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1.
Preprint in English | EuropePMC | ID: ppcovidwho-291952

ABSTRACT

When a new environmental policy or a specific intervention is taken in order to improve air quality, it is paramount to assess and quantify - in space and time - the effectiveness of the adopted strategy. The lockdown measures taken worldwide in 2020 to reduce the spread of the SARS-CoV- 2 virus can be envisioned as a policy intervention with an indirect effect on air quality. In this paper we propose a statistical spatio-temporal model as a tool for intervention analysis, able to take into account the effect of weather and other confounding factors, as well as the spatial and temporal correlation existing in the data. In particular, we focus here on the 2019/2020 relative change in nitrogen dioxide (NO$_2$) concentrations in the north of Italy, for the period of March and April during which the lockdown measure was in force. As an output, we provide a collection of weekly continuous maps, describing the spatial pattern of the NO$_2$ 2019/2020 relative changes. We found that during March and April 2020 most of the studied area is characterized by negative relative changes (median values around -25%), with the exception of the first week of March and the fourth week of April (median values around 5%). As these changes cannot be attributed to a weather effect, it is likely that they are a byproduct of the lockdown measures.

2.
Clin Gastroenterol Hepatol ; 19(7): 1410-1417.e9, 2021 07.
Article in English | MEDLINE | ID: covidwho-1499706

ABSTRACT

BACKGROUND & AIMS: The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed to evaluate whether screening procedure delays can affect the outcomes of CRC screening. METHODS: We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach. RESULTS: With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (P = .068). Compared to baseline (0-3 months), moderate (7-12 months) and long (> 12 months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; P = .008 and P < .001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (P = .005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (P < .001). CONCLUSIONS: Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.


Subject(s)
COVID-19 , Colorectal Neoplasms , Delayed Diagnosis , Early Detection of Cancer , Aged , Colonoscopy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/mortality , Humans , Italy , Mass Screening , Middle Aged , Neoplasm Staging , Pandemics
4.
Dig Liver Dis ; 53(6): 682-688, 2021 06.
Article in English | MEDLINE | ID: covidwho-1120261

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic has had a huge impact on healthcare systems, resulting in many routine diagnostic procedures either being halted or postponed. AIMS: To evaluate whether the diagnoses of colorectal, gastric and pancreatic cancers have been impacted by the SARS-CoV-2 pandemic in Italy. METHODS: A survey designed to collect the number of histologically-proven diagnoses of the three cancers in gastroenterology services across Italy from January 1 to October 31 in 2017-2020. Non-parametric ANOVA for repeated measurements was applied to compare distributions by years and macro-areas. RESULTS: Compared to 2019, in 2020 gastric cancer diagnoses decreased by 15.9%, CRC by 11.9% and pancreatic by 9.9%. CRC distributions showed significant differences between all years, stomach cancer between 2018 and 2020 and 2019-2020, and pancreatic cancer only between 2017 and 2019. The 2019-2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%), fewer stomach cancers in the North (-19.0%) and South (-9.4%), and fewer pancreatic cancers in the North (-14.1%) and Center (-4.7%), with an increase in the South (+12.3%). Distributions of CRC and gastric cancer were significantly different between all years in the North. CONCLUSIONS: This survey highlights the concerning effects of the COVID-19 pandemic on the diagnostic yield of gastroenterology services for stomach, colorectal and pancreatic cancers in Italy.


Subject(s)
COVID-19 , Delivery of Health Care , Digestive System Neoplasms , Early Detection of Cancer , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Diagnostic Techniques, Digestive System , Digestive System Neoplasms/diagnosis , Digestive System Neoplasms/epidemiology , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Gastroenterology/methods , Gastroenterology/statistics & numerical data , Humans , Infection Control/methods , Italy/epidemiology , Organizational Innovation , SARS-CoV-2 , Surveys and Questionnaires
5.
PLoS One ; 15(10): e0240286, 2020.
Article in English | MEDLINE | ID: covidwho-841410

ABSTRACT

In this study we present the first comprehensive analysis of the spatio-temporal differences in excess mortality during the COVID-19 pandemic in Italy. We used a population-based design on all-cause mortality data, for the 7,904 Italian municipalities. We estimated sex-specific weekly mortality rates for each municipality, based on the first four months of 2016-2019, while adjusting for age, localised temporal trends and the effect of temperature. Then, we predicted all-cause weekly deaths and mortality rates at municipality level for the same period in 2020, based on the modelled spatio-temporal trends. Lombardia showed higher mortality rates than expected from the end of February, with 23,946 (23,013 to 24,786) total excess deaths. North-West and North-East regions showed one week lag, with higher mortality from the beginning of March and 6,942 (6,142 to 7,667) and 8,033 (7,061 to 9,044) total excess deaths respectively. We observed marked geographical differences also at municipality level. For males, the city of Bergamo (Lombardia) showed the largest percent excess, 88.9% (81.9% to 95.2%), at the peak of the pandemic. An excess of 84.2% (73.8% to 93.4%) was also estimated at the same time for males in the city of Pesaro (Central Italy), in stark contrast with the rest of the region, which does not show evidence of excess deaths. We provided a fully probabilistic analysis of excess mortality during the COVID-19 pandemic at sub-national level, suggesting a differential direct and indirect effect in space and time. Our model can be used to help policy-makers target measures locally to contain the burden on the health-care system as well as reducing social and economic consequences. Additionally, this framework can be used for real-time mortality surveillance, continuous monitoring of local temporal trends and to flag where and when mortality rates deviate from the expected range, which might suggest a second wave of the pandemic.


Subject(s)
Cause of Death/trends , Coronavirus Infections/epidemiology , Databases, Factual , Pneumonia, Viral/epidemiology , Bayes Theorem , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/virology , Female , Humans , Italy/epidemiology , Male , Models, Theoretical , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , SARS-CoV-2
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