Patterns of utilisation of specialist care after SARS-Cov-2 infection: a retrospective cohort study.

OBJECTIVE: To explore the pattern of health services utilisation of people who had had a documented SARS-Cov-2 infection. DESIGN: Retrospective cohort study. SETTING: The Italian province of Reggio Emilia. PARTICIPANTS: 36 036 subjects who recovered from SARS-CoV-2 infection during the period September 2020-May 2021. These were matched for age, sex and Charlson Index with an equal number of subjects never found positive at the SARS-Cov-2 swab test over the study period. MAIN OUTCOME MEASURES: Hospital admissions for all medical conditions and for respiratory or cardiovascular conditions only; access to emergency room (for any cause); outpatient specialist visits (pneumology, cardiology, neurology, endocrinology, gastroenterology, rheumatology, dermatology, mental health) and overall cost of care. RESULTS: Within a median follow-up time of 152 days (range 1-180), previous exposure to SARS-Cov-2 infection was always associated with higher probability of needing access to hospital or ambulatory care, except for dermatology, mental health and gastroenterology specialist visits. Post-COVID subjects with Charlson Index≥1 were hospitalised more frequently for heart disease and for non-surgical reasons than subjects with Charlson index=0, whereas the opposite occurred for hospitalisations for respiratory diseases and pneumology visits. A previous SARS-CoV-2 infection was associated with 27% higher cost of care compared with people never infected. The difference in cost was more evident among those with Charlson Index>1. Subjects who had anti-SARS-CoV-2 vaccination had lower probability of falling in the highest cost quartile. CONCLUSIONS: Our findings reflect the burden of post-COVID sequelae, providing some specific insight on their impact on the extra-use of health services according to patients' characteristics and vaccination status. Vaccination is associated with lower cost of care following SARS-CoV-2 infection, highlighting the favourable impact of vaccines on the use of health services even when they do not prevent infection.

[About the communication of health research: generating trust through information and education.] / La comunicazione della ricerca scientifica: informare (e formare) generando fiducia.

Public communication strategies of scientific findings can be placed at various levels on a scale that originates from purely informative methods and, through increasingly persuasive methods, goes up to coercion. Institutional communication of science during the covid-19 pandemic is affected by the tension between the pursuit of the ethics of transparency and the need to achieve public health goals: a communication focused on information, that neutrally highlights both the risks and the advantages of an intervention, could reduce the acceptance of this intervention in the short term, but consolidate people's trust in institutions in the long term. On the other hand, a more persuasive communication could lead to a greater adherence to the proposed intervention in the short term, but weaken the trust of the communication's recipients towards the institutions. Whenever there is robust evidence in favor of the net benefit of an intervention, informative and persuasive communication tend to overlap, while interventions with an uncertain relation between pros and cons should orient communication towards more informative strategies: even when this is not possible, as in the case of health emergencies, transparency in communication remains decisive. In this regard, transparency is configured as the common denominator of a type of science communication that can generate trust in its recipients. But transparency alone is not enough. In fact, its effectiveness is lost if the communicated contents are not useful and if the recipients of the messages are not able to receive them adequately. Based on Italo Calvino's Six Memos, we define six requirements for transparent communication of scientific research and emphasize the importance of interventions aimed at promoting health literacy since primary school, such as the international Informed Health Choices project.

[Access to anti-covid vaccines: research, development and role of patents.] / Accesso ai vaccini anticovid: ricerca, sviluppo e ruolo dei brevetti.

Access to vaccines against covid-19 is a very topical issue. On the one hand, we are suffering from supply problems and inadequate availability of doses both nationally and internationally. On the other hand, public health needs do not coincide with those of the market economy: the need to vaccinate the entire world population to overcome the pandemic cannot be satisfied due to market rules and limits in production processes. The result is a radical inequality in access to vaccines. We are aware of the delicate balance between health and economy: the latter cannot ignore the former. Also for this reason, the demand for greater equity in access to vaccines is growing: the race for innovation may not be hindered by a targeted relaxation of the rules on intellectual property during a pandemic health emergency.

[Vitamin D and coronavirus: a new field of use?] / Viramina D e coronavirus: un nuovo campo di impiego?

Given the succession of communications in scientific and popular circuits, tending to take for granted a role for vitamin D in the control of the coronavirus pandemic, the authors conducted an analysis of the literature currently available in order to recognize what is supported by opinions personal and what evidence of effectiveness. At the end of the bibliographic survey there is the current absence of evidence of efficacy in favor of vitamin D in the treatment of coronavirus infection in its various expressions. The diffusion of personal opinions as if they were evidence can be a disturbing factor for adequate assistance and for correct research.