Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

Il ruolo dei sindaci nella tutela della salute dei cittadini

Introduzione: La Costituzione italiana pone la salute quale diritto fondamentale dell’individuo e un interesse della collettività. Essa prevede competenze legislative in capo allo Stato e alle Regioni, le quali collaborano con Aziende e Comuni affinchè tali garanzie siano uniformi sul territorio nazionale e quanto più integrate in un unico sistema di welfare. In seguito alla forte urbanizzazione registrata nell’ultimo secolo, molteplici determinanti di salute sono stati influenzati dalle amministrazioni comunali su ambiti che l’Urban Health ha spiegato essere centrali per la salute. In questa ottica, è necessaria chiarezza sulle competenze attribuite al sindaco e alle amministrazioni comunali in materia sanitaria sotto il profilo giuridico, poiché ricopre un ruolo di considerevole importanza ai fini della tutela della salute dei cittadini. Obiettivo: L’obiettivo di questo studio è descrivere il ruolo dei sindaci comunali nella la tutela della salute dei cittadini, in accordo con la normativa vigente. Metodi: È stata condotta una revisione della normativa vigente sulle competenze dei Comuni in materia sanitaria. Sono stati ricercati i riferimenti e i preamboli normativi attinenti ed inclusi nei risultati individuati. Le norme sono state classificate per livello nazionale, regionale e locale. Risultati: A livello nazionale, il Testo Unico degli Enti Locali individua il sindaco come massima autorità sanitaria locale; in caso di emergenze sanitarie o di misure per l’igiene pubblica a carattere esclusivamente locale, le ordinanze contingibili e urgenti sono adottate dal sindaco. A livello regionale, secondo le norme nazionali L.833/78, DLgs. 502/92 L. 419/98 e DLgs. 229/99, la pianificazione dei servizi sanitari e socio-sanitari deve prevedere la partecipazione dei Comuni. Questi analizzano i bisogni territoriali durante l’Assemblea dei sindaci del distretto e comunicano le proposte alla Conferenza dei sindaci, organismo istituito per legge, che definisce i piani sociosanitari territoriali e li comunica al direttore generale dell’ASL di competenza. A livello locale, i Comuni adottano regolamenti nelle materie di propria competenza, tra cui l’igiene urbano ed edilizio, mobilità, sicurezza, sviluppo delle aree residenziali e verdi. Conclusioni: I Comuni hanno competenze dirette e indirette sulle politiche che garantiscono la salute dei cittadini, quali igiene ambientale e urbana, mobilità e sicurezza. Nuove sinergie tra le amministrazioni comunali e gli operatori sanitari possono condurre all’implementazione di strategie di prevenzione e promozione della salute. Il sindaco compete nelle politiche che ricadono sulla tutela della salute individuale e collettiva e risulta fondamentale applicare la Health in All Policies, secondo la definizione dell’Organizzazione Mondiale della Sanità

Population health management: Principles, models and areas of application in public health

There is no single model for Population Health Management (PHM) and different definitions have been proposed. All PHM models and definitions share the overall aim of improving population health and reduce healthcare costs. To achieve these objectives, PHM makes use of conceptual tools such as the Chronic Care Model and predictive medicine, and technical tools such as information systems and computational and record-linkage techniques to collect and analyse data. Using these tools, it makes it feasible to articulate PHM approaches in the following steps: identification of a population, stratification of individuals according to risk levels, mapping of health needs and development of targeted interventions and models of care. PHM has been applied in a variety of national and regional settings, proving to have great potential. However, the success of PHM models depends on a number of factors. In particular, few key points have emerged that must be taken into consideration when planning and implementing PHM programs. They include PHM funding schemes, strategies to ensure people adherence, the equity dimension in its multiple aspects, and the privacy of personal data. In addition to these challenges, there is the need to act in a legislative context appropriate to the implementation of PHM

Healthcare-acquired Sars-Cov-2 infection: A viable legal category?

: In the context of the Sars-Cov-2 pandemic, according to the various periods of emergency and the rate of infections, hospitalized subjects also contracted the infection within the ward, sometimes with the development of disease (COVID-19) and sometimes with permanent damage. The authors wondered if Sars-Cov-2 infection should be considered on a par with other infections acquired in the healthcare setting. The non-diversified diffusion between the health and non-health sectors, the ubiquity of the virus and the high contagiousness, together with the factual inability to prevent it by the health structures, despite the adoption of entry control, practices of isolation of positive subjects, and staff surveillance, lead to consider COVID-19 in a different way, in order to otherwise burden health structures in the face of unmanageable risks, clearly also dependent on exogenous and uncontrollable factors. The guarantee of care safety must, in the pandemic, be able to compare with the real capacity for intervention according to the asset of the current health service, requesting State intervention with alternative instruments, such as una tantum compensation, for COVID-19 damage reparation occurred in the health sector

The role of Mayors in protecting citizens’ health: a brief report from Italy

The World Health Organization has identified urbanization as one of the most important public health challenges of our century. Nowadays, about half of the world’s population live in urban areas, thus municipal authorities can influence multiple determinants of health through Urban Health strategies. However, the health policies and welfare systems are usually managed by multi-level political governments. The aim of this report is to describe the legal and operational competences attributed to mayors and municipal councils with reference to health, taking Italy as case study. Our report summarises and analyses the national, regional, and local Italian legislations. Our results identified the mayors as the highest local health authorities. Indeed, the mayor can issue specific regulations for their local area or order contingent and urgent measures for preventing or delimiting serious health hazards for the safety of their citizens. Moreover, among their duties, municipalities play a crucial role in social care. Hence, municipalities are expected to cooperate with National Health Service at the regional level, to integrate their contributions in a single welfare system. In conclusion, mayors represent the institutional figures closest to the citizens. Municipalities and regional governments should coordinate and integrate their strategies and policies to meet health and social needs of citizens, providing easy access to shared pathways. Municipalities also regulate autonomously fundamental aspects related to the urban environment and can promote and protect health and improve the quality of life for citizens

Digital Information Approach through Social Media among Gen Z and Millennials: The Global Scenario during the COVID-19 Pandemic

An infodemic represents a concern for public health, influencing the general population’s perceptions of key health issues. Misinformation is rapidly spread by social media, particularly among young generations. We used data from the WHO “Social Media and COVID-19” study, which was conducted in 24 countries worldwide on over 23,000 subjects aged 18–40 years, to explore Generation Z and Millennials’ models for health-information-seeking behaviors on social media. We summarized data on the most used sources of information, content of interest, and content sharing, as well as the sentiment toward the infodemic, through descriptive statistics and Chi-square test to verify the differences between groups. Among the survey respondents, 9475 (40.3%) were from high-income countries (HIC), 8000 (34.1%) from upper-middle-income countries (UMIC), and 6007 (25.6%) from lower-middle-income countries (LMIC). Social media were the most used sources of information to retrieve news on COVID-19 disease (about 79% in HIC, 87% in UMIC, and 90% in LIC) and the COVID-19 vaccine (about 78% in HIC and about 88% in UMIC and LIC). More than a half of the young respondents declared that they pay attention to scientific contents (about 51% in HIC, 59% in UMIC, and 55% in LMIC). Finally, most young participants reported feeling overwhelmed by the infodemic. However, this sentiment did not stop them from seeking information about COVID-19. Our findings highlight the importance of shaping public health interventions and campaigns on social media platforms and leveraging scientific contents. Public health authorities should work also on strategies to improve the digital literacy of the population as a driving force to empower them and achieve better health outcomes

The potential of digital health records for public health research, policy, and practice:the case of the Lombardy region data warehouse

Digital health records can provide advantages to healthcare practice, policy, and research. Several countries have established population-based digitalised data collection, integrated through data linkage techniques. In Lombardy (Italy), a regional population-based registry was established in the 2000s. It collects data from the social and health sector, anonymised immediately after their acquisition and restructured in a single repository. Data can be used for public health interest, planning, monitoring, services evaluation, and research. Indeed, data can also be provided to universities and other scientific institutes. The availability of such data enables to explore the epidemiology of infectious, chronic, and rare diseases. Thus, epidemiological research can support policymakers to tackle public health threats. However, analysis of electronic health records comes along with several challenges, including data inaccuracy, incompleteness, and biases. Researchers should take into consideration limits and barriers related to quality of data. Moreover, health data use must adhere to the national and European privacy legislation, at times limiting the potential of data integration. Therefore, even if big data drives innovation and scientific knowledge, ethical issues regarding privacy should be considered in public debate. (www.actabiomedica.it)

Compliance with recommended preventive behaviours and restrictions for Covid-19: an exploratory analysis of Italians’ attitudes

Background and aim: as a reaction to the COVID-19 pandemic, countries all over the world have undertaken wide-scale measures to prevent and limit the spread of the virus. Suggested preventative measures mainly included “lockdown”, social distancing, wearing facemasks, and vaccinations. The success of these measures was widely dependent on the cooperation of citizens. However, people reacted differently to the several types of restrictions and recommendations. Even if the majority followed the rules, others ignored them. This study aims to investigate the reasons for the compliance or violation of the rules developed to fight against the COVID-19 pandemic in Italy. Methods: to answer the research question, the analysis of two different surveys conducted on a representative sample of Italians (N=2000) were conducted and ana- lysed through descriptive statistics. Results: the data collection agreed with published literature. Compliance with rules during emergencies followed diligence and altruistic patterns. Fear of sanctions did not seem to work in relation to rules compliance during emergency situations. The lack of clarity of regulations in terms of complexity or constant changes led to non-compliance even intervening as a neutralization technique. Conclusions: government’s fear-based interventions did not seem to work since Italians tended to adhere to the rules primarily out of respect for legitimate authority. Future research should focus more on the topic of trust in institutions in emergency situations with the aim of highlighting the key points for successful governance, also in terms of rules compliance

Depression and Objectively Measured Physical Activity:A Systematic Review and Meta-Analysis

Depression is a major contributor to the overall global burden of disease, with high prevalence and relapse rate. Several factors have been considered in order to reduce the depression burden. Among them, physical activity (PA) showed a potential protective role. However, evidence is contrasting probably because of the differences in PA measurement. The aim of this systematic review with meta-analysis is to assess the association between objectively measured PA and incident and prevalent depression. The systematic review was conducted according to methods recommended by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers published through 31 August 2019 were identified searching through the electronic databases PubMed/MEDLINE, Excerpta Medica dataBASE (Embase), PsycINFO, Scopus, Web of Science (WoS), and the Cochrane Library. All analyses were conducted using ProMeta3. Finally, 42 studies met inclusion criteria. The overall Effect size (ES) of depression for the highest vs. the lowest level of PA was -1.16 [(95% CI = -1.41; -0.91), p-value <0.001] based on 37,408 participants. The results of the meta-analysis showed a potential protective effect of PA on prevalent and incident depression

Compliance with recommended preventive behaviors and restrictions for COVID-19: an exploratory analysis of italians’ attitudes

Background and aim: as a reaction to the COVID-19 pandemic, countries all over the world have undertaken wide-scale measures to prevent and limit the spread of the virus. Suggested preventative measures mainly included “lockdown”, social distancing, wearing facemasks, and vaccinations. The success of these measures was widely dependent on the cooperation of citizens. However, people reacted differently to the several types of restrictions and recommendations. Even if the majority followed the rules, others ignored them. This study aims to investigate the reasons for the compliance or violation of the rules developed to fight against the COVID-19 pandemic in Italy. Methods: to answer the research question, the analysis of two different surveys conducted on a representative sample of Italians (N=2000) were conducted and ana- lysed through descriptive statistics. Results: the data collection agreed with published literature. Compliance with rules during emergencies followed diligence and altruistic patterns. Fear of sanctions did not seem to work in relation to rules compliance during emergency situations. The lack of clarity of regulations in terms of complexity or constant changes led to non-compliance even intervening as a neutralization technique. Conclusions: government’s fear-based interventions did not seem to work since Italians tended to adhere to the rules primarily out of respect for legitimate authority. Future research should focus more on the topic of trust in institutions in emergency situations with the aim of highlighting the key points for successful governance, also in terms of rules compliance