ABSTRACT
The ocean is facing multiple pressures from human activities, including the effects of climate change. Science has a prominent role in identifying problems and communicating these to society. However, scientists are also increasingly taking an active role in developing solutions, including strategies for adapting to and mitigating climate change, increasing food security, and reducing pollution. Transmitting these solutions to society changes our narrative about the ocean and motivates actions. The United Nations triple initiatives for this decade-the Sustainable Development Goals, the Decade on Ocean Science for Sustainable Development, and the Decade of Ecosystem Restoration-provide the momentum for this change in narrative and focus. Here, we reflect on the search for solutions and the need for better ways of communicating science in a positive way. We synthesize insights from a summer school held during the COVID-19 pandemic and present some examples of successes and failures and the lessons learned from these.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19), had two pandemic waves in 2020, respectively in April and November. In the general population, the first wave has been characterized by a higher prevalence in Northern Italy and a higher mortality rate compared to the second one. The aim of this study was to compare the characteristics of IBD patients and negative outcomes of COVID-19 (pneumonia, hospitalization, ventilatory support, death) between the two pandemic waves in Italy. Methods: Prospective observational cohort study. Patients with diagnosis of IBD and confirmed SARS-CoV-2 infection were enrolled. Differences between first and second wave were tested for significance using the Student's t test and Fisher's test, as appropriate. A two-tailed p value <0.05 was indicative of statistical significance. Results: We enrolled 937 IBD patients from 47 participating IBD centres across Italy (219 in the first wave, 718 in the second wave). There were no significant differences between the first and the second wave in terms of age (46.3 ± 16.0 vs. 44.1 ± 15.5 years, p=0.06) and gender (female 45.7% vs. 48.2%, p= 0.54). In the first wave, a lower percentage of patients was affected by Crohn's disease (CD): 92 (42.0%) vs. 399 (55.6%) (p<0.001) while no differences were observed for disease clinical activity: 97/219 (44.3%) vs. 280/718 (38.9%) in the first and second wave, respectively (p=0.18). Regarding biologic therapy, the percentage of patients on biologics in the two waves was similar: 119/219 (54.3%) vs. 393/718 (54.7%) (p=0.94), without differences in anti-TNFalpha, anti-integrins and anti-IL12/23 distribution. During the first wave, a significantly higher percentage of patients were from Northern Italy compared to Central-Southern Italy: 171/219 (78.1%) vs. 387/718 (53.9%), respectively (p<0.001). Overall, COVID-19 negative outcomes were significantly higher in the first wave compared to the second one: 110 (50.2%) vs. 95 (13.2%), respectively (p<0.001). Also the single negative outcomes were significantly higher in the first wave: 61/219 (27.8%) vs. 84/718 (11.7%) had pneumonia, 62/219 (28.3%) vs. 76/718 (10.6%) required hospitalization, 26/219 (11.9%) vs. 39/718 (5.4%) required ventilatory support, and 12/219 (5.5%) vs. 13/718 (1.8%) died (Figure 1). Conclusion: IBD patients had higher number of COVID-19 negative outcomes in the first wave than in second wave. In the first wave, a significantly higher percentage of patients were from Northern Italy, but no significant differences in negative outcomes were observed in comparison with those from Central- Southern Italy. Overall, findings in IBD population are coherent with those observed in the general population. (Table Presented).
ABSTRACT
Background and aim: Telemedicine has become a fundamental tool in the management of inflammatory bowel diseases and its role has mainly emerged due to the current COVID-19 pandemic.“Vicini di Salute” is a home telemonitoring project, born to support the management of patients affected by chronic diseases, such as Ulcerative Colitis (UC). The primary aims were to assess (1) the degree of involvement of UC patients, (2) the clinical disease course and the adherence to therapy and (3) the impact of the UC on health status. The secondary aim was to evaluate the degree of patient satisfaction. Materials and methods: The study design was to prospectively enrol twenty adult UC patients with quiescent or mild to moderate disease. They received a tablet for 6 months through which questionnaires about adherence to therapy and UC-related symptoms were periodically administered. The health-related quality of life was assessed through the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). The Satisfaction Questionnaire was sent at the baseline and then every three months. Patients also received educational and motivational messages related to bowel disease. Results: Patients received the tablets in June 2020 and all of them completed the study. Demographics and clinical characteristics of the participants are shown in Table 1. Eighty percent of patients regularly used the device and more than 95% answered all questionnaires at least once. The compilation rate was inversely proportional to the frequency of administration (from 54% of the weekly ones up to 80% of the quarterly Satisfaction Questionnaires). Thirteen patients completed at least two questionnaires on UC-related symptoms per month. Among them, 31% maintained clinical remission, 38% achieved clinical remission, 15% had persistent disease activity and 16% experienced disease flare. Based on treatment adherence questionnaires, therapy was regularly assumed in 89%, it was not spontaneously changed in 70% and it was interrupted for well-being in 2%. The mean SIBDQ score was 49±15. Participants reported a mean degree of satisfaction of 8,5 of 10. (table presented) Conclusions: This study was the first in Italy to be focused on telemedicine in UC patients. It showed a high involvement rate and it represented an important tool to assess the clinical disease course and the adherence to therapy, improving the overall management of patients. Based on our experience, telemedicine could become a promising method in the management of UC patients in clinical practice.