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Bertuccio P, Vigezzi GP, Amerio A, Cavalieri D'oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project. Scand J Public Health 2024; 52:262-270. [PMID: 37688313 DOI: 10.1177/14034948231184516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
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Affiliation(s)
- Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Italy
| | | | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Vigezzi GP, Bertuccio P, Amerio A, Bottini G, Gandola M, Cavalieri d'Oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Grandparenting during pandemic times: pros and cons for mental health. J Public Health (Oxf) 2023; 45:816-821. [PMID: 37632408 DOI: 10.1093/pubmed/fdad154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and associated lockdown measures posed an unprecedented challenge to the crucial role of grandparenting in family-oriented cultures, such as Italy. Reduced contact with grandchildren during this period potentially threatened grandparents' mental health and well-being. METHODS We analysed data from the LOckdown and lifeSTyles in Lombardia cross-sectional study conducted in November 2020. The study included a representative sample of 4400 older adults from Lombardy, Italy, of which 1289 provided childcare to their grandchildren. RESULTS A decrease in self-reported grandparenting was associated with an increased likelihood of experiencing depressive symptoms among grandparents (OR 1.50, 95% CI 1.01-2.24). Conversely, an increase in grandparenting was linked to poorer sleep quality (OR 11.67, 95% CI 5.88-23.17) and reduced sleep quantity (OR 2.53, 95% CI 1.45-4.41). CONCLUSIONS Despite the barriers posed by the pandemic, grandparenting played a beneficial role in maintaining the mental health and well-being of older adults. However, it is crucial to recognise specific vulnerabilities, such as gender, feelings of hopelessness and overcrowding, which can have detrimental effects during and beyond emergency situations. Careful attention to these factors is essential for developing targeted support systems and interventions aimed at safeguarding the mental health of older adults and enhancing their resilience in crises.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
- PhD Programme in Psychology, Neuroscience and Data Science, Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, 20162 Milan, Italy
| | - Martina Gandola
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, 20162 Milan, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100 Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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Kowall B, Kostev K, Landgraf R, Hauner H, Bierwirth R, Rathmann W. Routine care for people with newly diagnosed type 2 diabetes before and during the SARS-CoV-2 pandemic - results from the German Disease Analyzer database. Prim Care Diabetes 2023:S1751-9918(23)00103-1. [PMID: 37302936 PMCID: PMC10234340 DOI: 10.1016/j.pcd.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
AIM To investigate whether the SARS-CoV-2 pandemic affected care for people with newly diagnosed type 2 diabetes in Germany. METHODS The Disease Analyzer database (IQVIA, Germany) contains routine data on diagnoses and treatments (ICD-10 and ATC codes) from patients followed in selected physician practices across Germany. We compared 21,747 individuals with a first diagnosis of type 2 diabetes between January 2018 and September 2019 with 20,513 individuals with a first diabetes diagnosis between March 2020 and November 2021. RESULTS In March and April 2020, the number of new diagnoses of diabetes decreased by 18.3% and 35.7%, respectively, compared to March and April of the previous two years. The previous diabetes incidence level was reached again in June 2020. Mean pre-treatment glucose levels were higher during the pandemic than before (fasting plasma glucose: +6.3 mg/dl (95% confidence interval: 4.6-8.0)). In the first six months after diabetes diagnosis, the mean number of GP visits, specialist referrals and HbA1c measurements decreased. CONCLUSION We observed a decrease in diabetes incidence in the early phase of the pandemic and slightly higher pretreatment blood glucose levels during the pandemic than before. Care for newly diagnosed diabetes was slightly worse during the pandemic than before.
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Affiliation(s)
- Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany.
| | | | | | - Hans Hauner
- Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Germany
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Del Riccio M, Boccalini S, Cosma C, Vaccaro G, Bonito B, Zanella B, Salvati C, Giorgetti D, Rigon L, Biamonte MA, Monami M, Bonanni P, Bechini A. Effectiveness of pneumococcal vaccination on hospitalization and death in the adult and older adult diabetic population: a systematic review. Expert Rev Vaccines 2023; 22:1179-1184. [PMID: 37990793 DOI: 10.1080/14760584.2023.2286374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Diabetic patients are at a higher risk of getting pneumococcal disease and are therefore recommended to get vaccinated. The aim of our systematic review is the retrieval and analysis of all available evidence on the effect of pneumococcal vaccination on the risk of hospitalization and death in adult patients with diabetes. RESEARCH DESIGN AND METHODS MEDLINEand EMBASE were searched from inception until January 2023. We included all studies investigating whether pneumococcal vaccination reduces the risk of dying or being hospitalized in diabetic patients. The Newcastle-Ottawa scale was used to assess risk of bias. RESULTS Only two studies, encompassing a total of 68,246 subjects, were considered eligible for inclusion and of high quality. In both studies polysaccharide pneumococcal vaccination was associated with a reduction of the risk of hospitalization or death in adult diabetic patients (aHR: 0.76 in one study, aOR: 0.97 in the other one). However, in neither of the two included studies the lower risk was statistically significant. CONCLUSIONS Further research is needed due to the potentially major clinical implications for diabetic patients. The results of this systematic review can serve as a foundation for future studies, indicating the importance of continuing research in this area to improve patient outcomes.
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Affiliation(s)
- Marco Del Riccio
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Claudia Cosma
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Gabriele Vaccaro
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Beatrice Zanella
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Cristina Salvati
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Duccio Giorgetti
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Lisa Rigon
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | | | - Matteo Monami
- Diabetology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Firenze, Italy
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Vigezzi GP, Bertuccio P, Amerio A, Bosetti C, Gori D, Cavalieri d’Oro L, Iacoviello L, Stuckler D, Zucchi A, Gallus S, Odone A, Investigators LILP. Older Adults' Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811271. [PMID: 36141544 PMCID: PMC9565221 DOI: 10.3390/ijerph191811271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults' changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient's decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05-1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00-1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Collegio Ca’ della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16124 Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Science, University of Bologna, 40126 Bologna, Italy
| | | | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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