Emergency calls for time-depending during COVID-19 outbreak in center Italy

In the present study we analysed the emergency calls to the Umbrian Emergency Medical System (reached by dialling the emergency telephone number 118), that occurred for time-dependent-illnesses during the pandemic. Our analysis included all out-of- hospital ACSs, strokes and cardiac arrests electronically stored in the Emergency Department database. During the trimester 1st February- 30th April a total of 61,867 and 63,194 calls were registered in 2019 and 2020, respectively. In year 2020, compared to year 2019, there was a significant reduction in the frequency of calls to 118 for ACS (0.009% vs 0.14% 2=25.71, p=0.01), a non-significant reduction in the calls due to stroke (0.48% vs 0.5% 2=1.1, p=0.2) and cardiac arrest (0.43% vs 0.47%;2=2.85, p=0.09). Overall, these findings strongly suggest that, during the COVID-19 pandemic, a lower attention has been posed to time-dependent illness. This dramatically led to a general underutilization of the emergency medical system, and consequently reduced the number of time-dependent hospitalizations. Considering the differences among ACS calls with respect to stroke calls, we could speculate that patients who have a clinical presentation with mild symptoms have preferred to stay at home, given the widespread fear of going to hospitals.

Urban Green Spaces and Public Health Outcomes: a systematic review of literature

Background As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity. Methods In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included. Results Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects. Conclusions To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity. Key messages Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.

Application of the "immunization islands" model to improve quality, efficiency and safety of a COVID-19 mass vaccination site.

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.

COVID-19 and Recreational Skiing: Results of a Rapid Systematic Review and Possible Preventive Measures

COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. These measures were mostly upheld throughout the 2020 and 2021 winter season, generating significant economic loss for mountain communities. The aim of this rapid systematic review was to explore the association between recreational skiing and the spread of COVID-19. This review was conducted according to the WHO practical guidelines on rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, MedRxiv and Promed-mail were screened to identify relevant scientific and grey literature published since the emergence of COVID-19. Among the 11 articles included, seven focused on cases recorded during the first epidemic wave, when COVID-19 containment measures were not yet mandatory. Most infection clusters could be directly linked to public gatherings which took place without the enforcement of restrictions. There is currently no evidence to suggest an association between COVID-19 spread and recreational skiing. It may be reasonable to consider the reopening of ski areas in compliance with strict rules and preventive measures.

Epidemiology of emergency calls for time-dependent acute illnesses during COVID-19 outbreak in Umbria region (Italy).

The recent literature reported an inverse correlation between COVID-19 pandemic and hospital admissions for Acute Coronary Syndromes (ACS).