Access to SARS-CoV-2 diagnostic tests: are there barriers for the immigrants in Italy?

OBJECTIVES: to describe the epidemiology of SARS-CoV-2 infection in relation with the use of nasal swabs in the immigrant population in Italy, using data from the COVID-19 national surveillance system and to verify if a difference is present comparing natives and immigrant. DESIGN: descriptive study based on longitudinal health-administrative data. SETTING AND PAR TICIPAN TS: general population of six Italian Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio) covering about 55% of the resident population and 72% of foreigners' population. MAIN OUTCOME MEASURES: regional rates of access to at least a nasal swab, separately by country of origin. RESULTS: across all the periods, a lower rate in the foreigners' group was observed, with the only exception of the period May-June 2021. Considering separately High Migratory Pressure Countries (HMPCs) and Highly Developed Countries (HDCs), a higher proportion of nasal swabs performed in people coming from HDC with respect to HMPCs and natives was noticed. This observation is consistent in males and females. CONCLUSIONS: during the first wave of the pandemic, Italians have had a higher proportion of nasal swabs compared to migrants across all Regions. This difference disappeared in the following periods, probably due to a major availability of diagnostic tests.

Face memory and facial expression recognition are both affected by wearing disposable surgical face masks.

Faces are fundamental stimuli for social interactions since they provide significant information about people's identity and emotional states. With the outburst of the COVID-19 pandemic, global use of preventive measures, such as disposable surgical face masks (DSFMs), has been imposed. The massive use of DSFMs covering a large part of the face could interfere with identity and emotion recognition. Thus, the main aim of the current study was (i) to assess how DSFMs affect identity recognition (Experiment 1), (ii) how DSFMs affect emotion recognition (Experiment 2), and (iii) whether individual empathy levels correlate with emotion recognition with DSFMs. The potential relation between identity and emotion recognition with and without DSFMs was also investigated. Two tasks were administered to 101 healthy participants: (i) the Old-new face memory task aimed to assess whether the learning context (i.e., DSFMs on/off) affects recognition performance, whereas (ii) the Facial affect task explored DSFMs' effect on emotion recognition. Results from the former showed that the stimuli's features in the learning stage affect recognition performances; that is, faces wearing DSFMs were better recognized if wearing DSFMs at first exposure and vice versa. Results from the Facial affect task showed that DSFMs lead to reduced disgust, happiness, and sadness recognition. No significant correlation emerged between identity and emotion recognition. The Interpersonal Reactivity Index (IRI) was administered to assess affective and cognitive empathy; however, IRI scores did not correlate with either face memory recognition or facial affect recognition. Overall, our results demonstrate (a) a "context effect" for face memory with and without DSFMs; (b) a disruptive effect of DSFMs depending on the expressed emotion; and (c) no correlation between empathy and emotion recognition with DSFMs.

Digital transformation of public health systems: strengthening to take rights seriously : Anabelle Macedo Silva

The expansion of digital public health, with the use of data in digital systems for planning and operation of public health policy, presents itself as strategic for the public and digital future of Public Health Systems, such as Brazilian Sistema Único de Saúde/SUS, as well as for the effectiveness of the right to healthcare and expansion of the access to public health services (with the experience of COVID-19 highlighting the importance of digital health, as well as fostering its accelerated expansion). Such digital expansion will increasingly stress the fundamental right to the protection of personal data, and it is therefore important to strengthen the regulatory and care response of SUS in the field of digital public health, both for the preservation of its regulatory capacity in digital public health (facing market private interests of Big Tech for example), but also to guarantee the protection of fundamental rights, such as the protection of personal data. The theory of fundamental rights and the dogmatics on personal data protection offer support to solve the tensions to the right to data protection arising from the expansion of digital health, with consideration between the rights of patients-data subjects and the needs of managing and planning public health policy Key messages • The intense use of data and digital systems in public health policy is strategic to strengthen public health systems. • The enhancement of Public Health Systems’ regulatory capacity in digital transformation is important to protect right to health and data protection.

CKD and Rapid Kidney Function Decline During the COVID-19 Pandemic

The impact of COVID-19 infection and the indirect effects of the pandemic on the trajectory of CKD is unknown. We performed a retrospective study using de-identified administrative claims data for Medicare Advantage enrollees with CKD Stages G3-4 in 2018-2021. Rapid kidney function decline (RFKD) was defined as a decrease in eGFR of >5ml/min/1.73m2 per year. RFKD was compared for the overall cohort during the pre-pandemic period (Jan 1, 2018 to Feb 29, 2020) to RFKD for the pandemic period (March 1, 2020 to August 31, 2021), and comparatively between enrollees with and without a diagnosed COVID-19 infection. We also evaluated factors independently associated with RKFD. Of 90,734 enrollees with available data, mean age was 75 years, 59% were males, 70% were White;62%, 30%, 8% had CKD G3a, 3b, and 4, respectively. RKFD was observed in 20.4% of enrollees in the pre-pandemic period and in 26.8% during the pandemic. Overall, COVID infection was diagnosed in 8.7% of enrollees. RKFD was observed in 28.2% of those with a COVID-19 diagnosis and 25.1% of those without (p value < 0.05). Factors associated with increased odds of RKFD in the pandemic included Black or Hispanic race/ethnicity, RKFD in the pre-pandemic period, and documented COVID infection;advancing CKD stage was inversely associated with RRFD (Figure). The COVID-19 pandemic resulted in more than a quarter of the population experiencing rapid kidney function decline for individuals with CKD, irrespective of COVID-19 infection. The downstream impact of pandemic-related eGFR decline on health outcomes, such as cardiovascular disease, kidney failure or mortality, requires further study. (Figure Presented)

Real world evidence demonstrates replacement of 2D mammography with 3D mammography among insured women

Background Digital breast tomosynthesis (DBT), also called 3D mammography, was first approved by the Federal Drug Administration in 2011. The goal of 3D mammography is to improve accuracy compared to 2D digital mammography (DM), by increasing sensitivity and decreasing recall rates. To capture the broad utilization of DBT in populations receiving both screening and diagnostic imaging, this analysis investigates DBT usage over time in a longitudinal sample from 2016 through 2020 for adult women ranging from 18-74 years of age. Methods Retrospective analyses were conducted using de-identified administrative claims data from a large national U.S. health insurer. The study cohort consisted of women who were continuously enrolled in a commercial or Medicare Advantage plan from 1/2016 to 12/2020 and aged 18 to 74 years old as of 2016. All procedures were identified based on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. For each study year, receipt of breast cancer screening with DM (S-DM) or including DBT (S-DBT) were captured. Receipt of DM and DBT not specified for screening based on CPT code descriptions were categorized as diagnostic, D-DM and D-DBT respectively. Women that received both DBT and DM in the same year were included in the DBT group. In addition, women who received MRI and ultrasound were also captured. Rates of each procedure by study year, insurance type, and age categories that align with recommended screening guidelines (<40 years old, 40-49 years old and 50-74 years old) were examined. Results Approximately 3.8 million women met study criteria;85% were commercially insured and 15% were Medicare Advantage. Table 1 shows rates of adult women who received mammography, MRI and ultrasound over the study period. About 74% of study subjects receiving screening were 50-74 years old at the start of the study period, 25% were 40-49 years and 1% were under 40 years old. In 2020, there were fewer women (3%-13%) receiving imaging procedures compared to counts in 2019. During the 5-year study period, there was a 3.5-fold increase in the number of women who received S-DBT. In 2016, 23% of women who received a screening mammogram received S-DBT and by 2020, this percent increased to 82%. The percent of women who received a diagnostic mammogram using D-DBT compared to D-DM also increased overtime;29% of women received a D-DBT in 2016 and this increased to 77% in 2020. The number of women with receipt of ultrasound and MRI were similar in each study year. The percent diagnostic/screening tests (including DBT and DM) were in the range of 18.5%-20.2% each year. Conclusion Among this cohort of women who were continuously enrolled in the health plan throughout the 5-year study period, this analysis shows that screening and diagnostic DBT utilization rates increased from 2016 to 2020 while DM screening and diagnostic imaging utilization concomitantly decreased. The percentages of women that received S-DBT and D-DBT were highest in 2020, even though 8%-13% fewer women had evidence of mammography than in 2019, which is largely due to COVID-19 related healthcare service disruptions. The rate of diagnostic tests as a percent of screening tests did not decrease with the adoption of DBT. Further analyses investigating rates of follow-up procedures and downstream costs are warranted.

Epidemic Informatics and Control: A Review from System Informatics to Epidemic Response and Risk Management in Public Health

Epidemic outbreaks such as Coronavirus disease 2019 (COVID-19) impact the health of our society and bring significant disruptions to the US and the world. Each country has to dynamically adjust health policies, plan healthcare resources, control travels with little time latency to mitigate risks and safeguard the population. With rapid advances in health and information technology, more and more data are collected in the dynamically evolving process of epidemic outbreaks. The availability of data calls upon the development of analytical methods and tools to gain a better understanding of virus spreading dynamics, optimize the design of healthcare policies for epidemic control, and improve the resilience of health systems. This paper presents a holistic review of the system informatics approach, i.e., Define, Measure, Analyze, Improve, and Control (DMAIC), for epidemic response and management through the intensive use of data, statistics and optimization. Despite the sustained successes of system informatics in a variety of established industries such as manufacturing, logistics, services and beyond, there is a dearth of concentrated review and application of the data-driven DMAIC approach in the context of epidemic outbreaks. First, we define specific challenges posed by epidemic outbreaks to populational health, health systems, as well as economic challenges to different industries such as retailing, education and manufacturing. Second, we present a review of medical testing and statistical sampling methods for data collection, as well as existing efforts in data management and data visualization. Third, we discuss the importance to realizing the full potential of data for epidemic insights, and emphasize the need to leverage analytical methods and tools for decision support. Fourth, an epidemic brings imperative changes to health systems. We discuss the new trend of healthcare solutions to improve system resilience, including telehealth, artificial intelligence, resource allocation, and system re-design. In closing, prescriptive approaches are discussed to optimize the health policies and action strategies for controlling the spread of virus. We posit that this work will catalyze more in-depth investigations and multi-disciplinary research efforts to accelerate the application of system informatics methods and tools in epidemic response and risk management. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The proposal for an international convention on the response to pandemics: in defense of a human rights treaty for global health

In November 2021, the World Health Organization (WHO) launched the negotiation of a convention, agreement, or other international instrument on the response to pandemics. In this essay we defend and justify the position that this new pact should be a human rights treaty, as an indispensable condition for the prevention of new pandemics and for efficiency of the global response when they occur. After briefly reviewing the origin of the negotiations, we present the principal normative contents that reflect a human rights approach: the establishment of the rule of inseparability between quarantine and social protection measures;regulation of access to pharmaceutical technologies. Next, in a section dedicated to the future treaty's effectiveness, we classify the existing proposals as technocratic adjustments, such as alterations in the procedure for declaring emergencies;mechanisms of transparency and control such as the adoption of a mechanism of Universal Periodic Review (UPR), similar to that of the UN Human Rights Council, to monitor States' health-related obligations;coercive powers to be granted to the WHO or another agency such as inspections in national territories by independent scientists;and mechanisms of political coordination such as the creation of a Global Health Threats Council. We conclude that there is a risk of adoption of a more efficient surveillance system to alert the developed world of threats coming from developing countries rather than a treaty capable of contributing to preventing more vulnerable populations from continuing to be devastated by increasingly frequent pandemics.

Mobile Application for Healthcare: The Case of COVID-19 in MobileApp

The Covid-19 era asks for a reduction in face to face relationships. For this reason, the Information and Communication Technologies (ICT) are becoming the main tool able to substitute the direct relationship among people. So, one tool able to support health authorities in monitoring and mitigating the ongoing COVID-19 was Mobile Applications (mApps), by facilitating follow-up among patients and practitioners and providing direct guidance to citizens in order to play their part in the control of the disease. The main purpose of this paper, is to know and analyze features and functionalities of the mApps for COVID-19, currently available in the widely used smartphones applications stores, like Play Store and iTunes. The first results obtained at this stage of the research have permit to give a preliminary taxonomy of the mApps specifically oriented to COVID health management in Italy. The research found n°71 mApps operating on principle stores, by underlining features and aspects useful to make users more responsible and self management regarding own health. MApps in COVID period could represent one organizational support for maintaining a useful relationship among patients and health operators regarding health care assistance. In order to do this it’s necessary to determine optimal capabilities and evaluate utility and clinical benefit of these tools. This work permits to recognize and obtain first informations to this regard. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A molecular test based on RT-LAMP for rapid, sensitive and inexpensive colorimetric detection of SARS-CoV-2 in clinical samples.

Until there is an effective implementation of COVID-19 vaccination program, a robust testing strategy, along with prevention measures, will continue to be the most viable way to control disease spread. Such a strategy should rely on disparate diagnostic tests to prevent a slowdown in testing due to lack of materials and reagents imposed by supply chain problems, which happened at the beginning of the pandemic. In this study, we have established a single-tube test based on RT-LAMP that enables the visual detection of less than 100 viral genome copies of SARS-CoV-2 within 30 min. We benchmarked the assay against the gold standard test for COVID-19 diagnosis, RT-PCR, using 177 nasopharyngeal RNA samples. For viral loads above 100 copies, the RT-LAMP assay had a sensitivity of 100% and a specificity of 96.1%. Additionally, we set up a RNA extraction-free RT-LAMP test capable of detecting SARS-CoV-2 directly from saliva samples, albeit with lower sensitivity. The saliva was self-collected and the collection tube remained closed until inactivation, thereby ensuring the protection of the testing personnel. As expected, RNA extraction from saliva samples increased the sensitivity of the test. To lower the costs associated with RNA extraction, we performed this step using an alternative protocol that uses plasmid DNA extraction columns. We also produced the enzymes needed for the assay and established an in-house-made RT-LAMP test independent of specific distribution channels. Finally, we developed a new colorimetric method that allowed the detection of LAMP products by the visualization of an evident color shift, regardless of the reaction pH.