Comparison of geographical and individual deprivation index to assess the risk of Sars-CoV-2 infection and disease severity: a retrospective cohort study

BACKGROUND

It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020.

METHODS

This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction.

RESULTS

In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI.

CONCLUSIONS

Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.

Comparing Different Sticky Traps to Monitor the Occurrence of Philaenus spumarius and Neophilaenus campestris, Vectors of Xylella fastidiosa, in Different Crops

Following the detection of the quarantine bacterium Xylella fastidiosa (Wells et al.) in the Apulia region (southern Italy) and the identification of spittlebugs as the main vector species that contributes to its epidemic spread, monitoring activities have been intensified in an attempt to implement vector control strategies. To date, sweep nets have been the most widely used sampling method to monitor adult spittlebug populations. Field experiments were carried out, during 2018 and 2019, to evaluate the effectiveness of sticky traps in capturing spittlebugs in different woody crops. The attractiveness of different traps was compared: four colored sticky traps (white, red, blue, and yellow), with the yellow sticky traps having three different background patterns (plain yellow, yellow with a black circle pattern, and yellow with a black line pattern). In addition, the efficiency of the yellow sticky traps was evaluated by placing the traps on the ground or hanging them from the canopies in orchards with different spittlebug population densities. Trap catches of Philaenus spumarius (Linnaeus) and Neophilaenus campestris (Fallén) (Hemiptera: Aphrophoridae) were compared with those collected using sweep nets. The two spittlebug species showed a similar response to the colored traps and were mainly attracted to the yellow sticky traps. Captures throughout the adult season indicated that an accurate estimation of the presence and abundance of spittlebugs can be obtained by integrating the two sampling methods. Moreover, sweep nets appeared to be more efficient in collecting adults soon after their emergence, while the use of sticky traps was more efficient in the rest of the adult season when the use of traps can significantly expedite vector monitoring programs.

First report of Ceratocystis ficicola causing wilt disease on common fig (Ficus carica) in Italy

Common fig (Ficus carica L.) in is one of the most important crops in the Mediterranean area. In Italy, it is grown on a total area of 2118 ha. In Apulia (South-eastern Italy), the annual production of fig exceeds 3200 tons annually and together with olive and grapevine, they characterize the Apulian agricultural panorama. In September 2021, symptoms of a vascular wilt disease and, in severe cases, decline tree mortality were observed in Salento area (Apulia). Symptomatic Affected plants showed symptoms of leaf wilt and different stages of disease expression, which begins with leaf chlorosis on shoots, followed by wilting, extensive defoliation and twig dieback. On the main branches andlower part of the trunk and in some cases on lateral branches, bark cracks and cankers were observed and extended wood discoloration was detected in cross sections. In two orchards located in Salice Salentino (Site 1) and Squinzano (Site 2), where disease incidence exceeded 80%, 3-5 wood discs per tree were gathered from affected tissues from two (Site 1) and four (Site 2) trees. Isolations were performed on malt extract agar 2% amended with 0.5 g L-1 streptomycin sulfate. A Ceratocystis species was recovered from all samples trees with high frequencies (83.3%). Two-week-old colonies on potato dextrose agar showed black ascomata with 300-600 µm wide bases and 1100-2250 µm long necks. On the tips of the necks, ascospores (5-6x4-5 µm) exuded in creamy white sticky masses. Endoconidia (5-9x4.5-7 µm) were abundant, cylindrical, aseptate, and produced in chains. Two monoconidial representative strains CRSFA.Cer.033 (Site 1) and CRSFA.Cer.035 (Site 2) were deposited in the DISSPA Di.S.S.P.A. collection of the University of Bari. Species identification was done through sequence analyses of rDNA internal transcribed spacer region (ITS) using ITS5/ITS4 primers (White et al. 1990), elongation factor 1 alpha gene (TEF) using EF1/EF2 (O'Donnell et al. 1998) and RNA polymerase II gene (RPB2) gene using RPB2-5F/FRPB2fRPB2-7cR (Liu et al. 1999). Sequences were deposited in NCBI GenBank (accession numbers: OQ329983-OQ335969 (ITS), OQ352265-OQ352266 (TEF), OQ352268-OQ352267 (RPB2)). The sequences of both Apulian isolates were identical. BLAST searches revealed high similarity to the sequences of two isolates of Ceratocystis ficicola Kajitani and Masuya from Japan: ex-type CMW38543 and CMW38544, specifically 98.41% identity matching with KY685076 (ITS), 100% with KY685079 (TEF), and 99.87% with KY685083 and KY685082 (RPB2). Pathogenicity tests were conducted, on six common fig 'Dottato' seedlings by inoculating one year-old twigs with mycelium plugs (Bolboli et al. 2022). Control plants were inoculated with PDA plugs without mycelium. After one month, all inoculated twigs showed symptoms of wilt. Forty days post-inoculation, the bark of inoculated twigs was removed, and longitudinal and transverse sections revealed wood discolorations extending above and below the inoculation point. Ceratocystis ficicola was consistently reisolated from symptomatic tissues and identified as described above, thus fulfilling Koch's postulates. Neither symptoms nor positive isolations were observed in control seedlings. The pathogen was first described in 2011 in Japan (Kajitani and Masuya, 2011) where it currently affects all fig-producing areas. In 2018, it was reported for the first time in the EPPO region in Greece (Tsopelas et al., 2021), and to our knowledge, this is the first report on its detection in Italy. Since February 2022, C. ficicola has been included in the EPPO alert list because of its potential to cause tree mortality and the difficulty of its eradication. Regional national surveys are therefore urgently needed to determine its distribution in the fig growing areas of Italy and limit its spread. References Bolboli, Z., et al. 2022. Mycol. Prog. 21:89. doi: 10.1007/s11557-022-01834-9 Kajitani, Y., and Masuya, H., 2011. Mycoscience 52:349. doi: 10.1007/s10267-011-0116-5 Liu, Y. J., et al. 1999. Mol. Biol. and Evol. 16:1799. doi: 10.1093/oxfordjournals.molbev.a026092 O'Donnell, K., et al. 1998. Proc Natl Acad Sci USA 95:2044. doi: 10.1073/pnas.95.5.2044 Tsopelas, P., et al. 2021. Phytopathol. Mediterr. 60:337. doi: 10.36253/phyto-12794 White, T. J., et al. 1990. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego. doi: 10.1016/0307-4412(91)90165-5.

Pigments and Techniques of Hellenistic Apulian Tomb Painting

The wall paintings of five Hellenistic tombs in Apulia were analysed using a multi-technique approach to discern the painting techniques used and contextualise them within the phenomenon of Hellenistic tomb painting in Southern Italy. In particular, the question was asked whether technical knowledge played a role in the reception of Hellenistic artistic models and whether this knowledge was present locally. Raman and IR spectroscopies were used to identify pigments, colourants, and binders; light and electron microscopy were used to determine the structural characteristics of the paint layers and recognise the manufacturing technique. Analyses identified a fresco application for the Tomba dei Cavalieri (Arpi) and a dry application for the Canosian hypogea. The palette-typical for Hellenistic tomb painting in Southern Italy, Etruria and Macedonia-was composed of lime (white), charcoal (black), hematite (red), goethite (yellow), and Egyptian blue (blue). In the Tomba della Nike (Arpi), meanwhile, two particularly refined preparatory layers were observed. The palette was enriched with precious cinnabar and madder lake. The colouring components of the root were mixed with clay and K-alum applied on an additional layer of lime. The use of madder lake and a pink background link the painting to the polychrome Daunian pottery, and the contribution of a local workshop to the decoration of this tomb thus seems plausible.

Pedosedimentary and microbial investigation of a karst sequence record

A 3-m thick sediment sequence, found in a limestone mine located in the south of Italy at a depth of ca. 25-30 m from the current ground level, was investigated. Samples from 5 layers were analysed by X-ray diffraction, elemental analysis, Inductively Coupled Plasma Mass Spectrometry and micromorphology. Microbial DNA was analysed by 16S rRNA gene metabarcoding. The main mineral compounds found in the 5 layers were calcite (70-80%) and clay minerals in layers #1 and #5, goethite (75%) and hematite in layer #2, manganese (66%) and iron oxides in layer #3, and almost exclusively goethite in layer #4. Micromorphology data allowed to shed light in understanding whether these sediments formed by subsequent weathering of carbonates and silicates or by migration of soil sediments from the surface, or also by the accumulation of shallow marine sediments occurring between the middle Pliocene and the lower Pleistocene, when the extreme western sector of this area underwent strong subsidence. From the microbiological point of view, upon the 16S rRNA gene analysis, these 5 layers appear to cluster in three groups. Overall, such a distribution suggests that, both in the top (#1) and in bottom layers (#4 and #5), different communities would have undergone in situ reproduction and colonization exploiting metabolically the substrate, whereas the two mid layers would have received bacterial convection by passive transport of percolating waters. At the same time, micromorphological data show that each layer preserved its distinct features to be related to the environmental condition at the time of deposition. The chemical, mineralogical and micromorphological features of the layers and the known physiology of the microbial taxa thereby encountered highlight the possible role of the latter in elucidating the occurrence of certain mineral species as well as the biogeochemistry of elements like Mn and Fe in sediment layers.

Entomological Surveillance in Former Malaria-endemic Areas of Southern Italy

Malaria still represents a potential public health issue in Italy, and the presence of former Anopheles vectors and cases imported annually merit continuous surveillance. In areas no longer endemic, the concurrent presence of gametocyte carriers and competent vectors makes re-emergence of local transmission possible, as recently reported in Greece. In October 2017, due to the occurrence of four suspected introduced malaria cases in the province of Taranto (Apulia region), entomological investigations were performed to verify the involvement of local anopheline species. In 2019–2020 entomological surveys were extended to other areas historically prone to malaria between the provinces of Taranto and Matera and the province of Foggia (Gargano Promontory). Resting mosquitoes were collected in animal shelters and human dwellings, larvae were sampled in natural and artificial breeding sites, and specimens were both morphologically and molecularly identified. A total of 2228 mosquitoes were collected, 54.3% of which were anophelines. In all the investigated areas, Anopheles labranchiae was the most widespread species, while Anopheles algeriensis was predominant at the Gargano sites, and Anopheles superpictus and Anopheles plumbeus were recorded in the province of Matera. Our findings showed a potentially high receptivity in the surveyed areas, where the abundance of the two former malaria vectors, An. labranchiae and An. superpictus, is related to environmental and climatic parameters and to anthropic activities.

Traditional Old Dietary Pattern of Castellana Grotte (Apulia) Is Associated with Healthy Outcomes

BACKGROUND

There is still room for further studies aimed at investigating the most widespread diets in the Mediterranean area. The objective of the study is to analyze the relation of food group intake to clinical chemical indicators of health, and also to compare the food group intake with healthy well-known diet indices.

METHODS

Lifestyle, dietary, and clinical data collected in 2005/2006 and 2012/2018 from Castellana Grotte, located in the rural area of Apulia, were analyzed. The study populations included newly recruited subjects at each time period (n = 1870) as well as subjects examined twice and compared over time regarding health indicators (n = 734). Diet was assessed through a validated food frequency questionnaire. Three healthy diet indices were calculated and related to 29 food groups. We also performed prospective regression of food group consumption with health indicators.

RESULTS

The diet over the time period of observation was very stable and consisted of a high proportion of vegetables, fruit and grains. No major changes in body mass index (BMI) and blood pressure were observed. Consumption of low-fat dairy, juices, olive oil, and water were related to reductions in weight gain, systolic blood pressure, high-density lipoprotein (HDL)-cholesterol and cholesterol (total and HDL) levels, in that order. Over the time periods we observed only a slight decrease of adherence to the Meddietscore. The correlations of the healthy diet indices with food groups revealed some differences among the indices, mostly regarding the intake of fruit and vegetables.

CONCLUSIONS

The dietary pattern of Apulia is in line with many principles of a healthy diet and the cohort population seems to be less liable to undergo a transition to a westernized diet.

Age-Related Central Auditory Processing Disorder, MCI, and Dementia in an Older Population of Southern Italy

OBJECTIVE

We explored the associations of age-related central auditory processing disorder (CAPD) with mild cognitive impairment (MCI) and dementia in an older population-based cohort in Apulia, Southern Italy (GreatAGE Study).

STUDY DESIGN

Cross-sectional data from a population-based study.

SETTING

Castellana Grotte, Bari, Italy.

SUBJECTS AND METHODS

Between 2013 and 2018, MCI, dementia, age-related CAPD (no disabling hearing loss and <50% score on the SSI-ICM test [Synthetic Sentence Identification-Ipsilateral Competing Message]), neurologic and neuropsychological examinations, and serum metabolic biomarkers assays were investigated on 1647 healthy volunteers aged >65 years.

RESULTS

The prevalences of age-related CAPD, MCI, and dementia were 14.15%, 15.79%, and 3.58%, respectively. Among the subjects with MCI and dementia, 19.61% and 42.37% had age-related CAPD. In the regressive models, age-related CAPD was associated with MCI (odds ratio, 1.50; 95% CI, 1.01-2.21) and dementia (odds ratio, 2.23; 95% CI, 1.12-4.42). Global cognition scores were positively associated with increasing SSI-ICM scores in linear models. All models were adjusted for demographics and metabolic serum biomarkers.

CONCLUSION

The tight association of age-related CAPD with MCI and dementia suggests the involvement of central auditory pathways in neurodegeneration, but it is not clear which is the real direction of this association. However, CAPD is a possible diagnostic marker of cognitive dysfunction in older patients.

How can the role of leachate on nitrate concentration and groundwater quality be clarified? An approach for landfills in operation (Southern Italy)

Where the unique natural water resource is groundwater, the attention and the susceptibility of local communities and authorities to groundwater quality degradation risks can be so high to determine relevant problems to waste management, especially for landfills in operation or to be realised. A multi-methodological approach was suggested with the purpose to clarify the role of landfill leakage on groundwater quality degradation. The selected study area (SSA) hosts some landfills in a narrow portion of a wide and deep coastal karstic aquifer, for these characteristics to be considered a case of high hydrogeological complexity and vulnerability. News concerning nitrate and secondly iron groundwater concentration anomalously high caused concern in the population and strong local opposition to landfills. The multi-methodological approach includes: the hydrogeological site characterization; the chemical study and the multi-isotope characterization of groundwater and leachate; the land use analysis and the estimation of nitrogen contributions deriving from fertilizers; the mineralogical study of groundwater suspended particles to define the role of natural soil substances. The hydrogeological site characterisation highlighted the local peculiarities of the aquifer. The chemical study was used to define geochemical features, groundwater and leachate characteristics and their macroscopic mixing. The environmental isotopes of hydrogen, carbon, nitrogen, and oxygen were used to investigate the groundwater origin, the most relevant geochemical reactions, the existence of groundwater-leachate mixing, and the sources of anthropogenic NO₃^-. The land use analysis highlighted quantity and type of used fertilizers permitting to compare these with groundwater in terms of isotopic signature. The mineralogical study demonstrated the role of suspend natural particles due the presence of terre rosse (red or residual soils) in groundwater. The approach confirmed that there are not the groundwater quality degradation effects of landfills, contributing to reassure population and institutions, simplifying the waste management.

Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Impact of Mycobacterium avium subspecies paratuberculosis on profit efficiency in semi-extensive dairy sheep and goat farms of Apulia, southern Italy

A recent study on paratubercolosis in semi-extensive dairy sheep and goat farms in Apulia revealed a flock positivity of 60.5% and a seroprevalence of 3.0% for sheep and 14.5% for goat, with peaks of 50%. In such a context, providing detailed economic information is crucial for the implementation of a suitable control plan. In this paper we investigated the impact of Mycobacterium avium subspecies paratuberculosis (MAP) on profit efficiency of the Apulian dairy sheep and goat farms. Empirical results through a stochastic frontier model showed that the uninfected farms had a mean level of profit efficiency of 84%, which dropped to 64% in the presence of paratubercolosis as it negatively affected the productivity of feeding, veterinary and labour factors. Structural, managerial and production aspects were involved in the greater inefficiency of the infected farms compared to the uninfected ones: lower experience and schooling of farmers, no access to credit, fewer family members (women in particular) participating in the farming activities, high density of animals per hectare, small flocks, high number of goats in mixed flocks, no confinement practices for young and purchased animals and no pasture rotation. Hence, targeted interventions on these factors by decision makers can ensure effectiveness and efficiency to veterinary and economic action plans.

Microbiological and hydrogeological assessment of groundwater in southern Italy

This study represents the first investigation of microbiological groundwater pollution as a function of aquifer type and season for the Apulia region of southern Italy. Two hundred and seven wells were randomly selected from those monitored by the Regional Agency for Environmental Protection for emergency use. Both compulsory (Escherichia coli, Total Coliform, and Enterococci) and optional (Pseudomonas aeruginosa, Salmonella spp., Heterotrophic Plate Count at 37 and 22 °C) microbiological parameters were assessed regularly at these wells. Groundwater from only 18 of the 207 (8.7 %) wells was potable; these all draw from karst-fissured aquifers. The remaining 189 wells draw from karst-fissured (66.1 %) or porous (33.9 %) aquifers. Of these, 82 (43.4 %) tested negative for Salmonella spp. and P. aeruginosa, while 107 (56.6 %) tested positive for P. aeruginosa (75.7 %), Salmonella spp. (10.3 %), or for both Salmonella spp. and P. aeruginosa (14 %). A logistic regression model shows that the probability of potable groundwater depends on both season and aquifer type. Typically, water samples were more likely to be potable in autumn-winter than in spring-summer periods (odds ratio, OR = 2.1; 95 % confidence interval, 95 % CI = 1.6-2.7) and from karst-fissured rather than porous aquifers (OR = 5.8; 95 % CI = 4.4-7.8). Optional parameters only showed a seasonal pattern (OR = 2.6; 95 % CI = 1.7-3.9). Clearly, further investigation of groundwater microbiological aspects should be carried out to identify the risks of fecal contamination and to establish appropriate protection methods, which take into account the hydrogeological and climatic characteristics of this region.

Pulverized human skull in pharmacological preparations: possible evidence from the "martyrs of Otranto" (southern Italy, 1480)

ETHNOPHARMACOLOGICAL RELEVANCE

Ever since the Late Medieval Ages historico-medical literature has attested the use of cranium humanun as an ingredient in pharmacological preparations for the treatment of epilepsy. Some authors suggest the use of pulverized bone obtained from individuals who died a violent death and were not buried.

MATERIALS AND METHODS

The skeletal remains of hundreds of male inhabitants from Otranto, killed by the Ottomans in a mass execution on 14 August, 1480, are preserved in the Chapel of Martyrs in Otranto Cathedral (Apulia, southern Italy). The so-called "martyrs of Otranto" were beatified in 1771 and canonized by Pope Francis on 12 May, 2013. A cranial vault with 16 holes of different sizes, with regular rounded shape, was noticed among the skeletal remains, symmetrically arranged behind five large rectangular windows. Eight of the 16 holes, which exposed the diploe without reaching the endocranial surface, are incomplete perforations, while 8 holes are complete perforations; no evidence of bone reaction is visible.

RESULTS

The lesions are the result of a multiple trepanation performed by using an instrument equipped with a large rounded tip. This tool could not produce bone discs, but only bone powder. It is impossible to establish with certainty the reasons for these multiple trepanations, but several hypotheses can be advanced, ranging from experimental surgery to a procedure designed to obtain relics. However, saint bones are very likely to have been regarded as having medicinal properties. As a matter of fact the martyrs of Otranto died a violent death and were not buried, and the pulverized bone obtained from their skulls might have been considered a particularly powerful ingredient for pharmacological preparations, as attested in the historico-medical literature.

CONCLUSIONS

The skull of Otranto might represent a unique evidence of multiple trepanations carried out to obtain bone powder as ingredient for therapeutic preparations.

Risananeiza crassaparies n. sp. from the upper Chattian of Porto Badisco (southern Apulia, Italy)

A new species of Rotaliidae, Risananeiza crassaparies n. sp., is described from the upper Chattian of the Porto Badisco Calcarenites (Salento Peninsula, Southern Italy). The studied specimens are assigned to the foraminiferal genus Risananeiza based on the presence of vertical canals in both the ventral and dorsal side of the test, and an intraseptal canal system that evolves into marginal sutural canals. The new species differs from the type species of the genus, R. pustulosa, in having a lower chamber lumen, and smaller dimension.