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Internet-Based Psychological Interventions during SARS-CoV-2 Pandemic: An Experience in South of Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095425. [PMID: 35564820 PMCID: PMC9102592 DOI: 10.3390/ijerph19095425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to an increasing demand for online psychological intervention. The aim of this study is to evaluate the efficacy of received support in internet-based psychological intervention group (I-IG) patients, compared with a wait-list control group (CG). The Impact of Event Scale—Revised, Patient Health Questionnaire 9-item and Generalized Anxiety Disorder scale 7-item were administered. After participants had used the internet-based solution, the System Usability Scale was administered. In total, 221 patients (194 patients supported by internet-based interventions and 27 patients supported onsite) were included in intervention group, and 194 patients were included in CG. In a 6-month follow-up, participants in the I-IG demonstrated significant improvements in terms of PTSD risk (p < 0.0001, d = 0.64), depression (p < 0.0001, d = 0.68), and anxiety (p < 0.0001, d = 1.33), compared to the CG. Significant improvements in onsite intervention group patients with a large to very large effect size of PTSD risk (p < 0.0001, d = 0.91), depression (p < 0.0001, d = 0.81), and anxiety (p < 0.0001, d = 1.62) were found. After internet-based solution use, I-IG patients reported a very high usability and functionality (72.87 ± 13.11) of online intervention. In conclusion, SARS-CoV-2-related mental health problems can be improved by internet-based psychological intervention. The usability and functionality evaluation of online solutions by technological tools showed very positive results for the I-IG patients.
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The Effectiveness of Intervening on Social Isolation to Reduce Mortality during Heat Waves in Aged Population: A Retrospective Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111587. [PMID: 34770101 PMCID: PMC8583294 DOI: 10.3390/ijerph182111587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heat waves are correlated with increased mortality in the aged population. Social isolation is known as a vulnerability factor. This study aims at evaluating the correlation between an intervention to reduce social isolation and the increase in mortality in the population over 80 during heat waves. METHODS This study adopted a retrospective ecologic design. We compared the excess mortality rate (EMR) in the over-80 population during heat waves in urban areas of Rome (Italy) where a program to reduce social isolation was implemented, to others where it was not implemented. We measured the mortality of the summer periods from 2015 to 2019 compared with 2014 (a year without heat waves). Winter mortality, cadastral income, and the proportion of people over 90 were included in the multivariate Poisson regression. RESULTS The EMR in the intervention and controls was 2.70% and 3.81%, respectively. The rate ratio was 0.70 (c.i. 0.54-0.92, p-value 0.01). The incidence rate ratio (IRR) of the interventions, with respect to the controls, was 0.76 (c.i. 0.59-0.98). After adjusting for other variables, the IRR was 0.44 (c.i. 0.32-0.60). CONCLUSIONS Reducing social isolation could limit the impact of heat waves on the mortality of the elderly population.
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Pecoraro F, Luzi D, Clemente F. The efficiency in the ordinary hospital bed management: A comparative analysis in four European countries before the COVID-19 outbreak. PLoS One 2021; 16:e0248867. [PMID: 33750956 PMCID: PMC7984624 DOI: 10.1371/journal.pone.0248867] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/05/2021] [Indexed: 12/23/2022] Open
Abstract
During COVID-19 emergency the majority of health structures in Europe saturated or nearly saturated their availabilities already in the first weeks of the epidemic period especially in some regions of Italy and Spain. The aim of this study is to analyse the efficiency in the management of hospital beds before the COVID-19 outbreak at regional level in France, Germany, Italy and Spain. This analysis can indicate a reference point for future analysis on resource management in emergency periods and help hospital managers, emergency planners as well as policy makers to put in place a rapid and effective response to an emergency situation. The results of this study clearly underline that France and Germany could rely on the robust structural components of the hospital system, compared to Italy and Spain. Presumably, this might have had an impact on the efficacy in the management of the COVID-19 diffusion. In particular, the high availability of beds in the majority of the France regions paired with the low occupancy rate and high turnover interval led these regions to have a high number of available beds. Consider also that this country generally manages complex cases. A similar structural component is present in the German regions where the number of available beds is significantly higher than in the other countries. The impact of the COVID-19 was completely different in Italy and Spain that had to deal with a relevant large number of patients relying on a reduced number of both hospital beds and professionals. A further critical factor compared to France and Germany concerns the dissimilar distribution of cases across regions. Even if in these countries the hospital beds were efficiently managed, the concentration of hospitalized patients and the scarcity of beds have put pressure on the hospital systems.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council, Monterotondo, Rome, Italy
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Caratozzolo S, Zucchelli A, Turla M, Cotelli MS, Fascendini S, Zanni M, Bianchetti A, Psy MP, Rozzini R, Boffelli S, Cappuccio M, Psy FG, Psy CV, Bellandi D, Caminati C, Gentile S, Psy EL, Di Fazio I, Psy MZ, Vezzadini G, Psy CF, Psy MC, Psy RT, Psy SP, Scalvini A, Di Cesare M, Psy MG, Falanga L, Medici N, Palamini N, Psy EZ, Psy EG, Bellelli G, Marengoni A, Trabucchi M, Padovani A. The impact of COVID-19 on health status of home-dwelling elderly patients with dementia in East Lombardy, Italy: results from COVIDEM network. Aging Clin Exp Res 2020; 32:2133-2140. [PMID: 32918696 PMCID: PMC7486591 DOI: 10.1007/s40520-020-01676-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. AIMS To evaluate the impact of COVID-19 on health status in home-dwelling patients. METHODS 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. RESULTS Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality. DISCUSSION/CONCLUSIONS A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.
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Affiliation(s)
- Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Zucchelli
- Unità Geriatria, Dipartimento Scienze Cliniche e Sperimentale, Università degli Studi di Brescia, Brescia, Italy
| | - Marinella Turla
- Neurology Unit, Azienda Socio-Sanitaria Territoriale della Valcamonica, Esine (Brescia), Italy
| | - Maria Sofia Cotelli
- Neurology Unit, Azienda Socio-Sanitaria Territoriale della Valcamonica, Esine (Brescia), Italy
| | - Sara Fascendini
- Centro di Eccellenza Alzheimer FERB Onlus, Ospedale Briolini di Gazzaniga, Gazzaniga (Bergamo), Italy
| | - Mara Zanni
- Centro di Eccellenza Alzheimer FERB Onlus, Ospedale Briolini di Gazzaniga, Gazzaniga (Bergamo), Italy
| | - Angelo Bianchetti
- Gruppo San Donato - Ospedale Sant'Anna Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Matteo Peli Psy
- Gruppo San Donato - Ospedale Sant'Anna Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Renzo Rozzini
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Stefano Boffelli
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | | | | | - Chiara Vecchi Psy
- Coordinamento dei Caffè Alzheimer della Lombardia Orientale, Brescia, Italy
| | | | | | - Simona Gentile
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | - Elena Lucchi Psy
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | | | | | | | | | - Maura Cosseddu Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Rosanna Turrone Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Silvia Pelizzari Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Andrea Scalvini
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Marco Di Cesare
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Lina Falanga
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
| | | | | | | | - Eleonora Grossi Psy
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | - Giuseppe Bellelli
- Dipartimento Medicina e Chirurgia, Clinica Geriatrica, Università Bicocca, Milan, Italy
| | - Alessandra Marengoni
- Unità Geriatria, Dipartimento Scienze Cliniche e Sperimentale, Università degli Studi di Brescia, Brescia, Italy
| | | | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
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Pecoraro F, Clemente F, Luzi D. The efficiency in the ordinary hospital bed management in Italy: An in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak. PLoS One 2020; 15:e0239249. [PMID: 32960908 PMCID: PMC7508364 DOI: 10.1371/journal.pone.0239249] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Since the end of February 2020 a severe diffusion of COVID-19 has affected Italy and in particular its northern regions, resulting in a high demand of hospitalizations in particular in the intensive care units (ICUs). Hospitals are suffering the high degree of patients to be treated for respiratory diseases and the majority of the health structures, especially in the north of Italy, are or are at risk of saturation. Therefore, the question whether and to what extent the reduction of hospital beds occurred in the past years has biased the management of the emergency has come to the front in the public debate. In our opinion, to start a robust analysis it is necessary to consider the Italian health system capacity prior to the emergency. Therefore, the aim of this study is to analyse the availability of hospital beds across the country as well as to determine their management in terms of complexity and performance of cases treated at regional level. The results of this study underlines that, despite the reduction of beds for the majority of the hospital wards, ICUs availabilities did not change between 2010 and 2017. Moreover, this study confirms that the majority of the Italian regions have a routinely efficient management of their facilities allowing hospitals to treat patients without the risk of having an overabundance of patients and a scarcity of beds. In fact, this analysis shows that, in normal situations, the management of hospital and ICU beds has no critical levels.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council, Monterotondo (Rome), Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
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Liotta G, Gilardi F, Orlando S, Rocco G, Proietti MG, Asta F, De Sario M, Michelozzi P, Mancinelli S, Palombi L, Marazzi MC, Scarcella P. Cost of hospital care for the older adults according to their level of frailty. A cohort study in the Lazio region, Italy. PLoS One 2019; 14:e0217829. [PMID: 31185033 PMCID: PMC6559705 DOI: 10.1371/journal.pone.0217829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 01/15/2023] Open
Abstract
Background The increasing burden of chronic diseases associated with the ageing of the European population constitutes one of the main challenges for the welfare systems in developed western countries, especially through its impact on the use of hospital services and the cost of care. This study aims at evaluating the cost of hospital care for older adults living in the Lazio Region, Italy, according to their level of frailty. Methods Since 2014 a longitudinal randomized cohort study has been carried out on a sample consisting of 1280 older adults aged over 64 years resident in the Lazio region (Italy), with their being evaluated for multidimensional frailty. Accesses to Hospital Services (acute care and Day Hospital care admissions and Emergency Room accesses) during the first year after enrolment, as well as the related costs have been recorded through a regional database. Costs have been stratified on the basis of the state of frailty. Results The analysis of hospital services and costs highlights the role played by pre-frail individuals who generated 49.3% of the hospital care cumulative costs. Hospital Admission (HA) costs arising from robust and pre-frail subjects are 70% of the total HA costs. Pre-frail individuals also showed the highest average HA cost per person/year (7062.89 Euros). The main determinant of the highest HA costs was given by the number of HAs during the follow-up (multivariate linear regression, ß coefficient = 0.319; p<0.001), which was higher among pre-frail individuals than in any other group of patients. Conclusions Pre-frail individuals generated the highest cost for hospital care in a sample of representative subjects living in an Italian Region with a low rate of community care services, as is the case in the Lazio region. Assessment of the multidimensional frailty of older adults permits a better definition of the important target of the pre-frail population as the main category within which interventions to prevent or mitigate frailty should be carried out.
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Affiliation(s)
- Giuseppe Liotta
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - Francesco Gilardi
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
- * E-mail:
| | - Stefano Orlando
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | | | | | - Federica Asta
- Regione Lazio Department of Epidemiology, Rome, Italy
| | | | | | - Sandro Mancinelli
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - Leonardo Palombi
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | | | - Paola Scarcella
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
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Gilardi F, Scarcella P, Proietti MG, Capobianco G, Rocco G, Capanna A, Mancinelli S, Marazzi MC, Palombi L, Liotta G. Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study. Eur J Public Health 2019; 28:842-846. [PMID: 29590362 PMCID: PMC6148968 DOI: 10.1093/eurpub/cky006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Lowering mortality and hospitalization of older adults is one of the main goals of public health to improve both health systems’ sustainability and older adults’ quality of life. The aim of this study is to identify the determinants associated with mortality and the use of hospital services in the population older than 64 years of age. Methods A randomized sample from the population of the Lazio region (Italy) above the age of 64 was enrolled in 2014 by the administration of a questionnaire to assess frailty; the rates of use of hospital services and mortality in the year following the enrolment have been retrieved by the regional database. Univariable and multivariable analyses addressed the association of health status, social and economic variables with health outcomes. Results One thousand two hundred and eighty persons were recruited; 52 deaths were reported at 1 year of follow-up (robust 1.8%, frail 10.1% and very frail 19.1%, P < 0.001). The mean rate of use of hospital services was 692.2 per 1000 observation/year (robust 589.5, frail 1191.1 and very frail 848.4, P < 0.001). In the multivariate analysis, the higher rate of use of hospital services was independently associated with functional status, social support, psychological/psychiatric discomfort, availability of home care services and physical health. Conclusions Frailty, as a multidimensional issue, is also a strong predictor of survival in the short term. The use of the hospital services by older adults is associated mainly with functional status, social resources, psycho-physical status and health service organization factors.
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Affiliation(s)
- Francesco Gilardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Giovanni Capobianco
- Geriatric Division, Hospital Sant'Eugenio, Local Health Unit Roma 2, Rome, Italy
| | | | - Alessandra Capanna
- School of Specialization in Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Cammarota S, Cargiolli M, Andreozzi P, Toraldo B, Citarella A, Flacco ME, Binda GA, Annibale B, Manzoli L, Cuomo R. Increasing trend in admission rates and costs for acute diverticulitis during 2005-2015: real-life data from the Abruzzo Region. Therap Adv Gastroenterol 2018; 11:1756284818791502. [PMID: 30159036 PMCID: PMC6109850 DOI: 10.1177/1756284818791502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Scarce data are available on the epidemiological trend of diverticulitis and its financial burden in Italy. The aim of this work was to explore a potential variation in the rate and costs of hospital admissions for uncomplicated and complicated diverticulitis over the last decade. METHODS We selected all hospitalizations for diverticulitis of residents in the Abruzzo Region, Italy between 2005 and 2015. Age-standardized hospitalization rates (HRs) per 100,000 inhabitants for overall, uncomplicated and complicated diverticulitis were calculated. A linear model on the log of the age-standardized rates was used to calculate annual percentage changes (APC). Costs were derived from the official DRG tariff. RESULTS From 2005 to 2015, the HR for acute diverticulitis increased from 38.9 to 45.2 per 100,000 inhabitants (APC + 1.9%). The HR for complicated diverticulitis increased from 5.9 to 13.3 (APC + 7.6%), whereas it remained stable for uncomplicated diverticulitis. The mean hospital cost was 1.8-times higher for complicated diverticulitis compared with that for uncomplicated disease and 3.5-times higher for patients with a surgery stay compared with that for patients with a medical stay. CONCLUSION During the last decade, in the Abruzzo Region, the HRs for diverticulitis and their costs increased significantly, mainly due to disease complications. Further studies are needed to explore strategies to prevent complications and to realise cost-saving policies.
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Affiliation(s)
- Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | - Martina Cargiolli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | - Paolo Andreozzi
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | | | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | | | | | - Bruno Annibale
- Medical-Surgical Science and Translational Medicine Department, Sapienza University, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy; Regional Healthcare Agency of Abruzzo, Pescara, Italy
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