come in contact with the virus more likely due to intentional/relational proximity, while those living nearby could also be infected through random proximity.
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17
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Elderly People's Access to Emergency Departments during the COVID-19 Pandemic: Results from a Large Population-Based Study in Italy. J Clin Med 2021; 10:jcm10235563. [PMID: 34884265 PMCID: PMC8658732 DOI: 10.3390/jcm10235563] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 12/23/2022] Open
Abstract
Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients' characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from -52.4% in March to -18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the "first wave" of the COVID-19 pandemic in Italy), and in the autumn (during the "second wave"). The proportion of visits to the ED by ambulance has increased sharply since March 2020, and patients arrived more frequently with severe conditions (red or yellow triage tags) that often required a hospitalization. The greatest decrease was in fact observed for non-urgent complaints. This decreased concerned a wide range of conditions, including chest pain and abdominal pain. The sharp reduction observed in the present study is unlikely to be attributed entirely to the effect of lockdown measures. Individual psychological and media-induced fear of contagion most likely played a relevant role in leading people to avoid seeking medical attention.
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Older People's Lived Perspectives of Social Isolation during the First Wave of the COVID-19 Pandemic in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211832. [PMID: 34831586 PMCID: PMC8618043 DOI: 10.3390/ijerph182211832] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 02/06/2023]
Abstract
The aim of the present study is to understand the experiences of isolation and strategies used to cope with it among older people living at home during the first wave of the COVID-19 pandemic. More specifically, the roles of media and online technologies were also explored. Semistructured interviews were conducted via telephone between March and April 2020 with 30 people aged 72–94 years old living in Northern Italy. The thematic analysis identified six thematic areas: changes in daily life, emotions, social networks, exploited resources and strategies, use of media, and view of the future. Older people faced the emergency in heterogeneous ways; some were able to take advantage of their own residual resources and of social support, whereas in other cases, isolation exacerbated existing weaknesses. Technology and media were useful for reducing loneliness and fostering social contacts, but people with age-related impairments or low digital literacy presented many difficulties in approaching new technologies. Moreover, the overabundance of information could also increase anxiety and feelings of threat. Given the impact of social isolation on older people’s well-being, it is critical to identify and strengthen personal resources and social support strategies that may help older people cope with the restrictions imposed by the COVID-19 pandemic.
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Nogues X, Ovejero D, Pineda-Moncusí M, Bouillon R, Arenas D, Pascual J, Ribes A, Guerri-Fernandez R, Villar-Garcia J, Rial A, Gimenez-Argente C, Cos ML, Rodriguez-Morera J, Campodarve I, Quesada-Gomez JM, Garcia-Giralt N. Calcifediol Treatment and COVID-19-Related Outcomes. J Clin Endocrinol Metab 2021; 106:e4017-e4027. [PMID: 34097036 PMCID: PMC8344647 DOI: 10.1210/clinem/dgab405] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity. OBJECTIVE This work aims to elucidate the effect of 25(OH)D3 (calcifediol) treatment on COVID-19-related outcomes. METHODS This observational cohort study was conducted from March to May 2020, among patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain. A total of 930 patients with COVID-19 were included; 92 were excluded because of previous calcifediol intake. Of the remaining 838, a total of 447 received calcifediol (532 μg on day 1 plus 266 μg on days 3, 7, 15, and 30), whereas 391 were not treated at the time of hospital admission (intention-to-treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy individuals, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol. Main outcome measures were ICU admission and mortality. RESULTS ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required the ICU, compared to 82 (21%) out of 391 nontreated (P < .001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, sex, linearized 25-hydroxyvitamin D levels at baseline, and comorbidities showed that treated patients had a reduced risk of requiring the ICU (odds ratio [OR] 0.13; 95% CI 0.07-0.23). Overall mortality was 10%. In the intention-to-treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 nontreated (P = .001). Adjusted results showed a reduced mortality risk with an OR of 0.21 (95% CI, 0.10-0.43). In the second analysis, the obtained OR was 0.52 (95% CI, 0.27-0.99). CONCLUSION In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.
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Affiliation(s)
- Xavier Nogues
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Diana Ovejero
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Marta Pineda-Moncusí
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
| | - Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat, 3000 Leuven, Belgium
| | - Dolors Arenas
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona 08003, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona 08003, Spain
| | - Anna Ribes
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
| | - Robert Guerri-Fernandez
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona 08003,Spain
| | - Judit Villar-Garcia
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona 08003,Spain
| | - Abora Rial
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Carme Gimenez-Argente
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Maria Lourdes Cos
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Jaime Rodriguez-Morera
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Isabel Campodarve
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - José Manuel Quesada-Gomez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Fundación Progreso y Salud, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Hospital Universitario Reina Sofía, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Natalia Garcia-Giralt
- IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain
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Bonora E, Fedeli U, Schievano E, Trombetta M, Saia M, Scroccaro G, Tacconelli E, Zoppini G. SARS-CoV-2 and COVID-19 in diabetes mellitus. Population-based study on ascertained infections, hospital admissions and mortality in an Italian region with ∼5 million inhabitants and ∼250,000 diabetic people. Nutr Metab Cardiovasc Dis 2021; 31:2612-2618. [PMID: 34348880 PMCID: PMC8239199 DOI: 10.1016/j.numecd.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Diabetes conveys an increased risk of infectious diseases and related mortality. We investigated risk of ascertained SARS-CoV-2 infection in diabetes subjects from the Veneto Region, Northeastern Italy, as well as the risk of being admitted to hospital or intensive care unit (ICU), or mortality for COVID-19. METHODS AND RESULTS Diabetic subjects were identified by linkage of multiple health archives. The rest of the population served as reference. Information on ascertained infection by SARS-CoV-2, admission to hospital, admission to ICU and mortality in the period from February 21 to July 31, 2020 were retrieved from the regional registry of COVID-19. Subjects with ascertained diabetes were 269,830 (55.2% men; median age 72 years). Reference subjects were 4,681,239 (men 48.6%, median age 46 years). Ratios of age- and gender-standardized rates (RR) [95% CI] for ascertained infection, admission to hospital, admission to ICU and disease-related death in diabetic subjects were 1.31 [1.19-1.45], 2.11 [1.83-2.44], 2.45 [1.96-3.07], 1.87 [1.68-2.09], all p < 0.001. The highest RR of ascertained infection was observed in diabetic men aged 20-39 years: 1.90 [1.04-3.21]. The highest RR of ICU admission and death were observed in diabetic men aged 40-59 years: 3.47 [2.00-5.70] and 5.54 [2.23-12.1], respectively. CONCLUSIONS These data, observed in a large population of ∼5 million people of whom ∼250,000 with diabetes, show that diabetes not only conveys a poorer outcome in COVID-19 but also confers an increased risk of ascertained infection from SARS-CoV-2. Men of young or mature age have the highest relative risks.
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Affiliation(s)
- Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Mario Saia
- Azienda Zero, Veneto Region, Padua, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
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Mortality Associated with Idiopathic Pulmonary Fibrosis in Northeastern Italy, 2008-2020: A Multiple Cause of Death Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147249. [PMID: 34299699 PMCID: PMC8305452 DOI: 10.3390/ijerph18147249] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
Mortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008–2019, to compare results of underlying vs. multiple cause of death analyses, and to describe the impact of the COVID-19 epidemic in 2020. We identified IPF (ICD-10 code J84.1) among the causes of death registered in 557,932 certificates in the Veneto region. We assessed time trends in annual age-standardized mortality rates by gender and age (40–74, 75–84, and ≥85 years). IPF was the underlying cause of 1310 deaths in the 2251 certificates mentioning IPF. For all age groups combined, the age-standardized mortality rate from IPF identified as the underlying cause of death was close to the European median (males and females: 3.1 and 1.3 per 100,000/year, respectively). During 2008–2019, mortality rates increased in men aged ≥85 years (annual percent change of 6.5%, 95% CI: 2.0, 11.2%), but not among women or for the younger age groups. A 72% excess of IPF-related deaths was registered in March–April 2020 (mortality ratio 1.72, 95% CI: 1.29, 2.24). IPF mortality was increasing among older men in northeastern Italy. The burden of IPF was heavier than assessed by routine statistics, since less than two out of three IPF-related deaths were directly attributed to this condition. COVID-19 was accompanied by a remarkable increase in IPF-related mortality.
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