The Burden of Herpes Zoster on Hospital Admissions: A Retrospective Analysis in the Years of 2015-2021 from the Abruzzo Region, Italy

(1) Background: Herpes zoster (HZ) is a disease caused by the reactivation of the Varicella Zoster Virus (VZV). Clinical reactivation, herpes zoster, takes place in 10-20% of subjects who contracted the primary infection, with a higher risk of developing zoster increasing proportionally with age, especially after 50 years of age. HZ is a common clinical problem, particularly among patients aged over 50 years and immunocompromised patients. Immunocompromised patients and adults could present an atypical and more severe course. In addition, they are at greater risk of complications. For this reason, it is important to understand the real burden of the disease and to identify the subjects who are at higher risk of HZ and its complications, also to direct preventive strategies at the right targets. The aim of the present study is to analyze HZ-related hospitalization trends in Abruzzo in the period of 2015-2021. (2) Methods: Data related to hospital admissions were extracted from the hospital discharge records (HDRs) of the whole region, considering all admissions during the years of 2015-2021. The trends in hospital admissions and length of stay were evaluated and analyzed. (3) Results: A total of 768 hospital discharges with a diagnosis of herpes zoster were registered in Abruzzo during the 7-year study period. During the study period, an increasing trend was observed from the year 2015 to the year 2017, ranging from 8.19 cases/100,000 to 11.5 cases/100,000 (APC (Annual percentage change) +20.8%; 95%CI -2.3; 47.6). After the year 2017, a significantly decreasing trend was observed, reaching 5.46 cases/100,000 in the year 2021 (APC -18.4%; 95%CI -31.5; -12.0). Across the entire study period, an average annual percentage change (AAPC) of -7.0% (95%CI -13.0; -1.3) was observed. (4) Conclusions: Despite the trend of a reduction in hospitalizations, this study highlights that HZ continues to have a great impact on public health. So, it is important to update recommendations for the use of the already available HZ vaccine and to implement new strategies to increase awareness of the prevention of the disease.

Change in Caffeine Consumption after Pandemic (CCAP-Study) among University Students: A Cross-Sectional Study from Italy

(1) Background: The lockdown, imposed to limit the pandemic evolution, impacted the social habits and lifestyle of inhabitants also from many countries other than Italy. Caffeine consumption could be a useful option to improve mood, as the lockdown strongly affected mental health, particularly increasing anxiety and sleep disorders. (2) Methods: It was a cross-sectional study aimed to evaluate the change in caffeine consumption after the pandemic period in a sample of Italian University students. It investigated coffee and products containing caffeine consumption, the anxiety level by State Trait Anxiety Inventory (STAI) and sleep quality with the Insomnia Severity Index (ISS). (3) Results: A total of 404 participants were enrolled in the study. During the lockdown period, 23% of subjects consumed more coffee compared to the pre-pandemic period. Daily coffee consumption also changed after the lockdown period compared to the pre-pandemic period, with 36.1% of subjects that increased their consumption. Comparing other caffeine-based products, energizing supplement consumption showed a greater increase after the lockdown period than energy drinks. Regarding anxiety, subjects who reported increased coffee consumption reported higher STAI scores and ISS. (4) Conclusions: About a quarter of university students increased their consumption of caffeine-based products after the pandemic, reporting higher levels of anxiety and poor sleep quality.

Social network characteristics and well-being in Italy: insights from the PHRASI Study

Background

Mental well-being should be prioritized in public health as it represents a valuable resource for individuals and communities, influencing behavior, social cohesion and social inclusion. The support individuals receive from their social networks can have a significant impact on mental well-being. This study used data from the Public Health Residents' Anonymous Survey in Italy, a nationwide cross-sectional survey. The objective was to assess the level of well-being among the Public Health Residents and investigate the association between the social network characteristics and the well-being in this population.

Study design

The current cross-sectional study targeted 1,600 public health residents enrolled in various Italian public health specialization schools between June 14 and July 26, 2022.

Methods

Participants self-reported both functional and structural characteristics of social network. Well-being was assessed using the WHO-5 well-being index. Linear regression models, adjusted for age and sex, were applied to examine the association between WHO-5 score and social network characteristics.

Results

Out of 379 participants, 51.5% reported bad well-being. Those with bad well-being are more likely women, experience lower peer-to-peer and supervisor support, face higher work-to-private life interference, and less frequently have a partner. Greater peer-to-peer support (β=1.13, 95% CI=0.68; 1.57), and increased supervisor support (β=1.26, 95% CI=0.86; 1.67), were associated with higher levels of well-being. Conversely, higher work-to-private life interference was associated with lower perceived well-being. Having a partner resulted in a better perceived well-being (β=1.96, 95% CI=0.94; 2.98). In logistic regression analysis, higher peer-to-peer support (OR=0.68, 95% CI = 0.55;0.85) greater supervisor support (OR=0.60, 95% CI=0.49;0.74) and having a partner (OR=0.51, 95% CI = 0.32;0.82) were associated with reduced odds of bad well-being. Conversely, increased WLI was associated with higher odds of bad well-being (OR=1.47, 95% CI = 1.19;1.82).

Conclusions

The characteristics of an individual's social network play a crucial role in her/his well-being and should be considered both in personal and professional contexts when aimed to enhance mental well-being in communities.

An Italian Validation of the 5-Item Attitudes to Mental Illness Questionnaire (AMIQ): A Useful Tool for Rapid Assessment of Stigma, Acceptance, and Tolerance

Stigma negatively impacts individuals, families, and communities, affecting relationships, education, and employment and leading to an additional burden on mental health. Assessing public attitudes towards people with mental health conditions is crucial, especially in terms of public health. Therefore, the Attitudes to Mental Illness Questionnaire (AMIQ) was validated and adapted to the Italian cultural context. Translation followed four phases, involving bilingual speakers, comparison, back-translation, and expert review. In the pre-test phase, the questionnaire was administered to 21 participants anonymously. The validation test involved 213 subjects. Statistical analyses included exploratory and confirmatory factor analysis, and McDonald's Omega and Cronbach's alpha to assess the internal consistency. The results indicate good internal consistency (Omega = 0.71; Alpha = 0.72), and confirmatory factor analysis (CFI = 0.971) validated the questionnaire's construct. The study's findings align with the original validation, underscoring the questionnaire's robustness. Overall, understanding public attitudes is crucial for public health interventions combating stigma and fostering positive attitudes.

Incidence of Rotavirus-Related Hospitalizations in an Italian Southern Region from 2015 to 2021

(1) Background: Rotavirus is one of the leading causes of severe diarrhea and dehydration in infants and young children worldwide. The economic and social burden of rotavirus-related hospitalizations, particularly among children, remains a pressing concern for healthcare systems across the globe. Healthcare infrastructure and access to medical care can vary significantly within the region. Differences in the availability of healthcare facilities and the quality of care may influence the management and outcomes of rotavirus cases. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. The study considered all hospitalization due to rotavirus gastroenteritis that occurred in the Abruzzo region from the year 2015 to 2021. Data were extracted from the hospital discharge records. The trend in hospital admissions, hospitalization costs and length of stay were evaluated and analyzed. (3) Results: A total of 664 admissions were reported during the study period. The incident rate grew till year 2019 with an annual percentage change of +13.9% (95%CI 12.6-15.2, p < 0.001). During the pandemic years, the incident rate showed a significant decrease with an annual percentage change of 12.5% (95%CI 15.5-9.3, p = 0.004). The length of stay of admissions was significantly higher among patients aged less than 1 year. (4) Conclusions: Rotavirus admission represents a heavy burden even in a high-income country such as Italy. These findings have the potential to inform targeted public health interventions, including vaccination strategies, and improve the overall well-being of children.

Epidemiology of Bronchiolitis and Respiratory Syncytial Virus and Analysis of Length of Stay from 2015 to 2022: Retrospective Observational Study of Hospital Discharge Records from an Italian Southern Province before and during the COVID-19 Pandemic

BACKGROUND

Severe respiratory infections, including pneumonia or bronchiolitis, caused by RSV can range from mild upper respiratory tract infections to those leading to hospitalization and serious complications such as respiratory failure in children. High-risk groups, such as premature infants and infants with underlying medical conditions, have a higher susceptibility to severe RSV disease. We conducted a retrospective study from years 2015 to 2022 in the Local Health Authority (LHA) of Pescara that counts about 320,000 inhabitants, with the aim to evaluate the burden of RSV infection, focusing on the incidence, hospitalization, and characteristics that may prolong hospital stays.

METHODS

All hospitalizations from 2015 to 2022 were extracted from the hospital discharge record. The monthly hospitalization rates were calculated and standardized by gender and age for the population resident in the Province of Pescara on 1 January 2015.

RESULTS

During the study period, 31,837 admissions were reported among patients aged less than 6 years. Of those, 520 hospitalizations were referred for bronchiolitis. Monthly admission rates highlighted the seasonality of bronchiolitis admissions, with higher rates in the months from December to March in all study years included. The winter seasons of years 2021 and 2022 reported a surge in bronchiolitis incidence, with a rate of 4.0/1000 (95% CI 2.964-5.146) in December 2021 and 4.0 (95% CI 2.891-5.020) in December 2022.

CONCLUSIONS

Bronchiolitis represents an important cause of hospitalization among patients aged less than 6 years. The incidence was particularly increased during the winter seasons in years 2021 and 2022.

Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study

OBJECTIVE

The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents.

MATERIALS AND METHODS

The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses.

RESULTS

379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85.

CONCLUSIONS

Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Menstrual changes after COVID-19 vaccine administration: a systematic review

OBJECTIVE

During the mass vaccination campaign for COVID-19, cases of menstrual cycle changes in women emerged, so it was thought that the COVID-19 vaccine could affect the menstrual cycle. Over time, these observations have become more frequent, which strengthens the idea. This systematic review aims to show changes in the menstrual cycle after COVID-19 vaccination.

MATERIALS AND METHODS

This study was carried out following the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes.

RESULTS

A suitable bibliography on PubMed/Medline and Scopus was searched by combining text, words, and titles of medical topics. After completing the search, a total of 42 articles were included in this systematic review.

CONCLUSIONS

The COVID-19 vaccines may have an impact on the quality of life of women. The changes in the menstrual cycle tend to resolve within 2-3 months of vaccination and the symptoms are mild to moderate and tend to self-limit over time.

Social Network Characteristics and Depressive Symptoms of Italian Public Health Medical Residents: The Public Health Residents' Anonymous Survey in Italy (PHRASI)

Despite the high impact of the COVID-19 pandemic on social interactions and healthcare workers' (HWs') mental health, few studies have investigated the association between social network characteristics and HWs' mental health, particularly during the pandemic. Therefore, we aimed to assess the associations between public health residents' (PHRs') social network characteristics and depression. We used data from the Public Health Residents' Anonymous Survey in Italy (PHRASI), a nationwide cross-sectional study. Social network characteristics were self-reported. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire. Linear and logistic models adjusted for age, sex, physical activity, and alcohol were used. A moderation analysis by sex was also performed. A total of 379 PHRs participated in the survey (58% females, median age of 30 years). More peer-to-peer (odds ratio OR = 0.62 (0.47-0.83)) and supervisor support (OR = 0.49 (0.36-0.68)), more social participation ((OR) = 0.36 95% CI (0.25-0.50)), and having a partner (OR = 0.49 (0.25-0.96)) were significantly associated with a lower risk of clinically relevant depressive symptoms. Work-to-private-life interference was significantly associated with a higher risk of clinically relevant depressive symptoms (OR = 1.77 (1.28-2.45)). Promoting a supportive work environment and social participation as well as reducing work-to-private life interference can contribute to reducing the high burden among PHRs.

The Burden of Streptococcus pneumoniae-Related Admissions and In-Hospital Mortality: A Retrospective Observational Study between the Years 2015 and 2022 from a Southern Italian Province

Streptococcus pneumoniae (SP) has high worldwide incidence and related morbidity and mortality, particularly among children and geriatric patients. SP infection could manifest with pneumonia, bacteremia, sepsis, meningitis, and osteomyelitis. This was a retrospective study aimed at evaluating the incidence, comorbidities, and factors associated with in-hospital mortality of pneumococcal disease-related hospitalization in a province in southern Italy from the years 2015 to 2022. This study was performed in the Local Health Authority (LHA) of Pescara. Data were collected from hospital discharge records (HDRs): this database is composed of 288,110 discharge records from LHA Pescara's hospitals from 2015 to 2022. Streptococcus Pneumoniae-related hospitalizations were about 5% of the hospitalizations; 67% of these were without comorbidities; 21% were with one comorbidity; and 13% were with two or more comorbidities. Regarding mortality of SP infection, the most affected age group was older people, with the percentage of cases among the over-65s being more than 50% compared to the other age groups. HDRs represent a valid and useful epidemiological tool for evaluating the direct impact of pneumococcal disease on the population and also indirectly for evaluating the effectiveness of vaccination strategies and directing them.

Digital epidemiology and infodemiology of hand-foot-mouth disease (HFMD) in Italy. Disease trend assessment via Google and Wikipedia

BACKGROUND AND AIM

The study aimed to evaluate the epidemiological trend of hand, foot and mouth disease (HFMD) in Italy using data on Internet search volume.

METHODS

A cross-sectional study design was used. Data on Internet searches were obtained from Google Trends (GT) and Wikipedia. We used the following Italian search term: "Malattia mano-piede-bocca" (Hand-foot-mouth disease, in English). A monthly time-frame was extracted, partly overlapping, from July 2015 to December 2022. GT and Wikipedia were overlapped to perform a linear regression and correlation analyses. Statistical analyses were performed using the Spearman's rank correlation coefficient (rho). A linear regression analysis was performed considering Wikipedia and GT.

RESULTS

Search peaks for both Wikipedia and GT occurred in the months November-December during the autumn-winter season and in June during the spring-summer season, except for the period from June 2020 to June 2021, probably due to the restrictions of the COVID19 pandemic. A temporal correlation was observed between GT and Wikipedia search trends.

CONCLUSIONS

This is the first study in Italy that attempts to clarify the epidemiology of HFMD. Google search and Wikipedia can be valuable for public health surveillance; however, to date, digital epidemiology cannot replace the traditional surveillance system.

Attitudes and Beliefs towards Rotavirus Vaccination in a Sample of Italian Women: A Cross-Sectional Study

(1) Background: Rotavirus is the leading cause of severe diarrhea and dehydration in infants and young children worldwide. Despite the proven benefits of vaccination, vaccine hesitancy and refusal remains a significant barrier to achieving high vaccination coverage in many countries, such as Italy. (2) Methods: An online survey was conducted among women aged between 18 and 50 years from Abruzzo Region, Italy. The survey was composed of two main sections: demographic characteristics and attitudes and knowledge about rotavirus vaccination, based on a five-point Likert scale. Logistic regression analysis was performed to evaluate factors associated with willingness to get the rotavirus vaccination. (3) Results: A total of 414 women were enrolled in the study. Women who were unaware of rotavirus more frequently had a lower education level (university degree 62.5% vs. 78.7%, p = 0.004) and reported having no children (p < 0.001). About half of the enrolled women thought that rotavirus infection is dangerous (190, 55.6%) and that rotavirus can cause a serious illness (201, 58.8%). Regarding associated factors, women informed by a physician were more likely get a vaccination compared to women informed by friends or relatives (OR 34.35, 95% CI 7.12-98.98, p < 0.001). (4) Conclusions: The present study showed low levels of knowledge and attitudes towards rotavirus vaccination. These results highlight the need for developing and improving additional public education programs for parents.

The Burden of HPV-Related Hospitalizations: Analysis of Hospital Discharge Records from the Years 2015-2021 from a Southern Italian Region

(1) Background: The human papillomavirus (HPV) is the most common agent related to sexually transmitted infections in the general population. Its genotypes are classified into two main classes, high-risk genotypes and low-risk genotypes, according to their capacity to induce cancers. The low-risk class (types 6 and 11) is associated with anogenital and genital lesions. The high-risk class is responsible for up to 4.5% of all new cancer cases yearly. The aim of this study was to evaluate the incidence of HPV-related hospitalizations and its trend in a southern Italian region for the years 2015-2021. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. All admissions for the period 2015-2021 were extracted from the hospital discharge record (HDR). (3) Results: During the study period (2015-2021), a total of 5492 hospitalizations attributable to HPV infection occurred in the Abruzzo region, Italy. A significant number of admissions were related to cervical cancer (3386 cases) and genital warts (638 cases). The trend declined for all diagnoses except for penile cancer admissions. Considering the first year of the pandemic (year 2020), a decrease in the standardized incidence of the majority of the diseases considered was reported, particularly among cases of cervical cancer. (4) Conclusions: HPV-related hospitalizations decreased in Abruzzo during study period. These results could be useful to LHAs and policy-makers in improving vaccination coverage and screening adherence.

Severe Streptococcus equi Subspecies zooepidemicus Outbreak from Unpasteurized Dairy Product Consumption, Italy

During November 2021-May 2022, we identified 37 clinical cases of Streptococcus equi subspecies zooepidemicus infections in central Italy. Epidemiologic investigations and whole-genome sequencing showed unpasteurized fresh dairy products were the outbreak source. Early diagnosis by using sequencing technology prevented the spread of life-threatening S. equi subsp. zooepidemicus infections.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Extra-auditory effects of noise exposure in school workers and preventive measures: a systematic review

OBJECTIVE

Noise is still today one of the main causes of occupational diseases; in fact, in Italy in the three-year period 2019-2022, hearing loss represented 15% of all occupational diseases recognized by the National Institute for Insurance against Accidents at Work. The extra-auditory effects related to noise exposure also require particular attention, because they can interfere with mental activities that require concentration, memory and ability to deal with complex problems, causing sleep and learning disorders. For this reason, acoustic comfort is considered a fundamental requirement for obtaining an optimal degree of well-being in closed environments. In schools, a high degree of noise pollution not only makes it difficult for students to listen and learn, but also affects school workers. The aim of this study was to perform a systematic review of international literature and analysis of the preventive measures of extra-auditory effects among school workers.

MATERIALS AND METHODS

The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools (INSA, Newcastle Ottawa Scale, JADAD, JBI scale and AMSTAR). Only publications in English were selected. No restrictions were applied for the publication type. We excluded articles not concerned with the extra-auditory effects of noise exposure in school workers and preventive measures, findings of less academic significance, editorial articles, individual contributions, and purely descriptive studies published in scientific conferences.

RESULTS

Online research indicated 4,363 references: PubMed (2,319), Scopus (1,615) and Cochrane Library (429) have been consulted; 30 studies were included in this review (5 narrative or systematic reviews and 25 original articles). Regarding the scores of narrative reviews, the INSA score showed an average and a median value of 6.5, thus indicating an intermediate/high quality of the studies. Regarding the scores of systematic reviews, the AMSTAR score showed an average of 6.7 and a median and a modal value of 6, thus indicating a high quality of the studies. The scores assigned to the original articles have an average and median value of 7 and a modal value of 6 and this demonstrates an intermediate/high quality of the studies.

CONCLUSIONS

We can assume that, as it is highlighted by this study, to date these consequences are not considered at the legislative level for the protection of exposed workers. The extra-auditory effects impacting health afterward environmental noise exposure are many and widespread. Therefore, there is a need for interventions to be carried out by institutions and that the physician of the schools, during health surveillance, investigates the effects and clinical manifestations, in order to prevent disorders and deficits highlighted by our study.

Public Health Residents' Anonymous Survey in Italy (PHRASI): Study Protocol for a Cross-Sectional Study for a Multidimensional Assessment of Mental Health and Its Determinants

The COVID-19 pandemic has evolved into a severe psychosocial crisis affecting patients, their relatives, friends, and healthcare professionals. In Italy, public health residents (PHRs) remain essential to the national response to the pandemic. To assess their mental sphere, the "Public Mental Health" working group of the medical residents' Assembly of the Italian Society of Hygiene and Preventive Medicine has designed the Public Health Residents' Anonymous Survey in Italy (PHRASI). This is a nation-wide cross-sectional study based on an 88-item self-administered voluntary survey that evaluates how sociodemographic variables are associated with mental issues, including wellness, eating disorders, sleeplessness, alcohol misuse, depression, and anxiety. Data will be gathered by disseminating a Google Forms link across the Assembly network of medical residents. All PHRs enrolled in a four-year program in one of the Italian postgraduate schools of public health will be qualified as participants. PHRASI aims to draw a comprehensive and detailed picture of the mental health state of Italian PHRs. PHRs are a significant group of healthcare professionals that may serve as a future benchmark for developing and enacting regulations intended to support the mental health of healthcare professionals.

Impact of the COVID pandemic on mental health and training opportunities of Public Health Residents from 4 European countries: A cross-sectional study

Objectives

There is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic.

Methods

Between March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors.

Results

Among the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05-2.42]), anxiety (adjOR = 2.03, 95%CI [1.33-3.08]), and stress (adjOR = 2.35, 95%CI [1.53-3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28-2.93]) and stress (adjOR = 1.98, 95%CI [1.26-3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12-2.80]) for depression.

Conclusions

The pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

The Role of Gender in the Association between Mental Health and Potentially Preventable Hospitalizations: A Single-Center Retrospective Observational Study

Psychiatric disorders and substance abuse are barriers that limit access to timely treatment and can lead to Potentially Preventable Hospitalizations (PPH). The aim of this study is to identify the role played by gender in the association between mental health and PPH. Hospital discharge records (HDRs) from the Local Health Authority of Pescara (Italy) from 2015 to 2021 were examined and PPH were measured according to Prevention Quality Indicators (PQIs) provided by the Agency for Healthcare Research and Quality. In total, 119,730 HDRs were eligible for the study and 21,217 patients fell into the PQI categories. Mental health disorders and addictions were extracted from the HDRs through the Elixhauser Enhanced ICD-9-CM algorithm. The association between PQI hospitalization and some predictors considered was evaluated with multivariate logistic regression models. In males and females, alcohol abuse showed a protective role towards preventable admissions for PQI-90 (all types of conditions) and PQI-92 (chronic conditions). In contrast, there is a gender gap in accessibility to primary health care, especially for acute conditions leading to PPH. Indeed, in males, PQI-91 admissions for acute conditions were found to be positively associated with drug abuse, psychosis, and depression, whereas this was not the case for females.

Predictive comorbidities of hospital admission in 1,571 SARS- CoV-2 positive patients: analysis of administrative data from an Italian Local Health Autority

PURPOSE

Globally, age and some comorbidities have been associ-ated with the risk of more severe outcomes of COVID-19. The purpose of this research is to calculate the hospitalization rate of SARS-CoV-2 positive patients in an Italian Local health Authority (LHA) and to examine whether medical comorbidities encoded through pharmaceutical administrative data are predictors of hospital admission in patients with a positive SARS-CoV-2 naso-pharyngeal swab.

METHODS

This retrospective observational study was conducted in a LHA of Pescara. Comorbidities were coded through the consumption of drugs, using the WHO's Anatomical Therapeutic Chemical (ATC) classification System. The admission was ascertained by checking the hospital discharge records where generated.

RESULTS

During the study period, 1571 patients were tested positive for SARS-CoV-2 oro-and-nasopharyngeal swab. Multivariable logistic analisys showed as predictors of admission an age ≥65 in the total sample (aOR 10.91; 95%CI 6.86-17.36) as well as in the male (aOR 12.64;95%CI 6.42-24.87) and female. (aOR 9.27; 95%CI 4.87-17.66) in SARS-CoV-2 positive patients. Comorbidities assiociated with admission were (GERD) in overall (AdjOR 1.58; 95% CI 1.06-2.34) and male (AdjOR 2.30; 95%CI 1.12-4.72) samples and anticoagulants drugs use in male (AdjOR 3.90; 95% 1.11-13.65) sample, the presence of congestive heart failure (CHF) in female (AdjOR 0.47;95%CI 0.27-0.83) sample results as protective factor.

CONCLUSION

In conclusion, increasing age, male gender and PPI use are positively associated while female gender and CHF-related drug use are negatively associated with hospitalization in SARS-CoV-2 positive patients.

The role of gender in the association between mental health and avoidable hospitalization

Background

Hospital discharge records (HDR) can indirectly assess the quality of primary care through algorithms proposed by the Agency for Health Research and Quality (AHRQ). Mental illnesses or substance addictions represent barriers to accessibility to medical care which, can lead to hospitalizations deemed potentially preventable. The aim of this study is to evaluate the gender differences in the association between potentially preventable acute hospitalizations whether mental health or addiction.

Methods

The study examined HDRs of the Local Health Authority of Pescara, Abruzzo, period 2015-2021. The aggregate Prevention Quality Acute Composite 91 (PQI-91) has been coded according to the indications of the AHRQ. Were selected HDRs with a diagnosis of depression, psychosis, alcohol or substance abuse according to Enhanced ICD-9-CM Elixhauser algorithm. Four univariate logistic regression models were implemented correcting for age.

Results

In the study period 252,775 HDRs of which 3,459 PQI-91 were analyzed. A diagnosis of depression is positively associated with a PQI-91 hospitalization only in the male gender (aOR 3.16; 95%CI 2.18-4.58) and not in the female one (aOR 1.13; 95%CI 0.75-1.72). The same is true for a diagnosis of psychosis, males (aOR 2.41; 95%CI 1.66-3.48) and females (aOR 1.19; 95%CI 0.67-2.12). In both genders there was an association with substance abuse, males (aOR 3.92; 95%CI 2.65-5.81) and females (aOR 2.68; 95%CI 1.19-6.07), while for the alcohol abuse the female gender is positively associated (aOR 2.52; 95%CI 1.11-5.73) and not the male one (aOR 1.24; 95%CI 0.80-1.92).

Conclusions

Gender is an innovative approach to health inequalities: women and men respond to a different diagnostic-prescriptive appropriateness, which depends both on biology and on social, cultural, psychological and economic distances. Research efforts must be made to observe the effect healthcare access disparities have on patients who experience mental illness or addiction.

Key messages

• Mental health can limit access to primary care for other comorbidities or acute diseases; poor-quality primary care can result in preventable hospitalizations that increase the cost of health care.

• The gender differences for the same diagnosis of mental illness/addiction that cause potentially preventable acute hospitalizations impose gender-specific strategies aimed at modifying care pathways.

Alcohol Use during COVID-19 Pandemic: A Cross-Sectional Survey among Healthcare and Office Workers in Italy

BACKGROUND

The aim of our study of a sample of Italian healthcare (HCWs) and office workers (OWs) carried out during the pandemic period was to understand alcohol consumption patterns during the COVID-19 pandemic.

METHODS

A web-based cross-sectional survey based on Google Forms was developed. Harmful alcohol use was assessed through a validated questionnaire (AUDIT-C). Three multivariate logistic regression models were implemented for the overall sample of HCWs and OWs. The presence of harmful alcohol consumption (AUDIT-C score) was considered as a dependent variable.

RESULTS

A total of 1745 workers answered the survey. A lower risk of harmful drinking behavior among men overall and in both working groups was found (aOR 0.42, CI 95% 0.33-0.53), but also for both HCWs (aOR 0.62, CI 95% 0.46-0.84) and OWs (aOR 0.17, CI 95% 0.11-0.27). Comparing OWs and HCWs, we found a higher risk of harmful drinking in the first group (aOR 1.62, CI 95% 1.20-2.18).

CONCLUSIONS

The results of the survey indicate that unhealthy behaviors were elevated during the pandemic. It is urgent to implement company policies managed by an occupational doctor to raise workers' awareness of alcohol-related dangers and provide educational tools that have the task of preventing the damage caused by alcohol.

The impact of leadership on perceived work-related stress in healthcare facilities organisations

Purpose

Employees in the private, public, and third sectors have experienced an increase in stress over the years. Amongst the sectors, people working in hospitals and other healthcare facilities were put under severe stress during the COVID-19 pandemic. Indeed, the World Health Organisation has clearly stated that defending people's mental health at this particular time of restless pandemic growth is an absolute necessity. The purpose of this article is to assess the perceived work-related stress (WRS) of healthcare workers (HCWs) as a result of the spread of COVID-19, as well as how a leadership role can help to reduce WRS.

Design/methodology/approach

Based on a multiple case study approach applied to two Italian health-care facilities, the questionnaire results were subjected to a regression analysis.

Findings

The results show an association in HCWs between the perception of supportive leadership and the perception of negative psychosocial risks whose exposure can lead to manifestation of WRS during COVID-19 pandemic.

Originality/value

The study addresses the role that the perception of supportive leadership can play in reducing exposure to occupational psychosocial risks in a sample of healthcare professionals.

Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy

OBJECTIVE

The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020).

MATERIALS AND METHODS

A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being.

RESULTS

A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being.

CONCLUSIONS

Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them.

Total parenteral nutrition is associated with worse hospital outcomes among elderly diabetic patients: a propensity score matched analysis on discharge records

Background

Recent trials and reviews have raised question about the safety of total parenteral nutrition (TPN), due to the increased rate of TPN related complications. Diabetic patients are vulnerable to hyperglycaemia, and poor studies have investigated hospital out-comes of diabetic patients requiring TPN. The aim of this study was to evaluate the association of in-hospital mortality, prolonged length of stay and transfer to long-term care facilities among diabetic patients with TPN.

Methods

The study considered all hospital admissions of diabetic patients over 65 years of age performed between 2006 and 2015 in Abruzzo Region, Italy. To compare the outcomes of TPN and non-TPN patients, a propensity score matching procedure was performed.

Results

A total of 140,556 admissions were analyzed. After matching, 1947 patients were included into the analyses: 649 patients with TPN and 1298 controls. TPN was significantly associated to in-hospital mortality (OR=7.15; 95%CI 5.54-9.22), prolonged LOS (OR=2.78; 95%CI 2.28-3.38) and transfer to LTCF (OR=2.16; 95%CI 1.64-2.85).

Discussion

TPN is associated with poor outcomes among elderly diabetic patients in the Italian setting. Being aware of the risk factors among diabetic patients with TPN can be used to anticipate the patients' needs during the admission and the immediate post-discharge period.

Comparison of admissions for Acute Coronary Syndrome between 2020 and two control periods in Abruzzo

Background

The coronavirus epidemic has put unprecedented strain on health services, threatening hospital capacity in facing such a high number of Covid-19 patients in need of treatment. The aim of this study is to compare the hospitalization rate for acute coronary syndrome (ACS) in the first nine months of 2020 with the same period of 2018 and 2019.

Methods

This is a retrospective study of hospital discharge records. The pathologies of interest were coded as follows: all the hospitalizations with main discharge diagnosis as ICD-9-CM 410.xx, 411.xx, 413.xx for Acute Coronary Syndrome (ACS); 410.xx was used in all diagnoses except in codes 410.7x or 410.9x for acute ST-elevation myocardial infarction (STEMI); 410.7x was used in all diagnoses except 410.9.x for acute non-STEMI. Hospitalization rate ratios (HRR) comparing the study period with each of the control periods were calculated using Poisson regression.

Results

During the study period there was a statistically significant decrease in hospitalizations for ACS both vs 2018 (HRR 0.80;95%CI 0.80-0.81; p < 0.001) and vs 2019 (HRR 0.85;95%CI 0.84-0.86; p < 0.001). A decrease also affected STEMI vs 2018 (HRR 0.91;95%CI 0.90-0.92; p < 0.001) and vs 2019 (HRR 0.87;95%CI 0.86-0.88; p < 0.001) and NSTEMI vs 2018 (HRR 0.76;95%CI 0.75-0.77; p < 0.001) and vs 2019 (HRR 0.79;95%CI 0.78-0.80; p < 0.001).

Conclusions

This report shows a significant decrease in ACS-related hospitalization rates across the Region during the study period. General out-of-hospital mortality need to be further investigated, as to focus on patients died of ACS without receiving adequate assistance from the emergency network.

Key messages

Hospitalizations for acute coronary syndromes, STEMI and NSTEMI underwent a statistically significant decrease.

During the pandemic, some health needs related to fatal emergencies were not met by the health services.

The Indirect Impact of Covid-19 Pandemic on Hospitalizations for Cardiovascular Diseases in Abruzzo

Background

In 2020 the Covid-19 pandemic influenced the organization of all health systems, imposing new rules for accessing the hospitals and delaying or reducing the ability to cope with all the population needs. In addition, people with life-threatening conditions deferred care for their fear of contagion. The study aimed to evaluate the indirect impact of Covid-19 on hospitalization rates for cardiovascular diseases in 2020 in Abruzzo.

Methods

Data were obtained from the hospital discharge records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 5 (cardiovascular diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.

Results

A huge reduction in hospitalization in MCD 5 contest was observed in each subgroup. Specifically, ordinary regimen had a peak of -56,4% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of -84% in April. The largest reduction in hospitalizations occurred in private hospitals, in both ordinary (-81% in April) and DH admissions (-100% in April). A rebound in admissions was reported only for ordinary private regime between June and September, with a peak of + 24% in August.

Conclusions

Covid-19 had a severe impact on Abruzzo hospitalizations. The medical conditions that we examined needed effective hospital treatment to avoid adverse outcomes or death. Subsequently, fewer hospitalizations for such medical conditions were almost certainly associated with patient harm. Despite the pandemic, health system leaders should manage to provide subjects with hospital care, when necessary.

Key messages

Covid-19 had a significant indirect impact on the rate of hospitalizations for cardiovascular disease in Abruzzo.

Despite the pandemic, regional health systems should manage to provide effective hospital care for patients with cardiovascular conditions that require hospitalization.

Differences in COVID-19 mortality between pandemic phases in a southern Italian region

Background

Overall mortality is a relevant indicator of the population burden during COVID-19 pandemic, reflecting the overload and preparedness of the healthcare system. This study aimed to analyse the distribution of deaths in SARS-CoV-2 positive patients between pandemic phases and to evaluate the characteristics of COVID-19 patients deceased during the year.

Methods

Data on confirmed COVID-19 cases were collected from the recording system of the Department of Prevention of the Local Health Authority of Abruzzo Region, Italy. The course of the epidemic was stratified in 4 phases: the first wave (March-May 2020), the low incidence phase (June-September 2020), the second wave (October 2020-December 2021), and the variants spread phase in our region (January-March 2021).

Results

From March 2020 to March 2021 we registered 17,082 cases of SARS-CoV-2 infection, of these patients 571 (3.35%) had a fatal outcome. The mortality was the highest during the first ‘peak' phase, interesting the 14.20% of the notified cases, and the lowest during the last phase (2.50%). Mortality due to COVID-19 mainly affected men (54.99%) and geriatric patients (median age: 84; IQR: 75-90). Women dying for SARS-CoV-2 infection had a more advanced median age (87; IQR: 79-92) than men (81; IQR: 73-87). The lowest median age was registered in patients deceased during the low incidence phase (75.5; IQR: 71-82). The median time span, in days, from a SARS-CoV-2 positive test to death was significant lower in the phase 1 (days:10; IQR:4-20) then in phase 4 (days:14; IQR:8-22) (p < 0.001).

Conclusions

Our results showed that mortality markedly decreased during the COVID-19 epidemic, and this could be likely related to an improved organisation and delivery of care, in addition to a better knowledge of disease treatment. Elderly patients were more likely to progress toward fatal outcome. The healthcare systems should pay special attention to them in order to effectively manage possible future pandemics.

Key messages

The COVID-19 mortality reduction highlights an improvement of health care; the elderly remains at major risk of death.

Providing pandemic prevention and care models focused also on vulnerable groups is a major public health challenge.

Reduction in Neurological Disease Hospitalization Rate During Covid-19 Pandemic in Abruzzo

Background

As a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region.

Methods

Data were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.

Results

A huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (-75% in April) and DH admissions (-93,8% in March).

Conclusions

Despite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations.

Key messages

An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo.

Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic.

Vaccination coverage after the introduction of mandatory law: results from an Italian Southern Region

Background

Over the latest decades, Europe has been facing the spreading of vaccine hesitancy. This growing phenomenon has resulted in decreasing vaccination coverage all over Europe, particularly in Italy for measles, mumps and rubella. In order to face up this problem, in 2017 Italy introduced compulsory vaccination against 10 different infectious diseases: diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenzae B (all included in the hexavalent vaccine), measles, mumps, rubella (included in the MMR vaccine) and chickenpox (from the 2017 cohort). The aim of this study was to evaluate vaccination coverages in 2019 in Abruzzo, an Italian Southern Region, after the introduction of compulsory vaccinations.

Methods

In this study the following indicators were taken into account: vaccination coverages at 24 months of age (2017 cohort of birth), vaccination coverages at 36 month of age (2016 cohort), vaccination coverages at 5/6 years of age (2013 and 2014 cohorts) and vaccination coverages at 16 and 18 years of age (2001 and 2003 cohorts). Vaccination coverage rates were calculated as the number of vaccinated patients for each disease over the total number of patients born in the year considered.

Results

At the end of 2019, the 2017 cohort reached 95% coverage for all vaccinations except for chickenpox (87.9%). Conversely, the 2016 cohort showed low rates for MMR and chickenpox, up to 90.8% and 52.1% respectively. Additionally, 2013 and 2014 teenager cohorts showed coverage rates lower than 95% for all the compulsory vaccinations.

Conclusions

After two years of mandatory vaccination law in Italy, vaccination coverages have reached the 95% threshold only among patients of 24 months of age. Older cohorts still show inadequate vaccination coverages despite the introduction of mandatory vaccination law. Health services at regional level should develop policies and strategies aiming to improve vaccination coverages and to reach herd immunity.

Key messages

After the introduction on mandatory vaccination, vaccination coverages reached the 95% threshold only among patients of 24 months of age. Health services should develop strategies aiming to improve vaccination coverages.

Attitudes towards COVID-19 preventive measures: an Italian cross-sectional study

Background

The outbreak of COVID-19 was declared Public Health Emergency of International Concern on the January 2020. During an infectious disease outbreak, non-pharmaceutical interventions are essential to delay an epidemic peak and to flatten the epidemic curve, in order to wait for vaccine development. Perception or beliefs may be essential in determining adherence to official recommendations. The aim of this study was to assess whether perceptions of COVID-19 and awareness of preventive strategies effectiveness were associated to behavioural changes.

Methods

Web-based survey was performed in Italy between the 9 and the 15 March 2020. The survey contained six sections: subject's demographics, subject's behaviours during the latest three weeks, subject's behaviours during the latest 24 hours, perceived efficacy of behaviours, awareness raised by the government-led prevention campaign for COVID-19 and co-occurring anxiety.

Results

1912 participants were enrolled in the study. 48.1% of the participants (n = 919) reported to perform at least 7 preventive behaviours. Most people reported a change in the frequency of their hand-washing (94.7%), an increment in the frequency of surface cleaning and disinfecting (58.9%), and a reduction in the use of public transport (92.5%). Behavioural changes were related to an increase in the anxiety level (OR 1.47; 95%CI 1.16-1.87). After adjusting for personal characteristics and anxiety, an association resulted between clear perception of COVID-19 high infectiousness (OR 1.25; 95%CI 1.00-1.59) and of its severe consequences (OR 1.29; 95%CI 1.05-1.59), clearness of communication about the virus (OR 1.41; 95%CI 1.17-1.71), and increased likelihood of performing the recommended behavioural changes.

Conclusions

To better protect people against future epidemics, health-promotion efforts should be aimed at increasing the level of awareness towards infectious diseases and at implementing and encouraging non-pharmaceutical interventions.

Key messages

Clear perception of COVID-19 high infectiousness and of its severe consequences are associated with an increased likelihood of performing the recommended behavioural changes.

Health promotion strategies should be a critical part of infection prevention and control program.

Telework and its effects on mental health during the COVID-19 lockdown

OBJECTIVE

During the Covid-19 pandemic, many governments promoted the adoption and development of telework to reduce some of the consequences of the current health crisis on the economy and favor social distancing. The aim of this web-based cross-sectional study was to assess the consequences of the Covid-19 pandemic on job organization, exploring the effects of lockdown measures on the psychological distress and perceived well-being of workers experiencing telework.

SUBJECTS AND METHODS

A web-based cross-sectional survey has been used to collect data. The participants answered the questionnaire from April 1 to April 30, 2020. The questionnaire consisted of three sections, which investigated: 1) demographic and occupational variables, 2) lifestyle and habits variables, 3) psychological distress and perceived well-being. The General Health Questionnaire (GHQ-12) has been used to evaluate psychological distress and the 5-item World Health Organization Well-Being Index (WHO-5) to explore subjective well-being.

RESULTS

Psychological distress was associated with educational level, with habits, and with reporting poor well-being. Poor well-being was associated with a higher job demand during pandemic, lifestyle and habits variables, and psychological distress.

CONCLUSIONS

This is one of the first studies exploring the consequences of the COVID-19 pandemic and lockdown measures on the perceived well-being and psychological distress of workers experiencing telework. It is mandatory to pay more and more attention to the mental health of teleworkers, considering the increasing diffusion and adoption of this type of work organization.

Work-related stress risk and preventive measures of mental disorders in the medical environment: an umbrella review

OBJECTIVE

Work-related stress (WRS) is widespread among medical doctors. WRS not only affects the physician's mental and physical well-being, but also patient care quality and the overall efficiency of the healthcare system. The aim of this study is to conduct a systematic review of the current preventive measures against mental disorders, work-related stress, and burnout among physicians.

MATERIALS AND METHODS

The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools: INSA, Newcastle Ottawa Scale, JADAD scale, and AMSTAR. English publications only were selected. No restrictions applied for publication type. Reviewers excluded articles not concerning the following topics: WRS prevention, WRS risk factors and mental disorders among physicians. Reviewers also excluded findings of less academic significance, editorial articles, individual contributions, purely descriptive studies published in scientific conferences.

RESULTS

Online search returned 4748 references on the following databases: PubMed (1638), Scopus (3108) and Cochrane Library (2). 36 studies were included in this review (thereof, 13 reviews and 23 original articles). Narrative reviews were rated on the INSA scale. The mean, median, and modal rating was 6. This indicates an intermediate-high quality of these studies. Systematic reviews were rated on the AMSTAR scale. The mean and median rating was 9, and the modal rating was 8. This indicates a high quality of these studies. The scores assigned to the original articles have a mean, median, and modal rating of 7. This also indicates an intermediate-high quality of these studies.

CONCLUSIONS

Work-related stress and mental disorders seem to be widespread among medical practitioners. It is already a priority to adopt preventive measures against these phenomena. However, there is still no consensus on what the most effective measures are. Additional research is needed to formulate evidence-based recommendations.

Consequences of COVID19-pandemic lockdown on Italian occupational physicians' psychosocial health

COVID-19 was declared a pandemic on March 12, 2020. Italy has been the most affected country in the world, right after China. Healthcare workers (HCWs) were among the hardest hit by this event from both a working and psychological point of view. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian Occupational Physicians’ well-being and psychological distress, in relation to demographic and occupational characteristic, lifestyle and habits during the lockdown period. We conducted a web-based cross-sectional survey questionnaire from April 1 to April 21^st, 2020. To evaluate the level of psychological distress and the level of well-being, the general Health Questionnaire-12 (GHQ-12) and the WHO-5 Wellbeing Index were utilized. Since the statistical assumptions were respected, we proceeded with an analysis of variance (ANOVA) to ascertain the differences between the averages of the scores of the GHQ-12. Doctors who live in the most affected regions have a prevalence of psychological distress higher than their colleagues from the rest of Italy. ANOVA shows significant differences relating to the female gender, and to the life changes provoked by the lockdown for example not feeling sheltered at home or suffering from loneliness. This study showed a high prevalence of psychological distress in occupational physicians. To prevent the occurrence of mental disorders among Occupational Physicians, it is urgent to put in place policies of psychological support and well-being preservation.

The impact of gender on diabetes-related lower extremity amputations: An Italian regional analysis on trends and predictors

BACKGROUND

Diabetes-related lower extremity amputations (LEAs) are a major public health issue. The aim of the study was to evaluate trends by gender and predictors of LEAs in an Italian region.

METHODS

Data were collected from hospital discharge records between 2006 and 2015. Gender- and age-adjusted standardised hospitalisation rates for major and minor amputations were calculated. Poisson regression model was performed to estimate trends in LEAs.

RESULTS

Hospitalisation rates decreased for minor amputations both among males (-30.0%) and females (-5.3%), while the major amputation rates decreased only for males (-44.7%). Males were at higher risk of undergoing major (IRR 1.41, 95%CI 1.19-1.67) and minor (IRR 1.62, 95%CI 1.45-1.82) amputations. Peripheral vascular disease was the leading predictor of major and minor amputations.

CONCLUSION

A significant reduction of LEAs was observed only for males. Identifying their predictable factors may help caregivers to provide higher standards of diabetes care.

Reasons behind flu vaccine acceptance and suggested interventions to promote flu vaccination acceptance among healthcare workers

The flu vaccination rate is still too low, both among healthcare providers (HCPs) and among health sciences university students. This study aims to assess the reasons of past and future flu vaccination acceptance among health sciences university students, and second, to identify what interventions would be helpful to foster acceptance of the flu vaccination among HCPs. A multicentre cross-sectional study was performed, using a validated questionnaire administered to health sciences students enrolled in 14 Italian universities. A multivariable logistic regression model was used. A total of 3131 questionnaires were collected. The statement that mandatory vaccination is required to increase adhesions to vaccinations (adjusted odds ratio [aOR] = 1.57; 95% confidence interval [CI] = 1.25-1.97), being in favour of this obligation (aOR = 7.91; 95% CI = 2.50-25.02) and considering themselves as people at risk of infection (aOR = 1.96; 95% CI = 1.46-2.64), are associated with having received the vaccination in the past flu season; on the other hand, planning to be vaccinated for the next season to avoid infecting patients is protective (aOR = 0.51; 95% CI = 0.38-0.70). This study shows which beliefs are associated with having joined the previous vaccination campaign in a large sample of HCPs. The acceptance of vaccination is an outcome behaviour resulting from a complex decision-making process. In order to implement coverage of the influenza vaccination in HCPs, it is necessary to implement awareness campaigns and provide specific information for this category of workers.

Gender differences in childhood bmi z-score, alimentary behaviour and lifestyle in a sample of 9-11 children

BACKGROUND

Child overweight and obesity prevalence has risen substantially in most high-income countries. The prevention of childhood overweight and obesity is a major public health issue. Childhood obesity leads to an increased risk of both physical and mental health consequences,. The aim of this study was to investigate the gender differences in BMI z-score, eating habits, life style and healthy behaviors in children.

MATERIALS AND METHODS

With an approach so-called "cluster" method we selected third classes of primary schools. The study was conducted from September 2016 and May 2017 during a school year. Information was collected through a questionnaire filled in by the children with the help of their parents. The biometric data relating to height in meters and weight in kilograms was obtained through the questionnaire.

RESULT

A total of 1122 children were included in the current study. 33.9% of boys being overweight compared with 27.8% of girls and 19.1% of boys being obese compared with 12.5% of girls (p<0.001). There were significant differences between boys and girls for physical activity (p=0.004), sedentary behaviors (p<0.001), eating habits (p=0.004).

DISCUSSION

In this study, gender differences were analyzed with respect to BMI z-score, eating habits, life style and healthy behaviors in children between 9 and 11 years old. The results of the study confirm the differences that the scientific literature described. Between boys and girls there are different habits that on the one hand can determine differences in the quality of life and future health and on the other hand can be the key to implementing effective and targeted prevention interventions.

Norovirus foodborne outbreak in an agritourism: causes, development and legal consequences

Background

Norovirus is the main causative agent of viral acute gastroenteritis. It is easily transmitted and frequently causes foodborne and waterborne outbreaks. The Food Hygiene Service of ASL 2 Abruzzo received notification of gastrointestinal illness in 33 customers who attended a lunch at an agritourism on 28 July 2019.

Methods

The investigation started immediately. The event was reported to the Judicial Authority and food preparation was suspended. Stool specimens and rectal swabs were collected from 18 guests and 2 food handlers and tested. A questionnaire survey was given to the customers. During the inspection, the Food Hygiene Service sampled some food leftover and water from faucets. Furthermore, it found an incomplete HACCP manual.

Results

The 31 cases of gastrointestinal illness occurred within 12-72 hours and didn't need hospitalization. Among the affected subjects,18 were men (58.1%) with a median age of 51 years. All the biological samples collected from the subjects were positive for Norovirus GII, as revealed by Real Time-PCR. The two food handlers resulted positive for Norovirus GII, but they were asymptomatic. They were tested up to 3 weeks after the outbreak and their feces remained positive. Water and food samples resulted negative, except for raw ham's outer surface, that resulted positive for Norovirus GII. The contamination probably occurred during food preparation.

Discussion

This outbreak was related to food cross-contamination by infected food handlers, likely caused by a failure in application of both personal and food hygiene measures prescribed in HACCP plan. Food preparation restarted on 12 September 2019, but infected food handlers were dismissed until they were positive. The Judicial Authority will file a lawsuit against the food operator business that could lead to imprisonment or fines.

Key messages

Norovirus outbreaks are recognized as a public health concern causing a high number of cases and serious health consequences in children and the elderly. HACCP manual must be customized for each food business and integrally applied by food handlers in order to attain a higher standard of food safety for prevention of foodborne illness.

Rotavirus gastroenteritis hospitalization in children. Trends in Abruzzo Region, 2008-2018

Background

Rotavirus is the most important cause of hospitalization for gastroenteritis and dehydration in children under 5 years old. In developed countries, it significantly affects public health in terms of costs and morbidity. Despites the availability of an effective vaccine, the coverage remains low in Italy. This study aimed to evaluate the epidemiological impact of rotavirus hospitalizations in Abruzzo, an Italian region, from 2008 to 2018.

Methods

Data were obtained from hospital discharge records of all Abruzzo hospitals. For the study, only the admissions due to rotavirus infection occurring in children aged 0 to 5 over the study period were taken into consideration. For each year, age-adjusted standardized hospitalization rates for rotavirus infection were calculated, and time trends were analyzed by joint point regression models.

Results

A total of 747 admissions were identified. During the study period, a significant increase of admissions was observed among children under 1 year of age (AAPC +9.8%, 95%CI 0.0;20.5, p &lt; 0.001) and a significant decrease was observed among children between 2 and 3 years of age (AAPC -10.6%, 95%CI -20.0; -0.1, p &lt; 0.001). Overall, the standardized rate increased (AAPC +5.2%, 95%CI -3.0;14.1, p = 0.2).

Conclusions

These results confirm that Rotavirus gastroenteritis has a heavy impact on pediatric hospitalization in Abruzzo Region. Subsequently, the study gives evidence of the need to improve vaccination coverage, in order to reduce morbidity and costs for the Italian healthcare system.

Key messages

In Abruzzo region, rotavirus gastroenteritis is a very important cause of morbidity and hospitalization in children under 5 years old. This study confirms the need of an improvement in vaccination coverage, that is the most effective mean to reduce the high morbidity, as well as the social and health costs.

Paediatric ambulatory care sensitive hospitalisation and Italian deprivation index: retrospective multilevel analysis of administrative data from 2008 to 2018 in the Abruzzo Region (Southern Italy)

OBJECTIVES

to estimate and analyse the trend of paediatric hospitalisations for Ambulatory Care Sensitive Conditions (ACSCs) from 2008 to 2018 in a region of southern Italy and to assess the association with the socio-economic deprivation index (DI).

DESIGN

retrospective observational study.

SETTING AND PARTICIPANTS

ACSC hospitalisations in children (<=18 years) were identified. Discharges for ACSC of the Abruzzo Region from 2008 to 2018 were selected and the deprivation index of the municipality of residence was assigned to the hospital discharge record where the patient's residence was reported.

MAIN OUTCOME MEASURES

the rate of paediatric preventable admissions (PPHs) related to ACSC, standardized by age and gender with the direct method, was calculated for the years of observation. The average annual percentage change (AAPC) was calculated with a trend analysis. In addition, the odds ratios (ORs) of hospitalisation for ACSC were calculated using a hierarchical logistic regression model.

RESULTS

252,513 hospitalisations were examined, of which 16,264 (6.4%) attributable to ACSC. During the study period, the hospitalisation rate decreased from 8.59 per 1,000 to 6.12 per 1,000 residents, with an AAPC of -3.7, which was statistically significant (p<0.05). Furthermore, an association was highlighted between hospitalisations related to ACSC and the deprivation of the municipality of residence. Using as a comparison people residing in the municipalities belonging to the first quintile, the least deprived, the strength of the association between PPHs and DI increased from the third quintile (OR 1.13; CI95% 1.02-1.24) up to the fifth quintile, most deprived (OR 1.14; CI95% 1.01-1.30).

CONCLUSIONS

paediatric patients residing in Abruzzo have a risk of undergoing a preventable hospitalisation associated with an ACSC which depends on the deprivation index of the municipality of residence. Although it is difficult to evaluate the mechanisms involved in the relationship between economic deprivation and hospitalisation, DI can be useful to identify the areas which are most at risk on which to prioritize public health interventions.

A novel tool to predict in-hospital mortality after hip-fracture: the PRIMOF score

Background

Increased life expectancy has led to an increased incidence of hip fractures in aged people. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stays, significant complications, and higher mortality rates. Being aware of the factors associated with in-hospital death or adverse events can help patients and healthcare providers make informed planning and management. The aims of this study were the development and validation of a score predicting in-hospital mortality among hip fractured patients.

Methods

Patients were selected from the hospital discharge record referring to the period 2006-15 and including data on the population aged 40 years or over in Abruzzo, a region of Southern Italy. The whole population was divided into 2 random samples in order to control the accuracy of predictions and to increase the reliability of all the statistical analyses. A multivariate logistic regression model was performed to identify the predictors of in-hospital mortality. All the diagnoses significantly associated with in-hospital mortality were included in the final model.

Results

The score ranged between 0 and 27 and was divided into four groups to facilitate the tool interpretation. An increase in odds ratio values was documented alongside the increase in PRIMOF score both in training and in validation groups. The score showed a good calibration and a good accuracy in predicting in-hospital mortality.

Conclusions

This study has shown that a simple score, based on the clinical history of the patient, allows to stratify the risk of hip fractured population in terms of in-hospital mortality. The identification of individuals at high risk of short-term death can be of great significance to health providers and public and private health services.

Key messages

Patients reporting hip fractures often show relevant comorbidities leading to higher in-hospital mortality rates. A simple score, based on the clinical history of the patient, allows to stratify the risk of hip fractured population in terms of in-hospital mortality.

Physical multimorbidity, mental health and unplanned admissions from 2008 to 2018 in Abruzzo region

Background

Multimorbidity is defined as the presence of more than one long-term disorder and it is associated with increased use of health services. Socioeconomic deprivation and mental health conditions may lead to undesirable additional unplanned admission to hospital (urgent or emergency admission). This study examines the association among unplanned admission, multimorbidity, mental health and socioeconomic deprivation for both preventable and not preventable hospitalization.

Methods

We conducted a retrospective analysis of hospital discharge records between 2008 and 2018 in Abruzzo, an Italian region. Multilevel logistic regression models were implemented for both preventable and not preventable unplanned admissions. We set as levels the district of residence and Local Health Authority. As independent variables we used the Italian Deprivation Index of the district of residence to mitigate socioeconomic inequalities, unweighted count of physical health conditions (0, 1, 2, 3, ≥4), the presence of a diagnosis of mental health condition. All the models were also adjusted for age and gender.

Results

We selected 2,017,720 non preventable admissions, 836,808 (41.45%) of which unplanned, and 152,938 preventable admissions, 107,336 (70.18%) of which unplanned. Both unplanned and potentially unplanned admissions were associated with increasing physical multimorbidity (for ≥4 v. 0 condition, OR 4.85; CI95% 4.26-5.53 for unplanned admission and OR 1.42; CI95% 1.11-1.83 for preventable unplanned admission) and with mental health conditions (OR 1.66; CI95% 1.57-1.75 for unplanned admission and OR 1.18; CI95% 1.00-1.38 for preventable unplanned admission).

Conclusions

Co-occurrence of physical multimorbidity and mental health condition was associated either with unplanned admission or unplanned preventable admission. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.

Key messages

Physical multimorbidity substantially affects the use of acute hospital services. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.

Pediatric ambulatory care sensitive admission and deprivation index, ten years retrospective analysis

Background

Ambulatory Care Sensitive Conditions (ACSCs) are conditions where effective community care and case management can help prevent the need for hospital admission. Even if the ACSC episode itself is managed well, an emergency admission for an ACSC is often symptom of overall poor quality of primary and community care. Lower socioeconomic status individuals show higher rates of hospitalization due to ACSCs. The purposes of this study is to examine the association between socioeconomic status and the risk of hospitalization due to an ACSC in pediatric population through a retrospective analysis of administrative data of the Abruzzo region.

Methods

We identified hospital discharge records from 2008 to 2018 of subjects under 18 years of age to take into consideration for the study. Hospitalizations due to ACSCs were selected by ICD9-CM coding developed by Billings et al. and implemented by Lu et al. For establishing the socioeconomic status, we used the Italian Deprivation Index (IDI) developed by Caranci et al. as a categorical variable expressed in quintiles. A multilevel logistic regression model was implemented using ACSC vs non ACSC hospitalization as dependent variables.

Results

In the study period, a total of 317,586 hospital discharge records were selected, 18059 (5.69%) of which related to ambulatory care sensitive hospitalization. After correcting for age, gender, and citizenship, ACSCs hospitalization was associated with lower IDI (aOR1.21;CI95%1.09-1.34) and a slight gradient as the deprivation increased. Moreover, it was also associated with emergency department admission (aOR6.53;CI95%6.19-6.89).

Conclusions

Avoidable hospitalization in pediatric settings is associated with lower socioeconomic status computed by IDI. This study confirms inequity in primary care or community care after adjusting for age, gender and citizenship. Italian deprivation index represents a useful tool to identify population and areas where improving prevention is necessary.

Key messages

The Italian deprivation index could be used to implement primary and community care strategies in pediatric settings. Socio-economic factors are associated with the performance of the health services.

Attitudes toward vaccination among healthcare workers: a cross-sectional study from Italy

Background

In Italy, the loss of confidence in vaccines has resulted in low vaccination coverage also among healthcare workers (HCWs). Low vaccination coverage among HCWs may lead to dangerous outbreaks and may increase absenteeism. The aim of this study was to investigate vaccine coverage and the attitudes toward vaccination among HCWs.

Methods

A multicenter cross-sectional study was conducted from August to November 2019 among HCWs referring to all the hospitals of the Local Health Authority 02 of Abruzzo Region, Italy. The survey was based on the questionnaire proposed by the H-ProImmune Project, aiming at investigating vaccination coverage and beliefs towards vaccination. Besides a descriptive analysis of the results, a logistic regression analysis was performed to evaluate the association between vaccine coverage and type of occupation (medical doctor, nurse, obstetric nurse, other).

Results

A total of 347 HCWs were enrolled in the study. The 57.3% reported to have missed diphtheritis-tetanus-pertussis (DTP) vaccination, the 50.1% reported to have missed measles-mumps-rubella (MPR) vaccination, and the 62.5% reported to have missed flu vaccination. In comparison with medical doctors, obstetric nurses were more likely to be associated to MPR vaccination (OR 2.8;95%CI 1.1-7.6; p = 0.047). As far as flu vaccination was concerned, both nurses and obstetric nurses showed lower confidence (respectively OR 0.2; 95%CI 0.1-0.3; p &lt; 0.001 and OR 0.1; 95%CI 0.1-0.5; p = 0.003). Moreover, other healthcare professionals reported to believe in natural immunization more than in vaccination (26.5%; p &lt; 0.001) and they were also worried about long-term effects of vaccination (10.2%; p = 0.044). Differently, nurses were more frequently worried about vaccine side effects (24%; p &lt; 0.001).

Conclusions

This survey shows that the vaccination coverage taken into consideration results to be below the 95% threshold. Training on vaccine and mandatory measures may be necessary in order to achieve better coverage.

Key messages

Among HCW all vaccination coverage considered resulted below the threshold. Training on vaccine and mandatory measures may be needed in order to achieve better coverage.

Heart failure hospitalizations in persons with and without diabetes in an Italian region: 2008-2018

Background

Hospitalization rate for heart failure (HF) is considered a prevention quality indicator and it is used as a tool to evaluate health services quality. This study aims to assess time trends in HF hospitalizations in a region of Southern Italy, focusing on diabetes mellitus as comorbidity.

Methods

Data were collected from hospital discharge records. All patients aged 18 or over hospitalized for HF in Abruzzo between 2008 and 2018 were selected, either with or without a diagnostic code of diabetes. Admissions for cardiac procedures were excluded. For each year, gender- and age-adjusted standardized hospitalization rates were calculated. Predictors of HF admissions were estimated by a multivariable regression model.

Results

Over the study period, 60,737 HF admissions occurred, 34,518 of which among people aged more than 65 (56.8%). A total of 15,424 hospitalizations were performed among diabetic patients (25.4%). The overall age- and gender-adjusted HF hospitalization rate declined substantially from 2008 to 2018 (-12.1%). Diabetes (adjOR 2.48; 95%CI 2.41-2.55), myocardial infarction (adjOR 3.92; 95%CI 3.70-4.14), peripheral vascular disease (adjOR 2.30; 95%CI 2.16-2.44), chronic obstructive pulmonary disease (adjOR 3.97; 95%CI 3.86-4.09) and renal disease (adjOR 5.61; 95%CI 5.44-5.78) were factors associated to an increased risk of HF hospitalization. Although HF admission rates remained higher, a significant reduction was highlighted among diabetic patients (-34.7%). Instead, time trend was nearly stable among persons without diabetes (+2.7%).

Conclusions

This study has shown a decline in HF hospitalization rate over the period considered, particularly among diabetic patients. HF hospitalization may be potentially avoided with good outpatient care. As the causes for HF admissions may include poor quality of care or problems accessing care, it is worthwhile to identify the triggering factors and the potential targets for an early intervention.

Key messages

A reduction of HF admissions was observed only among diabetics and not among people without diabetes. As the HF hospitalizations are potentially preventable, the knowledge of the epidemiology is crucial for management of preventive health care.

Predictors of preventable hospitalizations in an Italian hospital: analysis of administrative data

Background

Preventable hospitalizations (PHs) represents less efficiency and low access to outpatient and primary health care. The lengthening of life expectancy and comorbidities that can be treated with primary care are associated with PHs. This study examines the risk of having a PH based on age, gender and comorbidities.

Methods

We designed a retrospective observational study of admission occurred in a great hospital of the southern of Italy from 2014 to 2019. Composite indicator for PHs were selected using the algorithm proposed by the Agency of Health Research Quality. Any composite indicator (PQI90, PQI91, PQI92) were used as dependent variable of a Poisson model to compute RRs. Comorbidities were decoded as proposed by Charlson et al. in secondary diagnosis.

Results

A total of 185264 admissions were included in the study, with 11815 (6,37%) PQI90, 2706 (1,46%) PQI91, 9109 (4,91%) PQI92. Age (1.03; CI95%1.03-1.03), cerebrovascular disease (1.33; CI95%1.22-1.44), Chronic obstructive pulmonary disease (COPD) (1.40; CI95%1.30-1.51), diabetes without (1.70; CI95%1.61-1.80) or with (1.83; CI95%1.53-2.18) complications and a mild liver disease (1.76; CI95%1.54-2.00) were associated with PQI90. Age (1.02; CI95%1.02-1.02), cerebrovascular disease (1.60; CI95%1.35-1.90), COPD (1.49; CI95%1.24-1.78), diabetes without complications (1.52; CI95%1.32-1.74) and a mild liver disease (2.87; CI95%2.33-3.54) were associated with PQI91. Age (1.04; CI95%1.04-1.04), cerebrovascular disease (1.26; CI95%1.15-1.39), COPD (1.38; CI95%1.26-1.50), diabetes without (1.76; CI95%1.65-1.87) or with (2.03; CI95%1.68-2.45) complications and a mild liver disease (1.40; CI95%1.18-1.65) were associated with PQI92.

Conclusions

All indicators of PHs are associated with the increase in age and the presence of common and treatable comorbidities in primary care assets. These indicators are useful for implementing preventive strategies in order to reduce the burden of admission in the hospital setting.

Key messages

Preventable hospitalizations represent an important portion compared to total hospitalizations. Improvement of primary care strategies are needed to reduce the burden of preventable hospitalizations.

Infections in diabetics: a ten-year analysis on hospital discharge records in an Italian region

Background

Patients with diabetes mellitus (DM) have increased risk of developing infections and complications from infections that require hospitalization and greater healthcare utilization. This study aimed to analyze hospitalizations in DM patients with a diagnosis of infection and to assess the burden of infections on the regional healthcare system in terms of length of stay and in-hospital mortality.

Methods

A retrospective cross-sectional study was performed from 2006 to 2015 in Abruzzo, an Italian region. Data were collected from hospital discharge records (HDRs) of patients with a diagnosis of DM. All the admissions with an ICD-9 infection diagnostic code were identified. Logistic regression models were implemented to evaluate the association between infections and the study outcomes.

Results

A total of 182,709 HDRs of DM patients were identified, 12,381 (6.78%) of which related to an infectious disease. The number of admissions with a diagnosis of infection increased during the study period (+4.0%). Respiratory infections were the most common (69.8%), followed by sepsis (9%), and skin and soft tissue infections (8.7%). Factors associated with the infection were age&lt;18 (aOR=1.88; 95%CI:1.42-2.47), age≥65 (aOR=1.29; 95%CI:1.23-1.35), and DM type 2 (aOR=1.19; 95%CI:1.12-1.26). Diabetic patients with an infectious disease had a longer median length of stay (days:10; IQR:6-16) than those without infections (days:7; IQR:3-12) (p &lt; 0.001), and showed higher in-hospital mortality (aOR=2.67; 95% CI:2.5-2.8).

Conclusions

Over the study period, hospitalizations related to infections among diabetics rose. The increase was registered mostly among the youngest and the oldest subjects. Infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with DM are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.

Key messages

Patients with diabetes have increased risk of developing infections. In our study, infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with diabetes are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.

The effect of COPD on length of stay and in-hospital mortality of diabetic patients

Background

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. It is currently one of the leading cause of death worldwide. Metabolic syndrome has been recognized as one of the most relevant clinical comorbidities associated with COPD. Diabetes is more prevalent in COPD than in the general population, ranging between 10.1-23.0%. However, the link between COPD and diabetes is much less clear. The aim of this study was to investigate the effect of COPD on diabetic patients, focusing on length of stay and in-hospital mortality.

Methods

The study considered all hospital admissions of diabetic patients aged over 65 years performed between January 2006 and December 2015 in Abruzzo, a region of Italy. Data were collected from all hospital discharge records. A 1:1 propensity score-matching algorithm was used to match patients with and without COPD, according to their baseline characteristics. Logistic regression analysis was performed to evaluate the risk of in-hospital mortality and prolonged length of stay among diabetic patients with COPD.

Results

A total of 140,556 ?patients were included: 18,379 with COPD and 122,177 without COPD. After matching procedure, 36,758 patients were included into the analysis: 18,379 with COPD and 18,379 controls. After matching, all the baseline characteristics resulted well balanced, with a standardized mean difference less than 10% for all the variables considered. COPD patients showed a higher risk of in-hospital mortality (OR: 1.10; 95%CI 1.01-1.20; p = 0.036) and length of stay over 15 days (OR:1.18; 95%CI 1.06-1.31; p = 0.002).

Conclusions

In a cohort of Italian patients, diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD. Defining the causes of these differences would improve public health surveillance systems and policies.

Key messages

Diabetes is more prevalent in COPD than in the general population. Diabetic patients with COPD showed a higher risk of in-hospital mortality and prolonged length of stay compared with diabetic patients without COPD.

The impact of COVID-19 on doctors' well-being: results of a web survey during the lockdown in Italy

OBJECTIVE

On March 12, 2020, the World Health Organization (WHO) declared the outbreak of a new Coronavirus disease (COVID-19), to be a pandemic. From the beginning, Italy (in particular the Northern regions) was the first large European country to be hit and one of the most affected countries worldwide. This had a significant impact on the workload and psychological health of health workers. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian doctors' well-being and psychological distress, in respect of demographic and occupational characteristics, lifestyle and habits during the lockdown period.

PATIENTS AND METHODS

We conducted a web-based cross-sectional survey based on Google® Forms to collect data. The participation was available during the lockdown period that started in Italy on March 9, 2020 and it was voluntary and anonymous. The questionnaire explored demographic and occupational variables, lifestyle and habits during the lockdown, perceived well-being and psychological distress. Multivariate logistic regression models were fitted.

RESULTS

Our study reported the very alarming psychological conditions of Italian doctors, especially among those who worked in the most affected regions, where a level of psychological distress of 93.8% and poor well-being of 58.9% were registered. These percentages were even higher in the case of female hospital workers with low job seniority, and those caring for COVID-19 patients.

CONCLUSIONS

Our findings reported a significant psychosocial impact of the COVID-19 outbreak on Italian doctors, particularly among those working in the most affected regions of the country. Further studies are necessary to better understand the effects of the COVID-19 pandemic on doctors' well-being and mental health over time, in order to implement effective prevention measures.

Attitude of students of health professions towards a health care workers' mandatory vaccination: a multi-center cross-sectional survey

Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, therefore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (χ2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages.