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Background The recent COVID-19 epidemic is showing how the response of the scientific literature is fundamental in the first days following the onset of a new epidemic. Quantifying which studies have a greatest impact can help researchers and policymakers in controlling the epidemic. The aim of this study is to describe the early scientific production in response to the COVID-19 epidemic through a scientometric analysis. Methods The study consisted of: 1) review of the scientific literature produced in the 30 days since the first paper related to COVID-19 has been published on Pubmed; 2) Identification of papers' Digital Object Identifiers (DOI) and analysis of related metrics with the construction of a 'Computed Impact Score' (CIS) that represents a unifying score over heterogeneous bibliometric indicators. The CIS takes into account all the bibliometric indicators both traditional (i.e. counting of citations) and alternative (i.e. altmetrics). In this study we use the altmetrics provided by Plum Analytics (PlumX). All bibliometric indicators for the selected papers have been collected by using their corresponding DOIs as the key for querying Scopus API, which integrates PlumX. On top of those indicators we compute the CIS. The papers with higher CIS are discussed and presented. Results 239 papers have been included in the study. A threshold for CIS of t = 1.04 (i.e.95% quantile) allowed us to record 8 papers as potentially impactful. The 8 papers are: 6 case reports, 1 methodological study, 1 editorial. First authors come from China (n = 6), USA (n = 1) and Germany (n = 1). The main topics are: case/s description (n = 5), outbreak investigation (n = 2) and 1 genomic study. Conclusions The early response of the scientific literature during an epidemic does not follow a pre-established pattern. Tracing the traditional and non-traditional metrics measures of papers can help to understand and evaluate the impact of literature on the scientific community and general population. Key messages The dynamic of the scientific community represents an important aspect of the early response to the onset of a new epidemic, which must be studied also to increase systems’ preparedness. In a connected digital world, tracing metrics measures of scientific papers can identify those with the greatest impact and help professionals to correctly inform the population.

Background Crowdfunding (CF) is the practice of financing a project by raising money from a large number of people. Many patients use online CF platforms to fund medical needs, whether unmet by their healthcare service - therefore to be sought elsewhere -, or when unable to afford them. CAR-T (Chimeric antigen receptor T-cells) is an innovative therapy approved to treat several types of lymphoma and with potential to treat many other cancers. CAR-T is available in most countries through clinical trials only and its diffusion is limited by high costs. Gofundme is a CF platform ’leader in online medical fundraising’. The objective of this study is to shed some light on the phenomenon of CF for CAR-T therapy, describing the campaigns started on Gofundme. Methods We extracted data from CAR-T campaigns started in Europe and publicly available on Gofundme until March 2019. Data related to each campaign has been analyzed and reported through descriptive analyses. Results Since 2017, 26 CAR-T treatment campaigns have been started. Due to the privacy policy of the platform, we were able to retrieve data from only 12 of them; 3 campaigns were closed, thus not disclosing enough data to be included. Nine campaigns were studied: 4 from Italy, 4 from the UK, 1 from Spain. The United States were the main destination. The median campaign goal was 180k€. The number of campaign shares on social media and the percentage of goal raised seemed to be linked. Conclusions CF is unquestionably a good expression of the Internet: it channels empathy towards important causes, providing tangible help. However, when applied to healthcare - especially to experimental treatments -, several questions arise. Patients affected by treatment resistant cancers may be prone trying new treatments to keep the hope alive, even when indication is missing or scientific evidence is lacking. Policymakers should monitor healthcare related CF campaigns, both for equity and safety reasons. Key messages Policymaker should monitor healthcare related CF campaigns, both for equity and safety reasons. Healthcare related crowdfunding campaigns could be interpreted as an indicator of unmet medical needs.

Background. Results from the World Health Survey indicate that physical health multimorbidity is significant increased across the depression and the psychosis spectrums worldwide. However, no research evidence is available on physical multimorbidity in patients with mental health problems in Italy. We investigated physical multimorbidity and pharmacological treatments among patients being treated by Italian community mental health services and the associated risk of hospitalization over 18 months. Materials and Methods. This retrospective study is based on linkage of data retrieved from the mental health information system, the hospital discharge records database and the pharmacological prescription databases. Patients living in Emilia-Romagna, Italy and treated by mental health services as of 1/1/2015 were extracted. A total of 17 physical health conditions and 9 pharmacological treatments for the cardiovascular system and thyroid problems were assessed. The association of psychiatric diagnoses and physical multimorbidity with hospitalization was analysed using multivariable Poisson regression models. Results. The study sample includes 8615 patients (59.2% male, mean age 40.3 years). Depression (33.4%), schizophrenia (17.6%) and personality disorder (13.3%) were the most frequent psychiatric diagnoses. Physical comorbidity, i.e. the presence of at least one physical health condition, was found in 19.2% of cases, and multimorbidity (≥2 physical conditions) in 6.5%. Patients treated pharmacologically for physical conditions were 39.6%. Personality disorders, substance use disorders and physical multimorbidity were associated with an increased risk of hospitalization during the follow-up. Conclusions. Physical multimorbidity is found in 6.5% of patients with mental disorders and is associated with an increased risk of hospitalization. Given that physical health multimorbidity can increase the mortality risk, early interventions to reduce it in mental healthcare are warranted.

BACKGROUND: Infant mortality rate (IMR) is used as a population health indicator. We provide an updated description of temporal and geographical trends of IMR in Italy. METHODS: Regional data on infant deaths and live births were available for France, Germany, England, Portugal (1999-2000), and Italy (1990-2001). Mortality rates including 95% CIs and time-trends were computed. RESULTS: IMR was 4.5 per 1000 live births in 1999-2001. Between 1999-2001 and 1990-1992 both neonatal and post-neonatal mortality rates declined (P < 0.05) but not the North/South ratio. In 1999-2000 the regional variability in IMR was higher in Italy than in other European countries. CONCLUSION: Despite progresses in reducing IMR, geographical disparities persist within Italy.