Estimating fuzzy measures of deprivation at local level in Tuscany.

In this paper we estimate monetary and non-monetary poverty measures at two sub-regional levels in the region of Tuscany (Italy) using data from the ad-hoc Survey on Vulnerability and Poverty held by Regional Institute from Economic Planning of Tuscany (IRPET). We estimate the percentage of households living in poverty conditions and three supplementary fuzzy measures of poverty regarding deprivation in basic needs and lifestyle, children deprivation, and financial insecurity. The key feature of the survey is that it was carried out after the COVID-19 pandemic, therefore, some of the items collected focus on the subjective perception of poverty eighteen months after the beginning of the pandemic. We assess the quality of these estimates either with initial direct estimates along with their sampling variance, and with a secondary small area estimation when the formers are not sufficiently accurate.

Vaccination against whooping cough in pregnancy: evaluation of an organizational proposal implemented between 2018 and 2022 in the health district of urban area of Pisa (italy) and a method for coverages calculation

Introduction: Vaccination against Bordetella pertussis is recommended by the Italian Ministry of Health starting from the 28th week of pregnancy. However, data about vaccine coverages are unknown and sharing good practices is necessary to increase adherence to vaccine programs implemented at local level. Here we present data on epidemiology and vaccine coverage of Pertussis in Tuscany from 2012 to 2021 and data on Pertussis vaccine coverage in pregnant women in the Health District of urban area of Pisa for the period 2017 to September 2022. Materials and methods: Data on pertussis cases and pertussis vaccine coverage were retrieved form the Regional Health Agency that made available data on Infectious Diseases Epidemiology in Tuscany on a public report. The diphteria, tetanus, pertussis (dTpa) vaccination in pregnant women were extracted from the vaccination registry from 2017 to 30 September 2022 and adjusted new births from 1st April to 30th March of the following year were considered as denominator. For the current year we assumed that the monthly trend of the absolute number of vaccinations is maintained (+45.3 vaccinations/month) and that the number of new-borns is the same as in 2021. Results: In Tuscany, a progressive increase in the number of cases has been observed since 2012, peaking in 2017 with 115 infections concentrated mainly in children under one year of age. After a significant reduction in the three-year period 2018-2020, with values between 25 and 39 infections per year, no cases of the disease were notified in 2021. Most likely due to the actions taken to counteract the transmission of SARS-CoV-2. Notably, from 2017 to 30 September 2022, a significant increase in vaccination coverage for dTpa in pregnant women was observed, with an average annual increase from 2018 onwards of 39% (range 18%-63%). Discussion and conclusions: Even if the vaccine coverage calculation has some limitations, the availability of a free access services for pregnant women and their contacts has improved adherence to the vaccination against pertussis. However, to achieve an active recruitment strategic to overcome cultural, linguistic and hesitancy barriers it is crucial to improve active call of the pregnant women.

Bicycle tourism, from pandemic to sustainability: "Terre di Casole Bike Hub” project

The outbreak of COVID-19 and the subsequent lockdowns have impelled us to question and reconsider our standards, schedules and lifestyle. One of the market sectors that was most affected by the mobility reduction was tourism. Its demand in 2020 showed indeed a significant change: tourists opted for unusual destinations, presumably less crowded, favouring smaller villages and mountain areas. Moreover, tourists have chosen destinations that feature the possibility to do sports, especially trekking and cycling. Considering these trends, this paper focuses on the bicycle tourism in Italy and analyses its development potential. More specifically, it analyses the "Terre di Casole Bike Hub” project as an example of best practices to promote the territory through cycling, aiming to support the territory recovery in the post-pandemic tourism. © 2022 Societe Belge de Geographie. All rights reserved.

Foreigners living in Tuscany at the time of coronavirus outbreak.

Background: During the coronavirus outbreak, a worldwide state of emergency and lockdown significantly affected the volunteer services for foreigners. The SARS-CoV-2 surveillance program was strengthened among migrants arriving in Italy. However, few screening measures for SARS-CoV2 infection have been conducted on the foreign population already present in Italy. In Tuscany, a great effort was made to know the epidemiological features of coronavirus outbreaks in the foreigners. Based on these premises, this study describes the prevalence and characteristics of SARS-CoV-2 infection in foreigners present in the Tuscan territory during the months of the highest incidence of this pandemic. Methods: Ministry of Health established the COVID-19 surveillance and predisposed the methods for reporting cases of SARS-CoV-2 infection in agreement with the Department of Infectious Diseases of the Istituto Superiore di Sanità. Data on SARS-CoV-2, updated daily, were collected based on the platform of the Istituto Superiore di Sanità.For each patient were available data on diagnosis, gender, age, nationality, exposure place, hospitalization and symptoms severity. Symptoms severity was classified using a 6-level scale (asymptomatic, paucisymptomatic, mild symptoms, severe symptoms, critic, and died). Results: By July 14, 2020, 10,090 SARS-CoV-2 cases were recorded. Out of 10,090 cases, 8,947 were Italians (88.7%), 608 foreigners (6%); in 535 patients (5.3%) citizenship was missing. The average age of foreigners was 44.1 years (range: 42.9-45.4), compared to 61.1 years (range: 60.7-61.5) of Italians. Chronic pathologies affected 16.8% of foreigners (14.0% -20.0%) and 36.4% of Italians (35.4% -37.4%). Foreigners with asymptomatic or mild symptoms of COVID-19 were 81.7% (78.4% -84.6%), while the Italians were 67% (66.6% -68.5%). Foreigners with severe COVID-19 were 15.2% (12.6% -18.4%) and Italians were 17.6% (16.8% -18.4%). Foreigners in critical conditions were 1.0% (0.5% -2.2%) and Italians were 2.6% (2.3% -3.0%). 38.6% (33.7% -43.7%) of foreigners were infected at the workplace as a health or social-health worker, compared to 24.2% (23.1% -25.4%) of Italians. Conclusion: The time between the onset of symptoms and the execution of the laboratory tests was similar between foreigners and Italians. The foreigners infected by SARS-COV-2 were younger compared to the Italians. Foreigners showed few comorbidities, and asymptomatic or mild symptomatic COVID-19, and consequently, a low lethality index. National and Tuscany policy decisions are needed to create equity in the access to the health care system for immigrants and their families, regardless of their immigration status.

Analysis of the excess mortality and factors associated with deaths from COVID-19 versus other causes in Central Tuscany (Italy) in 2020.

OBJECTIVES: to assess the extent of the excess mortality from all causes in 2020 compared to 2015-2019 in Central Tuscany (Italy) as a proxy to estimate COVID-19-related excess mortality and to identify demographic and clinical differences between subjects who died from COVID-19 and those who died from other causes in 2020. DESIGN: descriptive analysis of the temporal trend of general mortality. SETTING AND PARTICIPANTS: the study population is represented by the 1.6 million residents living in the territory of the Central Tuscany Healthcare Authority in Central Italy, i.e., little less than half of the population of Tuscany, in an area of just over one fifth of the entire region, where the provinces of Florence, Pistoia, and Prato are comprised. MAIN OUTCOME MEASURES: using the Italian National Resident Population Registry (ANPR) as a source of mortality data, standardized mortality ratios with 95% confidence intervals were calculated to compare the number of deaths in 2020 with the number of deaths expected on the basis of mortality data from 2015 to 2019. Furthermore, after record linkage with data from the integrated surveillance of cases of SARS-CoV-2 virus infection and with the MaCro dataset of comorbidities, the characteristics of subjects who died from COVID-19 were compared with those of patients who died from other causes using a multivariate logistic regression model; odds ratios with 95% confidence intervals were calculated. RESULTS: a statistically significant excess mortality was observed during the first pandemic wave in March and April, and during the second wave in the fall; it ranged between +9% in March and +51% in November. On the contrary, in January, February, and May, all-cause mortality was significantly lower than in previous years. The male gender, dyslipidaemia, and dementia were positively associated with death from COVID-19 rather than from all other causes. On the contrary, heart failure and recent tumours were more represented among deaths from other causes. CONCLUSIONS: much of the over-mortality observed in spring is attributable to the harvesting effect COVID-19 exerted on a segment of population with serious underlying chronic conditions and who in the previous months had survived a mild winter and a flu season of medium intensity. In the second pandemic wave, in autumn, the impact of both direct and indirect effects of COVID-19 was substantially higher. Consistently with the available evidence, death from COVID-19 was related to the male gender and to clinical conditions such as dyslipidaemia and dementia.

Prosocial behavior in emergencies: Evidence from blood donors recruitment and retention during the COVID-19 pandemic.

The impact of COVID-19 represents a specific challenge for voluntary transfusional systems sustained by the intrinsic motivations of blood donors. In general, health emergencies can stimulate altruistic behaviors. However, in this context, the same prosocial motivations, besides the personal health risks, could foster the adherence to social distancing rules to preserve collective health and, therefore, discourage blood donation activities. In this work, we investigate the consequences of the pandemic shock on the dynamics of new donors exploiting the individual-level longitudinal information contained in administrative data on the Italian region of Tuscany. We compare the change in new donors' recruitment and retention during 2020 with respect to the 2017-2019 period (we observe 9511 individuals), considering donors' and their municipalities of residence characteristics. Our results show an increment of new donors, with higher proportional growth for older donors. Moreover, we demonstrate that the quality of new donors, as proxied by the frequency of subsequent donations, increased with respect to previous years. Finally, we show that changes in extrinsic motivations, such as the possibility of obtaining a free antibody test or overcoming movement restrictions, cannot explain the documented increase in the number of new donors and in their performance. Therefore, our analyses indicate that the Tuscan voluntary blood donation system was effective in dealing with the challenges posed by the COVID-19 pandemic.

Social Innovation in Home-Based Eldercare: Strengths and Shortcomings of Integrating Migrant Care Workers into Long-Term Care in Tuscany.

Italy is one of the main receiving countries of migrant care workers in Europe. Its migrant-in-the-family model has developed since the 1990s, and, today, home-based eldercare is unimaginable without the work of the almost one million care workers employed in private households, of whom over 75% are migrants. Despite forming one of the most important pillars of eldercare provision in the country, the employment of migrant care workers is not addressed in national policy. However, regional policymaking is far from inactive in the face of growing gaps in care as regions and municipalities play a crucial role in regulating, organising, and providing eldercare. With a focus on comprehensive solutions, cross-sector collaborations, and interactive learning processes, social innovation becomes an important element in reforming eldercare in the context of institutional inertia, fragmentation, and permanent austerity. In what ways are regions using social innovation to respond to challenges in eldercare provision and integrate migrant care workers? This study is based on interviews with experts from the region of Tuscany, which is running the project Pronto Badante (emergency care worker). The results suggest several advantages of local interventions breaking with the institutional silo mentality, as well as ongoing challenges regarding the impact and sustainability of these interventions.

EFFECTS OF THE LOCKDOWN ON PERCEIVED STRESS AND WELL-BEING: A STUDY ON Italian UNIVERSITY IN THE FIRST PERIOD OF ISOLATION DUE TO COVID-19

This study investigated the effect of the isolation during the lockdown period on psychological distress and well-being in a sample of professors (N=150), students (N=150) and technical administrative staff (N=150) from 3 Italian Universities, in the region of Tuscany. We administered a self-reported online questionnaire to collect socio-demographic information, investigate issues in work and study life, and assess the level of perceived stress and psychological well-being. The results of this study indicate that under conditions of isolation perceived stress levels are increased, and this is related to the experience of an unpleasant house environment. This is also significantly predicted by the occurrence of issues with online lectures and administrative activities for university professors or by having issues with managerial support for technical administrative staff. On the other hand, for university students, a good relationship with other students is of great importance to maintain a high level of mental well-being and being male is a protective factor. Evidently, aspects related to the deprivation of opportunities for peer relationships are experienced as particularly problematic. © 2021 Virtual Simulation Innovation Workshop, SIW 2021. All rights reserved.

Obesity as a risk factor for hospitalization in COronaVirus Disease-19 (COVID-19) patients: Analysis of the Tuscany regional database.

BACKGROUND AND AIMS: Aim of the present study is to determine the role of obesity as a risk factor for COronaVirus Disease-19 (COVID-19) hospitalization. METHODS AND RESULTS: This observational study was performed using Istituto Superiore di Sanità (ISS) Tuscany COVID-19 database by the Agenzia Regionale Sanità (ARS), including all COVID-19 cases registered until April 30th, 2020, with reported information on chronic diseases. The principal outcome was hospitalization. An age and gender-adjusted logistic regression model was used to assess the association of clinical and demographic characteristics with hospitalization. Further multivariate models were applied. Of 4481 included subjects (36.9% aged over 70 years), 1907 (42.6%) were admitted to hospital. Obesity was associated with hospitalization after adjusting for age and gender. The association of obesity with hospitalization retained statistical significance in a fully adjusted model, including possible confounders (OR: 2.99 [IC 95% 2.04-4.37]). The effect of obesity was more evident in younger (<70 years) than in older (≥70 years) subjects. CONCLUSIONS: The present data confirm that obesity is associated with an increased risk of hospitalization in patients with COVID-19. Interestingly, the association of obesity with hospitalization was greater in younger (<70 years) patients.