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1.
J Sports Med Phys Fitness ; 61(2): 294-300, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1106688

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the Italian government took security measures to try to limit infections. Restrictive measures included social distancing, home confinement and the closure of all public structures like gyms and swimming pools. The impact of these limitations on health and lifestyle was inevitably negative. The purpose of this study was to establish the level of physical activity (PA), expressed as energy expenditure (MET-minute/week) in a Southern Italian population before and during the COVID-19 lockdown. METHODS: An adapted version of the International Physical Activity Questionnaire-short form (IPAQ-SF) was published on the official website of the National Institute of Gastroenterology IRCCS S. de Bellis, Castellana Grotte, Bari, Italy and on several social media in May 2020. RESULTS: Three hundred ten replies (72% women) from Apulia (60%), Calabria (28%), Campania (11%) and Sicily (1%) were included in the study. The COVID-19 lockdown had a negative effect on the vigorous PA intensity level and on walking, but not on the moderate PA intensity level. Additionally, daily time spent sitting down increased by more than 12% during the COVID-19 lockdown. CONCLUSIONS: Isolation changed PA behaviors. The decreased energy expenditure (MET-minute/week) during the lockdown had a negative impact in both genders, especially on the young adults and adults' groups.


Subject(s)
/epidemiology , Communicable Disease Control , Exercise , Adult , Aged , Cross-Sectional Studies , Energy Metabolism , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Sitting Position , Surveys and Questionnaires , Walking
2.
BMJ Open ; 11(2): e047216, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1096996

ABSTRACT

OBJECTIVES: To assess the seroprevalence of anti-SARS-CoV-2 IgG among health careworkers (HCWs) in our university hospital and verify the risk of acquiring the infection according to work area. DESIGN: Cross-sectional study. SETTING: Monocentric, Italian, third-level university hospital. PARTICIPANTS: All the employees of the hospital on a voluntary base, for a total of 4055 participants among 4572 HCWs (88.7%). PRIMARY AND SECONDARY OUTCOME MEASURES: Number of anti-SARS-CoV-2 positive serology according to working area. Association of anti-SARS-CoV-2 positive serology to selected variables (age, gender, country of origin, body mass index, smoking, symptoms and contact with confirmed cases). RESULTS: From 27 April 2020 to 12 June 2020, 4055 HCWs were tested and 309 (7.6%) had a serological positive test. No relevant difference was found between men and women (8.3% vs 7.3%, p=0.3), whereas a higher prevalence was observed among foreign-born workers (27/186, 14.5%, p<0.001), employees younger than 30 (64/668, 9.6%, p=0.02) or older than 60 years (38/383, 9.9%, p=0.02) and among healthcare assistants (40/320, 12.5%, p=0.06). Working as frontline HCWs was not associated with an increased frequency of positive serology (p=0.42). A positive association was found with presence and number of symptoms (p<0.001). The symptoms most frequently associated with a positive serology were taste and smell alterations (OR 4.62, 95% CI: 2.99 to 7.15) and fever (OR 4.37, 95% CI: 3.11 to 6.13). No symptoms were reported in 84/309 (27.2%) HCWs with positive IgG levels. Declared exposure to a suspected/confirmed case was more frequently associated (p<0.001) with positive serology when the contact was a family member (19/94, 20.2%) than a patient or colleague (78/888, 8.8%). CONCLUSIONS: SARS-CoV-2 infection occurred undetected in a large fraction of HCWs and it was not associated with working in COVID-19 frontline areas. Beyond the hospital setting, exposure within the community represents an additional source of infection for HCWs.


Subject(s)
Antibodies, Viral , Immunoglobulin G , Personnel, Hospital , Adult , Antibodies, Viral/blood , /epidemiology , Cross-Sectional Studies , Female , Hospitals, University , Humans , Immunoglobulin G/blood , Italy/epidemiology , Male , Middle Aged , Personnel, Hospital/statistics & numerical data , Seroepidemiologic Studies
3.
Front Immunol ; 11: 609198, 2020.
Article in English | MEDLINE | ID: covidwho-1080669

ABSTRACT

During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.


Subject(s)
Anemia, Hemolytic, Autoimmune/complications , Pneumonia, Viral/epidemiology , Purpura, Thrombocytopenic, Idiopathic/complications , Aged , Aged, 80 and over , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/virology , Young Adult
4.
Ann Ig ; 33(2): 201-202, 2021.
Article in English | MEDLINE | ID: covidwho-1079810

ABSTRACT

the SARS-CoV-2 pandemic started in December 2019 and still remains a major global health issue. Every country in the world has adopted drastic measures to contain the virus, although their stringency varies among countries, ranging from increased surveillance and focused interventions to strict lockdown (1). Italy was the second country where the disease had a major impact early in the pandemic, such that a strict nationwide lockdown was declared from March 9 to May 3, 2020. Nonetheless, between January and May 2020, there were 210,000 COVID-19 cases in Italy and 29,000 deaths were recorded (2). Due to the lockdown, universities (and in general all educational services) shifted to online classes, with students attending lessons and taking their exams from home. On-site activities were reduced to those considered indispensable. Research activities also had to be modified, such as by the adoption of a smart-working model (3). Between May and August 2020, the number of SARS-CoV-2 infections in Italy decreased. In response, the lockdown was loosened and some activities were restarted, albeit with specific safety protocols (social distancing, use of masks, temperature checks at the workplace entry, environmental disinfection, mixed models of smart and in-office work). These actions were accompanied by periodic serological and PCR screening tests (4).


Subject(s)
/prevention & control , Pandemics , Universities , /epidemiology , Communicable Disease Control/methods , Humans , Italy/epidemiology , Masks , Vaccination
5.
BMJ Open ; 11(2): e044388, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1072764

ABSTRACT

OBJECTIVE: In Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. Given the rapid spread of the infection in the population, it was suggested that in Europe, and specifically in Italy, the virus had already been present in the last months of 2019. In this paper, we aim to evaluate the hypothesis on the early presence of the virus in Italy by analysing data on trends of access to emergency departments (EDs) of subjects with a diagnosis of pneumonia during the 2015-2020 period. DESIGN: Time series cohort study. SETTING: We collected data on visits due to pneumonia between 1 October 2015 and 31 May 2020 in all EDs of the Agency for Health Protection of Milan (ATS of Milan). Trend in the winter of 2019-2020 was compared with those in the previous 4 years in order to identify unexpected signals potentially associated with the occurrence of the pandemic. Aggregated data were analysed using a Poisson regression model adjusted for seasonality and influenza outbreaks. PRIMARY OUTCOME MEASURES : Daily pneumonia-related visits in EDs. RESULTS : In the studied period, we observed 105 651 pneumonia-related ED visits. Compared with the expected, a lower occurrence was observed in January 2020, while an excess of pneumonia visits started in the province of Lodi on 21 February 2020, and almost 10 days later was observed in the remaining territory of the ATS of Milan. Overall, the peak in excess was found on 17 March 2020 (369 excess visits compared with previous years, 95% CI 353 to 383) and ended in May 2020, the administrative end of the Italian lockdown. CONCLUSIONS : An early warning system based on routinely collected administrative data could be a feasible and low-cost strategy to monitor the actual situation of the virus spread both at local and national levels.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Epidemiological Monitoring , Pneumonia/diagnosis , Adolescent , Adult , Aged , Cohort Studies , Communicable Disease Control , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pneumonia/epidemiology , Young Adult
6.
Int J Environ Res Public Health ; 18(4)2021 02 05.
Article in English | MEDLINE | ID: covidwho-1069810

ABSTRACT

Coronaviruses (CoVs) are a large family of respiratory viruses that can cause mild to moderate illness. The new variant COVID-19 has started to spread rapidly since December 2019, posing a new threat to global health. To counter the spread of the virus, the Italian government forced the population to close all activities starting from 9 March 2020 to 4 May 2020. In this scenario, we conducted a cross-sectional study on a heterogeneous sample (average age of 28 ± 12 years, 62.6% females) of the University of Naples Federico II (Italy). The aim of the study was to describe the lifestyle change in the university population during quarantine for the COVID 19 pandemic. Participants compiled an online survey consisting of 3 sections: socio-demographic data, dietary behaviours, physical activity habits and psychological aspects. The different results by gender are: 90.8% of females continued to work from home (81.9% were students); 34.8% increased their physical activity; and, only 0.8% prefer ready meals. Whereas, the same percentage of men continued to work from home (90%), but only 72.1% were students (p < 0.001 vs. females), only 23.9% increased physical activity (p < 0.001) and 1.7% favous ready meals. Our data shows that the male population was more affected by isolation and quarantine reporting more unfavourable behavioural changes.


Subject(s)
Diet , Exercise , Faculty , Pandemics , Students , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Italy/epidemiology , Life Style , Male , Quarantine , Surveys and Questionnaires , Universities , Work , Young Adult
7.
Front Public Health ; 8: 591900, 2020.
Article in English | MEDLINE | ID: covidwho-1069767

ABSTRACT

On March 11, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic. Simultaneously, in Italy, in which the first case had occurred on February 18, the rigid phase of the lockdown began. The country has attracted worldwide attention, becoming at the same time a field of study both concerning the spread of the pandemic and advanced assessments of the effectiveness of political, public health, and therapeutic measures. The protagonists of the Italian crisis were the healthcare workers (HCWs) who were exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without having any perception of what they were facing, courageously contributing to the containment of the epidemic to be defined by the media as "heroes." However, in the first phase of the pandemic (March-May 2020), the price that the Italian Public Health System had to pay both in terms of the number of positive virus cases and deaths among the HCWs was beyond and represented a peculiarity compared to what happened in other countries. In the current study, after a summary of the evolution of the pandemic in Italy, we offer an analysis of the statistical data concerning contagions and deaths among healthcare workers (physicians in particular). In conclusion, we describe the critical issues that still need to be resolved and the future challenges facing healthcare workers and the general population.


Subject(s)
Communicable Disease Control , Health Personnel/statistics & numerical data , RNA, Messenger , /epidemiology , Health Personnel/ethics , Humans , Italy/epidemiology , Middle Aged , Personal Protective Equipment , Public Health , Surveys and Questionnaires
9.
Epidemiol Prev ; 44(5-6 Suppl 2): 400-406, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068164

ABSTRACT

BACKGROUND: scientific literature indicates that there are sex, and gender differences in the development, symptomatology and evolution of different diseases, in the response to drugs and in the therapeutic pathways. Even in the COVID-19 epidemic some sex/gender differences emerged. OBJECTIVES: to analyze COVID-19 epidemic data by gender and age in Italy, Germany, Spain, and Sweden, characterized by having implemented different pandemic containment policies, with the aim of observing any characteristics that can be interpreted with the lens of sex/gender differences. MATERIALS AND METHODS: we used confirmed cases and deaths associated with COVID-19 for Italy, Spain, Germany, and Sweden from respective national surveillance databases. Mortality data for Italy were also analysed. The period of investigation was March-May 2020. As indicators, we used the case fatality ratio adjusted for time delay and SMR for mortality. RESULTS: women are more vulnerable to COVID- 19 infection in the 30-60-year age group. Case fatality ratio is higher in men than women, with a ratio men/women equal to 1.7 in Italy, Spain, and Sweden and 1,4 in Germany. The ratio increases in the lower age groups. The analysis of the mortality data observed/expected in Italy in the same period with respect to 2015-2019 shows a comparable excess with SMR equal to 132 for men and 127 for women. CONCLUSIONS: COVID-19 affects both genders with some differences in the incidence, higher in women, and lethality, higher in men. These differences highlight the need to better understand the sex/gender and age interaction both for epidemiological surveillance and for a better gender-appropriateness of the ongoing prophylactic and therapeutic treatments. This would be possible if all health indicators (symptoms, past illnesses, primary and hospital-level health care, hospitalization, etc.) were provided by age and gender. Analysis of the causes of death could help to better understand the increase in mortality for both genders, in particular for women, for whom a lower lethality for COVID-19 appears from data.


Subject(s)
/mortality , Pandemics , Sex Distribution , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Cause of Death , Child , Child, Preschool , Databases, Factual , Female , Germany/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Mortality/trends , Quarantine , Spain/epidemiology , Sweden/epidemiology , Time Factors , Young Adult
10.
Epidemiol Prev ; 44(5-6 Suppl 2): 398-399, 2020.
Article in English | MEDLINE | ID: covidwho-1068163

ABSTRACT

In the first stages of the pandemic, the adverse outcomes of COVID-19 were significantly higher in men than in women most likely as the effect of biological, hormonal, metabolic differences between the two sexes. However, gender-related differences in lifestyles and social roles can also greatly influence the course of disease. To fully understand the influence of gender in the COVID-19 outbreak, the collection and dissemination of disaggregated data must be enhanced to allow a better knowledge of the effects of SARS-CoV-2 infection in men and women, not only from a biomedical point of view, but also considering the risk factors associated with the different roles that they play in the society.


Subject(s)
/epidemiology , Pandemics , Sex Factors , Alcohol Drinking/epidemiology , Child , Child Care , Domestic Violence , Feeding Behavior , Female , Health Services Accessibility , Humans , Italy/epidemiology , Life Style , Male , Obesity/epidemiology , Occupations , Pregnancy , Quarantine , Risk Factors , Sedentary Behavior , Sex Characteristics , Smoking/epidemiology
11.
Epidemiol Prev ; 44(5-6 Suppl 2): 369-373, 2020.
Article in English | MEDLINE | ID: covidwho-1068159

ABSTRACT

During a pandemic, pregnancy and the postnatal period are complicated by multiple factors. On the one hand, worries about one's own health and the health of loved ones, in particular of the newborn child, can increase the risk of some mental disorders, such as depression and anxiety in the pregnant woman. On the other hand, as happened for the COVID-19 epidemic in Italy, given the need for physical distancing, the maintenance of the social and family network, so important for new parents in the perinatal period, is lacking. In addition, health services are forced to reorganize their offerings to ensure maximum safety for their operators and patients. This work proposes a model of screening and treatment aimed at identifying women at risk and providing them with effective and safe treatment.


Subject(s)
Anxiety/diagnosis , Depression/diagnosis , Mass Screening/organization & administration , Pandemics , Perinatal Care/organization & administration , Pregnancy Complications/diagnosis , Pregnant Women/psychology , Puerperal Disorders/diagnosis , Adult , Anxiety/epidemiology , Depression/etiology , Depression/therapy , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Depression, Postpartum/psychology , Depression, Postpartum/therapy , Diagnostic Self Evaluation , Empowerment , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Italy/epidemiology , Perinatal Care/methods , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Pregnancy Complications/therapy , Program Evaluation , Puerperal Disorders/epidemiology , Puerperal Disorders/psychology , Puerperal Disorders/therapy , Risk Factors , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology , Telemedicine
12.
Epidemiol Prev ; 44(5-6 Suppl 2): 353-362, 2020.
Article in English | MEDLINE | ID: covidwho-1068158

ABSTRACT

OBJECTIVES: to study the impact of social isolation, related to the SARS-CoV-2 epidemic, on lifestyles in Italy, with particular reference to physical activity, alcohol consumption, smoking, and eating habits. Moreover, to investigate the association between lifestyle changes during the pandemic and sociodemographic characteristics. DESIGN: epidemiological investigation based on a cross-sectional study. SETTING AND PARTICIPANTS: between April 21st and June 7th 2020, an electronic questionnaire to collect information on physical activity, alcohol consumption, smoking, and eating habits during the period of home containment was made available on the web. Respondents were recruited through non-probabilistic snowball sampling. The link to the electronic questionnaire was disseminated through institutional websites, social networks (Facebook, Twitter), and messaging systems such as WhatsApp, Telegram, and SMS. A total of 10,758 interviews were collected, of which 7,847 (73%) were complete for a minimum set of indicators (age, gender, and area of residence). MAIN OUTCOME MEASURES: reduction of physical activity, increase in alcohol consumption, increase in cigarette smoking, increase in consumption of unhealthy foods (processed meat, red meat or desserts) without increasing healthy foods (vegetables, legumes or whole grains) and, vice versa, increase in consumption of healthy foods without increasing unhealthy foods. RESULTS: the population under study consists of 7,847 people with a mean age of 48.6 years (standard deviation: 13.9). Most of respondents are women (71.3%), 92.5% have a high school or university degree and 91% live in Northern Italy. During home containment, 56% of interviewees reported they had reduced the time devoted to physical activity. In particular, this happened among older people and those living in large cities. More than 17% of respondents increased their alcohol consumption, especially men, those highly educated and those living in large urban centres. Older age and residence in the Southern Italy represent, instead, protective factors for this outcome. Among smokers, 30% increased cigarette consumption during the period of home containment, on average of 5.6 cigarettes per day. A small proportion of former smokers (0.6%) resumed smoking. With regard to eating habits, 3 out of 10 respondents (29.9%) reported an inappropriate eating behaviour (increasing unhealthy food without increasing healthy ones). This behaviour was less frequent among men (adjusted Prevalence Ratio 0.80, p=0.005). A lower percentage of respondents (24.5%) increased the consumption of healthy foods without increasing the consumption of unhealthy ones. CONCLUSIONS: the results of this survey show that social isolation during the SARS-CoV-2 pandemic has had an impact on citizens' behaviours. In particular, it was found a noteworthy increase in sedentariness, alcohol consumption, and tobacco smoking. A meaningful proportion of respondents reported a worsening of eating habits, especially among women. However, for each of the behavioural risk factors investigated, small proportions of respondents with resilient attitudes were also found, namely, capable of taking advantage of social isolation for improving their daily habits. Studying changes in lifestyles during a pandemic, identifying population groups most at risk of adopting unfavourable behaviours, is a useful tool for policy makers to plan targeted and effective public health interventions.


Subject(s)
/prevention & control , Life Style , Pandemics , Quarantine , Social Isolation , Adolescent , Adult , Aged , Alcohol Drinking/epidemiology , Cross-Sectional Studies , Diet, Healthy , Energy Intake , Exercise , Feeding Behavior , Female , Humans , Italy/epidemiology , Male , Middle Aged , Sedentary Behavior , Smoking/epidemiology , Socioeconomic Factors , Surveys and Questionnaires , Vulnerable Populations , Young Adult
13.
Epidemiol Prev ; 44(5-6 Suppl 2): 344-352, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068157

ABSTRACT

OBJECTIVES: to describe the course of Italian organized cancer screening programmes during the COVID-19 emergency; to provide estimates of the diagnosis of malignant or pre-malignant lesions that will face a diagnostic delay due to the slowing down of screening activities. DESIGN: quantitative survey of aggregated data for each Region and overall for Italy relating to screening tests carried out in the period January-May 2020 compared to those of the same period of 2019; estimate of diagnostic delays starting from the calculation of the average detection rate of the last 3 years available (specific by Region). SETTING AND PARTICIPANTS: Italian mass screening programmes. Data on the tests carried out in the target population of the breast (women 50-69 years old), cervix (women 25-64 years old), and colorectal (women and men 50-69 years old) cancer screening. MAIN OUTCOME MEASURES: the cumulative delay (in absolute numbers and as a percentage) in the period January-May 2020 compared to the same period of 2019, by Region; the difference of screening tests (in absolute number and in percentage) performed in May 2020 compared to May 2019; the estimate of the fewer lesions diagnosed in 2020 compared with 2019 with relative 95% confidence intervals (95%CI); the 'standard months' of delay (proportion of fewer tests carried out from January to May 2020 for the corresponding number of months). RESULTS: 20 Regions out of 21 participated. In the period January-May 2020, the fewer screening tests performed in comparison with the same period of 2019 were: 472,389 (equal to 53.8%) with an average delay of standard months of 2.7 for mammography screening; 585,287 (equal to 54.9%) with an average delay of standard months of 2.7 for colorectal screening; 371,273 (equal to 55.3%) with an average delay of 2.8 standard months for cervical screening. The estimated number of undiagnosed lesions is 2,201 (95%CI 2,173-2,220) breast cancers; 645 (95%CI 632-661) colorectal carcinomas; 3,890 (95%CI 3,855-3,924) advanced colorectal adenomas and 1,497 (95%CI 1,413-1,586) CIN2 or more serious lesions. CONCLUSIONS: mass screenings need to be restarted as quickly as possible. In order to make up for the delay that is accumulating, it is necessary to provide for wider delivery times, greater resources, and new organizational approaches. It will also be essential to develop communication strategies suitable for promoting participation during this emergency.


Subject(s)
Appointments and Schedules , Breast Neoplasms/diagnosis , Colorectal Neoplasms/diagnosis , Delayed Diagnosis , Early Detection of Cancer , Pandemics , Quarantine , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Breast Neoplasms/epidemiology , Colorectal Neoplasms/epidemiology , Delayed Diagnosis/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Female , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Humans , Italy/epidemiology , Mammography/statistics & numerical data , Middle Aged , Procedures and Techniques Utilization/statistics & numerical data , Uterine Cervical Neoplasms/epidemiology
14.
Epidemiol Prev ; 44(5-6 Suppl 2): 334-339, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068155

ABSTRACT

Aim of this paper is to describe the management of an outbreak of COVID-19 in a slaughtering and meat processing plant in Bari Province (Southern Italy). At the end of the outbreak investigation, 18.4% of the employees were positive to the molecular test for SARS-CoV-2. Higher prevalence has been reported in the bovine slaughtering house and swine meat processing plant.In addition to lack of physical distancing and correct use of personal protective equipment, the spread of the virus has been eased by low level of literacy, indoor microclimate, intensive working time, and aerosol-generating procedures in specific areas of the processing plant where more positive cases have been detected. The analysis of this cluster may suggest specific actions to prevent similar outbreaks in the future.


Subject(s)
Abattoirs/organization & administration , Disease Outbreaks , Food Handling , Food Industry/organization & administration , Infection Control/organization & administration , Meat , Occupational Diseases/epidemiology , Pandemics , /isolation & purification , Abattoirs/statistics & numerical data , Adult , Aerosols , Air Pollution, Indoor , Animals , Asymptomatic Infections/epidemiology , Cattle , Contact Tracing , Databases, Factual , Educational Status , Equipment Contamination , Female , Food Handling/instrumentation , Food Handling/methods , Food Handling/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Personal Protective Equipment , Sheep , Swine
15.
Epidemiol Prev ; 44(5-6 Suppl 2): 323-329, 2020.
Article in English | MEDLINE | ID: covidwho-1068154

ABSTRACT

OBJECTIVES: to study the cumulative incidence, the demographics and health conditions of the population tested for COVID-19, and to map the evolving distribution of individual cases in the population of the Friuli Venezia Giulia Region (North-Eastern Italy). DESIGN: population-based observational study based on a record linkage procedure of databases included in the electronic health information system of the Friuli Venezia Giulia Region. SETTING AND PARTICIPANTS: the study group consisted of individuals who resided in the Friuli Venezia Giulia Region and who underwent COVID-19 testing from 01.03 to 24.04.2020. The study group was identified from the laboratory database, which contains all the microbiological testing performed in regional facilities. Tested people were categorized into positive or negative cases, based on test results. MAIN OUTCOME MEASURES: probability of being tested for and cumulative incidence of COVID-19. RESULTS: the cumulative probability of being tested for COVID-19 was 278/10,000 inhabitants, while the cumulative incidence was 22 cases/10,000. Out of 33,853 tested people, 2,744 (8.1%) turned out to be positive for COVID-19. Women were tested more often than men (337 vs 216/10,000), and they showed a higher incidence of infection than men (25 and 19 infected cases/10,000 residents, respectively). Both cumulative incidence and cumulative probability of being tested were higher in the elderly population. About 25% of infected people was hosted in retirement homes and 9% was represented by healthcare workers. Thirty seven percent of positive cases had hypertension, 15% cardiologic diseases, while diabetes and cancer characterized 11.7% and 10% of the infected population, respectively. The geographic distribution of positive cases showed a faster spread of the infection in the city of Trieste, an urban area with the highest regional population density. CONCLUSIONS: the COVID-19 pandemic did not hit the Friuli Venezia Giulia Region as hard as other Northern Italian Regions. In the early phase, as documented in this study, the COVID-19 pandemic particularly affected women and elderly people, especially those living in retirement homes in Trieste.


Subject(s)
/epidemiology , Pandemics , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , /statistics & numerical data , Child , Child, Preschool , Comorbidity , Databases, Factual , Female , Geography, Medical , Homes for the Aged/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Procedures and Techniques Utilization , Retrospective Studies , Sex Distribution , Young Adult
16.
Epidemiol Prev ; 44(5-6 Suppl 2): 308-314, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068152

ABSTRACT

BACKGROUND: the COVID-19 pandemic represents a challenge for health systems around the world, with just under 10,000 cases in Tuscany Region (Central Italy) and about 4,500 in the Local Health Unit (LHU) 'Toscana Centro', updated on 11 May 2020. The risk factors reported are several, including age, being male, and some chronic diseases such as hypertension, diabetes, respiratory and cardiovascular diseases. However, the relative importance of chronic diseases is still to be explored. OBJECTIVES: to evaluate the role of chronic diseases on the risk to develop clinically evident (at least mild symptomatic) forms of SARS-CoV-2 infection in the population of the LHU Toscana Centro. DESIGN: case-population study. SETTING AND PARTICIPANTS: 'case' is a subject with SARS-CoV-2 positive swab with at least mild clinical status, who lives in the LHU Toscana Centro area; 'controls' are all people residing in the LHU Toscana Centro area at 1 January 2020. People aged under 30 and patients living in nursing care homes are excluded from the analysis. MAIN OUTCOME MEASURES: the analysis assesses the effect of gender, age, neoplasm, and the main chronic diseases on the onset of an infection with at least mild symptoms by calculating odds ratios (OR) by multivariate logistic regression models (to produce adjusted OR by potential confounders). RESULTS: among the 1,840 cases, compared to the general population, the presence of males and over-60-year-old people is greater. Almost all the considered chronic diseases are more frequent among the cases, compared to the general population. A chronic patient has a 68% greater risk to be positive with at least mild symptoms. Many of the considered diseases show an effect on the risk of getting COVID-19 in a symptomatic form, which remains even adjusting by other comorbidities. The main ones include heart failure, psychiatric disorders, Parkinson's disease, and rheumatic diseases. CONCLUSIONS: these results confirm evidence already shown in other studies on COVID-19 patients and add information on the chronic diseases attributable risk in the population, referred to the symptomatic forms and adjusted by age, gender or the possible copresence of more diseases. These risk estimates should guide prevention interventions by health services in order to protect the chronic patients affected by the pathologies most at risk.


Subject(s)
/epidemiology , Chronic Disease/epidemiology , Pandemics , Adult , Age Distribution , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Neoplasms/epidemiology , Nervous System Diseases/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Rheumatic Diseases/epidemiology , Sex Distribution
17.
Epidemiol Prev ; 44(5-6 Suppl 2): 297-306, 2020.
Article in English | MEDLINE | ID: covidwho-1068151

ABSTRACT

BACKGROUND: the first confirmed cases of COVID-19 in WHO European Region was reported at the end of January 2020 and, from that moment, the epidemic has been speeding up and rapidly spreading across Europe. The health, social, and economic consequences of the pandemic are difficult to evaluate, since there are many scientific uncertainties and unknowns. OBJECTIVES: the main focus of this paper is on statistical methods for profiling municipalities by excess mortality, directly or indirectly caused by COVID-19. METHODS: the use of excess mortality for all causes has been advocated as a measure of impact less vulnerable to biases. In this paper, observed mortality for all causes at municipality level in Italy in the period January-April 2020 was compared to the mortality observed in the corresponding period in the previous 5 years (2015-2019). Mortality data were made available by the Ministry of Internal Affairs Italian National Resident Population Demographic Archive and the Italian National Institute of Statistics (Istat). For each municipality, the posterior predictive distribution under a hierarchical null model was obtained. From the posterior predictive distribution, we obtained excess death counts, attributable community rates and q-values. Full Bayesian models implemented via MCMC simulations were used. RESULTS: absolute number of excess deaths highlights the burden paid by major cities to the pandemic. The Attributable Community Rate provides a detailed picture of the spread of the pandemic among the municipalities of Lombardy, Piedmont, and Emilia-Romagna Regions. Using Q-values, it is clearly recognizable evidence of an excess of mortality from late February to April 2020 in a very geographically scattered number of municipalities. A trade-off between false discoveries and false non-discoveries shows the different values of public health actions. CONCLUSIONS: despite the variety of approaches to calculate excess mortality, this study provides an original methodological approach to profile municipalities with excess deaths accounting for spatial and temporal uncertainty.


Subject(s)
/epidemiology , Models, Theoretical , Mortality/trends , Pandemics , Urban Population/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Bayes Theorem , Cities , Female , Geography, Medical , Humans , Italy/epidemiology , Male , Middle Aged , Risk , Young Adult
18.
Epidemiol Prev ; 44(5-6 Suppl 2): 288-296, 2020.
Article in English | MEDLINE | ID: covidwho-1068150

ABSTRACT

OBJECTIVES: to provide a description of inequalities in overall and COVID-19 mortality by ecological socioeconomic measures (ESEMs) during the first outbreak peak (March and April 2020) in Emilia-Romagna Region. DESIGN: cross-sectional study based on the record linkage of the COVID-19 notification system, the regional population health register and the 2011 census data. SETTING AND PARTICIPANTS: residents in Emilia-Romagna who were grouped according to three ESEMs calculated at census block level: the index of deprivation, the household crowding, and the percentage of the foreign resident population. MAIN OUTCOME MEASURES: counts of all deaths and those directly attributable to COVID-19. The association between mortality and ESEMs was assessed through rate differences and mortality rate ratios, estimated through Poisson models. RESULTS: during the outbreak peak, the nine provinces of the Emilia-Romagna Region were unequally hit by the COVID-19 outbreak, with Piacenza recording the highest COVID-19 absolute death toll and Ferrara the lowest. The overall and COVID-19 mortality burden was unequal also in terms of ecological socioeconomic measures. Percentage differences in the age-standardised mortality rates between the least and the most disadvantaged census blocks were greater for COVID-19 mortality than for overall mortality, suggesting that the Coronavirus outbreak has had a stronger impact on the most socioeconomically deprived areas. Although clear gradients were not always present, people living in the most disadvantaged census blocks experienced the highest absolute and relative risk of dying. Rate differences were larger among men, but mortality rate ratios were not always greater among men than women, especially for the COVID-19 mortality. CONCLUSIONS: these descriptive yet informative results are relevant to document inequalities and inform regional public health policies and interventions in case of new COVID-19 surges.


Subject(s)
/mortality , Mortality/trends , Pandemics , Poverty Areas , Socioeconomic Factors , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Crowding , Emigrants and Immigrants/statistics & numerical data , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Social Determinants of Health/statistics & numerical data , Vulnerable Populations/statistics & numerical data , Young Adult
19.
Epidemiol Prev ; 44(5-6 Suppl 2): 282-287, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068149

ABSTRACT

OBJECTIVES: 1. to evaluate mortality risk excess in the population residing in nursing care homes (NCHs) compared to non-NCHs before the COVID-19 outbreak; 2. to verify if the outbreak modified risk excess; 3. to estimate the COVID-19 impact; 4. to ascertain incidence-mortality relationship. DESIGN: cohort study. SETTING AND POPULATION: Mantua and Cremona provinces (Lombardy Region, Northern Italy) - included in ATS Val Padana - with COVID-19 incidence rate 7.5‰ and 16.9‰, respectively. Inhabitants aged >= 75 years as of 1st January 2018, 2019, and 2020 (three cohorts), stratified in NCH or not. The indicators calculated were: 1. rate ratio (RR) for NCH vs non-NCH, adjusted by gender, age, chronic diseases number, at least 1 hospitalisation, at least 1 Emergency room access in the previous year, for 2018, 2019, and 2020; 2. adjusted RR, 2019 and 2020 vs 2018, both sub-cohorts (i.e., NCH and non-NCH). MAIN OUTCOME MEASURES: first four-month period mortality of the considered years. RESULTS: aproximately 100,000 inhabitants by year, 7% in NCH. In the 2020 first four-month period, 4,343 deaths occurred of which 45% in NCH. RR in NCH population vs non-NCH for the year 2018 was 2.13 (95%CI 1.94-2.34); for the year 2019 was 2.70 (95%CI 2.43-3.00); for the year 2020 was 6.98 (95%CI 6,49-7,50). Adjusted RR for NCH population in 2020 vs 2018 was 2.22 (95%CI 2.05-2.42) in the whole ATS Val Padana; 1.58 (95%CI 1.40-1.77) in Mantua Province; 2.93 (2.62-3.27) in Cremona Province. Adjusted RR in non-NCH population in the year 2020 vs 2018 was 1.59 (95%CI 1.48-1.70) in the whole ATS; 1.34 (95%CI 1.23-1.46) in Mantua Province; 1.89 (95%CI 1.73-2.07) in Cremona Province. CONCLUSIONS: the NCH population experienced an excess risk mortality compared to non-NCH before the COVID-19; this excess increased during the outbreak. In 2020, in NCHs the risk was more than double compared to the 2018 risk, while in non-NCHs it rose approximately by 60%. The gap between NCHs/non-NCHs COVID-19 impact was higher in Cremona than in Mantua.


Subject(s)
/epidemiology , Mortality/trends , Nursing Homes/statistics & numerical data , Pandemics , Aged , Aged, 80 and over , Confidence Intervals , Female , Frail Elderly/statistics & numerical data , Geography, Medical , Humans , Incidence , Institutionalization/statistics & numerical data , Italy/epidemiology , Male , Risk
20.
Epidemiol Prev ; 44(5-6 Suppl 2): 271-281, 2020.
Article in English | MEDLINE | ID: covidwho-1068148

ABSTRACT

OBJECTIVES: to provide a time-varying classification of the Italian provinces based on the weekly age- and gender-specific relative risks (RR) for overall mortality, obtained comparing the number of deaths from 13 weeks from the beginning of the COVID-19 epidemics, with the average number of deaths from the same period in 2015-19. DESIGN: population overall mortality data provided by the Italian National Statistical Office (Istat). SETTING AND PARTICIPANTS: Italian residents 60 years or older from 7,357/7,904 Italian municipalities. For the included municipalities, the number of deaths from any cause from 1 January to 30 May 2020 was available for each day of the 2015-2020 period. Data were stratified by gender, 4 age categories (60-69, 70-79, 80-89, 90+), week, and province. MAIN OUTCOME MEASURES: province- and gender-specific weekly RR curves (age category vs RR), obtained for 13 weeks between 26 February and 26 May; excess mortality; time-varying/weekly classification of provinces. RESULTS: these results provide a weekly classification of the Italian provinces based on their RR curves in 5 groups, 2 of which had high and very high excess mortality during the epidemics. Most of the provinces that appeared at least once in the highest-risk group are neighbouring provinces in the Northern Regions of Lombardy, Emilia-Romagna, Piedmont, and Marche (in central Italy), where most of the COVID-19 cases and deaths were identified. Temporally, most of these provinces remained in the highest-risk group for 4 or 5 weeks; those that entered the group later, improved faster. The overall RR curves for groups differed in magnitude, but also in the shape, which varied markedly also between men and women and, most importantly, in the highest-risk group. CONCLUSIONS: this study gives timely re-analysis of the Istat data at weekly level and provides a classification of the geographical and temporal characteristics of the excess mortality in the Italian provinces during the COVID-19 epidemics. As expected, the used clustering method groups the provinces that have similar RR values in the two gender-specific curves. The results facilitate the presentation of the spatio-temporal mortality patterns of the epidemics and provide evidence of high heterogeneity in the group of provinces that were defined as high-risk groups by others, based on their geographical position or on the time of the observed spread of the virus.


Subject(s)
Age Distribution , Mortality/trends , Pandemics , Sex Distribution , Aged , Aged, 80 and over , Cluster Analysis , Female , Geography, Medical , Humans , Italy/epidemiology , Male , Middle Aged , Risk , Time Factors
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