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Segala FV, Ictho J, L'Episcopia M, Onapa E, De Vita E, Novara R, Olung N, Totaro V, Olal L, Patti G, Bingom C, Farina U, Papagni R, Agaro C, Bavaro DF, Amone J, Dall'Oglio G, Ngole B, Marotta C, Okori S, Zarcone M, Ogwang J, Severini C, Lochoro P, Putoto G, Saracino A, Di Gennaro F. Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis. Pathog Glob Health 2023:1-9. [PMID: 37872763 DOI: 10.1080/20477724.2023.2273023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda. METHODS An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models. RESULTS From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries. CONCLUSIONS In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries.Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.
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Affiliation(s)
- Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Jerry Ictho
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | | | - Emmanuel Onapa
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Novara
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Nelson Olung
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Valentina Totaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Lameck Olal
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Giulia Patti
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | | | - Umberto Farina
- Hygiene Unit, Policlinico Riuniti Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Caroline Agaro
- Health Office, Oyam District Local Government, Loro, Uganda
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - James Amone
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | | | - Benedict Ngole
- Operational Research Unit, African Network for Change, Kampala, Uganda
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Samuel Okori
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Maurizio Zarcone
- Unità Operativa Complessa di Epidemiologia Clinica con Registro Tumori, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Joseph Ogwang
- Operational Research Unit, St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Peter Lochoro
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Giovanni Putoto
- Health Service Management, Doctors with Africa CAUMM, Kampala, Uganda
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
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Sagaro GG, Angeloni U, Battineni G, Chintalapudi N, Dicanio M, Kebede MM, Marotta C, Rezza G, Silenzi A, Amenta F. Risk prediction model of self-reported hypertension for telemedicine based on the sociodemographic, occupational and health-related characteristics of seafarers: a cross-sectional epidemiological study. BMJ Open 2023; 13:e070146. [PMID: 37793918 PMCID: PMC10551994 DOI: 10.1136/bmjopen-2022-070146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES High blood pressure is a common health concern among seafarers. However, due to the remote nature of their work, it can be difficult for them to access regular monitoring of their blood pressure. Therefore, the development of a risk prediction model for hypertension in seafarers is important for early detection and prevention. This study developed a risk prediction model of self-reported hypertension for telemedicine. DESIGN A cross-sectional epidemiological study was employed. SETTING This study was conducted among seafarers aboard ships. Data on sociodemographic, occupational and health-related characteristics were collected using anonymous, standardised questionnaires. PARTICIPANTS This study involved 8125 seafarers aged 18-70 aboard 400 vessels between November 2020 and December 2020. 4318 study subjects were included in the analysis. Seafarers over 18 years of age, active (on duty) during the study and willing to give informed consent were the inclusion criteria. OUTCOME MEASURES We calculated the adjusted OR (AOR) with 95% CIs using multiple logistic regression models to estimate the associations between sociodemographic, occupational and health-related characteristics and self-reported hypertension. We also developed a risk prediction model for self-reported hypertension for telemedicine based on seafarers' characteristics. RESULTS Among the 4318 participants, 55.3% and 44.7% were non-officers and officers, respectively. 20.8% (900) of the participants reported having hypertension. Multivariable analysis showed that age (AOR: 1.08, 95% CI 1.07 to 1.10), working long hours per week (AOR: 1.02, 95% CI 1.01 to 1.03), work experience at sea (10+ years) (AOR: 1.79, 95% CI 1.33 to 2.42), being a non-officer (AOR: 1.75, 95% CI 1.44 to 2.13), snoring (AOR: 3.58, 95% CI 2.96 to 4.34) and other health-related variables were independent predictors of self-reported hypertension, which were included in the final risk prediction model. The sensitivity, specificity and accuracy of the predictive model were 56.4%, 94.4% and 86.5%, respectively. CONCLUSION A risk prediction model developed in the present study is accurate in predicting self-reported hypertension in seafarers' onboard ships.
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Affiliation(s)
- Getu Gamo Sagaro
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Ulrico Angeloni
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Gopi Battineni
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Nalini Chintalapudi
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Marzio Dicanio
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | | | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Giovanni Rezza
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Andrea Silenzi
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - Francesco Amenta
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
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Segala FV, Papagni R, Cotugno S, De Vita E, Susini MC, Filippi V, Tulone O, Facci E, Lattanzio R, Marotta C, Manenti F, Bavaro DF, De Iaco G, Putoto G, Veronese N, Barbagallo M, Saracino A, Di Gennaro F. Stool Xpert MTB/RIF as a possible diagnostic alternative to sputum in Africa: a systematic review and meta-analysis. Front Public Health 2023; 11:1117709. [PMID: 37293615 PMCID: PMC10244509 DOI: 10.3389/fpubh.2023.1117709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Worldwide, COVID-19 pandemic lead to a large fall in the number of newly reported TB cases. In sub-Saharan Africa, microbiological diagnosis of TB is generally based on smear microscopy and Xpert MTB/RIF on sputum samples, but good quality sputum samples are often difficult to obtain, leading clinicians to rely on more invasive procedures for diagnosis. Aim of this study was to investigate pooled sensitivity and specificity of Xpert MTB/RIF on stool samples compared to respiratory microbiological reference standards in African countries. Methods Four investigators independently searched PubMed, SCOPUS, and Web of Science until 12th October 2022, then screened titles and abstracts of all potentially eligible articles. The authors applied the eligibility criteria, considered the full texts. All the studies reported the data regarding true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Risk of bias and applicability concerns were assessed with the Quadas-2 tool. Results overall, among 130 papers initially screened, we evaluated 47 works, finally including 13 papers for a total of 2,352 participants, mainly children. The mean percentage of females was 49.6%, whilst the mean percentage of patients reporting HIV was 27.7%. Pooled sensitivity for Xpert MTB/RIF assay for detecting pulmonary tuberculosis was 68.2% (95%CI: 61.1-74.7%) even if characterized by a high heterogeneity (I2=53.7%). Specificity was almost 100% (99%, 95%CI: 97-100%; I2 = 45.7%). When divided for reference standard, in the six studies using sputum and nasogastric aspirate the accuracy was optimal (AUC = 0.99, SE = 0.02), whilst in the studies using only sputum for tuberculosis detection the AUC was 0.85 (with a SE = 0.16). The most common source of bias was exclusion of enrolled patients in the analysis. Conclusions Our study confirms that, in Africa, stool Xpert MTB/RIF may be a useful rule-in test for children above and below 5 years of age under evaluation for pulmonary tuberculosis. Sensitivity increased substantially when using both sputum and nasogastric aspirate as reference samples.
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Affiliation(s)
- Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
- Operational Research Unit, Doctors With Africa CUAMM, Padua, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Sergio Cotugno
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | - Ottavia Tulone
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Enzo Facci
- Doctors With Africa CUAMM, Wolisso, Ethiopia
| | - Rossana Lattanzio
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors With Africa CUAMM, Padua, Italy
| | | | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giuseppina De Iaco
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors With Africa CUAMM, Padua, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
- Operational Research Unit, Doctors With Africa CUAMM, Padua, Italy
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Sagaro GG, Angeloni U, Marotta C, Nittari G, Rezza G, Silenzi A, Battineni G, Amenta F. The Magnitude of Cardiovascular Disease Risk Factors in Seafarers from 1994 to 2021: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13050861. [PMID: 37241030 DOI: 10.3390/jpm13050861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this review estimates the pooled prevalence of major CVD risk factors among seafarers. METHODS We conducted a comprehensive search of studies published between 1994 and December 2021 in four international databases, namely PubMed/Medline, Scopus, Google Scholar, and Web of Science (WOS). Each study was evaluated for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. The DerSimonian-Laird random-effects model with logit transformations was used to estimate the pooled prevalence of major CVD risk factors. The results were reported in accordance with the Preferred Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RESULTS Out of all 1484 studies reviewed, 21 studies with 145,913 study participants met the eligibility criteria and were included in the meta-analysis. In the pooled analysis, the prevalence of smoking was found to be 40.14% (95% CI: 34.29 to 46.29%) with heterogeneity between studies (I2 = 98%, p < 0.01). The prevalence of hypertension, overweight, obesity, diabetes mellitus, and alcohol consumption was 45.32%, 41.67%, 18.60%, 12.70%, and 38.58%, respectively. However, the sensitivity analysis after excluding studies showed a pooled prevalence of hypertension, overweight, obesity, and diabetes mellitus of 44.86%, 41.87%, 15.99%, and 16.84%, respectively. The subgroup analysis demonstrated that smoking prevalence among seafarers had decreased significantly after 2013. CONCLUSION This study demonstrated that CVD risk factors, particularly hypertension, overweight, smoking, alcohol consumption, and obesity, are prevalent among seafarers. These findings may serve as a guide for shipping companies and other responsible bodies in order to prevent CVD risk factors among seafarers. PROSPERO Registration: CRD42022300993.
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Affiliation(s)
- Getu Gamo Sagaro
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo 138, Ethiopia
| | - Ulrico Angeloni
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Giovanni Rezza
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Andrea Silenzi
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Gopi Battineni
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
- Research Department, International Radio Medical Center (C.I.R.M.), 00144 Rome, Italy
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Silenzi A, Marotta C, Caredda E, Sá Machado R, Severoni S, Rezza G. Climate change, human migration and health nexus: what do we know about public health implications on a global scale? Epidemiol Prev 2023; 47:39-43. [PMID: 37455631 DOI: 10.19191/ep23.3.s1.a559.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE to address the nexus among climate change, migration, and health at global and Italian levels. DESIGN narrative review. SETTING AND PARTICIPANTS comprehensive, critical, and objective analysis of the current knowledge on the topic by searching online databases. MAIN OUTCOME MEASURES evidence from the literature examining health issues associated with migration in the context of climate change. RESULTS anthropogenic climate change has recently influenced the scale and patterns of human mobility, not only as a driver of migration, but also by interacting with and amplifying the effects of migration determinants, including health determinants. Despite research focusing on the distinct relationship between climate change and migration, as well as climate change and health, little attention has been paid to the nexus among climate change, migration, and health. Evidence available examining various health issues associated with migration in the context of climate change include changing patterns of infectious diseases and their risks, rising cases of malnutrition, trauma and injuries, changing patterns of noncommunicable diseases, impact on mental health. Inadequacy of access to health services due to the weakening and overstretching health systems also plays an important role. In a country like Italy, even if the immediate threats posed by climate change differ from one area to another, these threats are already exacerbating the country's existing infrastructure deficiencies, industrial pollution, and hydrogeological and seismic vulnerability. In addition, Italy has historically been a destination country of immigrant afflux through different migration routes. It is possible that the consequences of climate change in Sub-Saharan Africa will drive a growing number of people to cross the sea to reach Europe, specifically Italy. Conclusions: climate change, human migration, and health should be considered as an interconnected and complex issue. A shift to climate resilient health systems' is a useful precautionary measure as it aims to strengthen multiple aspects of national and sub-national health systems, regardless of the extent to which climate-related migration might occur.
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Affiliation(s)
- Andrea Silenzi
- General Directorate of Health Prevention, Italian Ministry of Health, Rome (Italy);
| | - Claudia Marotta
- General Directorate of Health Prevention, Italian Ministry of Health, Rome (Italy)
| | - Emanuele Caredda
- General Directorate of Health Prevention, Italian Ministry of Health, Rome (Italy)
| | - Rita Sá Machado
- Health and Migration Programme (PHM), World Health Organization, Geneva (Switzerland)
| | - Santino Severoni
- Health and Migration Programme (PHM), World Health Organization, Geneva (Switzerland)
| | - Giovanni Rezza
- General Directorate of Health Prevention, Italian Ministry of Health, Rome (Italy)
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Totaro V, Patti G, Segala FV, Laforgia R, Raho L, Falanga C, Schiavone M, Frallonardo L, Panico GG, Spada V, De Santis L, Pellegrino C, Papagni R, D’Argenio A, Novara R, Marotta C, Laforgia N, Bavaro DF, Putoto G, Saracino A, Di Gennaro F. HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study. Viruses 2023; 15:249. [PMID: 36680288 PMCID: PMC9861079 DOI: 10.3390/v15010249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 01/17/2023] Open
Abstract
Migrant populations are more susceptible to viral hepatitis and HIV due to the epidemiology from their country of origin or their social vulnerability when they arrive in Europe. The aims of the study are to explore the incidence of HIV and HCV in low-wage agricultural migrant workers and their knowledge, attitude, and practice with regard to HIV and HCV, as well as their sexual behaviour and risk factors. As part of the mobile clinic services, we performed a screening campaign for HIV-HCV involving migrants living in three Apulian establishments. Results: Between January 2020 and April 2021, 309 migrants (n. 272, 88% male, mean age 28.5 years) were enrolled in the study. Most of the migrants interviewed (n = 297, 96%) reported a stopover in Libya during their trip to Italy. Only 0.9% (n. 3) of migrants reported having been tested for HCV, while 30.7% (n. 95) reported being tested for HIV. Furthermore, screening tests found four migrants (1.3%) to be HIV positive and nine (2.9%) to be HCV positive. The median knowledge score was 1 (IQR 0-3; maximum score: 6 points) for HCV and 3 (IQR 1-4; maximum score: 7 points) for HIV and low use of condoms was 5% (n. 16), while more than 95% show an attitude score of 5 (IQR 5-6; maximum score:6 points) on HIV-HCV education campaigns. In a multivariate analysis, being male (OR = 1.72; 95% CI 1.28−1.92), being single (OR = 1.63; 95% CI 1.20−2.03), being of low educational status (OR = 2.09; 95% CI 1.29−2.21), living in shantytowns for >12 months (OR = 1.95; 95% CI 1.25−2.55), and originating from the African continent (OR = 1.43; 95% CI 1.28−2.01) are significant predictors of poor knowledge on HCV. Our data show low knowledge, especially of HCV, confirming migrants as a population with a higher risk of infection. To develop education programmes, integrated care and screening among migrants could be an effective strategy, considering the high attitude toward these items shown in our study.
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Affiliation(s)
- Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giulia Patti
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | | | - Lucia Raho
- Doctors with Africa CUAMM, 70123 Bari, Italy
| | | | | | - Luísa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Gianfranco Giorgio Panico
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Vito Spada
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Angelo D’Argenio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
| | | | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy
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Di Gennaro F, Occa E, Chitnis K, Guelfi G, Canini A, Chuau I, Cadorin S, Bavaro DF, Ramirez L, Marotta C, Cotugno S, Segala FV, Ghelardi A, Saracino A, Periquito IM, Putoto G, Mussa A. Knowledge, Attitudes and Practices on Cholera and Water, Sanitation, and Hygiene among Internally Displaced Persons in Cabo Delgado Province, Mozambique. Am J Trop Med Hyg 2023; 108:195-199. [PMID: 36509049 PMCID: PMC9833057 DOI: 10.4269/ajtmh.22-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022] Open
Abstract
In disaster situations, cholera outbreaks represent a public health emergency due to their high fatality rates and high spreading risk through camps for refugees and internally displaced persons (IDPs). The aim of this study is to examine water, sanitation, and hygiene attitudes and cholera knowledge, attitude, and practice (KAP) among people living in resettlement sites in Cabo Delgado, the northernmost province of Mozambique. Between January 1 and March 31, 2022, a cross-sectional survey was conducted by administering a face-to-face interview to IDPs and residents in six relocation sites in Cabo Delgado Province. A total of 440 people were enrolled in the study. Overall, 77.8% (N = 342) were female, 61% (N = 268) were younger than 35 years old, and 60.5% (N = 266) reported primary school to be the highest education level. Seventy-five percent (N = 334) of participants lived with children under 5 years old. Thirty-one percent (N = 140) and 11.8% (N = 52) of the respondents reported, respectively, at least one cholera case and at least one diarrheal-related death among their family members in the previous 2 years. In multivariate analysis, being female, being younger than 35 years old, having attained a higher education level, owning a phone, or having soap at home were factors significantly associated with improved cholera KAP. In severely deconstructed social contexts, continuous education and community sensitization are crucial to achieve and maintain positive cholera prevention attitudes.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | | | | | | | | | | | | | - Davide F. Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | | | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Francesco V. Segala
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | | | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Ally Mussa
- Nucleo de Investigacao Operacional de Pemba, Pemba, Mozambique
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8
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De Vita E, Segala FV, Amone J, Samuel K, Marotta C, Putoto G, Nassali R, Lochoro P, Bavaro DF, Ictho J, Okori S, Di Gennaro F, Saracino A. Subacute Cardiac Tamponade Due to Tuberculous Pericarditis Diagnosed by Urine Lipoarabinomannan Assay in a Immunocompetent Patient in Oyam District, Uganda: A Case Report. Int J Environ Res Public Health 2022; 19:15143. [PMID: 36429861 PMCID: PMC9690455 DOI: 10.3390/ijerph192215143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Uganda ranks among the countries with the highest burden of TB the world and tuberculous pericarditis (TBP) affects up to 2% of people diagnosed with pulmonary tuberculosis worldwide. In Africa, it represents the most common cause of pericardial disease. Here, we present the case of a 21-year-old male patient who was diagnosed of cardiac tamponade due to tuberculous pericarditis with a positive urine LF-LAM. CASE REPORT We report a case of a 21-year-old male living in Oyam district, Uganda, who presented to the emergency department with difficulty in breathing, easy fatigability, general body weakness, and abdominal pain. A chest X-ray showed the presence of right pleural effusion and massive cardiomegaly. Thus, percutaneous pericardiocentesis was performed immediately and pericardial fluid resulted negative both for gram staining and real-time PCR test Xpert MTB/RIF. The following day's urine LF-LAM test resulted positive, and antitubercular therapy started with gradual improvement. During the follow-up visits, the patient remained asymptomatic, reporting good compliance to the antitubercular therapy. CONCLUSION Our case highlights the potential usefulness of a LF-LAM-based diagnostic approach, suggesting that, in low-resource settings, this test might be used as part of routine diagnostic workup in patients with pericardial disease or suspected extra-pulmonary tuberculosis.
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Affiliation(s)
- Elda De Vita
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
| | - Francesco Vladimiro Segala
- Dipartimento di Sicurezza e Bioetica—Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - James Amone
- St. John’s XXIII Hospital Aber, Jaber 21310, Uganda
| | | | | | | | | | | | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
| | - Jerry Ictho
- Doctors with Africa CUAMM, Kampala 21310, Uganda
| | - Samuel Okori
- St. John’s XXIII Hospital Aber, Jaber 21310, Uganda
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Doctors with Africa CUAMM, 35100 Padua, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
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9
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Ferraro F, Frisicale EM, Rapiti A, Marotta C, Bonfigli S, Angeloni U, Maraglino F, Rezza G. Religious pilgrimage and COVID-19. An observational report in Italy from contact tracing activities. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/Problem
Religious Mass Gathering (MG) represent one of public health challenges for Health Authorities due to potential spread of communicable diseases. This is much more true during a pandemic as COVID-19. Surveillance is crucial to prevent further spreading of infectious disease related to a religious MG.
Description of the problem
During international contact tracing activities an increase of reporting of COVID-cases with a travel history to a Catholic shrine in Europe was observed, despite travel restrictions put in place. In order to promote public health actions as risk communication, a risk evaluation was conducted. A descriptive analysis was carried out: personal and vaccination data were collected; for cases, date and type of positive tests, date of symptoms’ onset were collected; for high-risk contacts, date and type of negative tests at the end of follow-up were collected. Frequencies were calculated.
Results
Six journeys back from Medjugorje were identified, with at least one positive case. All trips took place between 18/09/2021 and 29/10/2021. 31 positive cases out of 160 travellers were identified, with number of cases per travel ranging from 1 to 11.
Lessons
Religious MG represent an important global health issue. Even though a specific surveillance was not activated, international contact tracing activities turned out a great source of epidemic intelligence and consequent surveillance and control activities led to risk assessment and communication actions.
Key messages
• In the pandemic context, where travel restrictions were put in place, surveillance for Religious MG should be always implemented.
• Cooperation among all the stakeholders involved as Church, travel agency, Regional Health Systems and Government Bodies has to be promoted for specific surveillance in religious MG events.
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Affiliation(s)
- F Ferraro
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - EM Frisicale
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - A Rapiti
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - C Marotta
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - S Bonfigli
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - U Angeloni
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - F Maraglino
- DG Health Prevention, Ministry of Health , Rome, Italy
| | - G Rezza
- DG Health Prevention, Ministry of Health , Rome, Italy
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10
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Di Gennaro F, Veronese N, Marotta C, Shin JI, Koyanagi A, Silenzi A, Antunes M, Saracino A, Bavaro DF, Soysal P, Segala FV, Butler L, Milano E, Barbagallo M, Barnett Y, Parris C, Nicastri E, Pizzol D, Smith L. Human Monkeypox: A Comprehensive Narrative Review and Analysis of the Public Health Implications. Microorganisms 2022; 10:microorganisms10081633. [PMID: 36014051 PMCID: PMC9416167 DOI: 10.3390/microorganisms10081633] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 01/13/2023] Open
Abstract
Recently, numerous cases of monkeypox were reported from several non-endemic countries in Europe, North America, and Oceania, suggesting an unusual and alarming public health issue, particularly considering that the disease is not directly related to human or animal travels. Attention is currently being drawn to this phenomenon since more than 70% of the global population is no longer vaccinated against smallpox. Indeed, the smallpox vaccination also confers some indirect degree of protection against other poxviruses, including monkeypox. We performed a narrative review to describe the existing literature with regard to monkeypox using the MEDLINE, EMBASE, and Scopus databases. This review aims to provide updated evidence of findings on the epidemiology, clinical features, diagnosis, management, and prevention of monkeypox, also considering the concurrent zoonotic pandemic caused by the COVID-19 coronavirus, SARS-CoV-2.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy
- Correspondence:
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90133 Palermo, Italy
| | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08010 Barcelona, Spain
- ICREA, Passeig Lluis Companys 23, 08010 Barcelona, Spain
| | - Andrea Silenzi
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Mario Antunes
- Department of Surgery, Catholic University of Mozambique, Beira 13016, Mozambique
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | | | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Eugenio Milano
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90133 Palermo, Italy
| | - Yvonne Barnett
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Christopher Parris
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, 00135 Khartoum, Sudan
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
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11
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Segala FV, Di Gennaro F, Ictho J, L'Episcopia M, Onapa E, Marotta C, De Vita E, Amone J, Iacobelli V, Ogwang J, Dall'Oglio G, Ngole B, Murri R, Olal L, Fantoni M, Okori S, Putoto G, Severini C, Lochoro P, Saracino A. Impact of antimalarial resistance and COVID-19 pandemic on malaria care among pregnant women in Northern Uganda (ERASE): protocol of a prospective observational study. BMC Infect Dis 2022; 22:668. [PMID: 35927713 PMCID: PMC9351224 DOI: 10.1186/s12879-022-07645-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Uganda accounts for 5% of all malaria cases and deaths reported globally and, in endemic countries, pregnancy is a risk factor for both acquisition of P. falciparum infection and development of severe malaria. In recent years, malaria control has been threatened by COVID-19 pandemic and by the emergence, in Northern Uganda, of both resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. Methods In this facility-based, prospective, observational study, pregnant women will be recruited at antenatal-care visits and followed-up until delivery. Collected data will explore the incidence of asymptomatic parasitemia and malaria-related outcomes, as well as the attitudes towards malaria prevention, administration of intermittent preventive treatment, healthcare seeking behavior and use of insecticide-treated nets. A subpopulation of women diagnosed with malaria will be recruited and their blood samples will be analyzed for detection of genetic markers of resistance to artemisinin derivatives and sulfadoxine-pyrimethamine. Also, to investigate the impact of COVID-19 on malaria care among pregnant women, a retrospective, interrupted-time series will be conducted on at the study sites for the period January 2018 to December 2021. Discussion The present study will explore the impact of COVID-19 pandemic on incidence of malaria and malaria-related adverse outcomes, along with the prevalence of resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. To our knowledge, this is the first study aiming to explore the combined effect of these factors on a cohort of pregnant women. Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26th April, 2022. ClinicalTrials.gov Identifier: NCT05348746.
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Affiliation(s)
- Francesco Vladimiro Segala
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. .,Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy.
| | - Francesco Di Gennaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy.,Doctors with Africa Cuamm, Padua, Italy
| | | | | | | | | | - Elda De Vita
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - James Amone
- St. John's XXIII Hospital Aber, Jaber, Uganda
| | - Valentina Iacobelli
- Department Woman and Child Health Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica-Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica-Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
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12
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Di Gennaro F, Marotta C, Saracino A, Occa E, Putoto G. Mental health needs of adolescents with HIV in Africa. The Lancet HIV 2022; 9:e376. [DOI: 10.1016/s2352-3018(22)00130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
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13
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Costantino C, Mazzucco W, Scarpitta F, Ventura G, Marotta C, Bono SE, Arcidiacono E, Gentile M, Sannasardo P, Gambino CR, Sannasardo CE, Vella C, Vitale F, Casuccio A, Restivo V. Prevalence and factors associated with bullying phenomenon among pre-adolescents attending first-grade secondary schools of Palermo, Italy, and a comparative systematic literature review. Ital J Pediatr 2022; 48:56. [PMID: 35379316 PMCID: PMC8981760 DOI: 10.1186/s13052-022-01245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Bullying is recognized as one of the most significant social and health problems in the school environment for children and adolescents. In Italy, bullying involved 2 in 10 kids between 11–17 years that referred to have been bullied two or more times in a month. In Sicily, the estimated prevalence of children aged 11 to 15 that suffered at least one act of bullying in the last two months was 14% in 2011. Methods A questionnaire consisting of 30 items investigating physical, verbal and indirect bullying, observers of bullying, resiliency, and prosociality was administered to preadolescents of ten first-grade secondary schools within the Palermo Province in order to analyze prevalence and factors associated with bullying phenomenon. Also, a systematic literature review (SLR) analyzing manuscripts that reported prevalence of the bullying phenomenon worldwide was conducted. Results Survey: a total of 867 students, belonging to 35 s and 31 third classes of ten different schools in Palermo, Italy, were recruited in the survey. The values of physical bullying are included between the 4% of the single question method and the almost forty percent detected by the score of 7 method. Verbal bullying oscillates between 15.9% and 66.3%. Observers average values varies from 15.8% to 47.5%. SLR: the estimated prevalence showed a considerable fluctuation. The occurrence of the bullying phenomenon was low in some Northern European countries, while in Anglo-Saxon countries it affected over a quarter of the middle school student population (28% in Maryland, USA and 21% in the UK). Conclusions The prevalence of the bullying phenomenon recorded by this survey with the three different methods used is similar to observations in international literature. In the Sicilian context, a higher prevalence of bullying phenomena was observed in pre-adolescents attending major classes and in schools with lower socio-economic index. Though it remains difficult to obtain univocal data that clarifies the prevalence of different type of bullying, the continuous investigation of prevalence and factors associated with the phenomenon is a necessary starting point to introduce interventions and preventive measures in Public Health programs.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy.
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy.,Cincinnati College of Medicine, Department of Pediatric - Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Burnet Ave 3333, Cincinnati, OH, 45229, USA
| | - Francesco Scarpitta
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Gianmarco Ventura
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Claudia Marotta
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Stefania Enza Bono
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Evelina Arcidiacono
- Regional Educational Authority of Sicily, Via G. Fattori 60, 90100, Palermo, Italy
| | - Maurizio Gentile
- Regional Educational Authority of Sicily, Via G. Fattori 60, 90100, Palermo, Italy
| | | | | | - Claudia Emilia Sannasardo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Carlotta Vella
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Section of Hygiene, University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy
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14
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Di Gennaro F, Marotta C, Ramirez L, Cardoso H, Alamo C, Cinturao V, Bavaro DF, Mahotas DC, Lazzari M, Fernando C, Chimundi N, Atzori A, Chaguruca I, Tognon F, Guambe Dos Anjos H, De Meneghi G, Tribie M, Del Greco F, Namarime E, Occa E, Putoto G, Pozniak A, Saracino A. High Prevalence of Mental Health Disorders in Adolescents and Youth Living with HIV: An Observational Study from Eight Health Services in Sofala Province, Mozambique. AIDS Patient Care STDS 2022; 36:123-129. [PMID: 35438520 DOI: 10.1089/apc.2022.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adolescent mental health (MH) is a significant global health concern, which is extremely relevant when referring to adolescents and youth living with HIV (AYHIV). In Mozambique, ∼52% of the population is <18 years and the country has the world's eighth highest HIV prevalence (insert citation). We performed an observational study to evaluate anxiety, depression, post-traumatic stress disorder (PTSD) and alcohol-drug abuse in adolescents and youth assessing health services in Sofala Province, Mozambique. From November 20, 2019, to November 20, 2021, all adolescents and youth (10-24 years) accessing one of the psychological services offered at 8 Servicios Amigos dos Adolescentes (SAAJ) of the Sofala Province were screened by a psychologist using the following standardized tools: Generalized Anxiety Disorder-7 (GAD-7) for anxiety, Patient Health Questionnaire-9 (PHQ-9) for depression, Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) for PTSD, and Cut down, Annoyed, Guilty, and Eye-opener Adapted to Include Drugs (CAGE-AID) for alcohol-drug abuse. Overall, 2108 adolescents and youth were included in the study (63% female, median age: 19 years). Of them, 1096 (52%) were HIV positive. AYHIV had higher scores at the four tools tested and for concomitant MH disorders (GAD-7, PHQ-9, PTSD-5, and CAGE). The multivariable logistic regressions showed a greater probability to be GAD-7 > 10 for women, [adjusting odds ratio (AOR): 1.46, 95% confidence interval (CI): 1.01-2.10], for workers (AOR: 2.18, 95% CI: 1.12-4.23) and people living with HIV (AOR: 1.78, 95% CI: 1.25-2.54). Higher values of CAGE (≥2) and PTSD (≥3) seemed to be associated only with HIV-positive status (AOR: 4.87, 95% CI: 3.72-6.38 and AOR: 1.73, 95% CI: 1.28-237). These data further reinforce the urgent need for a global health policy action with focused intervention on MH in AYHIV patients.
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Affiliation(s)
- Francesco Di Gennaro
- Doctors with Africa CUAMM, Beira, Mozambique
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | | | | | | | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | | | | | | | | | - Francesca Tognon
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | | | | | | | | | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annalisa Saracino
- Doctors with Africa CUAMM, Beira, Mozambique
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
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15
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Chintalapudi N, Angeloni U, Battineni G, di Canio M, Marotta C, Rezza G, Sagaro GG, Silenzi A, Amenta F. LASSO Regression Modeling on Prediction of Medical Terms among Seafarers’ Health Documents Using Tidy Text Mining. Bioengineering (Basel) 2022; 9:bioengineering9030124. [PMID: 35324813 PMCID: PMC8945331 DOI: 10.3390/bioengineering9030124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022] Open
Abstract
Generally, seafarers face a higher risk of illnesses and accidents than land workers. In most cases, there are no medical professionals on board seagoing vessels, which makes disease diagnosis even more difficult. When this occurs, onshore doctors may be able to provide medical advice through telemedicine by receiving better symptomatic and clinical details in the health abstracts of seafarers. The adoption of text mining techniques can assist in extracting diagnostic information from clinical texts. We applied lexicon sentimental analysis to explore the automatic labeling of positive and negative healthcare terms to seafarers’ text healthcare documents. This was due to the lack of experimental evaluations using computational techniques. In order to classify diseases and their associated symptoms, the LASSO regression algorithm is applied to analyze these text documents. A visualization of symptomatic data frequency for each disease can be achieved by analyzing TF-IDF values. The proposed approach allows for the classification of text documents with 93.8% accuracy by using a machine learning model called LASSO regression. It is possible to classify text documents effectively with tidy text mining libraries. In addition to delivering health assistance, this method can be used to classify diseases and establish health observatories. Knowledge developed in the present work will be applied to establish an Epidemiological Observatory of Seafarers’ Pathologies and Injuries. This Observatory will be a collaborative initiative of the Italian Ministry of Health, University of Camerino, and International Radio Medical Centre (C.I.R.M.), the Italian TMAS.
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Affiliation(s)
- Nalini Chintalapudi
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.B.); (M.d.C.); (G.G.S.); (F.A.)
- Correspondence: ; Tel.: +39-35-33776704
| | - Ulrico Angeloni
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy; (U.A.); (C.M.); (G.R.); (A.S.)
| | - Gopi Battineni
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.B.); (M.d.C.); (G.G.S.); (F.A.)
| | - Marzio di Canio
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.B.); (M.d.C.); (G.G.S.); (F.A.)
- Research Department, International Radio Medical Centre (C.I.R.M.), 00144 Rome, Italy
| | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy; (U.A.); (C.M.); (G.R.); (A.S.)
| | - Giovanni Rezza
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy; (U.A.); (C.M.); (G.R.); (A.S.)
| | - Getu Gamo Sagaro
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.B.); (M.d.C.); (G.G.S.); (F.A.)
| | - Andrea Silenzi
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy; (U.A.); (C.M.); (G.R.); (A.S.)
| | - Francesco Amenta
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.B.); (M.d.C.); (G.G.S.); (F.A.)
- Research Department, International Radio Medical Centre (C.I.R.M.), 00144 Rome, Italy
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16
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Barello S, Caruso R, Palamenghi L, Nania T, Dellafiore F, Bonetti L, Silenzi A, Marotta C, Graffigna G. Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model. Int Arch Occup Environ Health 2021; 94:1751-1761. [PMID: 33660030 PMCID: PMC7928172 DOI: 10.1007/s00420-021-01669-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/09/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of the present cross-sectional study is to investigate the role of perceived COVID-19-related organizational demands and threats in predicting emotional exhaustion, and the role of organizational support in reducing the negative influence of perceived COVID-19 work-related stressors on burnout. Moreover, the present study aims to add to the understanding of the role of personal resources in the Job Demands-Resources model (JD-R) by examining whether personal resources-such as the professionals' orientation towards patient engagement-may also strengthen the impact of job resources and mitigate the impact of job demands. METHODS This cross-sectional study involved 532 healthcare professionals working during the COVID-19 pandemic in Italy. It adopted the Job-Demands-Resource Model to study the determinants of professional's burnout. An integrative model describing how increasing job demands experienced by this specific population are related to burnout and in particular to emotional exhaustion symptoms was developed. RESULTS The results of the logistic regression models provided strong support for the proposed model, as both Job Demands and Resources are significant predictors (OR = 2.359 and 0.563 respectively, with p < 0.001). Moreover, healthcare professionals' orientation towards patient engagement appears as a significant moderator of this relationship, as it reduces Demands' effect (OR = 1.188) and increases Resources' effect (OR = 0.501). CONCLUSIONS These findings integrate previous findings on the JD-R Model and suggest the relevance of personal resources and of relational factors in affecting professionals' experience of burnout.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB, Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Faculty of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
| | - Lorenzo Palamenghi
- EngageMinds HUB, Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy.
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy.
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, 26100, Cremona, Italy.
| | - Tiziana Nania
- EngageMinds HUB, Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
| | - Loris Bonetti
- Ente Ospedaliero Cantonale and Research and Development Unit of Oncology, Nursing Research Centre, Oncology Institute of Southern Switzerland (IOSI), 6500, Bellinzona, Switzerland
| | - Andrea Silenzi
- Ministry of Health, Rome, Italy
- Center for Leadership in Medicine Research and Studies, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Guendalina Graffigna
- EngageMinds HUB, Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, 26100, Cremona, Italy
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17
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Bitsolas N, Janiec J, Dionisio M, Marotta C, Kairiene B, Raulinaitis A, Ibanez Y, Ripoche R, Bitenc K, Hadjichristodoulou C. European Union Digital Passenger Locator Form System (EUdPLF) development. Eur J Public Health 2021. [PMCID: PMC8574878 DOI: 10.1093/eurpub/ckab164.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Passenger Locator Forms (PLFs) are used by public health authorities to facilitate international contact tracing. Digital PLFs (dPLF) allows for easier, more rapid data collection and exchange between stakeholders, making international contact tracing more effective and efficient. In response to COVID-19, EU HEALTHY GATEWAYS developed a common European Union digital Passenger Locator Form System (EUdPLF) for all transport sectors (aircrafts, cruise ships/ferries and ground transport). Methods A working group was established consisting of 9 EUMS, EASA, EMSA, ECDC, IATA, ERA, CLIA EUROPE. A minimum mandatory dataset was developed. Personal data protection procedures and security measures were implemented. Interconnection of EUdPLF with the EASA exchange platform allowing exchange of data between MS with national dPLF and MS using the EUdPLF was completed. Pilot testing was conducted with four MS for the air and ferry sector. Results The EUdPLF system developed consists of a multilingual website being the first point of information for users and the EUdPLF app which is the web app for completion of the dPLF. One dPLF is completed per family/group, a QR code is generated and dPLF is sent to the passenger's email. Pilot testing generated 1013 PLFs submissions and 1450 passenger registrations. Feedback received was positive and used to improve user experience. To date, Italy is officially using the EUdPLF for all arriving passengers for all modes of transport. France, Slovenia, Lithuania and Austria are finalising practicalities before official use and testing of the system is ongoing with other MS. Conclusions EUdPLF provides multilingual, user-friendly, secure and GDPR compliant single entry point and database for the collection of PLFs, flexible to be customised to the MS needs and to be connected to external systems e.g. check-in system of transport operators, vaccination/testing/certificate information systems of each MS.
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Affiliation(s)
- N Bitsolas
- Department of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece
| | - J Janiec
- National Institute of Hygiene, National Institute of Public Health, Warsaw, Poland
| | | | | | - B Kairiene
- National Public Health Centre, The Ministry of Health, Vilnius, Lithuania
| | - A Raulinaitis
- National Public Health Centre, The Ministry of Health, Vilnius, Lithuania
| | - Y Ibanez
- Directorate General of Health, Ministry of Health, Paris, France
| | - R Ripoche
- Directorate General of Health, Ministry of Health, Paris, France
| | - K Bitenc
- National Institute of Public Health, Ljubljana, Slovenia
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18
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Mazzucco W, Chiara di Maio V, Bronte F, Fabeni L, Pipitone RM, Grimaudo S, Ferraro D, Marotta C, Aragri M, Macaluso M, Vitale F, Di Raimondo F, Ceccherini-Silberstein F, Di Marco V. Phylogenetic analysis in the clinical risk management of an outbreak of hepatitis C virus infection among transfused thalassaemia patients in Italy. J Hosp Infect 2021; 115:51-58. [PMID: 34171407 DOI: 10.1016/j.jhin.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. AIM To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. METHODS Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods. FINDINGS All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response. CONCLUSION Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment.
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Affiliation(s)
- W Mazzucco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P. Giaccone', Palermo, Italy; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - V Chiara di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - F Bronte
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - L Fabeni
- Laboratory of Virology, 'Lazzaro Spallanzani' National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - R M Pipitone
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - S Grimaudo
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - D Ferraro
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - C Marotta
- General Directorate of Health Prevention, Ministry of Health, Rome, Italy
| | - M Aragri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - F Vitale
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P. Giaccone', Palermo, Italy
| | - F Di Raimondo
- Division of Hematology, Azienda Ospedaliero-Universitaria Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | - V Di Marco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
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19
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Bruno R, Cauda R, Gialluisi A, Guaraldi G, Menicanti L, Mennuni M, My I, Parruti A, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Ageno W, Aiello L, Agostoni P, Al Moghazi S, Arboretti R, Aucella F, Barbieri G, Barchitta M, Bartoloni A, Bologna C, Bonfanti P, Caiano L, Carrozzi L, Cascio A, Castiglione G, Chiarito M, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Dalena G, Dal Pra C, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Filippini T, Maria Fusco F, Gaudiosi C, Gentile I, Gini G, Grandone E, Guarnieri G, Lamanna GLF, Larizza G, Leone A, Lio V, Losito AR, Maccagni G, Maitan S, Mancarella S, Manuele R, Mapelli M, Maragna R, Marra L, Maresca G, Marotta C, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Milic J, Minutolo F, Molena B, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Perroni A, Petri F, Pinchera B, Pivato CA, Poletti V, Ravaglia C, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Spinicci M, Trecarichi EM, Veronesi G, Vettor R, Vianello A, Vinceti M, Visconti E, Vocciante L, De Caterina R, Iacoviello L. Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study. Front Med (Lausanne) 2021; 8:639970. [PMID: 34179035 PMCID: PMC8221239 DOI: 10.3389/fmed.2021.639970] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | | | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Agostino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Roma, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Filippo Aucella
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Giacomo Castiglione
- Servizio di Anestesia e Rianimazione II UO Rianimazione Ospedale San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giovanni Dalena
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Chiara Dal Pra
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giancarlo Gini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Veronica Lio
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | | | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord - Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Rosa Manuele
- UOC Malattie Infettive e Tropicali, P.O. San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | | | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - R. Mussinelli
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Annalisa Perroni
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Carlo A. Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elena Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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20
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Mazzucco W, Vitale F, Mazzola S, Amodio R, Zarcone M, Alba D, Marotta C, Cusimano R, Allemani C. Does access to care play a role in liver cancer survival? The ten-year (2006-2015) experience from a population-based cancer registry in Southern Italy. BMC Cancer 2021; 21:307. [PMID: 33761907 PMCID: PMC7988914 DOI: 10.1186/s12885-021-07935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.
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Affiliation(s)
- Walter Mazzucco
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy. .,Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy. .,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA. .,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Francesco Vitale
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Rosalba Amodio
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Davide Alba
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Claudia Marotta
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | | | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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21
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Marotta C, Nacareia U, Estevez AS, Tognon F, Genna GD, De Meneghi G, Occa E, Ramirez L, Lazzari M, Di Gennaro F, Putoto G. Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete. Healthcare (Basel) 2021; 9:healthcare9030321. [PMID: 33805689 PMCID: PMC7998514 DOI: 10.3390/healthcare9030321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 among a sample of adolescents and youths from two different Mozambican provinces. (3) Results: Only 25% of adolescents and youths had a high level of awareness and only 543/2170 participants reported a high level of knowledge regarding COVID-19. In our multivariate model, significant predictors of reporting a high level of knowledge about COVID-19 include female sex (O.R. = 1.47; 95% confidence interval (CI) 1.23–2.89), having a house without a thatched roof (O.R. = 1.85; 95% CI 1.02–2.95) and HIV-positive status (O.R. = 1.56; 95% CI 1.36–2.87). (4) Conclusions: Our study highlights an important and relevant knowledge gap in adolescents and youths with respect to the COVID-19 pandemic. Involving young people and adolescents in the fight against SARS-CoV-2 is an essential strategy, especially in countries where the national average age is young, such as Mozambique, and where this epidemic can aggravate an already fragile health system.
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Affiliation(s)
- Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
| | - Ussene Nacareia
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Alba Sardon Estevez
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Giselle Daiana Genna
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Giovanna De Meneghi
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Edoardo Occa
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Lucy Ramirez
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Marzia Lazzari
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Francesco Di Gennaro
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
- Correspondence:
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
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22
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Cauda R, Guaraldi G, Menicanti L, Mennuni M, Parruti G, Patti G, Santilli F, Signorelli C, Vergori A, Abete P, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Arboretti R, Astuto M, Aucella F, Barbieri G, Bartoloni A, Bonfanti P, Cacciatore F, Caiano L, Carrozzi L, Cascio A, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Fantoni M, Fusco FM, Gentile I, Gianfagna F, Grandone E, Graziani E, Grisafi L, Guarnieri G, Larizza G, Leone A, Maccagni G, Madaro F, Maitan S, Mancarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marongiu S, Marotta C, Marra L, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Meschiari M, Milic J, Minutolo F, Molena B, Montineri A, Mussini C, Musso M, Niola D, Odone A, Olivieri M, Palimodde A, Parisi R, Pasi E, Pesavento R, Petri F, Pinchera B, Poletti V, Ravaglia C, Rognoni A, Rossato M, Rossi M, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Taddei E, Torti C, Vettor R, Vianello A, Vinceti M, Virano A, Vocciante L, De Caterina R, Iacoviello L. Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study. Thromb Haemost 2021; 121:1054-1065. [PMID: 33412596 DOI: 10.1055/a-1347-6070] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality. AIM We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients. METHODS In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores. RESULTS Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49-0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation. CONCLUSION In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Vergori
- Department of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Pasquale Abete
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia," University of Catania; AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Marinella Astuto
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, U.O. Anestesia, Rianimazione 1. P.O. "G. Rodolico," AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Surgical, Medical and Molecular Medicine and Critical Care, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Cacciatore
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L, Spallanzani, IRCCS, Roma, Italy
| | - Massimo Fantoni
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Emauele Graziani
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Ferruccio Madaro
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord, Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S. Maria di Loreto Nuovo. ASL Napoli 1 Centro. Napoli. Italy
| | | | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marianna Meschiari
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco." AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | - Daniela Niola
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | | | - Roberta Parisi
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Emanuela Pasi
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Raffaele Pesavento
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Andrea Rognoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Eleonora Taddei
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Alexandra Virano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S. Maria di Loreto Nuovo. ASL Napoli 1 Centro. Napoli. Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
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23
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Casà C, Marotta C, Di Pumpo M, Cozzolino A, D'Aviero A, Frisicale EM, Silenzi A, Gabbrielli F, Bertinato L, Brusaferro S. COVID-19 and digital competencies among young physicians: are we (really) ready for the new era? A national survey of the Italian Young Medical Doctors Association. Ann Ist Super Sanita 2021; 57:1-6. [PMID: 33797398 DOI: 10.4415/ann_21_01_01] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Digital health (DH) is nowadays fundamental for physicians. Despite the improvement of information and communications technology (ICT), Italian medical doctors' (MDs) education system seems inadequate in this area. Moreover, due to the COVID-19 pandemic, societies are waking up to their limitations. The aim of this paper is to analyze the Italian status quo in DH. METHODS The Italian Young Medical Doctors Association (Segretariato Italiano Giovani Medici - SIGM) proposed a web-based survey to assess DH awareness and previous knowledge among young doctors. Investigated areas were: big data, -omics technology and predictive models, artificial intelligence (AI), internet of things, telemedicine, social media, blockchain and clinical-data storage. RESULTS A total of 362 participants answered to the survey. Only 13% had experience in big data during clinical or research activities, 13% in -omics technology and predictive models, 13% in AI, 6% had experience in internet of things, 22% experienced at least one telemedicine tool and 23% of the participants declared that during their clinical activities data collection was paper-driven. CONCLUSIONS Three categories of MDs, high-tech, low-tech and no-tech, can be identified from the survey-based investigation. Our survey's results indicate an urgent need for integration of pre- and post-graduation training in digital health to provide adequate medical education.
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Affiliation(s)
- Calogero Casà
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Marotta
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marcello Di Pumpo
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea D'Aviero
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuela Maria Frisicale
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - Azienda Sanitaria Locale - ASL Roma 1, Rome, Italy
| | - Andrea Silenzi
- Segretariato Italiano Giovani Medici - SIGM, Rome, Italy - Agenzia di Tutela della Salute - ATS, Brescia, Italy - Centro di Ricerca e Studi sulla Leadership in Medicina, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Gabbrielli
- Centro Nazionale per la Telemedicina e le Nuove Tecnologie Assistenziali, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Bertinato
- Segreteria Scientifica del Presidente, Istituto Superiore di Sanità, Rome, Italy
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24
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Pisani L, De Nicolo A, Schiavone M, Adeniji AO, De Palma A, di Gennaro F, Emuveyan EE, Grasso S, Henwood PC, Koroma AP, Leopold S, Marotta C, Marulli G, Putoto G, Pisani E, Russel J, Serpa Neto A, Dondorp AM, Hanciles E, Koroma MM, Schultz MJ. Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting. Am J Trop Med Hyg 2020; 104:478-486. [PMID: 33319731 PMCID: PMC7866347 DOI: 10.4269/ajtmh.20-0996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023] Open
Abstract
Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15–28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7–14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.
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Affiliation(s)
- Luigi Pisani
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers-Location AMC, Amsterdam, The Netherlands
| | - Anna De Nicolo
- Intensive Care Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | | | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | | | | | - Salvatore Grasso
- Intensive Care Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Patricia C Henwood
- Department of Emergency Medicine, Thomas Jefferson University Hospitals, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Stije Leopold
- Department of Internal Medicine, Amsterdam University Medical Centers - Location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Claudia Marotta
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Enzo Pisani
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - James Russel
- Department of Cardiology, Connaught Hospital, University of Sierra Leone, Freetown, Sierra Leone
| | - Ary Serpa Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Arjen M Dondorp
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Eva Hanciles
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers - Location AMC, Amsterdam, The Netherlands
| | | | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers - Location AMC, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers-Location AMC, Amsterdam, The Netherlands
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25
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Marotta C, Pisani L, Di Gennaro F, Cavallin F, Bah S, Pisani V, Haniffa R, Beane A, Trevisanuto D, Hanciles E, Schultz MJ, Koroma MM, Putoto G. Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone. Am J Trop Med Hyg 2020; 103:2142-2148. [PMID: 32840199 DOI: 10.4269/ajtmh.20-0623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.
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Affiliation(s)
- Claudia Marotta
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
| | - Luigi Pisani
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Sarjoh Bah
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Vincenzo Pisani
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | | | - Eva Hanciles
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Marcus J Schultz
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael M Koroma
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
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26
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Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Antinori A, Berselli N, Blandi L, Bruno R, Cauda R, Guaraldi G, My I, Menicanti L, Parruti G, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Abdeddaim A, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Aucella F, Barbieri G, Bartoloni A, Bologna C, Bonfanti P, Brancati S, Cacciatore F, Caiano L, Cannata F, Carrozzi L, Cascio A, Cingolani A, Cipollone F, Colomba C, Crisetti A, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Palma G, Di Tano G, Fantoni M, Filippini T, Fioretto P, Fusco FM, Gentile I, Grisafi L, Guarnieri G, Landi F, Larizza G, Leone A, Maccagni G, Maccarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marotta C, Marra L, Mastroianni F, Mengozzi A, Menichetti F, Milic J, Murri R, Montineri A, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Petri F, Pinchera B, Pivato CA, Pizzi R, Poletti V, Raffaelli F, Ravaglia C, Righetti G, Rognoni A, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scarafino A, Scorzolini L, Sgariglia R, Simeone PG, Spinoni E, Torti C, Trecarichi EM, Vezzani F, Veronesi G, Vettor R, Vianello A, Vinceti M, De Caterina R, Iacoviello L. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr Metab Cardiovasc Dis 2020; 30:1899-1913. [PMID: 32912793 PMCID: PMC7833278 DOI: 10.1016/j.numecd.2020.07.031] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. METHODS AND RESULTS Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6-14.7 for age ≥85 vs 18-44 y); HR = 4.7; 2.9-7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5-3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. CONCLUSIONS Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy.
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Affiliation(s)
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | | | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Roma, Italy
| | - Amina Abdeddaim
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Luca Aiello
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences. University of Naples, Federico II, Naples, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Cannata
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Annalisa Crisetti
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Gian B Danzi
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | - Gisella Di Palma
- UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Landi
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Giovanni Larizza
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Sandro Maccarella
- ASST Milano Nord - Ospedale Edoardo Bassini, Cinisello Balsamo, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Giulio Maresca
- Centro Cardiologico Monzino IRCCS, Milano, Italy; UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco", AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna. AUSL della Romagna, Ravenna, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Carlo A Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Roberto Pizzi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | | | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | - Giulia Righetti
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Antonio Scarafino
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Paola G Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Enrico Spinoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Enrico M Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Francesca Vezzani
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Di Gennaro F, Marotta C, Amicone M, Bavaro DF, Bernaudo F, Frisicale EM, Kurotschka PK, Mazzari A, Veronese N, Murri R, Fantoni M. Italian young doctors' knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey. J Glob Antimicrob Resist 2020; 23:167-173. [PMID: 32971291 DOI: 10.1016/j.jgar.2020.08.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is one of the major health issues worldwide. Clinicians should play a central role to fight AMR, and medical training is a pivotal issue to combat it; therefore, assessing levels of knowledge, attitudes and practices among young doctors is essential for future antimicrobial stewardship (AMS) programmes. METHODS A nationwide, cross-sectional, multicentre survey was conducted in Italy. A descriptive analysis of knowledge and attitudes was performed, along with a univariate and multivariate analysis of their determinants. RESULTS Overall, 1179 young doctors accessed the survey and 1055 (89.5%) completed all sections. Regarding the knowledge section of the questionnaire, almost all participants declared to know the different species of bacteria proposed, however the percentage of participants who correctly responded to clinical quizzes was 23% for the question on vancomycin-resistant enterococci (VRE), 42% on carbapenem-resistant Enterobacteriaceae (CRE), 32% on extended-spectrum β-lactamase-producing enterobacteria (ESBL) and 27% on methicillin-resistantStaphylococcus aureus (MRSA). Similarly, 81% of participants disagreed in stating that AMR was adequately addressed during their medical training and 71% disagreed that they received the right example from their tutors. Finally, a high rate of agreement with the proposed actions to combat AMR was documented; in particular, the percentage agreement was 76% for respondents who agreed to be part of an active surveillance system or AMS programme. CONCLUSIONS Tackling AMR should be a priority for politicians and for all health workers. Inclusion of competencies in antibiotic use in all specialty curricula is urgently needed.
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Affiliation(s)
- F Di Gennaro
- Italian Young Medical Doctors Association, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - C Marotta
- Italian Young Medical Doctors Association, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - M Amicone
- Italian Young Medical Doctors Association, Italy; Department of Public Health, Nephrology Unit, University of Naples Federico II, Naples, Italy
| | - D F Bavaro
- Italian Young Medical Doctors Association, Italy; Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Clinic of Infectious Diseases, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - F Bernaudo
- Italian Young Medical Doctors Association, Italy; Local Health Authority (ASP) Catanzaro, Italy
| | - E M Frisicale
- Italian Young Medical Doctors Association, Italy; Local Health Authority (ASL) Roma 1, Rome, Italy; Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P K Kurotschka
- Italian Young Medical Doctors Association, Italy; Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - A Mazzari
- Division of General Surgery, Cristo Re Hospital, Rome, Italy
| | - N Veronese
- University of Palermo, Geriatrics Department, Palermo, Italy
| | - R Murri
- Department di Clinica delle Malattie Infettive, Università Cattolica S Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - M Fantoni
- Department di Clinica delle Malattie Infettive, Università Cattolica S Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
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Mazzucco W, Costantino C, Restivo V, Alba D, Marotta C, Tavormina E, Cernigliaro A, Macaluso M, Cusimano R, Grammauta R, Tramuto F, Scondotto S, Vitale F. The Management of Health Hazards Related to Municipal Solid Waste on Fire in Europe: An Environmental Justice Issue? Int J Environ Res Public Health 2020; 17:E6617. [PMID: 32932886 PMCID: PMC7558387 DOI: 10.3390/ijerph17186617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
Landfilling should be the last option in an integrated Municipal Solid Waste (MSW) management approach. In the European Union (EU), the policy framework to protect the environment and the public health against the impact of health hazards related to urban solid waste management has been consistently implemented in recent decades. A growing interest in the negative impact of fires in waste landfills on the environment and people's health was reported in some European countries. In Italy, an increasing occurrence of arsons in MSW and landfills has been reported in recent years. During the summer of 2012, a multi-site arson occurred in the Palermo Municipal solid waste landfill of Bellolampo (western Sicily), giving rise to an environmental emergency of public health concern. Local health authorities reacted by creating an inter-institutional multidisciplinary task force with the aim to implement measures to prevent and control the risk of exposure by delimiting a protection area to be taken under strict monitoring. Environmental and epidemiological investigations were put in place by air, soil, and farm product sampling. A syndromic surveillance of the exposed population was conducted as well. The air monitoring stations system in place detected an increase in the concentrations of dioxins and dioxin-like substances with the PM10 highest emission pick documented within the first 24 h and estimated at about 60 μg/m3. Levels of heavy metals above the limits permitted by law were detected in the top- and sub-soil samples collected within the two landfill sampling sites and also in other nearby sites. Non-conforming concentration values of dioxins and dioxin-like substances were detected in samples taken from farms, milk, and water. The health syndromic surveillance did not document any daily increase in the notification of emergency admissions related to acute respiratory diseases or any other health effect potentially related to the waste arson, but these findings were limited by the non-systematic collection of data. The experience reported in the present case report, as declined within the European Union policy framework and in the view of environmental justice, documented the need to structure a permanent collaboration between the different institutional actors involved in environmental and public health protection activities in order to develop specific protocols to manage events related to the occurrence of waste-related environmental emergencies or disasters.
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Affiliation(s)
- Walter Mazzucco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital “P. Giaccone”, 90127 Palermo, Italy
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Claudio Costantino
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Vincenzo Restivo
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Davide Alba
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Claudia Marotta
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Elisa Tavormina
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Maurizio Macaluso
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | | | - Rosario Grammauta
- Institute for the Study of Anthropogenic Impacts and Sustainability in the Marine Environment (IAS), National Research Council, 91021 Torretta Granitola (Trapani), Italy;
| | - Fabio Tramuto
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, 90145 Palermo, Italy; (E.T.); (A.C.); (S.S.)
| | - Francesco Vitale
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, 90133 Palermo, Italy; (W.M.); (C.C.); (V.R.); (C.M.); (F.T.); (F.V.)
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Di Gennaro F, Marotta C, Storto M, D’Avanzo C, Foschini N, Maffei L, de Gaetano G, Centonze D, Iezzi E. SARS-CoV-2 Transmission and Outcome in Neuro-rehabilitation Patients Hospitalized at Neuroscience Hospital in Italy. Mediterr J Hematol Infect Dis 2020; 12:e2020063. [PMID: 32952974 PMCID: PMC7485473 DOI: 10.4084/mjhid.2020.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022] Open
Abstract
ABSTRACT
Introduction: Patients admitted to intensive neurorehabilitation facilities following neurological damage who developed SARS-CoV-2 infection during hospitalization have not yet been reported. Such patients are elderly, with severe disabling neurological syndromes, more likely have significant underlying comorbidities and develop fatal complications during the disease. We reported clinical features, underlying comorbidities, laboratory and radiological findings, treatment and outcome of severely disabled neurological patients with SARS-CoV-2 infection.
Methods: We retrospectively analyzed a group of 14 patients affected by severe neurological damage previously admitted to the Neurorehabilitation Unit of Neuromed Research Institute in Pozzilli, Italy, who developed confirmed COVID-19 during a SARS-CoV-2 outbreak occurred on March, 2020.
Results: One out of 14 patients (7%) died after developing a severe acute respiratory distress. The remaining patients did not present any symptom or laboratory or radiological signs of the disease; neither new neurological deficit nor worsening of the pre-existing clinical manifestations were observed. Thirtheen patients had underlying comorbitidies (93%), the most frequent being hypertension (11 patients, 78.5%) and diabetes mellitus type II (7 patients, 50%). Long before infection, all patients were already under anticoagulant therapy with enoxaparin.
Conclusions: In 13 out of 14 patients, the infection was asymptomatic; this is particularly intriguing considering their severe neurological clinical profile. According to the pivotal role played by inflammation and activation of blood coagulation in the pathogenesis of COVID-19, the anti-inflammatory and anticoagulant properties of enoxaparin, administered much earlier and during infection, could have favored an extremely benign disease course in these patients at high risk of poor outcome.
Keywords: SARS CoV 2, neurological patients, neurological damage, Infection, Coronavirus
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Affiliation(s)
| | - Claudia Marotta
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy
| | - Marianna Storto
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy
| | - Carmine D’Avanzo
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Nunzia Foschini
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Luigi Maffei
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Diego Centonze
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
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Marotta C, Lochoro P, Pizzol D, Putoto G, Mazzucco W, Saracino A, Monno L, Di Gennaro F, Ictho J. Capacity assessment for provision of quality sexual reproductive health and HIV-integrated services in Karamoja, Uganda. Afr Health Sci 2020; 20:1053-1065. [PMID: 33402951 PMCID: PMC7751512 DOI: 10.4314/ahs.v20i3.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Sexual and reproductive health (SRH) and Human Immunodeficiency Virus (HIV) are crucial global health issues. Uganda continues to sustain a huge burden of HIV and AIDS. METHODS A cross-sectional health facility-based assessment was performed in November and December 2016 in Karamoja Region, northern Uganda. All the 126 health facilities (HFs) in Karamoja, including 5 hospitals and 121 Health Centers (HCs), covering 51 sub-counties of the 7 districts were assessed. We assessed the capacity of a) leadership and governance, b) human resource, c) service delivery, d) SRH and HIV service integration and e) users satisfaction and perceptions. RESULTS 64% of the established health staffing positions were filled leaving an absolute gap of 704 units in terms of human resources. As for service delivery capacity, on 5 domains assessed, the best performing was basic hygiene and safety measures in which 33% HCs scored "excellent", followed by the presence of basic equipment. The level of integration of SRH/HIV services was 55.56%. CONCLUSION HFs in Karamoja have capacity gaps in a number of health system building blocks. Many of these gaps can be addressed through improved planning. To invest in improvements for these services would have a great gain for Uganda.
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Affiliation(s)
- Claudia Marotta
- University of Palermo, Department of Science for Health Promotion and Mother to Child Care “G. D'Alessandro”, Palermo, Italy
| | | | - Damiano Pizzol
- Doctors With Africa Cuamm, Research Section Padua, Italy
| | | | - Walter Mazzucco
- University of Palermo, Department of Science for Health Promotion and Mother to Child Care “G. D'Alessandro”, Palermo, Italy
| | | | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, Italy
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Di Gennaro F, Marotta C, Antunes M, Pizzol D. Diabetes in active tuberculosis in low-income countries: to test or to take care? Lancet Glob Health 2020; 7:e707. [PMID: 31097272 DOI: 10.1016/s2214-109x(19)30173-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francesco Di Gennaro
- Operational Research Unit, Doctors with Africa CUAMM, 1363 Beira, Mozambique; Department of Infectious Diseases, University of Bari, Bari, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, 1363 Beira, Mozambique; Department of Science for Health Promotion and Mother to Child Care, University of Palermo, Palermo, Italy
| | - Mario Antunes
- Department of Surgery, Central Hospital of Beira, Beira, Mozambique
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, 1363 Beira, Mozambique.
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Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N, Smith L. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health 2020; 17:E2690. [PMID: 32295188 PMCID: PMC7215977 DOI: 10.3390/ijerph17082690] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 01/08/2023]
Abstract
At the end of 2019 a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing severe acute respiratory syndrome expanded globally from Wuhan, China. In March 2020 the World Health Organization declared the SARS-Cov-2 virus a global pandemic. We performed a narrative review to describe existing literature with regard to Corona Virus Disease 2019 (COVID-19) epidemiology, pathophysiology, diagnosis, management and future perspective. MEDLINE, EMBASE and Scopus databases were searched for relevant articles. Although only when the pandemic ends it will be possible to assess the full health, social and economic impact of this global disaster, this review represents a picture of the current state of the art. In particular, we focus on public health impact, pathophysiology and clinical manifestations, diagnosis, case management, emergency response and preparedness.
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Affiliation(s)
- Francesco Di Gennaro
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy; (F.D.G.); (C.M.)
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum 79371, Sudan;
| | - Claudia Marotta
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, 86077 Pozzilli, Italy; (F.D.G.); (C.M.)
| | - Mario Antunes
- Department of Surgery, Central Hospital of Beira, Beira 2102, Mozambique;
| | | | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy;
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK;
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Costantino C, Restivo V, Gaglio V, Lanza GLM, Marotta C, Maida CM, Mazzucco W, Casuccio A, Torregrossa MV, Vitale F. Effectiveness of an educational intervention on seasonal influenza vaccination campaign adherence among healthcare workers of the Palermo University Hospital, Italy. Ann Ig 2020; 31:35-44. [PMID: 30554237 DOI: 10.7416/ai.2019.2256] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Healthcare workers are continuously exposed to the risk of being infected by influenza viruses during their work, thus representing a threat especially for fragile patients. Although the Italian Ministry of Health strongly recommends influenza vaccination for all HCWs, coverage levels in Italy are still far from the expected. Several studies report that one of the preferred strategies to improve vaccination coverage among Healthcare Workers is improving vaccination knowledge through specific multidisciplinary courses. To assess the effectiveness of an educational intervention on influenza vaccination coverage among Healthcare Workers a study was conducted at "Paolo Giaccone" University Hospital of Palermo, in the occasion of the 2016/2017 seasonal influenza vaccination campaign. MATERIAL AND METHODS Educational interventions on influenza infection and vaccination were organized involving personnel of the hospital units in which patients were more fragile. The Healthcare Workers who volunteered attend the course were considered as the intervention group, while two controls for each case, composed by Healthcare Workers not attending it, were randomly selected from the same unit. For both groups, a questionnaire was used to investigate attitude and behaviors toward influenza vaccination, while vaccination coverage data were obtained throughout the Hospital informational data system. RESULTS Overall, out of the 125 participants, 38 (30.4%) followed the course (intervention group) and 87 (69.6%), not attending the course, represented the control group; later, only 43 Healthcare Workers out of 125 (34.4%) underwent vaccination during the season considered. In particular, after the educational intervention, 42% of the attending Healthcare Workers got vaccinated, while vaccination prevalence in the control group was 31%. The Healthcare Workers who underwent vaccination reported, before the intervention, a higher risk perception for contracting (transmitting) influenza compared to those not vaccinated (p<0.05), while no significant difference in risk perception of transmitting influenza to their patients was reported between the two groups. DISCUSSION Despite the training provided, and an improvement in vaccination adherence by the Healthcare Workers involved, coverage obtained was lower than recommended to reduce influenza spread in hospital contexts. In conclusion, our data suggest that specific training alone may play a role in the improvement of influenza vaccination adherence, but it should be integrated by a wider range of public health measures, including mandatory vaccination.
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Affiliation(s)
- C Costantino
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - V Restivo
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - V Gaglio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - G L M Lanza
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - C Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - C M Maida
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - W Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - A Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - M V Torregrossa
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - F Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
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Quaglio G, Pizzol D, Isaakidis P, Bortolani A, Tognon F, Marotta C, Di Gennaro F, Putoto G, Olliaro PL. Breast Tuberculosis in Women: A Systematic Review. Am J Trop Med Hyg 2020; 101:12-21. [PMID: 31115305 DOI: 10.4269/ajtmh.19-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.
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Affiliation(s)
- Gianluca Quaglio
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy.,European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, Beira, Mozambique
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Arianna Bortolani
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Piero L Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Special Programme for Research and Training in Tropical Diseases, World Health Organization (WHO/TDR), Geneva, Switzerland
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Falanga C, Marotta C, Negri S, Di Gennaro F, Fiore Bavaro D, Poliseno M, Mazzucco W, Monno L, Saracino A, Lo Caputo S. HIV rapid test in a community setting as a strategy to improve access to HIV testing: data from a multicentre experience in Italy. Infez Med 2019; 27:415-421. [PMID: 31846992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
4,000 new HIV diagnoses and approximately 800 AIDS cases are still reported annually in Italy. Improving public awareness and bringing out HIV-undiagnosed individuals are keystones to progress towards the control of the HIV epidemic. For this purpose, the Open HIV TEST project was organized and delivered by the Italian NGO Anlaids, together with local infectious diseases specialists, in order to provide free access to HIV testing outside the healthcare setting. Between October 2017 and February 2019 six Open HIV TEST initiatives were delivered in six Italian cities (3 northern cities, 1 central and 2 southern cities). In all, 581 people were tested: the overall prevalence of HIV test reactivity was 0.7%. Participants were also asked about previous screenings and about their satisfaction with the initiative: previous HIV screening due to pregnancy or surgical procedures was reported mainly by participants in northern centres (p<0.001); finally, the initiative was considered useful and noteworthy by 99% of participants. Prevalence of HIV test reactivity in our experience was in line with national data. Our experience suggests that active testing and counselling strategies in community settings should be recommended and institutionalized by local health authorities in line with the 90-90-90 global strategy.
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Affiliation(s)
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | | | | | | | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Sergio Lo Caputo
- Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
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Costantino C, Mazzucco W, Marotta C, Saporito L, Bono S, Fiorino GR, Graziano G, Maniglia M, Marchese V, Napoli G, Palmeri S, Provenzano S, Raia DD, Santangelo OE, Ventura G, Colaceci S, Giusti A, Casuccio A, Restivo V. Methodological issues in a cross-sectional survey on cervical cancer screening using telephone interviews in Sicily (Italy): a SWOT analysis. J Int Med Res 2019; 47:5174-5184. [PMID: 31510892 PMCID: PMC6833421 DOI: 10.1177/0300060519860950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective A cross-sectional study on knowledge, perceptions, and adherence to cervical cancer screening was conducted using telephone interviews of Sicilian women that were performed in 2016. This study aimed to identify areas that need to be addressed to improve the validity of data collection and to minimize possible biases. Methods We performed a qualitative study through SWOT analysis, which is a multidimensional method based on evaluation of Strengths (S), Weaknesses (W), Opportunities (O), and Threats (T) of the research project. The contents of the SWOT forms underwent categorical, inductive, and deductive data analysis using the long table analysis method. Results The full availability of an updated address and phone number list was the main organizational aspect to be addressed. Socio-cultural context played a major role for understanding the questions and for acceptability of the topics. In some cases, a family member was a facilitating element, while in others, the family member hindered the interviews. Active involvement of general practitioners was considered essential for success of the interviews. Conclusions When performing a cross-sectional survey, organizational aspects and active involvement of general practitioners are crucial in the enrolment phase, regardless of the socio-cultural context.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Claudia Marotta
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Laura Saporito
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Stefania Bono
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Giusy Russo Fiorino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Giorgio Graziano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Marialuisa Maniglia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Valentina Marchese
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Giuseppe Napoli
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Sara Palmeri
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Sandro Provenzano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Daniele Domenico Raia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Omar Enzo Santangelo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Gianmarco Ventura
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Sofia Colaceci
- National Center for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialists, University of Palermo, Palermo, Italy
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Quaglio G, Tognon F, Finos L, Bome D, Sesay S, Kebbie A, Di Gennaro F, Camara BS, Marotta C, Pisani V, Bangura Z, Pizzol D, Saracino A, Mazzucco W, Jones S, Putoto G. Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study. BMJ Open 2019; 9:e029093. [PMID: 31488479 PMCID: PMC6731846 DOI: 10.1136/bmjopen-2019-029093] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the trends concerning utilisation of maternal and child health (MCH) services before, during and after the Ebola outbreak, quantifying the contribution of a reorganised referral system (RS). DESIGN A prospective observational study of MCH services. SETTING Pujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017. MAIN OUTCOME MEASURES MCH utililization was evaluated by assessing: (1) institutional deliveries, Cesarean-sections, paediatric and maternity admissions and deaths, and major direct obstetric complications (MDOCs), at hospital level; (2) antenatal care (ANC) 1 and 4, institutional delivery and family planning, at community level. Contribution of a strengthened RS was also measured. RESULTS At hospital level, there is a significant difference between trends Ebola versus pre-Ebola for maternal admissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI 1 to 7, p=0.006) and institutional deliveries (4, 95% CI 2 to 6, p=0.001). There is also a negative trend in the transition from Ebola to post-Ebola for maternal admissions (-7, 95% CI -10 to -4, p<0.001), MDOCs (-4, 95% CI -7 to -1, p=0.009) and institutional deliveries (-3, 95% CI -5 to -1, p=0.001). The differences between trends pre-Ebola versus post-Ebola are only significant for paediatric admissions (3, 95% CI 0 to 5, p=0.035). At community level, the difference between trends Ebola versus pre-Ebola and Ebola versus post-Ebola are not significant for any indicators. The differences between trends pre-Ebola versus post-Ebola show a negative difference for institutional deliveries (-7, 95% CI -10 to -4, p<0.001), ANC 1 (-6, 95% CI -10 to -3, p<0.001), ANC 4 (-8, 95% CI -11 to -5, p<0.001) and family planning (-85, 95% CI -119 to -51, p<0.001). CONCLUSIONS A stronger health system compared with other districts in Sierra Leone and a strengthened RS enabled health facilities in Pujehun to maintain service provision and uptake during and after the Ebola epidemic.
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Affiliation(s)
- Gianluca Quaglio
- European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
- Department of International Health/CAPHRI, University of Maastricht, Maastricht, The Netherlands
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Francesca Tognon
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Livio Finos
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - David Bome
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Santigie Sesay
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Atiba Kebbie
- Department for Woman and Child Health, Pujehun Hospital, Pujehun, Sierra Leone
| | | | - Bienvenu Salim Camara
- National Centre for Training and Research in Rural Health of Maferinyah, Forécariah, Guinea
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care, University of Palermo, Palermo, Italy
| | - Vincenzo Pisani
- Department for Woman and Child Health, Pujehun Hospital, Pujehun, Sierra Leone
| | - Zainab Bangura
- Department for Woman and Child Health, Pujehun Hospital, Pujehun, Sierra Leone
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | | | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care, University of Palermo, Palermo, Italy
| | - Susan Jones
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, London, UK
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
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Mazzucco W, Tavormina E, Macaluso M, Marotta C, Cusimano R, Alba D, Costantino C, Grammauta R, Cernigliaro A, Scondotto S, Vitale F. Do emissions from landfill fires affect pregnancy outcomes? A retrospective study after arson at a solid waste facility in Sicily. BMJ Open 2019; 9:e027912. [PMID: 31278100 PMCID: PMC6615803 DOI: 10.1136/bmjopen-2018-027912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES In response to public health concern about effects of arson at solid waste management plants in July 2012, we analysed vital statistics data to evaluate any potential effect on pregnancies at different gestational ages of pollutants emitted from the landfill on fire. SETTING A community living near the largest landfill plant in Sicily. PARTICIPANTS The study group comprised 551 births, live births and stillbirths from pregnancies of mothers residing in the extra-urban exposed area, conceived during a 40 week period during which the highest fire's peak might have influenced pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Birth outcomes (gestational age <37 and <32 weeks, low birth weight, very low birth weight and small for gestational age) in the study group were compared with the ones of a reference group of women residing in areas of Sicily with similarly low population density and industrial development. RESULTS Among singleton live births we observed a three-fold increase in risk of very preterm birth between the extra-urban area and the remaining low inhabitants density and unindustrialised areas for births whose pregnancies were in the third trimester (OR adjusted for maternal age and infant gender=3.41; 95% CI 1.04 to 11.16). There was an excess of very low birth weight singleton infants in the study group as compared with the reference group, which was limited to births to mothers exposed during periconception period (OR adjusted for maternal age and infant gender=4.64; 95% CI 1.04 to 20.6) and first trimester (OR adjusted for maternal age and infant gender=3.66; 95% CI 1.11 to 12.1). The association estimates were imprecise due to the small number of outcomes recorded. CONCLUSIONS The study documented an excess of very preterm and very low birth weight among infants born to mothers exposed to the landfill fire emissions during conception or early pregnancy.
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Affiliation(s)
- Walter Mazzucco
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Sicilia, Italy
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Elisa Tavormina
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Claudia Marotta
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Sicilia, Italy
| | - Rosanna Cusimano
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Davide Alba
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Sicilia, Italy
| | - Claudio Costantino
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Sicilia, Italy
| | - Rosario Grammauta
- Institute for the Study of Anthropogenic Impacts and Sustainability in the Marine Environment (IAS), National Research Council, National Research Council, Torretta Granitola (Trapani), Italy
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Francesco Vitale
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Sicilia, Italy
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
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Costantino C, Casuccio A, Marotta C, Bono SE, Ventura G, Mazzucco W, Vitale F, Restivo V. Effects of an intervention to prevent the bullying in first-grade secondary schools of Palermo, Italy: the BIAS study. Ital J Pediatr 2019; 45:65. [PMID: 31133055 PMCID: PMC6537154 DOI: 10.1186/s13052-019-0649-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bullying is one of the most common expressions of violence in the peer context during school years. This study investigates the prevalence of bullying and the short-term effects on students' bullying perceptions of a preventive intervention conducted among teachers of first-grade secondary schools in Palermo, Sicily (Italy). METHODS Between the 2017/2018 and 2018/2019 school years, a pre-post intervention study was conducted among nine school institutions, sampled and categorized by neighbourhood socioeconomic index. A questionnaire investigating physical, verbal, and indirect bullying, the role of observers, prosociality, and resiliency in bullying was administered before and after intervention with formative cascade training of the teachers of the selected classes. Three different methods (sentinel questions, the five-question method, the 'score of seven' method) were used to detect the baseline level of bullying. RESULTS A total of 402 students participated in the study (72.7% response rate). A decrease in the number of bullying episodes after the intervention was reported by the students in all types of bullying explored (physical, verbal, and indirect bullying, observers, resiliency, and prosociality), with all three methods. In particular, a statistically significant decrease in all the bullying areas investigated (except for resiliency) was reported for students attending schools of an intermediate socioeconomic level. CONCLUSIONS Even if many school-based interventions have been implemented to reduce school bullying throughout the world, this is one of the first conducted in Europe and it assesses the effectiveness among students of an anti-bullying intervention tailored for teachers. The encouraging results in reducing the number of bullying episodes together with the low cost in terms of human and economic resources could suggest an extension of this research on a regional/national scale.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Claudia Marotta
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Stefania Enza Bono
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Gianmarco Ventura
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro n 133, 90127 Palermo, Italy
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Mazzucco W, Cusimano R, Marotta C, Zarcone M, Mazzola S, Gaglio V, Casuccio A, Vitale F. Funnel plots and choropleth maps in cancer risk communication: a Delphi study. Ann Ig 2019; 31:244-251. [PMID: 31069369 DOI: 10.7416/ai.2019.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In the last decades, the issues related to health risk communication to stakeholders and citizens involving health care practitioners and local political authorities have been increasingly debated. The study evaluated an alternative strategy to communicate cancer risk to local communities, involving an expert panel of public health operators in comparing two different graphic tools, Funnel Plot and Choropleth map. STUDY DESIGN A Delphi method process was implemented to achieve a unified consensus on an expert panel of public health operators with regard to weaknesses and strengths of the Funnel Plot and the Choropleth map as tools for cancer risk communication to local communities and other stakeholders. METHODS Participants were asked to score the efficacy of the two tools using a scale. Six properties were explored through two consecutive consensus rounds. Scales were used to calculate frequencies and the content validity ratio for each domain within the consensus rounds. RESULTS After the two consecutive rounds, participants expressed their preference in favour of the Choropleth map for its ability to define the spatial location of the risk and to locate any potential cluster, while reaching a consensus with regard to the Funnel Plot properties to identify hot spots, displaying the scope of the phenomenon under investigation, and to show the precision of estimates and communicating the significance of estimates. CONCLUSIONS The Delphi process allowed us to conclude that Funnel Plot could be used as a complement to the current and commonly used graphical and visual formats to effectively communicate cancer epidemiological data to communities and local authorities, representing a useful tool for empowering the general population.
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Affiliation(s)
- W Mazzucco
- Palermo Province Cancer Registry, Palermo, Italy - Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - R Cusimano
- Palermo Province Cancer Registry, Palermo, Italy - Local Health Unit 6, Department of Prevention, Palermo, Italy
| | - C Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - M Zarcone
- Palermo Province Cancer Registry, Palermo, Italy - Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" Teaching Hospital, Palermo, Italy
| | - S Mazzola
- Palermo Province Cancer Registry, Palermo, Italy - Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" Teaching Hospital, Palermo, Italy
| | - V Gaglio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - A Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - F Vitale
- Palermo Province Cancer Registry, Palermo, Italy - Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy - Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" Teaching Hospital, Palermo, Italy
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Bobbio F, Di Gennaro F, Marotta C, Kok J, Akec G, Norbis L, Monno L, Saracino A, Mazzucco W, Lunardi M. Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open 2019; 9:e027179. [PMID: 30944140 PMCID: PMC6500283 DOI: 10.1136/bmjopen-2018-027179] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature. DESIGN Cross-sectional study. SETTING Voluntary Counselling and Testing Centre (VCT) of Yirol Hospital, South Sudan. PARTICIPANTS From May to November 2017, 252 HIV-positive patients out of 624 newly admitted to VCT Centre were registered for antiretroviral treatment. According to the number of trained doctors available to practise ultrasound (US) scan, a sample of 100 patients were screened using the FASH protocol. INTERVENTIONS Following a full clinical examination, each patient was scanned with a portable US scanner in six different positions for pleural, pericardial, ascitic effusion, abdominal lymphadenopathy and hepatic/splenic microabscesses, according to the FASH protocol. A k39 antigen test for visceral leishmaniasis was also performed on patients with lymphadenopathy and/or splenomegaly. All demographic, clinical and HIV data, as well as FASH results and therapy adjustments, were recorded following the examination. RESULTS The FASH protocol allowed the detection of pathological US findings suggestive of tuberculosis in 27 out of the 100 patients tested. Overall, FASH results supported tuberculosis treatment indication for 16 of 21 patients, with the treatment being based exclusively on FASH findings in half of them (8 patients). The group of FASH-positive patients had a significantly higher proportion of patients with CD4 count below 0.2 x109/L (n=22, 81%) as compared with FASH-negative patients (n=35, 48%) (p=0.003). Moreover, 48% (n=13) of FASH-positive patients had CD4 below 100 cells/mm3. All patients tested had a negative result on k39 antigen test. CONCLUSION FASH was found to be a relevant diagnostic tool to detect signs of tuberculosis. Further research is needed to better define a patient profile suitable for investigation and also considering diagnostic accuracy.
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Affiliation(s)
| | | | - Claudia Marotta
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
| | - John Kok
- Yirol Hospital, Yirol, South Sudan
| | | | - Luca Norbis
- Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Laura Monno
- Infectious Diseases, University of Bari, Bari, Italy
| | | | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
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Francavilla VC, Vitale F, Ciaccio M, Bongiovanni T, Marotta C, Caldarella R, Todaro L, Zarcone M, Muratore R, Bellia C, Francavilla G, Mazzucco W. Use of Saliva in Alternative to Serum Sampling to Monitor Biomarkers Modifications in Professional Soccer Players. Front Physiol 2018; 9:1828. [PMID: 30618836 PMCID: PMC6306404 DOI: 10.3389/fphys.2018.01828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/06/2018] [Indexed: 01/05/2023] Open
Abstract
We aimed to investigate the correlation between serum and salivary concentrations of steroid hormones and IgA, and the variation in concentrations of these biomarkers, across a soccer competitive season in a sample of players playing for an Italian major League team. Thirty-five elite male soccer players were recruited and assessed for salivary hormones (cortisol, testosterone, T/C‰ and DHEA-S) and IgA at three different time-points: (t1) after the pre-season period and 16 official matches played; (t2) after a winter break and three official matches played; (t3) 2 days after the final match of the championship and 19 matches played. Players were also tested for blood biomarkers (ser-C, ser-T, ser-T/C‰, ser-IgA, ACTH) at two detection times (t1 and t3). Blood samples were collected immediately after saliva sampling. The Spearman’s rank correlation was used to explore the correlation between blood and salivary concentrations of cortisol, free testosterone and IgA in the different time points. One-way ANOVA and permutation test were performed to explore changes by time of hormones and IgA concentrations over the competitive season. We documented a positive correlation between serum and saliva concentrations for Cortisol at t1 (+58.2%; p-value = 0.002) and t3 (+54.2%; p-value = 0.018) and for Testosterone at t1 (+42.0%; p-value = 0.033). Moreover, a positive variation was documented across the season (D = t3–t1) for Cortisol (D = +6.83; SEM = ±2.70; Var% = +37.6; p-value = 0.032), Testosterone (D = +0.33; SEM = ±0.07; Var% = +27.3; p-value = 0.002) and DHEA-S (D = +44.48; SEM = ±18.54; Var% = +82.0; p-value = 0.042), while a decrease of sal-T/C ratio and no variation in salivary IgA concentrations were reported. In conclusion, our findings support for experimental use of saliva samples to monitor steroid hormones modifications in professional soccer players across a competitive season.
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Affiliation(s)
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Department of Laboratory Medicine, "P. Giaccone" University Hospital, Palermo, Italy
| | - Tindaro Bongiovanni
- Nutrition, Hydration & Body Composition Department, Parma Calcio 1913, Parma, Italy
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Rosalia Caldarella
- Complex Unit of Laboratory Medicine, "P. Giaccone" University Hospital, Palermo, Italy
| | | | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, Palermo, Italy
| | - Roberto Muratore
- Complex Unit of Laboratory Medicine, "P. Giaccone" University Hospital, Palermo, Italy
| | - Chiara Bellia
- Department of Laboratory Medicine, "P. Giaccone" University Hospital, Palermo, Italy
| | - Giuseppe Francavilla
- Department of Surgical, Anatomical and Oncological Disciplines, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro," University of Palermo, Palermo, Italy
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Mazzucco W, Cusimano R, Mazzola S, Rudisi G, Zarcone M, Marotta C, Graziano G, D'Angelo P, Vitale F. Comparison of paediatric cancers outcomes between Palermo Province (Sicily) and Southern Europe. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - R Cusimano
- Local Health Agency Palermo, Palermo, Italy
| | - S Mazzola
- Palermo Province Cancer Registry, Palermo, Italy
| | - G Rudisi
- Local Health Agency Palermo, Palermo, Italy
| | - M Zarcone
- Palermo Province Cancer Registry, Palermo, Italy
| | - C Marotta
- University of Palermo, Palermo, Italy
| | | | | | - F Vitale
- University of Palermo, Palermo, Italy
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Costantino C, Ventura G, Marotta C, Bono SE, Arcidiacono E, Gambino CR, Gentile M, Palmeri S, Ripoli G, Sannasardo CE, Sannasardo P, Scarpitta F, Vella C, Mazzucco W, Casuccio A, Restivo V. Prevalence of the bullying phenomenon in a schools sample of Palermo, Sicily: a pre-post intervention observational study among teachers. Acta Biomed 2018; 89:443-451. [PMID: 30333458 PMCID: PMC6502116 DOI: 10.23750/abm.v89i3.7575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Bullying involves a significant percentage of school-age children. According to the latest available surveillance data, in Sicily, the estimated prevalence among 11-15 years old children is 14%. This study aimed to estimate a prevalence of the bullying phenomenon, observed by teachers, in a sample of secondary schools of Palermo, Sicily. Moreover, after the conduction of preventive interventions among teachers, aimed to evaluate any modification in bullying prevalence. Methods:A cluster sampling selection according to socio-economic level of the school neighborhood was carried out. Two anonymous online questionnaires, pre and post-intervention, were administered to the 63 teaching staff, belonging to second and third year classes of ten secondary schools enrolled. Preventive interventions were conducted among teachers by experienced researchers. Results:Prevalence of bullying reported decreased significantly from 44.4% to 19.0% (p-value 0.001), comparing pre and post-intervention questionnaires. A reduction in the prevalence of verbal and physical bullying and a concomitant slight increase of indirect bullying were also observed. All the characteristics, reported by the teaching staff, for describing bullies, victims and observers of bullying have been categorized under three different content domains (affective-relational discomfort, socio-cultural context, and character/natural disposition). Conclusions: The present study estimated the prevalence and the characteristics of bullying phenomenon in a sample of secondary schools of Palermo, evaluating the reduction of bullying episodes among students, after a preventive interventions conducted among teaching staff. Data obtained confirmed the effectiveness of this approach and suggested an extension of the project at Regional Level.
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Affiliation(s)
- Claudio Costantino
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo.
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Di Gennaro F, Marotta C, Pizzol D, Chhaganlal K, Monno L, Putoto G, Saracino A, Casuccio A, Mazzucco W. Prevalence and Predictors of Malaria in Human Immunodeficiency Virus Infected Patients in Beira, Mozambique. Int J Environ Res Public Health 2018; 15:ijerph15092032. [PMID: 30227677 PMCID: PMC6163722 DOI: 10.3390/ijerph15092032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/31/2022]
Abstract
Co-infection between malaria and HIV has major public health implications. The aims of this study were to assess the malaria prevalence and to identify predictors of positivity to malaria Test in HIV positive patients admitted to the health center São Lucas of Beira, Mozambique. A retrospective cross-sectional study was performed from January 2016 to December 2016. Overall, 701 adult HIV patients were enrolled, positivity to malaria test was found in 232 (33.0%). These patients were found to be more frequently unemployed (76.3%), aged under 40 (72.0%), with a HIV positive partner (22.4%) and with a CD4 cell count <200 (59.9%). The following variables were predictors of malaria: age under 40 (O.R. = 1.56; 95%CI: 1.22–2.08), being unemployed (O.R. = 1.74; 95%CI: 1.24–2.21), irregularity of cotrimoxazole prophylaxis’s (O.R. = 1.42; 95%CI: 1.10–1.78), CD4 cell count <200 (O.R. = 2.01; 95%CI: 1.42–2.32) and tuberculosis comorbidity (O.R. = 1.58; 95%CI: 1.17–2.79). In conclusion, high malaria prevalence was found in HIV patients accessing the out-patients centre of São Lucas of Beira. Our findings allowed us to identify the profile of HIV patients needing more medical attention: young adults, unemployed, with a low CD4 cell count and irregularly accessing to ART and cotrimoxazole prophylaxis.
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Affiliation(s)
- Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Damiano Pizzol
- Doctors with Africa-CUAMM, Research Unit, Beira 1363, Mozambique.
| | - Kajal Chhaganlal
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira 1363, Mozambique.
| | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, 35128 Padova, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
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Marotta C, Di Gennaro F, Pizzol D, Madeira G, Monno L, Saracino A, Putoto G, Casuccio A, Mazzucco W. The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. Int J Environ Res Public Health 2018; 15:ijerph15071350. [PMID: 29954117 PMCID: PMC6069480 DOI: 10.3390/ijerph15071350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.
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Affiliation(s)
- Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | - Damiano Pizzol
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | | | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova 35128, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
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Mazzucco W, Cusimano R, Mazzola S, Rudisi G, Zarcone M, Marotta C, Graziano G, D'Angelo P, Vitale F. Childhood and Adolescence Cancers in the Palermo Province (Southern Italy): Ten Years (2003⁻2012) of Epidemiological Surveillance. Int J Environ Res Public Health 2018; 15:E1344. [PMID: 29949937 PMCID: PMC6069060 DOI: 10.3390/ijerph15071344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/16/2018] [Accepted: 06/23/2018] [Indexed: 02/06/2023]
Abstract
Italy has one of the highest paediatric cancer incidence rates in Europe. We compared cancer incidence and survival rates in children (0⁻14 years) and adolescents (15⁻19 years) residing in Palermo Province (PP) with statistics derived from Italian and European surveillance systems. We included all incident cancer cases, malignant tumours and non-malignant neoplasm of central nervous system (benign and uncertain whether malignant or benign), detected in children and adolescents by the Palermo Province Cancer Registry (PPCR) between 2003 and 2012. A jointpoint regression model was applied. Annual Average Percentage Changes were calculated. The Besag⁻York-Mollie model was used to detect any cluster. The 5-year survival analysis was computed using Kaplan-Meier and actuarial methods. We identified 555 paediatric cancer incident cases (90% “malignant tumours”). No difference in incidence rates was highlighted between PPCR and Italy 26 registries and between PPCR and Southern Europe. No jointpoint or significant trend was identified and no cluster was detected. The 5-year overall survival didn’t differ between PP and the Italian AIRTUM pool. A borderline higher statistically significant survival was observed in age-group 1⁻4 when comparing PPCR to EUROCARE-5. The epidemiological surveillance documented in the PP was a paediatric cancer burden in line with Italy and southern Europe. The study supports the supplementary role of general population-based cancer registries to provide paediatric cancer surveillance of local communities.
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Affiliation(s)
- Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | | | - Sergio Mazzola
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | - Giuseppa Rudisi
- Local Health Unit 6, via Giacomo Cusmano, 24 Palermo, Italy.
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
| | - Giorgio Graziano
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
| | - Paolo D'Angelo
- Paediatric Haematology and Oncology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Piazza Nicola Leotta, 4 Palermo, Italy.
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
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Mazzucco W, Pastorino R, Lagerberg T, Colotto M, d'Andrea E, Marotta C, Marzuillo C, Villari P, Federici A, Ricciardi W, Boccia S. Current state of genomic policies in healthcare among EU member states: results of a survey of chief medical officers. Eur J Public Health 2018; 27:931-937. [PMID: 27687585 PMCID: PMC5881673 DOI: 10.1093/eurpub/ckw155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background A need for a governance of genomics in healthcare among European Union (EU) countries arose during an international meeting of experts on public health genomics (PHG). We have conducted a survey on existing national genomic policies in healthcare among Chief Medical Officers (CMOs) of the 28 EU member states, plus Norway. Methods A questionnaire was sent to CMOs after a meeting on the policy implications of PHG held during the Italian presidency of the Council of EU in 2014. The survey was closed in November 2015. Results CMOs response rate was 65.5% (19/29). Twelve (63.2%) reported that their countries had a policy for genomics in healthcare in place, and 15 (78.9%) reported that public funding existed. Public research facilities for the development of such policies were documented in 13 (68.4%) countries, and 15 (83.3%) had working groups devoted to policy development. National agencies carrying out Health Technology Assessment of genomic-based technologies were present in nine countries (50%). Sixteen (88.9%) countries reported having agencies dealing with ethical issues related to genomic technologies. About 55% of countries disclosed the lack of information campaigns aimed at citizens, and 44.4% reported they had a legal framework for direct-to-consumer genetic tests. Conclusion Belgium, France, Italy, Spain and UK documented the presence of a policy on genomics in healthcare. While many caveats are necessary because of the methodology, results suggest a need for a co-ordinated effort to foster development and harmonization of dedicated policies across EU to responsibly integrate genomics policies into existing health systems.
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Affiliation(s)
- W Mazzucco
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Italy
| | - R Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Lagerberg
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Better Value HealthCare, Oxford, UK
| | - M Colotto
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E d'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Marotta
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - P Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - W Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,National Institute of Health, Rome, Italy
| | - S Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'Agostino Gemelli', Rome, Italy
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Marotta C, Giaquinto C, Di Gennaro F, Chhaganlal KD, Saracino A, Moiane J, Maringhini G, Pizzol D, Putoto G, Monno L, Casuccio A, Vitale F, Mazzucco W. Pathways of care for HIV infected children in Beira, Mozambique: pre-post intervention study to assess impact of task shifting. BMC Public Health 2018; 18:703. [PMID: 29879951 PMCID: PMC5992883 DOI: 10.1186/s12889-018-5646-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services. Methods The study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services. Two time periods, pre- and post-intervention, were compared using a set of endpoints. Variables distribution was explored using descriptive statistics. T-student, Mann Whitney and Chi-square tests were used for comparisons. Results Overall, 588 HIV infected children (F = 51.4%) were recruited, 330 belonging to the post intervention period. The mean time from referral to ARCC until initiation of ART decreased from 2.3 (± 4.4) to 1.1 (± 5.0) months after the intervention implementation (p-value: 0.000). A significant increase of Isoniazid prophylaxis (O.R.: 2.69; 95%CI: 1.7–4.15) and a decrease of both regular nutritional assessment (O.R. = 0.45; 95%CI: 0.31–0.64) and CD4 count at the beginning of ART (O.R. = 0.46; 95%CI: 0.32–0.65) were documented after the intervention. Conclusions Despite several limitations and controversial results on nutrition assessment and CD4 count at the initiation of ART reported after the intervention, it could be assumed that TS alone may play a role in the improvement of the global effectiveness of care for HIV infected children only if integrated into a wider range of public health measures.
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Affiliation(s)
- Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del vespro, 133, 90127, Palermo, Italy.
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Kajal D Chhaganlal
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira, Mozambique
| | | | - Jorge Moiane
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira, Mozambique
| | | | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa, Beira, Mozambique
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, Padova, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del vespro, 133, 90127, Palermo, Italy
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del vespro, 133, 90127, Palermo, Italy
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del vespro, 133, 90127, Palermo, Italy
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Pizzol D, Veronese N, Marotta C, Di Gennaro F, Moiane J, Chhaganlal K, Monno L, Putoto G, Mazzucco W, Saracino A. Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira, Mozambique. BMC Res Notes 2018; 11:99. [PMID: 29402317 PMCID: PMC5800087 DOI: 10.1186/s13104-018-3209-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Tuberculosis (TB) remains a major global health issue, ranking in the top ten causes of death worldwide. A deep understanding of factors influencing poor treatment outcomes may allow the development of additional treatment strategies, focused on the most vulnerable groups. Aims of the study were: (i) to evaluate the treatment outcome among TB subjects followed in an outpatient setting and (ii) to analyze factors associated with treatment failure in newly diagnosed patients with pulmonary TB in Beira, the second largest city of Mozambique. Results A total of 301 TB adult patients (32.6% females) were enrolled. Among them, 62 (20.6%) experienced a treatment failure over a 6 months follow-up. On multivariate model, being males (O.R. = 1.73; 95% CI 1.28–2.15), absence of education (O.R. = 1.85; 95% CI 1.02–2.95), monthly income under 50 dollars (O.R. = 1.74; 95% CI 1.24–2.21) and being employed (O.R. = 1.57; 95% CI 1.21–1.70), low body mass index values (O.R. = 1.42; 95% CI 1.18–1.72) and HIV status (O.R. = 1.42; 95% CI 1.10–1.78) increased the likelihood of therapy failure over 6 months of follow-up. In this study, patients who need more medical attention were young males, malnourished, with low income and low educational degree and HIV positive. These subjects were more likely to fail therapy.
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Affiliation(s)
- Damiano Pizzol
- Research Unit, Doctors with Africa-CUAMM, Beira, Mozambique
| | - Nicola Veronese
- Department of Medicine (DIMED)-Geriatrics Section, University of Padova, Padua, Italy
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133, Palermo, Italy
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy. .,Doctors with Africa-CUAMM, Padua, Italy.
| | - Jorge Moiane
- Faculty of Health Sciences, Catholic University of Mozambique, Center for Research in Infectious Diseases, Beira, Mozambique
| | - Kajal Chhaganlal
- Faculty of Health Sciences, Catholic University of Mozambique, Center for Research in Infectious Diseases, Beira, Mozambique
| | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy
| | | | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133, Palermo, Italy
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy
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