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1.
BMJ Open ; 12(4): e048916, 2022 04 05.
Article in English | MEDLINE | ID: covidwho-1779360

ABSTRACT

OBJECTIVES: The present work aims to present the results of the 'PRESTOinsieme' (which is 'we will be together soon' in English). The web-based survey (www.prestoinsieme.com) describes changes in lifestyle habits and symptoms of psychological discomfort in the Italian population during the COVID-19 lockdown. DESIGN: Cross-sectional online survey disseminated by messaging apps (ie, WhatsApp and Telegram) and social networks (ie, Instagram, Facebook and LinkedIn). SETTING: Italy. PARTICIPANTS: Italian population older than 16 years of age. EXPOSURE: COVID-19 lockdown. MAIN OUTCOMES AND MEASURES: Survey respondents filled out a set of validated questionnaires aimed at assessing lifestyle habits and psychological health, that is, the General Health Questionnaire (GHQ-12) to screen for psychological distress, the Impact of Event Scale-Revised (IES-R) to screen for post-traumatic stress and the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Survey respondents totalled 5008. Moderate or severe psychological distress was reported in 25.5% and 22% of survey respondents, respectively. Lower age, female gender, being unemployed (OR 1.57, 95% CI 1.22 to 2.02) or being a student (OR 1.73, 95% CI 1.31 to 2.28) were predictors of more severe depressive symptoms. CONCLUSIONS: The present study is one of the largest population-based surveys conducted in Italy during the first COVID-19 lockdown, providing valuable data about the Italian population's psychological health. Further studies should be conducted to understand whether psychological distress persists after the end of the lockdown.


Subject(s)
COVID-19 , Anxiety/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Cross-Sectional Studies , Depression/epidemiology , Female , Habits , Humans , Italy/epidemiology , SARS-CoV-2 , Stress, Psychological/epidemiology , Surveys and Questionnaires
2.
Healthcare (Basel) ; 10(3)2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-1731990

ABSTRACT

The pandemic outbreak of COVID-19 has posed several questions about public health emergency risk communication. Due to the effort required for the population to adopt appropriate behaviors in response to the emergency, it is essential to inform the public of the epidemic situation with transparent data sources. The COVID-19ita project aimed to develop a public open-source tool to provide timely, updated information on the pandemic's evolution in Italy. It is a web-based application, the front end for the eponymously named R package freely available on GitHub, deployed both in English and Italian. The web application pulls the data from the official repository of the Italian COVID-19 outbreak at the national, regional, and provincial levels. The app allows the user to select information to visualize data in an interactive environment and compare epidemic situations over time and across different Italian regions. At the same time, it provides insights about the outbreak that are explained and commented upon to yield reasoned, focused, timely, and updated information about the outbreak evolution.

3.
Crit Care ; 25(1): 305, 2021 08 24.
Article in English | MEDLINE | ID: covidwho-1582036

ABSTRACT

BACKGROUND: Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. METHODS: We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th-75th percentile range. RESULTS: From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94-97)% supine vs 98 (96-99)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0-8.0) to 6.0 (5.0-7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7-40.5)% to 41.5 (29.8-50.0)% (p = 0.025). CONCLUSIONS: In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731 .


Subject(s)
COVID-19/therapy , Noninvasive Ventilation/methods , Patient Positioning , Prone Position , Respiration, Artificial/methods , Wakefulness , Adult , Diaphragm , Female , Humans , Intensive Care Units , Male , Pneumonia, Ventilator-Associated/prevention & control , Prospective Studies
4.
Int J Environ Res Public Health ; 18(24)2021 12 11.
Article in English | MEDLINE | ID: covidwho-1572460

ABSTRACT

The COVID-19 pandemic has tested the performance of hospitals and intensive care units around the world. Health care workers (HCWs) have been used to developmental symptoms, but this was especially true during the COVID-19 pandemic when HCWs have been faced with many other sources of stress and anxiety that can usually be avoided. Moreover, long-term shifts and unprecedented population restrictions have weakened people's ability to cope with stress. The research aims to observe the dynamic interplay between burnout, depression, distress, and anxiety in HCWs working in various settings, with specific a focus on emotional exhaustion, depersonalization, and a diminished sense of personal achievement in mediating a worse mental health status during the first wave of the COVID-19 pandemic in Italy. We performed a mediation analysis, which resulted in a strong correlation among depression, psychological distress, health perception and anxiety, and the impact of job burnout on anxiety, depression, and distress. Gender seemed to have a strong correlation with burnout, anxiety, and distress; the impact of the COVID-19 pandemic on Quality of Life seemed to affect anxiety and depression; the possible changes in job tasks and duties (intended as a change in work area or location and role change)influenced depression and job burnout. Encouraging supportive and educational strategies would be recommended to policymakers.


Subject(s)
COVID-19 , Anxiety/epidemiology , Depression/epidemiology , Health Personnel , Humans , Mental Health , Pandemics , Quality of Life , SARS-CoV-2
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-294753

ABSTRACT

The COVID19 pandemic tested the performance of hospitals and intensive care units around the world. Health care workers (HCWs) have been used to develop mental symptoms, but this was especially true during the COVID19 pandemic when HCWs must deal with many other sources of stress and anxiety that can usually be avoided, and long-term shifts and unprecedented population restrictions have weakened people's ability to cope with stress. The research aims to observe the dynamic interplay between burnout, depression, distress, and anxiety in HCWs working in various settings, with specific a focus on Emotional exhaustion, depersonalization, and a diminished sense of personal achievement in mediating a worst mental health status during the first wave of the COVID19 pandemic in Italy. To analyze that we performed a mediation analysis, from which resulted a strong correlation among depression, psychological distress, health perception and anxiety, and the impact of job burnout on anxiety, depression, and distress. Gender seemed to have a strong correlation with burnout, anxiety, and distress;the impact of COVID19 pandemic on Quality of Life seemed to affect anxiety and depression;the changing of mansion influenced depression and job burnout. Encouraging supportive and educational strategies would certainly be recommended to policy makers.

7.
Disaster Med Public Health Prep ; : 1-6, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1526015

ABSTRACT

OBJECTIVE: The present study aims to explore whether a relationship exists between the immediate sharp increase in intensive care unit (ICU) admissions and the mortality rates in Italy. METHODS: Official epidemiological data on coronavirus disease (COVID-19) were employed. The forward lagged (0, 3, 7, 14 days) daily variations in the number of deaths according to the number of days after the outbreak started and the daily increases in ICU admissions were estimated. RESULTS: A direct relationship between the sharp increase of ICU admissions and mortality rates has been shown. Furthermore, the analysis of the forward lagged daily variations in the number of deaths showed that an increase in the daily number of ICU admissions resulted in significantly higher mortality after 3, 7, and 14 days. The most pronounced effect was detected after 7 days, with 250 deaths (95% CI: 108.1-392.8) for the highest increase in the ICU admissions, from 100 to 200. CONCLUSIONS: These results would serve as a warning for the scientific community and the health care decision-makers to prevent a quick and out-of-control saturation of the ICU beds in case of a relapse of the COVID-19 outbreak.

8.
Vaccines (Basel) ; 9(11)2021 Nov 10.
Article in English | MEDLINE | ID: covidwho-1512744

ABSTRACT

Several European countries suspended or changed recommendations for the use of Vaxzevria (AstraZeneca) for suspected adverse effects due to atypical blood-clotting. This research aims to identify a reference point towards the number of thrombotic events expected in the Italian population over 50 years of age who received Vaxzevria from 22 January to 12 April 2021. The venous thromboembolism (VT) and immune thrombocytopenia (ITP) event rates were estimated from a population-based cohort. The overall VT rate was 1.15 (95% CI 0.93-1.42) per 1000 person-years, and the ITP rate was 2.7 (95% CI 0.7-11) per 100,000 person-years. These figures translate into 83 and two expected events of VT and ITP, respectively, in the 15 days following the first administration of Vaxzevria. The number of thrombotic events reported from the Italian Medicines Agency does not appear to have increased beyond that expected in individuals over 50 years of age.

9.
Lorenzoni, Giulia, Sella, Nicolò, Boscolo, Annalisa, Azzolina, Danila, Bartolotta, Patrizia, Pasin, Laura, Pettenuzzo, Tommaso, De Cassai, Alessandro, Baratto, Fabio, Toffoletto, Fabio, De Rosa, Silvia, Fullin, Giorgio, Peta, Mario, Rosi, Paolo, Polati, Enrico, Zanella, Alberto, Grasselli, Giacomo, Pesenti, Antonio, Navalesi, Paolo, Gregori, Dario, Tocco, Martina, Pretto, Chiara, Tamburini, Enrico, Fregolent, Davide, Pirelli, Pier Francesco, Marchesin, Davide, Perona, Matteo, Franchetti, Nicola, Paolera, Michele Della, Simoni, Caterina, Falcioni, Tatiana, Tresin, Alessandra, Schiavolin, Chiara, Schiavi, Aldo, Vathi, Sonila, Sartori, Daria, Sorgato, Alice, Pistollato, Elisa, Linassi, Federico, Gianoli, Sara, Gaspari, Silvia, Gruppo, Francesco, Maggiolo, Alessandra, Giurisato, Elena, Furlani, Elisa, Calore, Alvise, Serra, Eugenio, Pittarello, Demetrio, Tiberio, Ivo, Bond, Ottavia, Michieletto, Elisa, Muraro, Luisa, Peralta, Arianna, Persona, Paolo, Petranzan, Enrico, Zarantonello, Francesco, Graziano, Alessandro, Piasentini, Eleonora, Bernardi, Lorenzo, Pianon, Roberto, Mazzon, Davide, Poole, Daniele, Badii, Flavio, Bosco, Enrico, Agostini, Moreno, Trevisiol, Paride, Farnia, Antonio, Altafini, Lorella, Calò, Mauro Antonio, Meggiolaro, Marco, Lazzari, Francesco, Martinello, Ivan, Papaccio, Francesco, di Gregorio, Guido, Bonato, Alfeo, Sgarabotto, Camilla, Montacciani, Francesco, Alessandra, Parnigotto, Gagliardi, Giuseppe, Ferraro, Gioconda, Ongaro, Luigi, Baiocchi, Marco, Danzi, Vinicio, Zanatta, Paolo, Donadello, Katia, Gottin, Leonardo, Sinigaglia, Ezio, da Ros, Alessandra, Marchiotto, Simonetta, Bassanini, Silvia, Zamperini, Massimo, Daroui, Ivan, Mosaner, Walter.
Journal of Anesthesia, Analgesia and Critical Care ; 1(1):3-3, 2021.
Article in English | BioMed Central | ID: covidwho-1388853
10.
Front Public Health ; 9: 667379, 2021.
Article in English | MEDLINE | ID: covidwho-1389257

ABSTRACT

The 2019-nCOVID pandemic as a public health emergency has faced healthcare systems with unprecedented challenges. Our study aimed to focus on the mental health impact of the 2019-nCOVID pandemic on healthcare workers (HCWs) from North-Eastern Piedmont, Italy. For this purpose, we performed an online survey which was e-mailed to HCWs at the end of the first peak of the pandemic. We involved both frontline and not-frontline HCWs, employed in the hospital or in healthcare services outside the hospital. The primary outcome of our research was the assessment of burnout, while secondary outcomes included the investigation of anxiety, depression, and post-traumatic stress symptoms. We observed higher levels of burnout (especially in the Depersonalization and Personal Accomplishment dimensions), in females, in HCWs aged <30 years, in those exposed to changes in their daily and family habits, in those who had to change their duties at work and in residents in training. In our HCWs sample we found lower levels of anxiety and depression than those reported in the literature. The problematic levels of burnout and adverse psychological outcomes observed during the pandemic cannot be underestimated. Given the recurrence in autumn 2020 of a new pandemic peak, which has once again put a strain on the health system and HCWs, it is supported the importance of a careful assessment of HCWs' mental health, and of the possible risk and protective factors both in the work environment and in the extra-work one.


Subject(s)
COVID-19 , Mental Health , Female , Health Personnel , Humans , Italy/epidemiology , Neoplasm Recurrence, Local , SARS-CoV-2
11.
Crit Care ; 25(1): 268, 2021 07 30.
Article in English | MEDLINE | ID: covidwho-1330231

ABSTRACT

BACKGROUND: Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU. METHODS: We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with 'do-not-intubate' (DNI) orders. RESULTS: Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30-41%]. 26% [21-30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36-54%]. 23% [15-32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65-78%]. Oxygenation on admission was the main source of between-study heterogeneity. CONCLUSIONS: During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. REGISTRATION: PROSPERO, https://www.crd.york.ac.uk/prospero/ , CRD42020224788, December 11, 2020.


Subject(s)
COVID-19/therapy , Noninvasive Ventilation , Respiratory Distress Syndrome/therapy , COVID-19/mortality , Continuous Positive Airway Pressure , Hospital Mortality , Humans , Intensive Care Units , Intubation/statistics & numerical data , Observational Studies as Topic , Randomized Controlled Trials as Topic , Respiration, Artificial , Respiratory Distress Syndrome/virology
12.
Int J Environ Res Public Health ; 18(13)2021 07 04.
Article in English | MEDLINE | ID: covidwho-1302318

ABSTRACT

Wearable devices (WDs) can objectively assess patient-reported outcomes (PROMs) in clinical trials. In this study, the feasibility and acceptability of using commercial WDs in elderly patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) will be explored. This is a prospective observational study. Participants were trained to use a WD and a smartphone to collect data on their physical activity, rest heart rate and number of hours of sleep. Validated questionnaires were also used to evaluate these outcomes. A technology acceptance questionnaire was used at the end of the follow up. In our participants an overall good compliance in wearing the device (75.1% vs. 79.8%, SAVR vs. TAVR) was assessed. Half of the patients were willing to continue using the device. Perceived ease of use is one of the domains that scored higher in the technology acceptance questionnaire. In this study we observed that the use of a WD is accepted in our frail population for an extended period. Even though commercial WDs are not tailored for clinical research, they can produce useful information on patient behavior, especially when coordinated with intervention tailored to the single patient.


Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis Implantation , Wearable Electronic Devices , Aged , Aortic Valve Stenosis/surgery , Feasibility Studies , Humans , Patient Reported Outcome Measures , Risk Factors , Treatment Outcome
13.
Sci Rep ; 11(1): 13418, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1286475

ABSTRACT

In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6-11] days in early extubated patients versus 11 [6-15] days in standard weaning group (p = 0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p = 0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p = 0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.


Subject(s)
COVID-19/pathology , Noninvasive Ventilation/methods , Ventilator Weaning/methods , Aged , COVID-19/mortality , COVID-19/virology , Comorbidity , Female , Hospital Mortality , Humans , Intensive Care Units , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Time Factors , Tracheostomy
14.
J Multidiscip Healthc ; 14: 1475-1488, 2021.
Article in English | MEDLINE | ID: covidwho-1278269

ABSTRACT

OBJECTIVE: To compare the psychological impact of the lockdown measures contrasting the COVID-19 outbreak between systemic lupus erythematosus (SLE) and general population. PATIENTS AND METHODS: From July 15th to August 15th 2020, a retrospective survey referring to the period March 9th to May 18th 2020 was administered to SLE patients and the results of the survey, called LEPRE (Lupus Erythematosus PREsto) study, were compared with those from the PRESTO (imPact of quaRantine mEasures againST cOvid19) project, the same survey provided to the general population. Consecutive patients >18 years old affected by SLE and regularly followed in a single rheumatologic centre were involved. Primary outcome was to compare the scores of the Impact of Events Scale-Revised (IES-R), the General Health Questionnaire 12 (GHQ-12) and the Center for Epidemiological Depression Scale (CES-D) between patients and general population. RESULTS: A total of 64 patients completed the survey. After a propensity score matching, they were compared to 128 people from PRESTO project. The median age among patients was 43 years (I-III interquartile range 35-54.5), 88% were female and 100% Caucasian. IES-R [(score>23: 57% (34) vs 49% (58)], GHQ-12 [(score>13: 85% (52) vs 88% (106)], and CES-D [(score>15: 45% (28) vs 40% (46)] scores were not statistically different between patients and controls (p>0.05). CONCLUSION: Restrictive measures for COVID-19 pandemic had no greater impact on patients with SLE than in the general population. Strategy for coping to the SLE might be useful during lockdown measures and may be helpful for other chronic conditions.

16.
Int J Environ Res Public Health ; 18(11)2021 May 26.
Article in English | MEDLINE | ID: covidwho-1244029

ABSTRACT

Recent literature has reported a high percentage of asymptomatic or paucisymptomatic cases in subjects with COVID-19 infection. This proportion can be difficult to quantify; therefore, it constitutes a hidden population. This study aims to develop a proof-of-concept method for estimating the number of undocumented infections of COVID-19. This is the protocol for the INCIDENT (Hidden COVID-19 Cases Network Estimation) study, an online, cross-sectional survey with snowball sampling based on the network scale-up method (NSUM). The original personal network size estimation method was based on a fixed-effects maximum likelihood estimator. We propose an extension of previous Bayesian estimation methods to estimate the unknown network size using the Markov chain Monte Carlo algorithm. On 6 May 2020, 1963 questionnaires were collected, 1703 were completed except for the random questions, and 1652 were completed in all three sections. The algorithm was initialized at the first iteration and applied to the whole dataset. Knowing the number of asymptomatic COVID-19 cases is extremely important for reducing the spread of the virus. Our approach reduces the number of questions posed. This allows us to speed up the completion of the questionnaire with a subsequent reduction in the nonresponse rate.


Subject(s)
COVID-19 , Bayes Theorem , Cross-Sectional Studies , Humans , SARS-CoV-2 , Social Networking
17.
Dis Markers ; 2021: 8863053, 2021.
Article in English | MEDLINE | ID: covidwho-1231192

ABSTRACT

INTRODUCTION: The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions. MATERIALS AND METHODS: In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients (F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded. RESULTS: At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) (χ 2 10.4; p < 0.001), neutrophil-to-lymphocyte (NL) ratio (χ 2 7.6; p = 0.006), and platelet count (χ 2 5.39; p = 0.02), along with age (χ 2 87.6; p < 0.001) and gender (χ 2 17.3; p < 0.001), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL ratio > 4.68 was characterized by an odds ratio for in-hospital mortality (OR) = 3.40 (2.40-4.82), while the OR for a RDW > 13.7% was 4.09 (2.87-5.83); a platelet count > 166,000/µL was, conversely, protective (OR: 0.45 (0.32-0.63)). CONCLUSION: Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment.


Subject(s)
Blood Cell Count , COVID-19/blood , COVID-19/mortality , Clinical Decision Rules , Hospital Mortality , Severity of Illness Index , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Female , Humans , Italy/epidemiology , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies
18.
Applied Sciences ; 11(9):4042, 2021.
Article in English | MDPI | ID: covidwho-1223920

ABSTRACT

Testing for the SARS-CoV-2 infection is critical for tracking the spread of the virus and controlling the transmission dynamics. In the early phase of the pandemic in Italy, the decentralized healthcare system allowed regions to adopt different testing strategies. The objective of this paper is to assess the impact of the extensive testing of symptomatic individuals and their contacts on the number of hospitalizations against a more stringent testing strategy limited to suspected cases with severe respiratory illness and an epidemiological link to a COVID-19 case. A Poisson regression modelling approach was adopted. In the first model developed, the cumulative daily number of positive cases and a temporal trend were considered as explanatory variables. In the second, the cumulative daily number of swabs was further added. The explanatory variable, given by the number of swabs over time, explained most of the observed differences in the number of hospitalizations between the two strategies. The percentage of the expected error dropped from 70% of the first, simpler model to 15%. Increasing testing to detect and isolate infected individuals in the early phase of an outbreak improves the capability to reduce the spread of serious infections, lessening the burden of hospitals.

19.
Eur J Phys Rehabil Med ; 57(2): 199-207, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1224409

ABSTRACT

BACKGROUND: COVID-19 has been mainly investigated concerning the acute and subacute phase implications and management. Meanwhile, few studies focused on the midterm sequelae, which still remain largely unknown. AIM: To assess the physical performance of COVID-19 survivors at 3 to 6 months from Hospital discharge. DESIGN: A cross-sectional study focused on mid-term functional outcomes evaluation in COVID-19 survivors. SETTING: Outpatients who had been previously hospitalized due to COVID-19 from March to May 2020 at the University Hospital of Novara, Italy. POPULATION: We enrolled 204 patients, of which 60% were men, with the mean age of 57.9 years. METHODS: Patients firstly underwent the short physical performance battery test (SPPB), which is composed of a series of physical tests assessing the lower limb function and the functional status of the subjects. Subsequently, based on SPPB results, patients' cardiorespiratory fitness performance was further investigated. Patients with normal SPPB score (SPPB>10) underwent the 2-minute walking test (2MWT) whereas, in order to safely test the cardiorespiratory function, in patients with abnormal SPPB score (SPPB≤10) the 1-minute sit-to-stand test (1MSTST) was performed. It should be noted that the 1MSTST can be safely performed even by subjects with compromised walking ability. RESULTS: Overall, 66 patients (32% of our sample) showed an impaired physical performance at 3 to 6 months after hospital discharge. In particular, 29 patients presented an SPPB score ≤10, and the 1MSTST confirmed this status in the whole group (100%) compared to the reference values for age and sex. Besides, among patients with a normal SPPB score, 37 showed a lower sex- and age-matched 2MWT score. Finally, a significant association between Intensive Care Unit hospitalization or mechanical ventilation and physical impairment was observed together with a significant association between the walking ability (measured with SPPB and 2MWT) and the number of comorbidities. CONCLUSIONS: A residual physical and functional impairment was observed in COVID-19 survivors at mid-term evaluation after hospitalization. CLINICAL REHABILITATION IMPACT: Considering the current COVID-19 epidemiology, we might expect a tremendous burden of disability in the next future. Thus, an appropriate clinical rehabilitation pathway must be implemented.


Subject(s)
COVID-19/rehabilitation , Disability Evaluation , Disabled Persons/statistics & numerical data , Physical Functional Performance , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/physiopathology , Cross-Sectional Studies , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Walk Test , Young Adult
20.
BMC Public Health ; 21(1): 797, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1204062

ABSTRACT

BACKGROUND: Italy has been the first European country to be affected by the COVID-19 epidemic which started out at the end of February. In this report, we focus our attention on the Veneto Region, in the North-East of Italy, which is one of the areas that were first affected by the rapid spread of SARS-CoV-2. We aim to evaluate the trend of all-cause mortality and to give a description of the characteristics of the studied population. METHODS: Data used in the analyses were released by the majority of municipalities and cover the 93% of the total population living in the Veneto Region. We evaluated the trend of overall mortality from Jan.01 to Jun.30. 2020. Moreover we compared the COVID-19-related deaths to the overall deaths. RESULTS: From March 2020, the overall mortality rate increased exponentially, affecting males and people aged > 76 the most. The confirmed COVID-19-related death rate in the Veneto region between Mar.01 and Apr.302020 is 30 per 100,000 inhabitants. In contrast, the all-cause mortality increase registered in the same months in the municipalities included in the study is 219 per 100,000 inhabitants. CONCLUSIONS: COVID-19 has a primary role in the increase in mortality but does not entirely explain such a high number of deaths. Strategies need to be developed to reduce this gap in case of future waves of the pandemic.


Subject(s)
COVID-19 , Aged , Cities , Disease Outbreaks , Europe , Humans , Italy/epidemiology , Male , Mortality , SARS-CoV-2
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