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Nodari R, Perini M, Fois L, Sterzi L, Luconi E, Vaglienti F, Bandi C, Biganzoli E, Galli M, Comandatore F. Computational protocol to perform a spatiotemporal reconstruction of an epidemic. STAR Protoc 2023; 4:102548. [PMID: 37717214 PMCID: PMC10514217 DOI: 10.1016/j.xpro.2023.102548] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023] Open
Abstract
Here, we present a computational protocol to perform a spatiotemporal reconstruction of an epidemic. We describe steps for using epidemiological data to depict how the epidemic changes over time and for employing clustering analysis to group geographical units that exhibit similar temporal epidemic progression. We then detail procedures for analyzing the temporal and spatial dynamics of the epidemic within each cluster. This protocol has been developed to be used on historical data but could also be applied to modern epidemiological data. For complete details on the use and execution of this protocol, please refer to Galli et al. (2023).1.
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Affiliation(s)
- Riccardo Nodari
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Matteo Perini
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Luca Fois
- Department of Humanities, Section of Historical and Geographical Science, University of Pavia, Pavia, Italy
| | - Lodovico Sterzi
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Ester Luconi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Folco Vaglienti
- Department of Historical Studies, University of Milan, Milan, Italy
| | - Claudio Bandi
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biosciences, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesco Comandatore
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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2
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Suardi I, Posio C, Luconi E, Boracchi P, Caporali R, Ingegnoli F. Disease activity and disease-related factors are drivers of patient global assessment in rheumatoid arthritis: a real-life cross-sectional study. Rheumatol Int 2023; 43:1885-1895. [PMID: 37454308 PMCID: PMC10435653 DOI: 10.1007/s00296-023-05383-6] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Despite that the Patient Global Assessment (PGA) is widely used for measuring Rheumatoid Arthritis (RA) disease activity to define the remission state of the disease, the primary contributors influencing patients' ratings are still debated. This study aims to determine which clinical, sociodemographic and lifestyle-related contextual factors might be key drivers of PGA in RA. This single-center cross-sectional study recruited 393 consecutive adult RA patients. Median age 60 years, females 306 (77.9%). Data related to disease activity were assessed by using Simplified Disease Activity Index (SDAI), severity by Health Assessment Questionnaire (HAQ), and impact by RA Impact of Disease (RAID). Sociodemographic/lifestyle features were collected. Disease remission was calculated using Boolean-based criteria 1.0 and 2.0. Quantile regression models were used for univariate and multivariate analysis. The remission rate progressively increased from 15% by using SDAI with a Boolean 1.0-based definition to 43.5% using a Boolean 2.0-based remission. Among factors related to disease activity, the use of low-dose corticosteroids, the RAID items pain and sleep difficulties were predictive for worse PGA scores (p = 0.01). Among factors related to disease severity HAQ score and RAID total were independent factors associated with higher median PGA (p = 0.02 and p < 0.001). RAID's physical well-being was related to PGA scores (p = 0.01). An increasing trend in PGA was observed in longstanding diseases (> 15 years). Our results confirmed that there is no unambiguous interpretation of the PGA score. It is a measure related to some disease activity parameters, but it is also influenced by contextual factors related to disease severity and impact. These data highlighted that PGA should have a broad interpretation, thus supporting the proposal of a dual targets (biological and impact) approach to obtain a more accurate estimate of disease activity.
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Affiliation(s)
- Ilaria Suardi
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Cristina Posio
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Ester Luconi
- Università degli Studi di Milano, Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy
| | - Patrizia Boracchi
- Università degli Studi di Milano, Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy
| | - Roberto Caporali
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Francesca Ingegnoli
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
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Pellegrinelli L, Luconi E, Marano G, Galli C, Delbue S, Bubba L, Binda S, Castaldi S, Biganzoli E, Pariani E, Boracchi P. A Flexible Regression Modeling Approach Applied to Observational Laboratory Virological Data Suggests That SARS-CoV-2 Load in Upper Respiratory Tract Samples Changes with COVID-19 Epidemiology. Viruses 2023; 15:1988. [PMID: 37896765 PMCID: PMC10610845 DOI: 10.3390/v15101988] [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: 07/04/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background. Exploring the evolution of SARS-CoV-2 load and clearance from the upper respiratory tract samples is important to improving COVID-19 control. Data were collected retrospectively from a laboratory dataset on SARS-CoV-2 load quantified in leftover nasal pharyngeal swabs (NPSs) collected from symptomatic/asymptomatic individuals who tested positive to SARS-CoV-2 RNA detection in the framework of testing activities for diagnostic/screening purpose during the 2020 and 2021 winter epidemic waves. (2) Methods. A Statistical approach (quantile regression and survival models for interval-censored data), novel for this kind of data, was applied. We included in the analysis SARS-CoV-2-positive adults >18 years old for whom at least two serial NPSs were collected. A total of 262 SARS-CoV-2-positive individuals and 784 NPSs were included: 193 (593 NPSs) during the 2020 winter wave (before COVID-19 vaccine introduction) and 69 (191 NPSs) during the 2021 winter wave (all COVID-19 vaccinated). We estimated the trend of the median value, as well as the 25th and 75th centiles of the viral load, from the index episode (i.e., first SARS-CoV-2-positive test) until the sixth week (2020 wave) and the third week (2021 wave). Interval censoring methods were used to evaluate the time to SARS-CoV-2 clearance (defined as Ct < 35). (3) Results. At the index episode, the median value of viral load in the 2021 winter wave was 6.25 log copies/mL (95% CI: 5.50-6.70), and the median value in the 2020 winter wave was 5.42 log copies/mL (95% CI: 4.95-5.90). In contrast, 14 days after the index episode, the median value of viral load was 3.40 log copies/mL (95% CI: 3.26-3.54) for individuals during the 2020 winter wave and 2.93 Log copies/mL (95% CI: 2.80-3.19) for those of the 2021 winter wave. A significant difference in viral load shapes was observed among age classes (p = 0.0302) and between symptomatic and asymptomatic participants (p = 0.0187) for the first wave only; the median viral load value is higher at the day of episode index for the youngest (18-39 years) as compared to the older (40-64 years and >64 years) individuals. In the 2021 epidemic, the estimated proportion of individuals who can be considered infectious (Ct < 35) was approximately half that of the 2020 wave. (4) Conclusions. In case of the emergence of new SARS-CoV-2 variants, the application of these statistical methods to the analysis of virological laboratory data may provide evidence with which to inform and promptly support public health decision-makers in the modification of COVID-19 control measures.
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Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
| | - Ester Luconi
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20133 Milan, Italy
| | - Giuseppe Marano
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20133 Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elia Biganzoli
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20133 Milan, Italy
- Data Science and Research Center (DSRC), L. Sacco, “Luigi Sacco” University Hospital, University of Milan, 20133 Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (L.P.)
| | - Patrizia Boracchi
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20133 Milan, Italy
- Data Science and Research Center (DSRC), L. Sacco, “Luigi Sacco” University Hospital, University of Milan, 20133 Milan, Italy
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Ferraro S, Luconi E, Calcaterra V, Cordaro E, Bianchi A, Cereda C, Zuccotti G, Kavsak P, Plebani M, Biganzoli EM, Marano G, Boracchi P. Reference intervals for thyroid biomarkers to enhance the assessment of thyroid status in childhood and adolescence. Clin Chem Lab Med 2023; 61:1309-1318. [PMID: 36704909 DOI: 10.1515/cclm-2022-1053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/18/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The determination of assay-dependent upper and lower reference limits (URL, LRL) of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) during childhood and adolescence, is challenging. METHODS Thyroid hormones were measured via the Abbott Alinity system in 502 euthyroid children partitioned in the following age groups: ≤2, 2.1-10, and 10.1-18 years. The 97.5th and 2.5th percentiles (URL and LRL) were derived according to CLSI EP28- A3c guidelines. Quantile regression models were used to assess: (a) 90% confidence intervals of the URL and LRL, (b) the effect of age on URL and LRL within each age class and on overall age range, (c) the difference between the URLs and LRLs estimated for each age partition with an estimate of the confidence interval divided by the reference interval being derived (CI/RI). RESULTS The CI/RI for the LRLs are smaller as compared to the URLs, except for FT4 for the 2.1-10 years age group. Considering the CI/RI and the overlap between CIs across the three age groups, one single LRL might be considered for TSH, FT3 and FT4 between 0 and 18 years. However, for the URL, there was a noticeable decrease in the URL over the 3 age groups for all three biomarkers, with there being no overlap in CIs for the URL between the ≤2 vs. the 10.1-19 years age groups. CONCLUSIONS A common LRL for TSH, FT4 and FT3 for patients aged ≤18 years may be utilized when these biomarkers are measured with the Alinity system. For the URLs the use of age-specific URLs for these biomarkers is recommended.
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Affiliation(s)
- Simona Ferraro
- Center of Functional Genomics and Rare Diseases, Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Ester Luconi
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Erika Cordaro
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Alice Bianchi
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Cristina Cereda
- Center of Functional Genomics and Rare Diseases, Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | | | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
- Data Science Research Center, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Patrizia Boracchi
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
- Data Science Research Center, University of Milan, Milan, Italy
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Galli M, Oreni L, Ridolfo AL, Formenti A, Luconi E, Boracchi P, Antinori S, Biganzoli E, Vaglienti F. Milan's forgotten epidemic of summer 1629, a few months before the last great plague: An investigation into the possible cause. PLoS One 2023; 18:e0279218. [PMID: 37289732 PMCID: PMC10249863 DOI: 10.1371/journal.pone.0279218] [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: 12/01/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
An epidemic not attributable to plague caused thousands of deaths in Milan in the summer of 1629, a time of war and famine that immediately preceded the even more fatal Great Plague of 1630 that killed an estimated ten of thousands of people. The 5,993 deaths of 1629 recorded in the Liber Mortuorum of Milan (a city with an estimated population of 130,000 inhabitants at the time) were 45.7% more than the average number recorded between 1601 and 1628. Registered deaths peaked in July, and 3,363 of the deaths (56,1%) were attributed to a febrile illness which, in most cases (2,964, 88%), was not associated with a rash or organ involvement. These deaths involved 1,627 males and 1,334 females and occurred at a median age of 40 years (range 0-95). In this paper, we discuss the possible cause of the epidemic, which may have been an outbreak of typhoid fever.
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Affiliation(s)
- Massimo Galli
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Letizia Oreni
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Lisa Ridolfo
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Angelo Formenti
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Spinello Antinori
- Unit of Infectious Diseases, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, and DSRC, Università degli Studi di Milano, Milan, Italy
| | - Folco Vaglienti
- Department of History and Historical Documentation Sciences, Università degli Studi di Milano, Milan, Italy
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Galli M, Nodari R, Perini M, Luconi E, Fois L, Vaglienti F, Bandi C, Biganzoli E, Comandatore F. A spatiotemporal reconstruction of the 1630 plague epidemic in Milan. iScience 2023; 26:106704. [PMID: 37187697 PMCID: PMC10176250 DOI: 10.1016/j.isci.2023.106704] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/23/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
In 1630, a devastating plague epidemic struck Milan, one of the most important Italian cities of that time, deeply affecting its demography and economy for decades. The lack of digitized historical data strongly limits our comprehension of that important event. In this work, we digitized and analyzed the Milan death registers of 1630. The study revealed that the epidemic evolved differently among the areas of the city. Indeed, we were able to group the parishes of the city (comparable with modern neighborhoods) in two groups based on their epidemiological curves. These different epidemiological progressions could reflect socio-economical and/or demographic features specific of the neighborhoods, opening questions about the relationship between these features and the evolution of epidemics in the pre-modern period. The study of historical records, like the one presented here, can help us to better understand European history and pre-modern epidemics.
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Affiliation(s)
- Massimo Galli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Riccardo Nodari
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Corresponding author
| | - Matteo Perini
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ester Luconi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Luca Fois
- Department of Humanities, Section of Historical and Geographical Science, University of Pavia, Pavia, Italy
| | - Folco Vaglienti
- Department of Historical Studies, University of Milan, Milan, Italy
| | - Claudio Bandi
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biosciences, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesco Comandatore
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Chiti LE, Gariboldi EM, Ferrari R, Luconi E, Boracchi P, De Zani D, Zani D, Manfredi M, Spediacci C, Grieco V, Giudice C, Recordati C, Ferrari F, Stefanello D. Surgical complications following sentinel lymph node biopsy guided by γ-probe and methylene blue in 113 tumour-bearing dogs. Vet Comp Oncol 2023; 21:62-72. [PMID: 36178370 DOI: 10.1111/vco.12861] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is an accepted veterinary surgical procedure given the impact of early detection of nodal metastases on staging of several canine malignancies. This study aims at reporting the incidence and risk factors for surgical complications of SLNB in tumour-bearing dogs. A total of 113 client-owned dogs that underwent tumour excision and SLNB guided by γ-probing and blue dye were retrospectively enrolled. Recorded variables included: signalment, location and number of extirpated lymphocenters and nodes, time for SLNB, histopathological status of excised nodes. Incidence of SLNB complications was calculated. They were classified as minor and major based on severity and required treatment, and as short-term (0-30 days) and long-term (31-90 days). Univariate analysis with generalized linear model with binomial error estimated the association between variables and incidence of SLNB complications. Significance was set at 5%. Median overall time for SLNB was 25 min. Surgeons excised one node in 38% of dogs and multiple nodes in 62% of cases, belonging to one (62%) or multiple (38%) lymphocenters. Metastases were detected in 45% of nodes. No intraoperative complications occurred. The overall incidence of postoperative complications of SLNB was 21,24%, the majority of which (91.67%) were minor. Only increasing dogs' weight was associated with an increased incidence of SLNB complications (p = .00976). Sentinel lymphadenectomy was associated with a relatively low incidence of complications, most of which were self-limiting. The low morbidity and previously reported impact on staging of SLNB justify its implementation to collect data for prognostic studies.
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Affiliation(s)
- Lavinia Elena Chiti
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy.,Unit of Medical Statistics, Biometry and Epidemiology,Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco", LITA Vialba Campus, Università degli Studi di Milano, Milan, Italy
| | - Elisa Maria Gariboldi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco", LITA Vialba campus, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco" & DSRC, LITA Vialba campus, Università degli Studi di Milano, Milan, Italy
| | - Donatella De Zani
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Davide Zani
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Martina Manfredi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Carlotta Spediacci
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Chiara Giudice
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Camilla Recordati
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Francesco Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
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8
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Luconi E, Boracchi P, Nodari R, Comandatore F, Marano G, Vaglienti F, Galli M, Biganzoli E. Spatial and Temporal Analyses of the Event of Death for 1480 in Milan Using the Data Contained in the Sforza's Registers of the Dead. Int J Environ Res Public Health 2023; 20:2783. [PMID: 36833481 PMCID: PMC9956338 DOI: 10.3390/ijerph20042783] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 05/28/2023]
Abstract
Historical death registration was conducted primarily to assess the presence of plague. The Liber Mortuorum of Milan was one of Europe's first registers with many socio-demographical details. In this work, we consider 1480 to make spatial and temporal analyses of the event of death to find possible explanations about the events' distribution and the events' trend over time. The spatial analyses involved Moran's I, the LISA, and the heatmaps; the temporal analysis applied the Durbin-Watson test. All the analyses were conducted separately on all subjects (1813), children (765), and adults (1046). Contrade (districts) were considered for spatial analysis. Moran's I and the Durbin Watson test were significant on all subjects and children's analyses, and the LISA showed the same results for those groups. Children may significantly impact the distribution of death and the trend over time. At least half of the children were 0 years old, and survival in the very first childhood period was closely linked to the family, so that it could be a proxy of the conditions of an area.
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Affiliation(s)
- Ester Luconi
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20157 Milan, Italy
| | - Patrizia Boracchi
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20157 Milan, Italy
- Data Science and Research Center (DSRC), University of Milan, 20157 Milan, Italy
| | - Riccardo Nodari
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Francesco Comandatore
- Romeo ed Enrica Invernizzi Paediatric Research Centre, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Giuseppe Marano
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20157 Milan, Italy
| | - Folco Vaglienti
- Department of Historical Studies, University of Milan, 20122 Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20157 Milan, Italy
| | - Elia Biganzoli
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, 20157 Milan, Italy
- Data Science and Research Center (DSRC), University of Milan, 20157 Milan, Italy
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9
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Castaldi S, Perrone PM, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, Alagna L, Palomba E, Bandera A, Boracchi P, Biganzoli E. Hospital acquired infections in COVID-19 patients in sub intensive care unit: analysis of two waves of admissions. Acta Biomed 2022; 93:e2022313. [PMID: 36300221 PMCID: PMC9686160 DOI: 10.23750/abm.v93i5.13402] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM The pandemic caused by SARS-COV-2 has increased Semi-Intensive Care Unit (SICU) admission, causing an increase in healthcare-associated infection (HAI). Mostly HAI reveals the same risk factors, but fewer studies have analyzed the possibility of multiple coinfections in these patients. The study aimed was to identify patterns of co-presence of different species describing at the same time the association between such patterns and patient demographics and, finally, comparing the patterns between the two cohorts of COVID-19 patients admitted at Policlinico during the first wave and the second one). METHODS All the patients admitted to SICUs during two COVID-19 waves, from March to June 2020 months and from October to December 2020, were screened following the local infection control surveillance program; whoever manifested fever has undergone on microbiological culture to detect bacterial species. Statistical analysis was performed to observe the existence of microbiological patterns through DBSCAN method. RESULTS 246 patients were investigated and 83 patients were considered in our study because they presented infection symptoms with a mean age of 67 years and 33.7% of female patients. During the first and second waves were found respectively 10 and 8 bacterial clusters with no difference regarding the most frequent species. CONCLUSIONS The results show the importance of an analysis which considers the risk factors for the possibility of co- and superinfection (such as age and gender) to structure a good prognostic tool to predict which patients will encounter severe coinfections during hospitalization.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Pier Mario Perrone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco”, LITA Vialba Campus, Università degli Studi di Milano
| | - Giuseppe Marano
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco”, LITA Vialba Campus, Università degli Studi di Milano
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Maraschini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Patrizia Bono
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Emanuele Palomba
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba Campus, Università degli Studi di Milano
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba Campus, Università degli Studi di Milano
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10
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Mameli C, Scaramuzza A, Macedoni M, Marano G, Frontino G, Luconi E, Pelliccia C, Felappi B, Guerraggio LP, Spiri D, Macellaro P, Chiara Redaelli F, Cardani R, Zampolli M, Calcaterra V, Sordelli S, Calzi E, Cogliardi A, Brambilla I, Pistone C, Rigamonti A, Boracchi P, Biganzoli E, Zuccotti GV, Bonfanti R. Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence. EClinicalMedicine 2021; 39:101067. [PMID: 34430836 PMCID: PMC8365462 DOI: 10.1016/j.eclinm.2021.101067] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Italian Lombardy region has been the epicenter of COVID-19 since February 2020. This study analyses the epidemiology of pediatric type 1 diabetes (T1D) onset during the first two pandemic waves and three previous years. METHODS All the 13 pediatric diabetes centers in Lombardy prospectively evaluated charts of children at T1D onset (0-17 years), during year 2020. After calculating the annual incidence, the data were compared with those of the 3 previous years, using generalized linear models, adjusted for age and sex. Monthly T1D new onsets and diabetic ketoacidosis (DKA) were investigated yearly from 2017 to 2020. Data were extracted from outpatients charts of the pediatric diabetes centers and from the database of the national institute of statistics. FINDINGS The estimated incidence proportion of T1D was 16/100·000 in 2020, compared to 14, 11 and 12 in 2019, 2018 and 2017, respectively. When adjusting for age and gender, the incidence was significantly lower in 2018 and 2017 compared to 2020 (adjusted incidence ratio: 0.73 and 0.77 respectively, with 95% CI: 0.63 to 0.84, and 0.67 to 0.83; p = 0·002 and p = 0·01), but no difference was found between the years 2020 and 2019. A reduction trend in the percentage of T1D diagnosis during the first wave (March-April) over the total year diagnoses was observed compared to previous years (11·7% in 2020, 17·7% in 2019, 14·1% in 2018 and 14·4% 2017). No difference was observed during the second wave (October-December) (32·8% in 2020, 33·8% in 2019, 34% in 2018, 30·7% in 2017). The proportion of DKA over the total T1D diagnoses during the second wave had higher trend than the first one (41·7% vs 33·3%), while severe DKA over the total DKA appeared higher during the first wave (60% vs 37·1%). INTERPRETATION The study suggests an increase in the incidence of pediatric T1D in Lombardy throughout the past five years. Pandemic waves may have affected the clinical presentation at onset. FUNDING None.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
- Corresponding author at: Department of Paediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science L. Sacco, Università degli Studi di Milano, Italy.
| | - Andrea Scaramuzza
- Department of Pediatrics, Ospedale Maggiore, ASST Cremona, Cremona, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
| | - Giuseppe Marano
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | - Giulio Frontino
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
| | - Ester Luconi
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | | | - Barbara Felappi
- Department of Pediatrics, ASST Spedali Civili, Brescia, Italy
| | | | - Daniele Spiri
- Department of Pediatrics, Ospedale di Legnano, ASST Ovest milanese, Legnano, Italy
| | - Patrizia Macellaro
- Department of Pediatrics, Ospedale di Legnano, ASST Ovest milanese, Legnano, Italy
| | | | - Roberta Cardani
- Department of Pediatrics, Ospedale Del Ponte Varese, ASST Sette Laghi, Varese, Italy
| | - Maria Zampolli
- Department of Pediatrics, Ospedale Sant'Anna, Como, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Silvia Sordelli
- Department of Pediatrics, Ospedale Carlo Poma, Mantova, Italy
| | - Elena Calzi
- Department of Pediatrics, Ospedale Maggiore, ASST Crema, Italy
| | - Anna Cogliardi
- Department of Pediatrics, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelo Pistone
- Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Rigamonti
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
| | - Patrizia Boracchi
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | - Elia Biganzoli
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | | | - Riccardo Bonfanti
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
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11
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Deandrea S, Cavazzana L, Principi N, Luconi E, Campoleoni M, Bastiampillai AJ, Bracchi L, Bucchi L, Pedilarco S, Piscitelli A, Sfondrini MS, Silvestri AR, Castaldi S. Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme. Radiol Med 2021; 126:946-955. [PMID: 33954896 PMCID: PMC8206050 DOI: 10.1007/s11547-021-01357-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. MATERIALS AND METHODS The study was conducted in a screening centre in Milan in the years 2009-2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. RESULTS A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. CONCLUSIONS Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.
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Affiliation(s)
- Silvia Deandrea
- Health Protection Agency Metropolitan City of Milan, Milan, Italy
| | - Laura Cavazzana
- Post Graduate School of Public Health, University of Milan, Milan, Italy.
| | - Niccolò Principi
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lucia Bracchi
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori, IRST, "Dino Amadori"), Meldola, Forlì, Italy
| | - Stella Pedilarco
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Piscitelli
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Maria Silvia Sfondrini
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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12
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De Nard F, Deandrea S, Bastiampillai AJ, Cavazzana L, Carnevali D, Principi N, Luconi E, Schulz PJ, Castaldi S, Silvestri AR. [Women's perception, preconceptions, and information preferences for the limitations of breast cancer screening and overdiagnosis: a think-aloud study on the new information materials of the Agency for Health Protection of the Metropolitan Area of Milan]. Epidemiol Prev 2021; 45:271-280. [PMID: 34549569 DOI: 10.19191/ep21.4.p271.083] [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: 06/13/2023]
Abstract
BACKGROUND communicating breast cancer screening (BCS) limits and overdiagnosis implies providing complete and balanced information to allow informed decision-making. OBJECTIVES to describe women's perceptions, preconceptions, and information preferences regarding the breast cancer screening (BCS) programme paper and web information materials of the Agency for Health Protection of the Metropolitan Area of Milan (Lombardy Region, Northern Italy). DESIGN qualitative, descriptive study. SETTING AND PARTICIPANTS participants' voluntary recruitment took place in the registration departments of three hospitals. Participants were purposively recruited based on sociodemographic characteristics of the target population of the programme (44 women aged 40-74 years, living in the Metropolitan Area of Milan). In each material type subgroup, different health literacy levels and age classes were included, until thematic saturation was reached. MAIN OUTCOME MEASURES thematic analysis of qualitative data collected during think-aloud interviews. RESULTS the thematic analysis identified 5 main themes: 1. validation of the information reported in the materials, according to the interviewees' personal experiences;2. information preferences of particular subgroups of women, which led to a tailored approach for the web materials;3. negative emotions elicited while receiving information regarding BCS limits, which guided the rewriting of certain definitions; 4. disproportioned risk perception, with greater weight attributed to the risk of false negative results than the risk of overdiagnosis; 5. organizational preferences regarding the type and frequency of the provided tests and the age limits of the programme. CONCLUSIONS in the present sample of women living in the Metropolitan Area of Milan, knowledge and comprehension of overdiagnosis are scarce. The main reasons for distrust in the BCS programme rely on the preexisting beliefs regarding the most appropriate tests and age limits. These beliefs were established from previously received information, inconsistent with that officially provided by the programme.
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Affiliation(s)
- Francesca De Nard
- Scuola di specializzazione in igiene e medicina preventiva, Dipartimento di scienze biomediche per la salute, Università degli Studi di Milano;
- UOC medicina preventiva di comunità-screening, Agenzia di tutela della salute di Milano Città Metropolitana, Milano
| | - Silvia Deandrea
- UOC medicina preventiva di comunità-screening, Agenzia di tutela della salute di Milano Città Metropolitana, Milano
| | - Anan Judina Bastiampillai
- UOC medicina preventiva di comunità-screening, Agenzia di tutela della salute di Milano Città Metropolitana, Milano
| | - Laura Cavazzana
- Scuola di specializzazione in igiene e medicina preventiva, Dipartimento di scienze biomediche per la salute, Università degli Studi di Milano
| | - Davide Carnevali
- Scuola di specializzazione in igiene e medicina preventiva, Dipartimento di scienze biomediche per la salute, Università degli Studi di Milano
| | - Niccolò Principi
- Scuola di specializzazione in igiene e medicina preventiva, Dipartimento di scienze biomediche per la salute, Università degli Studi di Milano
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda, Ospedale maggiore policlinico, Milano
| | - Peter Johannes Schulz
- Istituto di comunicazione sanitaria, Università della Svizzera italiana, Lugano (Svizzera)
| | - Silvana Castaldi
- Scuola di specializzazione in igiene e medicina preventiva, Dipartimento di scienze biomediche per la salute, Università degli Studi di Milano
- UOC qualità, internal auditing e privacy, Fondazione IRCCS Ca' Granda, Ospedale maggiore policlinico, Milano
| | - Anna Rita Silvestri
- UOC medicina preventiva di comunità-screening, Agenzia di tutela della salute di Milano Città Metropolitana, Milano
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13
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Castaldi S, Luconi E, Rivieccio BA, Boracchi P, Marano G, Pariani E, Romano L, Auxilia F, Nicolussi F, Micheletti A, Manzi G, Salini S, Galli M, Biganzoli E. Are Epidemiological Estimates Able to Describe the Ability of Health Systems to Cope with COVID-19 Epidemic? Risk Manag Healthc Policy 2021; 14:2221-2229. [PMID: 34104013 PMCID: PMC8180273 DOI: 10.2147/rmhp.s290801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/07/2020] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) epidemic is an infectious disease which was declared a pandemic and hit countries worldwide from the beginning of the year 2020. Despite the emergency vigilance plans, health systems in all countries experienced a different ratio of lethality, amount of admissions to intensive care units and quarantine management of positive patients. The aim of this study is to investigate whether some epidemiological estimates could have been useful in understanding the capacity of the Italian Regional Health Services to manage the COVID-19 epidemic. Methods We have compared data between two different Italian regions in the Northern part of Italy (Lombardy and Veneto) and the national data to determine whether different health strategies might be significant in explaining dissimilar patterns of the COVID-19 epidemic in Italy. Data have been extracted from a public database and were available only in an aggregated form. Results The regions in question displayed two different health policies to face the COVID-19 epidemic: while Veneto’s health service was largely territorially oriented, Lombardy’s strategy was more hospital-centered. Discussion The key to facing epidemics like this one consists in identifying solutions outside of hospitals. This however requires there be well-trained general practitioners and enough healthcare personnel working outside hospitals.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Ester Luconi
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | | | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elena Pariani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Luisa Romano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federica Nicolussi
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | | | - Giancarlo Manzi
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | - Silvia Salini
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
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14
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Marano G, Boracchi P, Luconi E, Pariani E, Pellegrinelli L, Galli C, Gandolfi CE, Magoni M, Piro A, Scarcella C, Castaldi S, Biganzoli EM. Evaluation of influenza vaccination efficacy in reducing influenza-related complications and excess mortality in Northern Italy (2014-2017). Expert Rev Vaccines 2021; 20:73-81. [PMID: 33480821 DOI: 10.1080/14760584.2021.1874927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/30/2023]
Abstract
OBJECTIVE The main objective of this study was to estimate the efficacy of influenza vaccination in reducing influenza-attributable hospitalization and emergency room (ER) admission for severe complications and influenza-attributable excess mortality in individuals ≥65 years of age. METHODS We analyzed the ≥65 years-old community (n = 952,822) afferent to the Brescia (Northern Italy) Health Protection Agency, considered an Italian population reference, to evaluate the efficacy of influenza vaccination (seasons 2014-17) in reducing deaths, ER-admissions, and hospitalizations for influenza-related complications in the elderly. RESULTS A protective effect of influenza vaccination emerged in reducing hospitalization and ER admission for diseases of the respiratory system and for death from all causes in people ≥65 years. The major effect of influenza vaccination was the reduction in risk of death from all causes, increasing with age and comorbidity. CONCLUSION Influenza vaccination has reduced the number of ER admissions and hospitalizations caused by influenza-related complications and has prevented death among high-risk groups in elderly ≥65 years, resulting in social and public health cost savings. Stronger or new vaccination strategies are needed to improve vaccination rates among the elderly.
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Affiliation(s)
- Giuseppe Marano
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", University of Milan, Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", University of Milan, Milan, Italy
| | - Ester Luconi
- Health Management Department, Fondazione IRCCS Ca' Granda OMP, Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cecilia E Gandolfi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michele Magoni
- Prevention Department, ATS Di Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Antonio Piro
- Prevention Department, ATS Di Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Carmelo Scarcella
- Prevention Department, ATS Di Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Silvana Castaldi
- Health Management Department, Fondazione IRCCS Ca' Granda OMP, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elia M Biganzoli
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", University of Milan, Milan, Italy
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15
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Di Pietro GM, Capecchi E, Luconi E, Lunghi G, Bosis S, Bertolozzi G, Cantoni B, Marano G, Boracchi P, Biganzoli E, Castaldi S, Marchisio P. Diagnosis of SARS-CoV-2 in children: accuracy of nasopharyngeal swab compared to nasopharyngeal aspirate. Eur J Clin Microbiol Infect Dis 2021; 40:1155-1160. [PMID: 33411175 PMCID: PMC7788172 DOI: 10.1007/s10096-020-04131-z] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
The tests currently used for the identification of SARS-CoV-2 include specimens taken from the upper and lower respiratory tract. Although recommendations from the World Health Organization prioritise the usage of a nasopharyngeal swab (NS), nasopharyngeal aspirates (NPA) are thought to be superior in identifying SARS-CoV-2 in children. To our knowledge, however, no paediatric study has been published on the subject. The aim of this study is to evaluate the diagnostic performances of NS referred to NPA for SARS-CoV-2 in children. We calculated the sensitivity and specificity of the NS referred to the NPA of the whole sample and considered both age and collection period as covariates in different analyses. We collected 300 paired samples. The NS had a specificity of 97.7% and a sensitivity of 58.1%. We found similar results for the group of subjects ≥ 6 years old, while for subjects < 6 years old, the sensitivity was 66.7% and the specificity 97.8%. Considering period as a covariate, the sensitivity and specificity for patients hospitalised in March (31 patients, 52 records) were 70.0% and 97.6%, while for patients involved in the follow-up (16 patients, 57 records), they were 57.2% and 89.7%. The NS has a low sensitivity in detecting SARS-CoV-2 in children when referred to the NPA, whereas its specificity is high. Our results suggest that in children under 6 years of age, NSs should be preferred whenever possible. Though statistically not significant, the sensitivity of the NS rises when performed before the NPA.
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Affiliation(s)
| | - Ester Capecchi
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
| | - Ester Luconi
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Lunghi
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Barbara Cantoni
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elia Biganzoli
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Silvana Castaldi
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- University of Milan, Via della Commenda 9, 20122, Milan, Italy
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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16
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Castaldi S, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, Ungaro R, Bandera A, Boracchi P, Biganzoli E. Hospital Acquired Infections in COVID-19 patients in sub intensive care unit. Acta Biomed 2020; 91:e2020017. [PMID: 32921713 PMCID: PMC7717023 DOI: 10.23750/abm.v91i3.10376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/28/2023]
Abstract
The aim of this study is to assess the association among species of bacteria and to identify the presence of clusters of patients in sub intensive care unit with different profiles of infection, and to study the relationship between such profiles and patient demographics (gender, age), kind of investigations and material used to detect the infection. The findings need to analyse a bigger amount of data in the same setting to make evident that it is constant the infection only with Escherichia coli and Staphylocossus epidemidis and a third case in which more bacteria are inlvolved.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Hospital, Milan, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | | | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Policlinico Milano Italia.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Alessandra Bandera
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti University of Milan Italy .
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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17
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Auxilia F, Maraschini A, Bono P, Ungaro R, Luconi E, Biganzoli E, Castaldi S. COVID-19: new scenario old problems. Acta Biomed 2020; 91:90-91. [PMID: 32701922 PMCID: PMC8023089 DOI: 10.23750/abm.v91i9-s.10119] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
The short paper present the problem of hospital acquired infection in subintensive units og a research and teaching hospital.
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Affiliation(s)
- Francesco Auxilia
- Department of Biomedical Sciences for Health University of Milan, Italy.
| | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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18
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Maffeo M, Luconi E, Castrofino A, Campagnoli EM, Cinnirella A, Fornaro F, Gallana C, Perrone PM, Shishmintseva V, Pariani E, Castaldi S. 2019 Influenza Vaccination Campaign in an Italian Research and Teaching Hospital: Analysis of the Reasons for Its Failure. Int J Environ Res Public Health 2020; 17:ijerph17113881. [PMID: 32486224 PMCID: PMC7311955 DOI: 10.3390/ijerph17113881] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
Background: Despite recommendations, the influenza vaccination coverage rate in healthcare workers (HCWs) in Italy is far from the recommended target. The aim of the study is to analyze the influenza vaccination campaign performed in 2019 in a research and teaching hospital in Milan. Methods: The vaccination strategy included an ad hoc ambulatory, as in the previous years, and an onsite ambulatory, introduced for the first time. Personal data and professional categories were collected and analyzed using univariate logistic regression. HCWs who refused the vaccination were asked to fill in a questionnaire to explain their reasons for dissent. Results: The achieved vaccination coverage rate (VCR) for HCWs was 21.5 %, compared to 17.1% in 2018. The lowest VCR was registered among nurses (11.9%), while physicians had the highest VCR (40.7%). Prevalence ratios show that some professional categories were more frequently vaccinated for the first time than attending physicians (reference category); those with statistically significant confidence intervals were nurses (PR: 2.42; 95% CI: 1.78–3.28), residents (PR: 1.85; 95% CI: 1.36–2.53), and auxiliary staff (PR: 2.33; 95% CI: 1.45–3.74). Conclusions: An onsite vaccination strategy failed in providing a remarkable increase in VCR in 2019, but it is important to point out that the campaign was influenced by several logistic problems.
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Affiliation(s)
- Manuel Maffeo
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
- Correspondence: ; Tel.: +39-389-470-4937
| | - Ester Luconi
- Quality Unit Fondazione IRCCS Ca’ Granda OMP, 20122 Milan, Italy;
| | - Ambra Castrofino
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Emanuela Maria Campagnoli
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Andrea Cinnirella
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Federica Fornaro
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Claudia Gallana
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Pier Mario Perrone
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Viktoriia Shishmintseva
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Elena Pariani
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
| | - Silvana Castaldi
- Postgraduate School in Public Health, Department Biomedical Sciences for Health, University of Milano, 20136 Milano, Italy; (A.C.); (E.M.C.); (A.C.); (F.F.); (C.G.); (P.M.P.); (V.S.); (E.P.); (S.C.)
- Quality Unit Fondazione IRCCS Ca’ Granda OMP, 20122 Milan, Italy;
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19
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Rivieccio BA, Luconi E, Boracchi P, Pariani E, Romanò L, Salini S, Castaldi S, Biganzoli E, Galli M. Heterogeneity of COVID-19 outbreak in Italy. Acta Biomed 2020; 91:31-34. [PMID: 32420921 PMCID: PMC7569642 DOI: 10.23750/abm.v91i2.9579] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
Abstract
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019 in China and was declared a pandemic on 11.03.2020 by WHO. Italy is one of the most afflicted Country by this epidemic with 136,110 confirmed cases and 16,654 deaths on 9.4.2020 (at the same date, the Ministry of Health was reporting 143,626 cases). During these few months the National Health Service have made a great effort to cope with the increasing request of intensive care beds and all the elective activities in hospital have been suspended. Data from the different Italian regions shows different patterns of positive and dead for this syndrome. Moreover, striking differences of the observed lethality of the infections among different areas were immediately evident from the epidemic reports. It will be of critical relevance to understand the expected evolution of the first lock-down phase, driving the exhaustion of the Covid-19 outbreak. (www.actabiomedica.it)
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Affiliation(s)
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | - Elena Pariani
- Dept Biomedical Sciences for Health, University of Milan, Italy .
| | - Luisa Romanò
- Dept Biomedical Sciences for Health, University of Milan, Italy .
| | - Silvia Salini
- Department of Economics, Management and Quantitative Methods and DSRC, University of Milan, Italy.
| | | | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC , University of Milan, Italy.
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Italy.
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20
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Marano G, Pariani E, Luconi E, Pellegrinelli L, Galli C, Magoni M, Piro A, Scarcella C, Biganzoli EM, Boracchi P, Castaldi S. Elderly people: propensity to be vaccinated for seasonal influenza in Italy. Hum Vaccin Immunother 2020; 16:1772-1781. [PMID: 32040352 DOI: 10.1080/21645515.2019.1706931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/12/2022] Open
Abstract
Seasonal influenza continues to be a major cause of illness and death. Vaccination is the most cost-effective prophylaxis to prevent the disease and it is particularly important for people who are at high risk of serious complications derived from influenza, especially for people ≥65 years. In Italy, the influenza vaccination program has been unsuccessful with low rates of uptake in people ≥65 years. We analyzed all the community ≥65 years of the Health Promoting Agency (HPA) of Brescia (northern Italy) to evaluate the propensity attitudes toward influenza vaccination among people ≥65 years in four consecutive seasonal influenza campaigns (from 2014/2015 to 2017/2018). Information about subjects were retrieved from administrative databases. Data from 952,822 records were analyzed. The prevalence of vaccinated subjects in the four campaigns was 38.6%, 33.7%, 37.7%, and 40.1%, respectively. Among vaccinated people, the frequencies of individuals aged 65-69.9 years were lower than the frequencies of those in the other age classes, with highest frequencies of vaccinated people in the 75-79.9 years age-class. Overall, males showed a slightly higher propensity to be vaccinated and the propensity toward vaccination increased with age in both genders. Suffering from a chronic disease increased the propensity to vaccination; hypertension had the highest impact on the propensity whereas suffering from vasculopathy has the opposite effect. The value of this study is the possibility to know the factors that might indicate a propensity to get an influenza vaccination and to consider a different approach to people ≥65 years with the characteristics indicating a lower propensity to vaccination.
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Affiliation(s)
- Giuseppe Marano
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", University of Milan , Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan , Milan, Italy
| | - Ester Luconi
- Health Management Department, Fondazione IRCCS Ca' Granda OMP , Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan , Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan , Milan, Italy
| | - Michele Magoni
- Prevention Department, ATS di Brescia (Brescia Health Protection Agency) , Brescia, Italy
| | - Antonio Piro
- Prevention Department, ATS di Brescia (Brescia Health Protection Agency) , Brescia, Italy
| | - Carmelo Scarcella
- Prevention Department, ATS di Brescia (Brescia Health Protection Agency) , Brescia, Italy
| | - Elia M Biganzoli
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Data Science Research Center, University of Milan , Milan, Italy.,Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Data Science Research Center, University of Milan , Milan, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan , Milan, Italy.,Health Management Department, Fondazione IRCCS Ca' Granda OMP , Milan, Italy
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21
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Mascitti M, Luconi E, Togni L, Rubini C. Large cell neuroendocrine carcinoma of the submandibular gland: a case report and literature review. Pathologica 2020; 111:70-75. [PMID: 31388199 DOI: 10.32074/1591-951x-13-19] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of malignancies with a broad spectrum of histomorphologies, tissue origins, and clinical outcomes, which arise from neural crest cells with neuroendocrine differentiation. Salivary gland tumors account for 3-6% of all head and neck neoplasms, while large cell neuroendocrine carcinomas (LCNEC) of the salivary gland are extremely rare, with few cases reported in literature, and only 5 cases involving submandibular gland. The rarity of these tumors in salivary glands is probably related to the scarcity of neuroendocrine cells in this tissue, whose presence is still a matter of debate. Regardless of their low frequency, it is imperative to differentiate these tumors from the much more common squamous cell carcinomas and metastatic NETs, due to different therapeutic approach and prognosis. In this paper, we report the case of a 21-year-old man, with a LCNEC involving a submandibular gland followed by several recurrences over the years. In addition, we include a comprehensive review of the available literature on this topic.
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Affiliation(s)
- M Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - E Luconi
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - L Togni
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - C Rubini
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
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