Trends in influenza coverage rates in five consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy).

Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying conditions are at increased risk of complications. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy are not optimal. The study investigated the coverage rate in five consecutive influenza seasons (2010/2011-2014/2015) in Local Health Unit (LHU) of Ferrara (Italy). The amount of delivered vaccinations was not constant, with a decreasing trend. An increase in coverage with increasing age was observed, but in no immunisation seasons the 75% target of over-65 years old individuals immunised was achieved. As number of delivered doses and coverage rates decreased, the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage was the Western District. In elderly, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Higher levels of immunisation were observed in South-Eastern District in the pediatric age and in North-Central District in adult age group with a statistically significant difference. The trend in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and achieving as much as possible effective elderly immunisatio

Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 citt? italiane: risultati del progetto EpiAir2 Air pollution and urgent hospital admissions in 25 Italian cities: results from the EpiAir2 project

OBJECTIVE: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project. DESIGN: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analysis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September). SETTING AND PARTICIPANTS: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006- 2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005). MAIN OUTCOME MEASURES: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 μg/m3 and interquartile range (IQR) of the concentration of each pollutant were calculated. RESULTS: reported results were related to an increment of 10 μg/m3 of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75%at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0- 5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57%at lag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005). CONCLUSION: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period.OBIETTIVO: valutare la relazione tra inquinamento atmosferico e ricoveri ospedalieri nelle citt? italiane partecipanti alla seconda fase del progetto EpiAir (Sorveglianza epidemiologica dell\u27inquinamento atmosferico: valutazione dei rischi e degli impatti nelle citt? italiane). DISEGNO: studio di serie temporali con metodologia case-crossover, con aggiustamento per i fattori temporali e meteorologici rilevanti. L\u27associazione inquinamento atmosferico- ospedalizzazioni ? stata analizzata in ciascuna delle 25 citt? in studio, le stime complessive di effetto sono state ottenute successivamente mediante una metanalisi. Gli inquinanti considerati sono stati il particolato (PM10), il biossido di azoto (NO2) e l\u27ozono (O3), quest\u27ultimo limitatamente al semestre estivo (da aprile a settembre). In 13 citt? in cui i dati erano disponibili ? stata analizzata anche la frazione fine del particolato (PM2.5). SETTING E PARTECIPANTI: lo studio ha esaminato 2.246.448 ricoveri ospedalieri urgenti per cause naturali di pazienti residenti e ricoverati, nel periodo 2006-2010, in 25 citt? italiane, di cui 10 gi? partecipanti alla prima fase del progetto EpiAir (2001-2005). PRINCIPALIMISURE DI OUTCOME: sono stati considerati i ricoveri ospedalieri urgenti per malattie cardiache, cerebrovascolari e respiratorie per tutte le fasce di et?. I ricoveri per cause respiratorie sono stati analizzati separatamente anche per la fascia di et? 0-14 anni. L\u27esposizione ? stata valutata per incremento sia di 10 μg/m3 sia pari all\u27intervallo interquartile (IQR) della concentrazione di ciascun inquinante. RISULTATI: considerando un incremento di 10 μg/m3 per inquinante, per il PM10 ? stato osservato un incremento percentuale di rischio per patologie cardiache dello 0,34%a lag 0 (IC95% 0,04-0,63), e per patologie respiratorie dello 0,75% a lag 0-5 (IC95% 0,25-1,25). Per il PM2.5 l\u27incremento percentuale di rischio per patologie respiratorie ? risultato dell\u271,23%a lag 0-5 (IC95%0,58-1,88). Per l\u27NO2 la stima di effetto per patologie cardiache ? risultata dello 0,57% a lag 0 (IC95% 0,13-1,02), e per patologie respiratorie dell\u271,29% a lag 0-5 (IC95% 0,52-2,06). L\u27ozono non ? risultato positivamente associato n? alle patologie cardiache n? a quelle respiratorie (a differenza del periodo 2001-2005). CONCLUSIONE: i risultati dello studio confermano l\u27effetto a breve termine dell\u27inquinamento atmosferico da PM10, PM2.5 e NO2 sulla morbosit?, in particolare respiratoria, nelle citt? italiane. Non sono state rilevate associazioni positive per l\u27O3

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Epidemiological, clinical and laboratory features of chronic hepatitis B infection in a cohort of immigrant and Italian patients from Ferrara, Italy

Background. Italy has recently become a land of immigration. Two hundred and fifty thousand carriers are immigrants and chronic HBV infection is the prevalent form. Considering the elevated number of foreigners resident in our province and the potential risk of transmission to local people, we retrospectively investigated the patterns of chronic hepatitis B (CHB) in 154 patients (76 foreigners, 78 Italians) observed in our Institution, with regard to demographic and clinical/laboratory characteristics.Results. The immigrants were younger (mean age 31 years) compared to Italians (51.5) and mainly came from East Europe. Regarding exposure to HBV, the intra-familial risk factor was most frequently observed in foreigners, compared to Italians (p = 0.03). Foreigners also showed a higher prevalence of HBeAg positive forms, HDV co-infection (7.9%) and abnormal ALT and/or HBV-DNA values, compared to Italians. HBeAg positivity was more associated with increased ALT (OR = 36.6, p = 0.001) than with elevated HBV viremia (OR = 6.5, p = 0.049); age was a protective factor (OR = 0.1; p = 0.014). No significant association was found between increased ALT and foreign nationality. The simultaneous presence of increased ALT and viremia was more frequent among foreigners, (OR = 7.6, p = 0,014) and increased with age (OR = 1.06, p = 0.013). Antiviral therapy was given in 7.8% of foreign citizens.Conclusion. Immigrants constitute a vulnerable population subgroup that would benefit from a more active approach regarding doctor-patient relationship for early recognition of HBV and treatment programmes

Clinical Validation Results of an Innovative Non-Invasive Device for Colorectal Cancer Preventive Screening through Fecal Exhalation Analysis

Screening is recommended to reduce both incidence and mortality of colorectal cancer. Currently, many countries employ fecal occult blood test (FOBT). In Emilia-Romagna (Italy), since 2005, FOBT immunochemical version (FIT) is performed every two years on people aged between 50 and 69 years. A colonoscopy is then carried out on those who are FIT positive. However, FIT shows approximately 65% false positives (non-tumoral bleedings), leading to many negative colonoscopies. The use of an economic and easy-to-use method to check FOBT-positives will improve screening effectiveness, reducing costs to the national health service. This work illustrates the results of a three-year clinical validation protocol (started in 2016) of a patented device composed of a core of nanostructured gas sensors. This device was designed to identify CRC presence by fecal volatile compounds, with a non-invasive, in vitro and low-cost analysis. Feces are, in fact, affected by tumor-volatile biomarkers, produced by cellular peroxidation and metabolic alterations. The protocol consisted in the analysis of fecal samples of FIT-positive subjects, using colonoscopy as a gold standard. A total of 398 samples were analyzed with machine learning techniques, leading to a sensitivity and specificity of 84.1% and 82.4%, respectively, and a positive predictive value of 72% (25&ndash;35% for FIT)

Factors Associated with Reduction in Physical Activity during the COVID-19 Pandemic in São Paulo, Brazil: An Internet-Based Survey Conducted in June 2020

Background: The COVID-19 pandemic negatively affected physical activity levels. This study investigated the factors associated with the change in physical activity level in Brazilians residing in the city of São Paulo. Methods: A self-administered questionnaire, addressing personal data, restriction level, education level, family income, daily working hours, and physical activity level, was answered by 2140 volunteers, of which 1179 were excluded because the answers were either incomplete or the respondents were not from São Paulo. The total number of participants selected was 961 (581 female and 380 male). Results: The physical activity level adopted prior to the pandemic period (p < 0.001) and family income (p = 0.001) correlated significantly with physical activity level reduction during the pandemic. The proportion of people who reduced their physical activity was greater among those who were very active than those who were active (adjusted prevalence ratio [aPR]: 0.65 [confidence interval (CI): 0.52–0.80]) or insufficiently active [aPR: 0.39 (0.18–0.82)]. The proportion of people who reduced their physical activity was greater among those who received a salary less than minimum wage (MW) than those who received a salary between three to six times minimum wage [(aPR: 0.50 (CI 0.35–0.70)] or more than 6 MW [(aPR: 0.56 (CI 0.40–0.79)]. Conclusions: A higher prevalence of Brazilians residing in the city of São Paulo reduced their physical activity who had a vigorous level of physical activity prior to the pandemic and who received less than a MW

Use of Gas Sensors and FOBT for the Early Detection of Colorectal Cancer

Among the major challenges of medicine today there are screening and early detection of tumors (since the adenoma stage) in order to prevent their degeneration into malignant cancer and/or metastases. In particular, the colorectal cancer shows a high curability rate, up to 90%, if identified when in its benign stage. The Protocol discussed here is proposed to implement the clinical validation of a device consisting of an array of chemoresistive gas sensors made of semiconductor materials, able of identifying the difference between fecal exhalation of healthy subjects and of subjects suffering from high-risk colorectal polyps or tumors. The tests are compared to the results of fecal occult blood test and colonoscopy as a gold standard

Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens

AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. CONCLUSION: No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians