Strengthening preparedness against global health threats: A paradigm shift based on One Health approaches.

The implementation of preparedness strategies to prevent and mitigate the impact of global health threats poses several challenges. It should promptly identify cross-cutting drivers of pandemic threats, assess context-specific risks, engage multiple stakeholders, and translate complex data from multiple sources into accessible information for action. This requires a coordinated, multidisciplinary and multisectoral effort engaging systems that, most of the time, work in isolation. The One Health (OH) approach promotes the collaboration and communication among different disciplines and sectors, and could be applied across the preparedness phases at national and international level. We discuss here gaps and needs in preparedness strategies, which can benefit from the OH approach, and a set of actionable recommendations, as shared with the G20-2021 with a dedicated Policy Brief. The discussion adds to the current debate about OH operationalization and promotes a paradigm shift towards coordinated prevention and preparedness strategies for early assessment and management of global health threats.

Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis.

INTRODUCTION: The corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic. METHODS: We designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression. RESULTS: A total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity. The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement. CONCLUSIONS: Among Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

Incidence and outcome of sars-cov-2 infection in the population undergoing dialysis treatment in lazio region

BACKGROUND AND AIMS: Patients with chronic kidney disease (CKD) represent a frail population with severe co-morbidities and different degrees of immune dysfunction. These patients might be at higher risk of SARS-CoV-2 infection and might experience severe consequences of COVID-19. In March 2020, the Lazio Regional Dialysis and Transplantation Registry (LRDTR) implemented a questionnaire to obtain information on dialysis patients who have developed SARS-CoV-2 infection. The aims of this study is to evaluate the incidence and the short-term lethality of SARS-CoV-2 infection in the population undergoing dialysis treatment in Lazio Region. METHOD: A cohort of patients treated in the dialysis units of Lazio Region was enrolled. Prevalent dialysis patients at 1/1/2020 and incident patients during the period 01/01/2020-08/01/2020 were included. The LRDTR collects information on dialysis patients from the start of chronic dialysis treatments with biannual update and immediately informing about the end of dialytic treatment (death, renal transplant, etc). Infection was traced in the LRDTR from March 2020 to 08/13/2020. The information on vital status was obtained from LRDTR and the mortality Lazio registry up to 10/30/2020. Poisson models, crude and adjusted for sex and age, were used to estimate incident rate of infection and mortality rate on dialysis patients and on dialysis patients who have developed SARS-CoV-2 infection, and respective confidence intervals of 95% (CI95%). RESULTS: During the study period, the estimate of the number of patients undergoing dialysis treatment was 5196 in Lazio Region, 65% were males with mean age of 70 years. Thirty-seven patients were infected with SARS-CoV-2: 70% males, mean age 73 years. These patients were treated in 24 different dialysis units. The cumulative incidence rate of SARS-CoV-2 infection was 0.71% (95% CI 0.52-0.98) and the adjusted incidence rate was 3.3 ∗100,000 Person Days (PD) (95% CI 2.4-4.7). The distribution of positive swabs by month was: 21 in March 7 in April, 6 in May, 1 in June, 2 in July. Twenty-seven patients had symptoms while 10 patients, who have had contact with infected individuals, had positive swabs in absence of symptoms. Infected and hospitalised dialysis patients were 78%. Of the 29 hospitalized patients: 6 were in sub-intensive care, 16 in intensive care, of these 7 needed intubations, 9 underwent non-invasive ventilation. The adjusted cumulative mortality rate in dialysis patients was 6.8% (95% CI 6.0-7.6), the same measure for SARS-CoV-2 infected patients was 37.4% (95% CI 19.8-70.4) with an average follow-up of 205 PD. The adjusted mortality rate was 3.3 ∗ 10,000PD (95% CI: 2.9-3.7) among dialysis patients and 21.2∗10,000PD (95% CI: 11.1-40.7) among infected dialysis patients. CONCLUSION: This study highlights a greater susceptibility of dialysis patients to SARS-CoV-2 infection, with a rate three times higher than that observed in the general population (source: Civil Protection Department). Mortality risk for dialysis patients with SARS-CoV-2 infection is about 6 times higher than in the dialysis patients it suggesting a major impact of infection on this fragile population.

Factors predicting weight gain during Covid-19 lockdown in patients with obesity: A national survey

Rationale: We hypothesized that Covid-19 epidemics lockdown1,2 might have negatively impacted on weight control in Italian patients with obesity being followed-up at Specialistic Centres. Methods: A survey was carried out at Italian Clinical Nutrition & Dietetic Services by means of a structured questionnaire (77 items) - covering diet, physical activity and psychological aspects - to get information about how their patients with obesity coped with Covid-19 lockdown. Ethical clearance was obtained. The survey has been carried out between 2ndMay and 25th June 2020 during follow-up phone calls by direct questioning or by sending invitations to complete the questionnaire on the Web. Data were analyzed by Chi-square test, ANOVA and MANCOVA as appropriate. Results: 1046 patients from 23 Centers (41% Obesity Class 2 to 3) completed the questionnaires (71% females, mean age 50,5 ± 14,2 yrs, mean BMI 34.7 ± 7.6 kg/m2). During the lockdown period, 49,3% of patients increased and 27.4% reduced their weight, while this was unchanged in 19,6%. Mean weight change was +2.3 ± 4.8 kg (+ 4% in those who experienced weight gain). There was a significant association between reduced physical activity, emotional difficulties during lockdown and weight gain. Moreover, those working from home and those on layoffs experienced a significantly higher weight gain than those allowed to work outside home or retired. Sixty-six% declared to be on a weight control diet before the lockdown, and of these, 40% reported difficulty to follow their diet. More frequent snacking and increased intake of high calorie foods were the most frequent food habits change declared. Only 4% of patients were on obesity medications, but 14% of patients would have liked to be on obesity medications during the lockdown. Conclusion: During Covid-19 lockdown about half of patients with obesity in follow-up at Italian Dietetic Services did not increase their weight or experiences weight loss. However, the remaining half experienced a clinically relevant weight gain. Those who increased their weight likely did mostly so because of reduced physical activity and difficult emotional coping. Working from home was also associated with more difficult weight control. References: 1. Disclosure of Interest: None declared