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.

[Reassessment of burden of occupational fatal injuries in Italy, 1951-2017]. / Rivalutazione del carico di danni dovuti agli infortuni mortali sul lavoro in Italia, 1951-2017.

BACKGROUND: occupational injuries in Italy are registered primarily by the Italian National Institute for insurance against accidents at work (Inail); its statistics show the number of events by consequence type (temporary, permanent, fatal). Data prior to 2001 include fatalities only if benefits were paid to survivors entitled to compensation, typically spouse and/or children. OBJECTIVES: to estimate the number of fatal injuries occurred to workers without survivors entitled to compensation, not considered in INAIL statistics for the period 1951-2000; to evaluate years lived with disability (YLD) years of life lost (YLL), disability-adjusted life years (DALY) caused by all occupational injuries occurred in Italy, period 1951-2016. DESIGN: evaluation of the stability of the ratio among fatal accidents with and without survivors, along the period of observation (2001-2017); retrospective application of such ratio to data related to the period 1951-2000; linkage of individual injury data to Global Burden of Disease injury categories and calculation of corresponding YLLs, YLDs, DALYs; calculation of mean values by main type of consequences (temporary, permanent, fatal); application of above means to Italian data 1951-2017. SETTING AND PARTICIPANTS: occupational injuries compensated by Inail in Italy, 1951-2017. MAIN OUTCOME MEASURES: number of injuries, YLDs, YLLs, DALYs. RESULTS: fatal occupational injuries, not considered in official statistics for the period 1951-2000, are estimated to be 26,218 cases, corresponding to 1.4 millions of YLLs. In the same period, total occupational injuries (with temporary, permanent or fatal consequences) correspond to 11.5 millions of DALYs, fatal component corresponded to 5.1 millions of YLLs. CONCLUSIONS: Estimated total number of fatal occupational injuries in 1951-2000 is 28% higher than official Inail data. Considering YLLs, such increase rises up to 37%. Such difference reflects younger mean age and consequent longer life expectancy of workers without survivors. Considering DALYs, the increase is 14%. Throughout the period 1951-2017, a progressive reduction of the burden of injury is observed. At the same time a qualitative change is observed, with reduction from 55% to 30% of YLL/DALY ratio.

Italian translation and validation of the Perinatal Grief Scale.

AIMS: The short version of the Perinatal Grief Scale (PGS) has 33 items of Likert type whose answers vary from 1 (strongly agree) to 5 (strongly disagree), and is used to assess the grief after perinatal loss and to identify women at major need of specific support. This is the first attempt to validate an Italian version of PGS. MATERIALS AND METHODS: The English version of PGS by Potvin et al. was translated into Italian by a professional mother tongue English translator. The survey was administered at 3 different times (translated Italian version; original English version after 10 days; and same Italian version after other 10 days) to 16 Italian/English bilingual women who had experienced a perinatal loss. The reproducibility among the three administrations and concordance were assessed using Cronbach's alpha and Cohen's kappa, respectively. RESULTS: Considering the PGS, median score ranged from 74.5 (58.5-94.5) to 78 (64-95), with no significant difference among the three questionnaire administrations (p = 0.616). No significant difference emerged among the three administered questionnaires for subscales (p = 0.095, 0.410 and 0.410 for 'active grief' AG, 'difficulty in coping' DC and 'despair' D scores, respectively). Concordance varied from good to very good among all questionnaire administrations. CONCLUSIONS: This Italian version of the PGS can be used by clinicians to assess Italian women's responses to stillbirth and perinatal loss, as well as by researchers for research purposes.

Stillbirth and perinatal care: Are professionals trained to address parents' needs?

OBJECTIVE: To assess current practices of health care providers (HCPs) caring for women experiencing a stillbirth and to explore their needs for training to better support bereaved families. DESIGN: Nationwide cross-sectional survey. The main outcome measures were the evaluation of HCPs cognition, emotions and behaviours with regard to the care of women with a stillbirth care, as well as their compliance with international guidelines. PARTICIPANTS: 750 HCPs, in 11 Italian hospitals, were administered a multiple-choice questionnaire. FINDINGS: The response rate was 89.9%; the majority (94.1%) were female, with a mean age of 37.6 (SD = 10.4) years. Midwives were the most represented (72.8%). Half of the respondents recommended immediate birth; only 55% routinely bathed and dressed stillborn babies for their parents to see, while 44.4% of HCPs immediately took the babies away without allowing parents to properly say goodbye to them. More than half felt inadequate and some even reported having failed to provide support to the family when caring for a woman with stillbirth in the past. The need for professional training courses was expressed by 90.2%, and three-quarters had never previously attended a course on perinatal bereavement care. When answers by Italian HCPs are systematically evaluated with reference to international guidelines, the results were very poor with only 27.9% of respondents reported having created memories of the baby and less than 3% complied with all recommendations in the areas of respect for baby and parents, appropriate birth options, and aftercare. KEY CONCLUSIONS: There is a substantial gap between the standards of care defined by international guidelines and the practices currently in place in Italy. Italian HCPs feel an urgent need to be offered professional training courses to better meet the needs of grieving families. IMPLICATION FOR PRACTICE: Perinatal HCPs should be aware of their pivotal role in helping bereaved parents after stillbirth and perinatal loss, and seek appropriate training.

Effects of the work limitations on the career path of a cohort of health workers. / Efetti delle limitazioni impartitie dal Medico Competente sul percorso lavorativo di una coorte di lavoratori della sanità.

BACKGROUND: The median age of the workforce, and of healthcare workers in particular, is increasing, resulting in a reduced work capacity. This may prompt the occupational physician to issue fitness for work limitations. OBJECTIVES: To examine the health surveillance data collected over 20 years on the employees of a large healthcare institution to identify the effects of the limitations imposed on their career paths. METHODS: The database of health surveillance records gathered over the years was analysed using the same dedicated software. Fourteen types of limitations were classified via a "text mining" treatment. 3,653 subjects were selected, divided in two groups (A: with a limitation and B: without limitation) comprised of 655 and 2,998 subjects, respectively. The subjects were then ranked on the basis of departments and tasks involved. We also evaluated the number of departmental changes for each worker and the corresponding rate of change for the three groups A, B and B post-limitation. RESULTS: Limitations have been increasing in parallel with the aging of workers, in particular those relating to Manual Load Handling/Posture (MLH/P). The limitations due to Allergy/Latex lasted longer, and in a greater proportion than MLH/P, particularly when compared to the limitation for Shift Work and those for "Other Limitations" that were shrinking faster. CONCLUSIONS: There is a clear relationship between certain types of limitations/prescriptions and workers' ages. It is necessary to carry out an assessment of the association with the work performed in order to implement age management strategies aimed at maintaining work capacity in aging workers.

[Fatal injuries at work in Tuscany Region (Central Italy): content analysis of newspapers]. / Infortuni mortali sul lavoro in Toscana: analisi dei contenuti informativi della stampa quotidiana.

OBJECTIVES: to describe how journalists report events such as fatal accidents work through the newspapers. DESIGN: analysis of the textual content of titles and texts, using qualitative and quantitative techniques. SETTING AND PARTICIPANTS: 184 articles related to 180 work-related fatalities occurred in Tuscany Region (Central Italy) in the period 2008-2009 were examined. MAIN OUTCOME MEASURES: frequency of citation of significant adjectives relating to the use of frames in titles was measured; frequency of citation of the laquo;subjects attended the venue for office tasksraquo; and laquo;subjects whose statements are reported in relation to the eventraquo; in relation to the circumstances of the event and some available demographic features was also evaluated. RESULTS: compared to texts, titles of the articles are characterized by higher frequency of adjectives that describe the emotional intensity. Articles describing tractors or road accidents and articles that describe sudden deaths are shorter than the others. Among the subgroups of subjects quoted in the text of the articles, health authorities are less mentioned in the articles dealing with road accidents, while they are more common in those due to falls from a height, where also social forces which issue statements to the press are more frequently mentioned. The analysis of co-occurrences visually shows which activities are carried out by these subgroups of subjects in the texts of the selected articles. CONCLUSION: the study shows the message that is conveyed to the public by the mass medium newspaper. Hopefully, in the future, following results of similar studies, it will be easier focusing awareness and transmission of information, which are essential for prioritization process of public health initiatives to be taken. This study was preliminary in nature, opening a field of interest so far little practised in our Country.