Mortality attributable to COVID-19 and air pollution. An italian case study

University of Pavia, ItalyIntroduction. Several evidences suggest an association between the air pollution and COVID-19 mortality. However, other factors might impact on COVID-19 mortality. The aim of present work is to explore association between air pollution and COVID-19 mortality in Emilia-Romagna region one of the Italian Region strongly involved in the initial phase of COVID-19 pandemic, taking into account other exogenous factors. Material and methods. An ecological study is used: the official open data are aggregated at the municipality level, for a total of 328 municipalities in the Emilia-Romagna region (https://www.istat.it/). The cumulative-period COVID-19 deaths were the outcome of interest. The deaths attributable to COVID-19 occurred in the pandemic period January 1 – August 31, 2020 were estimated as the excess of all deaths registered in the pandemic period with respect to the average number of all deaths in the same period of previous 5 years. As main predictor of COVID-19 mortality the particulate matter (PM) with diameter less than 10 µm was chosen. As proxy of air pollution at municipalities level, PM10 emissions in tons/year was used (https://dati.arpae.it/dataset/inventario-emissioni-aria-inemar). Several potential determinants of COVID-19 mortality or confounding for the association between PM10 exposure and mortality were also investigated: Degree of urbanization index (DEGURBA), Italian multiple deprivation index (IMD), Ecoregions index (https://www.isprambiente.gov.it/it/attivita/suolo-e-territorio/) and the amount of soil consumed. Geographic distribution of COVID-19 deaths, air pollution and predictors were plotted in maps to describe graphically the spatial distribution. After assigning zero to response variable for those municipalities with a no COVID-9 attributable deaths, negative binomial regression was applied. Results. In the 328 municipalities of Emilia-Romagna, the estimated number of deaths attributable to COVID-19 during the first 8 months of 2020 was in median around 6 deaths (IQR: 15.3). Nevertheless, 5 municipalities showed a number of deaths attributable to COVID-19 over 75th, ranging from 160 to 540; for 75 municipalities no death attributable to COVID-19 was estimated. The median PM10 emissions was around 23 tons/year (IQR: 20.7): 15 municipalities showed a PM10 over 75th. The great majority of municipalities had a thin population (about 60%) and were prevalently rich or very rich: only 7% deprived. The predominant ecoregion was that of central Tuscan and Marche Apennines (about 48%). In median the percentage of soil consumed was 8.5%. The municipalities with the highest number of COVID-19 attributable deaths had a quite high level of PM10 emissions. These were all rich or very rich urban or semi-urban municipalities. Conversely, the municipalities with the lowest tons by year of PM10 emission showed lower COVID-19 attributable mortality. These areas were also characterized by increasing level of deprivation and were mainly rural. The effect of PM10 emission on the COVID-19 attributable deaths estimated in the study period was confirmed by multivariate analysis. Conclusions. The main findings from this work seems to confirm the effect of PM10 on the COVID-19 mortality, in agreement with published evidences. But, given the limit of the ecological study our results may not be conclusive. The latter should be integrated with further studies that analyse the single individual

The new European regulation on personal data protection: significant aspects for data processing for scientific research purposes

On 27 April 2016, after a troubled gestation,, Regulation 2016/6791 of the European Parliament and of the Council on the protection of natural persons with regard to the processing of personal data and on the free movement of such data was finally published. The Regulation is to have a two-year transitional period, meaning it will actually enter into force in the first half of 2018

Is drop-out from obesity treatment a predictable and preventable event?

BACKGROUND: Attrition is an important but understudied issue that plays a vital role in the successful treatment of obesity. To date, most studies focusing on attrition rates and/or its predictors have been based on pretreatment data routinely collected for other purposes. Our study specifically aims at identifying the predictors of drop-out focusing on empirically or theoretically-based factors. METHODS: We conducted a retrospective observational study in an academic outpatient clinical nutrition service in Pavia, Italy. We examined a total of 98 adult obese patients (36 males, 62 females) who underwent a 6-month dietary behavioral weight-loss treatment at our Center. Pre-treatment and treatment-related variables were collected or calculated from clinical charts in order to discriminate those subjects who completed treatment from those who abandoned it before its completion. Multivariable regression analysis was used to identify the independent predictors of drop-out. RESULTS: The drop-out rates were 21% at 1 month and 57% at 6 months. Compared with completers, noncompleters were significantly younger in terms of age at first dieting attempt (24.0 ± 10.7 vs. 31.3 ± 11.2 years, P = 0.005), had lower diastolic blood pressure (87.8 ± 9.7 vs. 92.7 ± 11.4 mmHg, P = 0.022), had a lower baseline body fat percentage (38.5 ± 6.4 vs. 41.2 ± 4.4% weight, P = 0.015), and had a lower percentage of early weight loss (-1.8 ± 1.8% vs. -3.1 ± 2.1%, P = 0.035). Moreover, noncompleters significantly differed from completers with regard to type of referral (34.1% vs. 53.3% sent by a physician, P = 0.036) and SCL-90 anger-hostility subscale (0.83 ± 0.72 vs. 0.53 ± 0.51, P = 0.022). A multivariable logistic regression analysis including pre-treatment variables showed that body fat percentage (P = 0.030) and SCL-90 anger-hostility subscale (P = 0.021) were independently associated with attrition. In a multivariable model considering both pre-treatment and treatment-related factors, attrition was found to be independently related to the age at first dieting attempt (P = 0.016) and the achievement of early weight loss (P = 0.029). CONCLUSIONS: Our data confirm that psychopathological tracts, early dieting attempts, and a poor initial treatment response are key independent predictors of drop-out from obesity treatment

Legal aspects regarding the use and integration of electronic medical records for epidemiological purposes with focus on the Italian situation

The "Observational Studies" working group of the Italian Association of Medical Statistics and Clinical Epidemiology (SISMEC) has undertaken to study the impact of recent healthcare sector regulations on the legal and organisational aspects of managing all EMR databases with emphasis on Legislative Decree No. 196/2003 (the Italian Personal Data Protection Law). This paper examines six issues relating to theirs legal implications. The first section, “Confidentiality”, provides definitions and the regulatory context for the terms "confidentiality" and "personal data". In the second, “Nature of data held in electronic medical record archives”, we discuss the problem of sensitive data and procedures to make the identification code anonymous. In “Data ownership” we highlight the difference between the data controller and the database controller. The fourth section, “Conditions for processing”, discusses problems associated with using research data from one study in other investigations. In the fifth, “Patient consent”, we address the problems related to patient consent. Finally in “Penalties” we outline the main civil and criminal liability issues applied in case of non-compliance with the provisions of the Personal Data Protection Code. Where possible, we provide suggestions on how to comply with the legal requirements of managing medical record archives in order to make it easier for researchers to remain in compliance with the relevant provisions

THE IMPACT OF RISK FACTORS ON HEALTH AND ONLINE TEACHING EXPERIENCE OF MOLDOVAN TEACHERS DURING THE COVID-19 PANDEMIC

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Dezvoltarea fulminantă a pandemiei de COVID-19 a impus schimbări radicale în modul de predare în școli, toate acestea afectând în cea mai mare parte activitatea cotidiană a cadrelor didactice precum ți starea de sănătate a acestora. Scopul lucrării. Evaluarea factorilor de risc din mediul ocupațional precum și a problemei adaptării cadrelor didactice la schimbarea a metodologiei de predare impusă de restricțiile din timpul pandemiei de COVID 19.Materiale și metode. Pentru atingerea scopului propus a fost inițiat un studiu transversal descriptiv. Datele au fost colectate folosind un chestionar structurat care a fost aplicat online., ce a cuprins capitole precum: condiții de muncă și de viață, evaluarea subiectivă a sănătății și evaluare obiectivă a schimbărilor cauzate de predarea online ș.a . Rezultate. Din cei 519 profesori, 79% au diplomă de licență, 13,5% - studii postuniversitare, iar doar 3,9% studii medii. Dacă caracterizăm eșantionul după disciplina predată, atunci 64,7% dintre profesori predau discipline în profil real (cum ar fi matematică, fizică,), iar 36,3% predau obiecte umaniste (precum limba română, limbi străine). Referitor la predarea online, 68,3% spun că aceasta se caracterizează prin suprasolicitare neuro-psihică, neafectată fiind doar aproximativ 9,5%. Din prima grupă, peste 59,6% dintre cadrele didactice susțin că această încordare emoțională persistă permanent, cazuri rare de afectare emoțională fiind înregistrate în 35,3%. Influența acestor factori sa caracterizat prin creșterea incidenței de maladii cardiovasculare cu 19 %; a afecțiuni ale tractului gastrointestinal (65.2 %); disfuncții endocrine (17.3 %).Concluzii. Acest studiu este relevant pentru că descrie elementele critice ale experienței de predare online și identifică unii factori de risc la cadrele didactice care își desfășoară activitatea într-o zonă puternic marcată de restricțiile sociale impuse de pandemie.Background. The sudden development of the COVID-19 pandemic imposed radical changes, which affected most of the day-to-day work of teachers as well as their health. Objective of the study. Assessment of occupational risk factors as well as the problem of teachers’ adaptation to the change of teaching methodology imposed by the restrictions during the COVID-19 pandemic. Material and methods. In order to achieve the proposed goal, a descriptive cross-sectional study was initiated. The data were collected using a structured questionnaire that was applied online. The questionnaire contained several chapters such as: general data, working and living conditions, eating behavior, subjective assessment of health and objective assessment of changes caused by online teaching. Results. Of the 519 teachers, the vast majority 79% have a bachelor’s degree, 13.5% - postgraduate studies, and only 3.9% secondary education. If we characterize the sample by the subject taught then 64.7% of teachers teach subjects in real profile (such as mathematics, physics, chemistry, biology) and the remaining 36.3% teach objects in humanities (such as Romanian languages, foreign languages, geography or history). Regarding online teaching, 68.3% say that it is characterized by neuro-psychic overload, unaffected by only about 9.5%. From the first group, over 59.6% of teachers claim that this emotional strain persists permanently, rare cases of emotional impairment being recorded in only 35.3%. The influence of these factors was characterized by an increased incidence of cardiovascular disease by 19%; of diseases of the gastrointestinal tract (65.2%); endocrine dysfunction (17.3%). Conclusions. This study is relevant because it describes the critical elements of the online teaching experience and identifies some risk factors in teachers operating in an area strongly marked by social restrictions imposed by the pandemic

Influence of socio-demographic features and apolipoprotein E epsilon 4 expression on the prevalence of dementia and cognitive impairment in a population of 70-74-year olds: The InveCe.Ab study

Abstract The age-specific prevalence rates of dementia vary widely. Studies focusing on specific age groups are needed to provide reliable estimates for healthcare providers and policy makers. We estimated the prevalence of dementia, dementia subtypes and cognitive impairment in "InveCe.Ab" (ClinicalTrials.gov, NCT01345110 ), a single-step multidimensional population-based study of 70–74-year olds living in Abbiategrasso (Milan, Italy). We also looked for associations with socio-demographic factors and the presence of the apolipoprotein E-ɛ4 allele. The overall dementia prevalence was 3% (95%CI: 2.1–4.1%) [Alzheimer's disease (AD): 1.2% (95%CI 0.6–1.9%); vascular dementia (VD): 1.4% (95%CI: 0.8–2.2%)]. Being single was found to be a risk factor for vascular dementia; subjects born in southern Italy were shown to be at greater risk both of overall dementia and of vascular dementia. The prevalence of cognitive impairment, with or without subjective cognitive complaints (cognitive impairment, no dementia, CIND) was 7.8% (95%CI: 6.4–9.4%). As regards the CIND subgroups, the prevalence of subjects with subjective cognitive complaints (mild cognitive impairment, MCI) was 5.0% (95%CI 3.9–6.3%), while the prevalence of those without MCI (CIND-other) was 2.8% (95%CI: 1.9–3.8). The males had a higher risk of MCI and CIND-other; the older subjects were more likely to have MCI, and those born in north-eastern Italy to have CIND-other. The prevalence of AD was higher among the apolipoprotein E-ɛ4 carriers. Our data highlight the importance of dementia and cognitive impairment in the transitional period from adulthood to old age, and reveal the presence of different associations with socio-demographic and genetic factors