Search

Background: COVID‐19 overwhelmed all healthcare workers, especially nurses, who worked tirelessly in patient care in extremely stressful situations. Italy, with its hospital overcrowding and staff shortages, exacerbated these negative consequences. Design: A three‐wave prospective longitudinal‐design was adopted to use validated scales to examine the trend of stress, anxiety, depression and resilience on the professional quality of life of nurses who worked during the pandemic. During an 8‐month period, a sample of 411 individuals was recruited and surveyed three times. Results: Resilience showed an increasing positive trend from the first to the third wave, increasing its effects on the outcomes and demonstrating its important protective role. The compassion fatigue showed progressively higher scores in the three waves, indicating greater workload perception and greater difficulty in managing the patients' perceived stress. Burnout increased in the first compared to second waves but decreased significantly in the third wave, due to the effect of resilience on burnout that was significantly stronger in the third wave. Conclusion: Our findings align with the literature about the role of resilience and emphasize the importance of investing in strategies aimed at developing resilience in healthcare workers and providing prevention and assistance to them in terms of job demands and unsustainable stressors. Summary statement What is already known about this topic? Studies have shown that healthcare workers, and in particular frontline workers, are more prone to burnout, psycho‐physical disorders (insomnia, fatigue, irritability) and cognitive disorders (difficulty in concentrating) than other professions and healthcare workers in other units.In contrast, potential protective factors were found to be compassion satisfaction, resilience and psychological capital, indicating that high levels of these constructs can keep healthcare workers strong and stable.The persistence of the pandemic and emergency situation exacerbated these negative effects, maintaining high levels of pressure and forcing healthcare workers to face additional challenges. What this paper adds: (research findings/key new information) This study found that the psychological stress of health workers increased as the pandemic increased, especially in those who had to work on the front line.Even under conditions of high stress and risk, the effect of resilience over time results in a noticeable and significant reduction in anxiety, which translates into better management of the situation and an enhanced ability of nurses to cope, considering the challenges faced during the experience The implications of this paper: Knowing how the health of our healthcare workers evolves, knowing the factors that influence them psychologically is useful and essential to creating mental health strategies, which should be timely, flexible and holistic to protect our healthcare workers.Implementation of psychological support is recommended for these workers, but above all a series of timely interventions to assist and support them. Evidence to support this derives from the effect of resilience on the professional quality of life of these workers. [ABSTRACT FROM AUTHOR]

Background: The global pandemic raised ethical issues for nurses about caring for all patients, not just those with COVID-19. Italy was the first European country to be seriously affected by the first wave, while Estonia's infection and death rates were among the lowest in Europe. Did this raise different ethical issues for nurses in these two countries as well? Aim: The aim was to describe and compare ethical issues between nurses working during the first wave of the COVID-19 pandemic in Estonia and Italy. Research design: A cross-sectional survey study with a self-administered questionnaire. The impact of COVID- 19 emergency on nursing care questionnaire was used. Participants and research context: Convenience sampling was used to recruit 1098 nurses working during the first wave of the pandemic in 2020: 162 from Estonia and 936 from Italy. Ethical considerations: Research ethics approvals were obtained, and the nurses provided informed consent. Results: The most frequent ethical issues for Estonian nurses were professional communication and ensuring access to care for patients without COVID-19, and for Italian nurses, the end-of-life care and the risk of them getting the virus and transmitting it to their loved ones. There were no statistically significant differences in the frequency of ethical issues between Estonian nurses working with patients with and without COVID-19. Italian nurses caring for COVID-19 patients faced statistically significantly more (both p <.001) issues around prioritising patients and end-of-life. Nurses working with patients without COVID-19 in Italy faced more issues about access to care (p <.001). Conclusions: Estonian and Italian nurses, working in different clinical contexts during the first wave of the pandemic, faced different ethical issues. Local contextual aspects need to be considered to support nurses' ethical decision-making in providing care during future crises and to ensure ethical care for patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the interest in online and in‐person psychological support services in Italy during the COVID‐19 pandemic, stimulated by the implementation of the government‐issued 'bonus psicologo' for psychotherapy sessions. Methods and Measures: Public interest was measured using data from Google Trends, a resource that offers open access to actual search requests, within the time frame of 2 July 2017 to 13 November 2022. These data were stratified for Italian regions to explore regional differences. We conducted interrupted time series analyses to assess changes in interest before, during and after the lockdown. Results: Results indicated a significant increase in interest in online psychological support during the lockdown, which was sustained over time and was positively correlated with the implementation of the 'bonus psicologo' (p <.001). Interest in in‐person support decreased during the lockdown but began to rise post‐lockdown (p =.028), with no notable impact from the economic incentive. High interest in online support continued in certain regions even 1 year post‐lockdown, warranting further analysis. Conclusion: The study underscores a heightened post‐pandemic interest in psychological support, both online and in person, in comparison with pre‐pandemic levels. Google Trends emerges as a valuable tool for monitoring public interest during specific events, though the findings must be interpreted with care, given the study's time frame and reliance on relative search volume as a measure. Future research is needed to validate these findings and to compare them against epidemiological data. [ABSTRACT FROM AUTHOR]

Critically ill COVID-19 patients may exhibit various clinical symptoms of renal dysfunction including severe Acute Kidney Injury (AKI). Currently, there is a lack of bibliometric analyses on COVID-19-related AKI. The aim of this study is to provide an overview of the current research status and hot topics regarding COVID-19 AKI. The literature was retrieved from the Web of Science Core Collection (WoSCC) database. Subsequently, we utilized Microsoft Excel, VOSviewer, Citespace, and Pajek software to revealed the current research status, emerging topics, and developmental trends pertaining to COVID-19 AKI. This study encompassed a total of 1507 studies on COVID-19 AKI. The United States, China, and Italy emerged as the leading three countries in terms of publication numbers, contributing 498 (33.05%), 229 (15.20%), and 140 (9.29%) studies, respectively. The three most active and influential institutions include Huazhong University of Science and Technology, Wuhan University and Harvard Medical School. Ronco C from Italy, holds the record for the highest number of publications, with a total of 15 papers authored. Cheng YC's work from China has garnered the highest number of citations, totaling 470 citations. The co-occurrence analysis of author keywords reveals that 'mortality', 'intensive care units', 'chronic kidney disease', 'nephrology', 'renal transplantation', 'acute respiratory distress syndrome', and 'risk factors' emerge as the primary areas of focus within the realm of COVID-19 AKI. In summary, this study analyzes the research trends in the field of COVID-19 AKI, providing a reference for further exploration and research on COVID-19 AKI mechanisms and treatment. [ABSTRACT FROM AUTHOR]

Vaccination is a crucial tool for the primary prevention of infectious diseases. Thanks to the widespread of vaccinations it has been possible to eradicate very serious diseases. Unfortunately, vaccination coverage in Italy has been decreasing starting from 2015, getting worse during COVID-19. Nowadays, very few Italian regions have achieved the goal of 95% coverage. In this study we present a vaccination recovery model proposed by Local Health Department "Napoli 3 Sud" in Campania. An evaluation of the vaccination coverage from January 2019 to December 2021 of the 13 Districts of the Local Health Department "Napoli 3 Sud" in Campania was carried out, by extraction from the regional computerized platform "GE.VA" Regional Vaccine Registry and from Sinfonia Vaccini Soresa platform. Vaccination coverage of the Local Health Department "Napoli 3 Sud" for the cohorts of newborns in the year 2019–2021 improved to an average of 96.29% for Pneumococco, of 84.78% for Meningococcal, of 94.3% for Measles, Mumps and Rubella, 91.4% for chickenpox. This study highlights how the collaboration between family pediatricians and the Local Health Department, with the help of a regional computerized platform GE.VA, is effective in improving vaccination coverage. [ABSTRACT FROM AUTHOR]

Tele-support in breastfeeding can be defined as any support provided by a service that connects health workers and/or lactation consultants with breastfeeding parents through video visits, although a telephone contact with the breastfeeding mother remains the first method of remote breastfeeding support. The tele-support in breastfeeding has increased significantly during the SARS-CoV2 pandemic worldwide and, given its effectiveness, may be maintained also after the pandemic. The Italian Society of Neonatology on the basis of: 1) two focus group studies on the tele-support in breastfeeding conducted in Italy with 11 Neonatal Intensive Care Unit nurses and 10 neonatologists, respectively, 2) a national survey on tele-support in breastfeeding addressing the Italian Neonatal Intensive Care Units, and 3) a review of the available experiences and literature, has provided a Position Statement, limitedly to the individual tele-support in breastfeeding. The Italian Society of Neonatology states that: 1) the tele-support in breastfeeding can be used when a consultation in person is not shortly available and may allow to select those situations that require an in-person visit; 2) the organization of a tele-support in breastfeeding session requires the use of a competent, dedicated healthcare staff (specifically trained and/or with adequate experience) and an appropriate methodology while preparing, running and concluding the support session. According to Italian Society of Neonatology the tele-support in breastfeeding may be an effective intervention to promote breastfeeding as a complementary method to the in-person assistance and should be possibly provided in an integrated manner by the Community Health Services and the Maternity Hospital. [ABSTRACT FROM AUTHOR]

BACKGROUND. Recent studies conducted in individuals who survived COVID-19 suggest that SARS-CoV-2 infection is associated with an increased risk of dyslipidemia. However, it remains unclear whether this augmented risk is confirmed in the general population and how this phenomenon is affecting the overall burden of cardiometabolic diseases. METHODS. To address these aspects, we conducted a 6-year longitudinal study to examine the broader effects of COVID-19 on dyslipidemia incidence in a real-world population (228,266 individuals) residing in Naples in southern Italy. The pre-COVID-19 and COVID-19 groups were balanced for demographic and clinical factors using propensity score matching. RESULTS. Our analysis spans a period of 3 years during the COVID-19 pandemic (2020-2022), comparing dyslipidemia incidence with pre-pandemic data (2017-2019), with a follow-up of at least 1,095 days corresponding to 21,349,215 person- years. During the COVID-19 period, we detected an increased risk of developing any dyslipidemia when compared with the pre-COVID-19 triennium (OR = 1.29; 95% CI, 1.19-1.39). Importantly, these estimates were adjusted for comorbidities by a multivariate analysis. CONCLUSIONS. Taken together, our data reveal a notable rise in dyslipidemia incidence during the COVID-19 pandemic, suggesting the utility of establishing specialized clinical monitoring protocols for patients who survive COVID-19 to mitigate the risk of developing dyslipidemia. [ABSTRACT FROM AUTHOR]

Aim: To evaluate midwives' level of stress and burnout during the COVID‐19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. Design: A mixed‐methods study was undertaken from July to December 2022. Methods: Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open‐ended responses, that were merged with quantitative data following a convergent mixed‐methods approach. Results: A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Conclusion: Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Impact: Studies conducted during the first COVID‐19 pandemic wave showed an increased level of stress, anxiety, burnout, post‐traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high‐quality woman‐centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long‐term psychological effects of COVID‐19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. Reporting Method: During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking. [ABSTRACT FROM AUTHOR]

Although studies have highlighted the role played by couple and parental relationships for children's psychosocial adjustment, especially in challenging situations, research on these two relationship domains has largely developed separately and mostly focussed on negative couple processes. However, Family Systems Theory highlights how these subsystems are interconnected, and studies inspired by this theoretical framework provide evidence of how the quality of the interparental relationship predicts the parent–child relationship. This study focussed on the association between two relational resources (dyadic coping and parent–child relationship quality) and children's emotional difficulties during the outbreak of the COVID‐19 pandemic in Italy. Five hundred ninety‐one Italian parents filled in an online self‐report questionnaire. A path analysis model was estimated to test the mediating role of parent–child relationship quality in the association between partner positive dyadic coping and children's emotional difficulties. The findings showed both a direct effect and an indirect effect of partner positive dyadic coping on children's emotional difficulties, because parent–child relationship quality partially mediated this association. Enhancing parents' ability to cope together with stress and the quality of the parent–child relationship might contribute to decrease children's vulnerability to emotional difficulties in challenging times. [ABSTRACT FROM AUTHOR]

Background/Objectives: Mental disorders in nursing students, although very common under normal circumstances, have worsened over time due to the COVID-19 pandemic. This study aimed to assess (1) what the prevalence of anxiety and depression symptoms in Italian nursing students was and (2) what factors were associated with them. Methods: In May 2023, a cross-sectional study was conducted on the bachelor's degree Nursing course in an Italian university. Levels of anxiety and stress were assessed using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), respectively. In addition, socio-demographic variables and data on mental health, drug intake, and substance use were collected. Multiple binary logistic regression adjusted analyses were used to identify predictive factors. Results: A total of 148 nursing students completed the questionnaire. A total of 9.5% reported a previous diagnosis of a mental disorder, and, of these, 35.7% reported that it was diagnosed after the start of the COVID-19 pandemic. The mean GAD-7 and PHQ-9 score was 9.68 (SD = 5.2) and 8.37 (SD = 5.6), respectively. Protective factors for depressive symptoms included not having a previous diagnosis of a mental disorder (adjusted odds ratio = 0.10, 95% CI: 0.002–0.47, p < 0.001) and a perceived high (adjusted odds ratio = 0.03, 95% CI: 0.003–0.22 p < 0.001) or medium (adjusted odds ratio = 0.14, 95% CI: 0.03–0.82, p < 0.05) socioeconomic level, while the predictor of anxiety symptoms was returning home once a month for students studying away from their residence (adjusted odds ratio = 6.4, 95% CI: 1.01–40.8, p < 0.05). Conclusions: Urgent investments are needed in universities to implement mental health promotion programmes and to offer counselling services to reduce and prevent mental health problems among students. [ABSTRACT FROM AUTHOR]

Background/Objectives. Problematic Internet uUse (PIU) is a multifaceted syndrome characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding Internet use leading to significant impairments in daily life and mental health. Previous research has separately related PIU to loneliness and dissociation, both in adults and adolescents. The aim of the present study is to analyze the mutual relationship between PIU, loneliness, and dissociation in an adolescent sample, in particular evaluating the indirect effect of dissociation on the relationship between loneliness and PIU. Methods. A cross-sectional design was used with 243 Italian high school students (69.1% females), from year 9 to 13 (age: M = 17.1, SD = 1.4 years), who participated in the study from January to June 2020. They completed measures of PIU (Generalized Problematic Internet Use Scale-2), loneliness (UCLA Loneliness Scale), and dissociation (Adolescent Dissociative Experiences Scale). Socio-demographic and contextual variables were also collected (i.e., age, gender, type of school, school year, sport practice, hobby engagement, assessment before/during the COVID-19 pandemic). Data were analyzed using regression, Pearson's correlation, and mediation analysis. Results. Severe PIU was observed in 8.6% of the sample. None of the socio-demographic and contextual variables had a significant effect on PIU. Positive medium-sized correlations were observed between PIU, loneliness, and dissociation. Mediation analyses showed an indirect effect of loneliness on PIU through dissociation. Conclusions. Feelings of loneliness may significantly exacerbate adolescents' PIU by increasing their dissociative tendency. Understanding this dynamic is crucial for developing targeted interventions to address both loneliness and dissociation in efforts to mitigate PIU among adolescents. [ABSTRACT FROM AUTHOR]

Background: Supportive Care is a person-centred approach encompassing non-pharmacological interventions targeted towards persons with dementia to contain the effects of their behavioural disorders, improving their quality of life. Aims: To investigate the effects of lockdown restrictions during the first wave of COVID-19 pandemic on behavioural symptoms of patients involved in a Supportive Care programme in an Italian nursing home. Methods: Analysis is based on Neuropsychiatric Inventory (NPI) scores and related symptoms data collected before (October/November 2019) and after (July 2020) the introduction of COVID-19 restrictions on a non-random sample of 75 patients living in two units of the facility: 38 involved in a Supportive Care programme and 37 receiving standard care (Control). Group performances were compared over time according to univariate statistics and Latent Class Analysis (LCA). Results: NPI scores and number of reported symptoms in NPI evaluations increased over time among Supportive Care patients with dementia and decreased in the Control group. Differences are statistically significant. LCA resulted in 3-classes and 5-classes specifications in the two time-occasions. Discussion: Supportive Care patients showed a worsening in behavioural and psychological symptoms after the first pandemic wave, as opposed to the elderly not involved in the programme. LCA showed that patients in the two groups differed according to the combinations of NPI symptoms. Conclusions: The discontinuation of a Supportive Care programme due to COVID-19 restrictions had strong negative effects on nursing home persons with dementia involved in the programme: Supportive Care interventions are important in controlling the psycho-behavioural symptoms associated with dementia. [ABSTRACT FROM AUTHOR]

Italy was the first Western country to be severely affected by the COVID-19 pandemic. Within it, immigrants have played an important role as essential workers and throughout solidarity initiatives. The present article is based on 64 in-depth interviews with immigrants who engaged in solidarity actions directed toward the immigrant population and the host society during the COVID-19 pandemic. Analytically, it emerged that through solidaristic initiatives, immigrants articulated what we called 'claims of recognition.' Recognition here is considered in both its individual form, as interpersonal acceptance and esteem for single immigrants, and its collective form, as the social regard of immigrant groups as constituents of Italian society. Despite being perhaps 'elementary,' these claims aim to fight forms of both non-recognition and mis-recognition that are pervasive in Italy and aim to transform the symbolic 'fabric' of this country. [ABSTRACT FROM AUTHOR]

This article explores the long-term impact of the COVID-19 pandemic on everyday life through a qualitative research study focusing on the role of age in managing uncertainty. Grounded in a cultural and symbolic perspective on risk, the study examines how rituals, emotions, and cultural contexts shaped the experiences of individuals aged 15–34 in Milan, Italy, as they navigated daily risks. Drawing on 42 semi-structured interviews conducted between September 2022 and May 2023, the findings reveal that age significantly influenced how young people navigated post-pandemic uncertainties. The youngest participants often felt fear and anxiety, mainly due to concerns for others' well-being, coupled with a strong need for social interaction and community. In contrast, slightly older young professionals showed a more complex emotional response characterised by caution, frustration, and empathy. Across all age groups in the sample, daily routines and social interactions kept reinforcing societal norms and hierarchies, particularly concerning generations and family dynamics within Italian culture, with a specific emphasis on vulnerable populations, namely older adults. These findings highlight the importance of considering both life stage and cultural context when analysing responses to uncertainty. Still, they underscore young people's adaptability as both a reactive process and a forward-looking one involving agency. This flexibility was particularly evident in the context of the COVID-19 pandemic in the Lombardy region of Italy, where the virus spread earlier and with more severe consequences than in most parts of the Western world. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the psychological impact of COVID‐19 on burning mouth syndrome (BMS) patients. It focuses on comparing post‐traumatic stress symptoms (PTSS), post‐traumatic growth (PTG), and resilience between BMS patients and Controls. Methods: A total of 100 BMS patients and 100 Controls from five Italian centers participated in this observational cross‐sectional study. They completed several assessments, including the General Health Questionnaire, Depression Anxiety and Stress Scale, Insomnia Severity Index, National Stressful Events Survey Short Scale, Impact of Event Scale‐Revised, Post Traumatic Growth Inventory Short Form, and Connor‐Davidson Resilience Scale. Results: BMS patients had significantly higher stress, anxiety, and depression (DASS‐21 score) and post‐traumatic stress symptoms (IES‐R‐6 score), particularly in terms of intrusive thoughts. They showed lower post‐traumatic growth (PTGI‐SF score) compared to Controls. The resilience scale (CDRS‐10) was a key predictor of PTG in both groups, explaining a significant variance in PTGI‐SF scores. Conclusions: BMS patients experienced heightened post‐traumatic stress, stress, anxiety, and depression during the COVID‐19 pandemic, with reduced post‐traumatic growth. This highlights the need to prioritize their psychological well‐being, focusing on stress management and fostering post‐traumatic growth in challenging times. [ABSTRACT FROM AUTHOR]

Background/Objectives: The main outcomes of the COVID-19 pandemic can be used to assess the capability and sustainability of public healthcare and Long-Term Care (LTC) systems. This study aims to identify the population's demographic and socio-economic characteristics, as well as other national resources associated with the incidence and mortality of COVID-19, by comparing three European countries during the first pandemic period (Italy, Spain, and Germany). The results will identify possible strengths and weaknesses that could be considered as hints of the need for health and social intervention. Methods: Variables describing the countries' core demographics, socio-economic characteristics, and national resources were collected from 2001–2021 from well-established international databases. COVID-19 incidence and death figures from 1 March 2020 to 31 March 2021 were extracted from national health databases. Analysis focused on bivariate and weighted multivariable linear regressions between incidence, mortality, and socio-economic covariates. Results: Findings show that both care models and socio-demographic characteristics influenced the capability of the first year's response to the COVID-19 emergency. Formal public care appears to represent the most effective strategy against incidence and mortality regarding COVID-19, especially for older people, because it mitigates the adverse effects of socio-economic characteristics. Conclusions: Current strategies oriented towards privatizing care should, therefore, be considered critically, since they may result in weaker protection of vulnerable groups, such as frail older people, due to the unequal position of individuals with different socio-economic conditions in purchasing services from the care market. [ABSTRACT FROM AUTHOR]

Background: Despite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated. Methods: In June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023. Results: Among 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis. Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. Conclusions: We reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool. In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had an unparalleled impact, precipitating not only direct threats to physical health but also widespread economic and psychological challenges. This study aims to explore the dynamics of coping behaviour and psychological distress (PD) across different phases of the pandemic within an adult general population sample, spanning Austria and Italy. Methods: An online questionnaire-based panel study was conducted between 2020 and 2023 including three measurements. We collected data on sociodemographic variables, coping responses (Brief COPE), and PD (Brief-Symptom-Checklist). Statistical analyses were conducted within a linear-mixed-model framework. Multiple imputation and sensitivity analysis were applied to validate the results obtained by complete case analysis. Results: The study follows 824 participants and reveals a marginal decrease in overall PD from the first to the second follow-up, particularly in clinically relevant phobic anxiety (35.6% and 34.5% to 25.4%). Most coping behaviours exhibited stable mean-levels with intra-individual variability across the study period. Maladaptive coping strategies were consistently linked to increased PD, whereas adaptive strategies were associated with decreased PD. Conclusion: Our findings underscore the complex nature of coping behaviours and PD during and after the pandemic, suggesting that while mean-levels of PD and coping responses remained relatively stable, most coping strategies were subject to intra-individual change. Maladaptive strategies were associated with increased PD, pinpointing to the need for interventions that establish the foundation for adaptive coping mechanisms and promote their application. Further research should explore the reciprocal influences of mental health on coping behaviour, incorporating interventional designs to unravel the nuances of these relationships. [ABSTRACT FROM AUTHOR]

Background: Group B Streptococcus (GBS) is a major cause of sepsis and meningitis in newborns. The Centers for Disease Control and Prevention (CDC) recommends to pregnant women, between 35 and 37 weeks of gestation, universal vaginal-rectal screening for GBS colonization, aimed at intrapartum antibiotic prophylaxis (IAP). The latter is the only currently available and highly effective method against early onset GBS neonatal infections. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the preventive measures implemented to mitigate the effects of SARS-CoV-2 infection led to the reduction in the access to many health facilities and services, including the obstetric and perinatal ones. The purpose of the present study was to evaluate the prevalence of maternal GBS colonization, as well as use of IAP and incidence of episodes of neonatal GBS infection when antibiotic prophylaxis has not been carried out in colonized and/or at risk subjects, in a population of pregnant women during (years 2020–2021) and after (year 2022) the COVID-19 pandemic, also with the aim to establish possible epidemiological and clinical differences in the two subjects' groups. Methods: We retrospectively analyzed the clinical data of pregnant women admitted to, and delivering, at the Gynaecology and Obstetrics Unit, Department of Sciences for Health Promotion and Mother and Child Care, of the University Hospital of Palermo, Italy, from 01.01.2020 to 31.12.2022. For each of them, we recorded pertinent socio-demographic information, clinical data related to pregnancy, delivery and peripartum, and specifically execution and status of vaginal and rectal swab test for GBS detection, along with eventual administration and modality of IAP. The neonatal outcome was investigated in all cases at risk (positive maternal swabs status for GBS, either vaginal or rectal, with or without/incomplete IAP, preterm labor and/or delivery, premature rupture of membranes ≥ 18 h, previous pregnancy ended with neonatal early onset GBS disease [EOD], urine culture positive for GBS in any trimester of current gestation, intrapartum temperature ≥ 38 °C and/or any clinical/laboratory signs of suspected chorioamnionitis). The data concerning mothers and neonates at risk, observed during the pandemic (years 2020–2021), were compared with those of both subjects' groups with overlapping risk factors recorded in the following period (year 2022). The chi squared test has been applied in order to find out the relationship between pregnant women with GBS colonization receiving IAP and outcome of their neonates. Results: The total source population of the study consisted of 2109 pregnant women, in addition to their 2144 newborns. Our analysis, however, focused on women and neonates with risk factors. The vaginal-rectal swab for GBS was performed in 1559 (73.92%) individuals. The test resulted positive in 178 cases overall (11.42% of those undergoing the screening). Amongst our whole sample of 2109 subjects, 298 women had an indication for IAP (vaginal and/or rectal GBS colonization, previous pregnancy ended with neonatal GBS EOD, urine culture positive for GBS in any trimester of current gestation, and unknown GBS status at labor onset with at least any among delivery at < 37 weeks' gestation, amniotic membranes rupture ≥ 18 h and/or intrapartum temperature ≥ 38.0 °C), and 64 (21.48%) received adequate treatment; for 23 (7.72%) it was inadequate/incomplete, while 211 (70.8%) did not receive IAP despite maternal GBS colonization and/or the presence of any of the above mentioned risk factors. Comparing the frequency of performing vaginal-rectal swabs in the women admitted in the two time periods, the quote of those screened out of the total in the pandemic period (years 2020–2021) was higher than that of those undergoing GBS screening out of the total admitted in the year 2022 (75.65% vs. 70.38%, p = 0.009), while a greater number (not statistically significant, p = 0.12) of adequate and complete IAP was conducted in 2022, than in the previous biennium (26.36 vs. 18.62%). During the whole 3 years study period, as expected, none of the newborns of mothers with GBS colonization and/or risk factors receiving IAP developed EOD. Conversely, 13 neonates with EOD, out of 179 (7.3%) born to mothers with risk factors, were observed: 3 among these patients' mothers performed incomplete IAP, while the other 10 did not receive IAP. Neither cases of neonatal meningitis, nor deaths were observed. The incidence rate in the full triennium under investigation, estimated as the ratio between the number of babies developing the disease out of the total of 2144 newborns, was 6.06‰; among those born to mothers with risk factors, if comparing the two time periods, the incidence was 8.06% in the pandemic biennium, while 5.45% in the following year, evidencing thus no statistical significance (p = 0.53). Conclusions: The present study revealed in our Department an increased prevalence of pregnant women screened for, and colonized by GBS, in the last decade. However, an overall still low frequency of vaginal-rectal swabs performed for GBS, and low number of adequate and complete IAP despite the presence of risk factors have been found, which did not notably change during the two time periods. Moreover, significant EOD incidence rates have been reported among children of mothers carrying risk factors, although also in this case no statistically significant differences have been observed during and after the pandemic. Such data seem to be in contrast to those reported during the COVID-19, showing a decrease in the access to health facilities and increased mortality/morbidity rates also due to the restrictive measures adopted to mitigate the effects of the pandemic. These findings might be explained by the presence within the same metropolitan area of our Department of a COVID hospital and birthing center, which all the patients with SARS-CoV-2 infection referred to, and likely leading to a weaker concern of getting sick perceived by our patients. Although IAP is an easy procedure to implement, however adherence and uniformity in the management protocols are still not optimal. Therefore, the prophylactic measures adopted to date cannot be considered fully satisfactory, and should be improved. Better skills integration and obstetrical-neonatological collaboration, in addition to new effective preventive tools, like vaccines able to prevent invasive disease, may allow further reduction in morbidity and mortality rates related to GBS perinatal infection. [ABSTRACT FROM AUTHOR]

Simple Summary: Screening for breast, colorectal, and cervical cancer is correlated with diagnosis at an earlier stage, less extensive surgery, and reduced mortality and fewer complications. Adherence rates to cancer screening are lower for individuals with low socio-economic conditions and educational attainment. These social disparities are only partially reduced by free screening through national initiatives. Education and information and appropriate expenditure for preventive care have the potentials to increase adherence to screening for colorectal, breast, and cervical cancer with the possibility of reduced cancer mortality. The findings of our study highlight the importance of the implementation of nationally organized screening programs for several other types of cancers that are often detected after the occurrence of symptoms. Nationally organized screening programs for several types of cancers, like esophageal, gastric, and pancreatic cancer, in regions with a high prevalence may increase the possibility of diagnosis at earlier stages and improved early and late results. The objective of this study was to determine the correlation between adherence to cancer screening programs and earlier diagnosis of the 14 most common types of cancers in the adult population, before and during the COVID-19 pandemic. National data concerning number of admissions and operations in Italy for adult patients admitted with oncologic problems during the COVID-19 pandemic (2020 to 2022) and in the pre-pandemic period (2015 to 2019) were analyzed. We selected 14 types of cancer that present the most common indications for surgery in Italy. This study included 1,365,000 adult patients who had surgery for the 14 most common types of cancer in the period 2015–2022, and interviews concerning adherence rates to screening for breast, colorectal, and cervical cancer were conducted for 133,455 individuals. A higher decrease in the number of operations for the 14 types of cancer (−45%) was registered during the first three acute phases of the pandemic, and it was more evident for screenable cancers like breast, colorectal, and cervical cancer (p < 0.001). During the first year of the COVID-19 pandemic, the number of screened individuals for breast, colorectal, and cervical cancer decreased by 33.8% (from 7,507,893 to 4,969,000) and the number of diagnoses and operations for these three types of cancer decreased by 10.5% (from 107,656 to 96,405). The increase and return to normality of the number of screened individuals in the last year of the pandemic (2022) and in the first post-pandemic year (2023) was associated with a return to the pre-pandemic levels of diagnoses and operations. The adherence rates were lower for individuals living in rural areas, with low socio-economic status, and unmarried persons; however, the most statistically significant factor for reduced adherence was a lower level of educational attainment. Free screening through nationally organized programs reduced social disparities. There were no significant differences between the pre-pandemic and pandemic periods for several types of cancers (stomach, esophagus, pancreas, liver) that are diagnosed for the occurrence of symptoms and for which nationally organized programs might increase the possibility of earlier diagnosis and improved clinical outcomes. Education, information, and appropriate expenditure for preventive care have the potential to reduce cancer mortality. Nationally organized screening programs for several types of cancers, which are often detected for the occurrence of symptoms, may increase the possibility of diagnosis at earlier stages. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of COVID‐19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. Material and Methods: This was a cross‐sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro‐areas were used for subgroup analysis. Results: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self‐reported COVID‐19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. Conclusion: The self‐reported COVID‐19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample. [ABSTRACT FROM AUTHOR]

During the Covid‐19 pandemic new stressors were added to the usual challenges parents face, changing habits and reduced physical activity, all factors that negatively affect sleep quality in adults and children. This study examines (1) possible changes in the sleep‐wake patterns of parents and children before and after the March–May 2020 lockdown and during the new restrictions imposed by the Italian government in March 2021; (2) possible associations between children and parents' sleep quality reported by parents and intrinsic and extrinsic factors. A total of 264 Italian parents with children aged 1–6 years (M = 40 months, SD = 18.18) completed self‐report questionnaires. Children's sleep habits changed, and parental insomnia symptoms worsened after the March–May 2020 lockdown, while children's insomnia symptoms decreased. Positive associations between children's negative affectivity and insomnia symptoms emerged, as well as between generalized parental anxiety and parental insomnia symptoms and between parental fear of Covid‐19 and sleep‐related habits not in line with paediatric recommendations. Partner's involvement in children's care promoted good sleep habits. Results identified risks and protective factors that could impact Italian parents' and children's sleep during the second wave of the Covid‐19 pandemic, raising awareness among families, education practitioners, healthcare providers and the general public. Highlights: Italian children's sleep habits changed, and parental insomnia symptoms worsened after the March–May 2020 lockdown, while children's insomnia symptoms decreased.During the second wave of the Covid‐19 pandemic, higher levels of children's temperamental negative affectivity were associated with higher levels of parental and children's insomnia, higher levels of parental anxiety, and the presence of children's sleep‐related habits not in line with pediatric recommendations.Partner's involvement in children's care promoted good and healthy children's sleep habits. [ABSTRACT FROM AUTHOR]

Aim: Long-term-care facility residents are a vulnerable population who experienced reduced healthcare access during the pandemic. This study aimed to assess the indirect impact of the COVID-19 pandemic, in terms of hospitalisation and mortality rates, among this population in two Italian Regions, Tuscany and Apulia, during 2020 in comparison with the pre-pandemic period. Subject and methods: We conducted a retrospective cohort study on people residing in long-term-care facilities from 1 January 2018 to 31 December 2020 (baseline period: 1 January 2018–8 March 2020; pandemic period: and 9 March–31 December 2020). Hospitalisation rates were stratified by sex and major disease groups. Standardised weekly rates were estimated with a Poisson regression model. Only for Tuscany, mortality risk at 30 days after hospitalisation was calculated with the Kaplan–Meier estimator. Mortality risk ratios were calculated using Cox proportional regression models. Results: Nineteen thousand two hundred and fifty individuals spent at least 7 days in a long-term-care facility during the study period. The overall mean non-Covid hospital admission rate per 100 000 residents/week was 144.1 and 116.2 during the baseline and pandemic periods, with a decrease to 99.7 and 77.3 during the first (March–May) and second lockdown (November–December). Hospitalisation rates decreased for all major disease groups. Thirty-day mortality risk ratios for non-Covid conditions increased during the pandemic period (1.2, 1.1 to 1.4) compared with baseline. Conclusion: The pandemic resulted in worse non-COVID-related health outcomes for long-term-care facilities' residents. There is a need to prioritise these facilities in national pandemic preparedness plans and to ensure their full integration in national surveillance systems. [ABSTRACT FROM AUTHOR]

Post COVID-19 Condition (PCC) is a clinical syndrome following COVID-19 disease. PCC symptoms in adults entail significant productivity loss and reduced quality of life. This study aimed at estimating the epidemiological and economic burden of PCC among the working-age population of Italy and the US. This ecological analysis was conducted on data from January 2020 to April 2023, regarding population aged 18–64. PCC incidence for the US was retrieved from publicly reported estimates, while for Italy it was estimated from COVID-19 cases. Prevalence of factors associated with PCC and parameters to calculate temporary productivity losses (TPL) were retrieved. An estimated incidence rate ratio (eIRR) of PCC incidence in Italy and the US was calculated. TPL for reduced earnings and total quality-adjusted life years (QALYs) lost were also estimated. The ecological eIRR Italy/US was 0.842 [95%CI 0.672–1.015], suggesting that, holding COVID-19 cases constant, 15.8% fewer PCC cases have occurred in Italy compared to the US. Overall PCC cases were found to be 12.0 [95%CI 9.9–14.1] million in the US, with 1.9 [95%CI 1.6–2.3] million QALYs lost, and 2.4 [95%CI 1.8–3.0] million in Italy, with 0.4 [95%CI 0.3–0.5] million QALYs lost. Up to April 2023, the TPL was estimated to be Int$7.5 [95%CI 5.8–10.1] billion in Italy and $41.5 [95%CI 34.3–48.7] billion in the US. PCC has had a significant epidemiological and economic impact on the working-age population. The findings from this study may be of use for health planning and policy regarding PCC in working-age adults. [ABSTRACT FROM AUTHOR]

Effective risk communication is crucial for enhancing societal resilience. It's not just about scientific strategies; it's also about ensuring that communities are informed and prepared. Educating local populations, especially younger generations, is key to improving disaster readiness. Notably, engaging younger generations assumes significance, given their role as both the future of society and conduits for educating their families. Serious Games, specifically Escape Rooms, present a compelling tool for engaging and interacting with young people. These games, designed not primarily for entertainment but for educational purposes, facilitate active participant involvement, thereby enhancing learning. In our didactic approach, comprising a frontal lesson and an Escape Room, we sought to leverage the appeal of Serious Games to educate young people. This approach was particularly timely during the COVID-19 pandemic, where virtual experiences gained positive evaluations despite the inherent challenges. Italy frequently faces large magnitude earthquakes. Yet many Italians, especially young people, have low seismic risk awareness, hindering preparedness efforts. To address this issue, the use of games and interactive experiences proves promising. By involving young people, seismic risk awareness can be effectively raised, fostering a culture of safety. Throughout the implementation of the Escape Room exercise dedicated to seismic risk, we conducted an evaluation phase both before and after the activities. The insights gained from this evaluation process provided valuable feedback on the learning experience and the effectiveness of the science communication technique. Notably, the virtual nature of the escape room experience was positively evaluated, demonstrating its adaptability during the pandemic. It is imperative to acknowledge that participants in these activities were aged between 15 and 18 years old, requiring ethical considerations in the design and execution of the educational intervention. The findings are highly promising, indicating that students viewed the protocol as beneficial for understanding fundamental concepts in seismology and enhancing their perception of risk. Moreover, the protocol positively influenced students' interest in science and geophysics. Furthermore, an aspect that remains unexplored is the extent to which the knowledge acquired by the participants was disseminated within their families, representing a potential area for future investigation. [ABSTRACT FROM AUTHOR]

Background: Fever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection. Methods: This was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones. Results: 442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001). Conclusions: Although the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious. [ABSTRACT FROM AUTHOR]

Global estimates of sepsis mortality are based on multiple causes of death (MCOD, any mention of the condition on death certificates); however, MCOD data are sparse and mainly referring to the pre-pandemic period. To investigate recent trends in sepsis-related mortality, associated sites of infection, and comorbidities in Veneto (Northeastern Italy). Mortality records from 2008 to 2022 were extracted, and sepsis-related mortality was assessed based both on the underlying cause of death (UCOD) and on MCOD. The average annual percent change in age-standardised rates was estimated by join point regression through the whole study period. MCOD records were investigated to retrieve infection sites and comorbidities. Sepsis was mentioned in 63,479 death certificates, growing from 4.9% out of all deaths in 2008 to 12.9% in 2022. Age-standardised mortality rates increased yearly by 8.2% (95%CI 2.1–14.7%) based on the UCOD and by 5.9% (95%CI 5.3–6.5%) based on MCOD. Sharp peaks in monthly mortality were observed in correspondence with flu epidemics, COVID-19 pandemic waves, and periods of extreme heat. The percentage of sepsis-related deaths associated to urinary tract infections, and with mention of neurodegenerative disorders and chronic kidney disease increased over time. Raised awareness of physicians, ageing of the population, spread of antimicrobial resistance further fuelled by the COVID-19 pandemic are among reasons of increasing sepsis-related mortality in Italy. Continuous monitoring of sepsis by means of MCOD data and other surveillance tools is warranted. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web‐based survey (January‐February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10‐item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID‐19 seem to be associated with sleep disturbances directly and indirectly through stress. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic may be considered a unique mass‐trauma experience. This study examined the relations between Italian late adolescents' emotion regulation strategies, their anxiety states, and their experience of the lockdown (in terms of discomfort related to restrictions, capacities to create new functional daily routines, and to find positive changes in one's own life) during the first wave of this pandemic. We analysed how participants' reports of cognitive reappraisal and expressive suppression were associated with anxiety states during the 2020 Italian COVID‐19 lockdown (large scale physical distancing and movement restrictions) and one month after the lockdown restrictions had been removed. We also examined how cognitive reappraisal, expressive suppression, and anxiety states were linked to late adolescents' experience of lockdown. The participants were 497 Italian adolescents, aged from 17 to 24 years (Mage = 21.11, SD = 1.83). A longitudinal structural equation modelling showed that emotion regulation strategies and anxiety states were not associated across time. Cognitive reappraisal was positively associated with routine reorganization and positive changes. In contrast, participants' expressive suppression was negatively related to their discomfort related to restrictions, ability to functionally reorganise their daily routine, and ability to find positive changes related to the COVID‐19 emergency. Anxiety was positively linked to discomfort related to restrictions. The findings are discussed in light of the current literature related to emotion regulation and anxiety. Limitations and implications for practice are presented. [ABSTRACT FROM AUTHOR]

Introduction: Income inequality, a pivotal determinant of general and mental health, operates through intricate mechanisms at various geographical scales. While established at country or region levels, the impact of lower-level (municipal or neighborhood) inequality remains inconsistent. This study explores the influence of regional- and municipal-level income inequality on individual psychological distress during the COVID-19 pandemic in Italy, employing a multilevel data analysis. Materials and methods: In a post hoc analysis of data from the first wave of the pandemic (March to April 2020), three hierarchical levels were considered: individual participants, municipalities, and regions. Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7 scales, while the Gini coefficient gauged income inequality at municipal and regional levels. The analysis incorporated demographic variables as potential confounders. Results: The study encompassed 21 regions, 3,900 municipalities, and 21,477 subjects. Income inequality at both regional and municipal levels exhibited associations with distress scores, suggesting independent effects. Notably, higher distress scores were identified in southern regions with elevated inequality, despite a more substantial COVID-19 impact in the north. Discussion: Findings contribute to existing literature by emphasizing the independent impact of lower-level (municipal) and higher-level (regional) income inequality on population psychopathology. The study supports theories suggesting diverse pathways through which inequality at different levels influences health, such as potential associations with healthcare system dysfunction at the regional level and welfare dysfunction at the municipal level. The observed north-south gradient in distress scores highlights the need for psychosocial interventions to alleviate income inequality, especially in historically disadvantaged southern regions. Future research should explore the nuanced interplay between income inequality and various ecological variables to provide a comprehensive understanding of its health impact. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic shock heavily affected households and prompted governments to design policies supporting household consumption. Differentiated strategies were among the most commonly adopted policies, targeting territories and economic activities with a stringency consistent with the severity of the contagion. Leveraging a unique dataset of over 1 billion household payment transactions, which captures digital and physical consumption, we provide a retrospective analysis of targeted restrictions in Italy during the fall of 2020. We show that territories implementing less stringent policies exhibit a smaller reduction in consumption and that differentiated restrictions are effective in limiting the spread of infections. Furthermore, in our analyses we account for common factors limiting household consumption choices such as disposable income, liquidity constraints and fear of contagion. Our results demonstrate the effectiveness of targeted restrictions in balancing between economic and public health objectives and call for data-driven and evidence-based policymaking during crises. • The COVID-19 pandemic represented an unexpected income shock for most households. • Heavily affected consumption habits needed government interventions to recover. • Many countries adopted differentiated interventions targeting territories or sectors. • Epidemic models show that targeted restrictions limited the spread of the virus. • Less stringent targeted policies led also to a smaller reduction in consumption. [ABSTRACT FROM AUTHOR]

Background and Aim: Pelvic inflammatory disease (PID) is usually managed by conservative treatment, but in selected cases, especially in the presence of a tubo‐ovarian abscess (TOA), surgical management is a recognized treatment option. We compared the trends in managing PID and short‐term outcomes before and during the SARS‐CoV‐2 pandemic. Methods: This is a retrospective study performed in three Italian gynecological centers. We included patients admitted to hospital with a diagnosis of PID. Demographic characteristics, management, time to diagnosis, and time to treatment were compared before versus during the SARS‐CoV‐2 pandemic. Results: One hundred nineteen PID patients were screened, eighty‐one before the SARS‐CoV‐2 pandemic, and thirty‐eight after the onset. At admission, leukocytosis (median 19.73 vs. 13.99 WBC/mm3, p‐value = 0.02) was significantly higher in patients who underwent surgery after the onset of the pandemic. TOA incidence was higher in patients who underwent surgery during the SARS‐CoV‐2 pandemic, but the difference did not reach statistically significance (p = 0.06). The proportion of patients treated with surgery dropped to 26.3% after the onset from 46% of patients before the onset of pandemic (p = 0.03). Furthermore, a higher percentage of emergency surgical procedures on day 0 of hospital admission were performed after the onset of the pandemic (50% vs. 13.1%, p = 0.01). Conclusions: In this retrospective cohort study, we found that the SARS‐CoV‐2 pandemic influenced the clinical presentation and management of PID in favor of conservative treatment. Patients who underwent surgery during the SARS‐CoV‐2 pandemic had higher inflammatory markers. [ABSTRACT FROM AUTHOR]

Due to its high short-term global warming potential (GWP) compared to carbon dioxide, methane (CH4) is a considerable agent of climate change. This research is aimed at analyzing data on methane gathered at the GAW (Global Atmosphere Watch) station of Lamezia Terme (Calabria, Southern Italy) spanning seven years of continuous measurements (2016–2022) and integrating the results with key meteorological data. Compared to previous studies on detected methane mole fractions at the same station, daily-to-yearly patterns have become more prominent thanks to the analysis of a much larger dataset. Overall, the yearly increase of methane at the Lamezia Terme station is in general agreement with global measurements by NOAA, though local peaks are present, and an increase linked to COVID-19 is identified. Seasonal changes and trends have proved to be fully cyclic, with the daily cycles being largely driven by local wind circulation patterns and synoptic features. Outbreak events have been statistically evaluated depending on their weekday of occurrence to test possible correlations with anthropogenic activities. A cross analysis between methane peaks and specific wind directions has also proved that local sources may be deemed responsible for the highest mole fractions. [ABSTRACT FROM AUTHOR]

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disorder with a high multidimensional burden, with an obscure etiopathogenesis. We designed a longitudinal, population-based study of people residing in Central Italy (Marche Region) who were beneficiaries of the National Health System. People with an unprecedented ALS hospitalization (335.20 ICD-9 CM) or tagged with an ALS exemption between 2014 and 2021 were considered incident cases. ALS cases residing in the region for <3 years or with an active ALS exemption or hospitalized for ALS before 2014 were excluded. We used secondary sources to identify new ALS diagnoses. The regional referral center for ALS's database was used to test the accuracy of secondary sources in detecting cases. ALS mean incidence was compared to that reported in similar studies conducted in Italy. The incidence rate trend adjusted by sex and age was evaluated using the Poisson regression model. We detected 425 new ALS cases (median age: 70y) in the 2014–2021 period, with a mean incidence of 3.5:100,000 py (95%CI: 3.2–3.8; M:F = 1.2), similar to that reported in similar studies conducted in Italy. No trend was observed during 2014–2019. After including 2020–2021 in the model, we observed a mean decrease in incidence of 5.8% (95% CI 2.0%; 9.5%, p = 0.003). We show a decrease in the incidence rate of ALS in Marche, during the 2014–2021 period, as a possible outcome of a delayed neurological assessment and diagnosis during the pandemic. An ad hoc developed identification algorithm, based on healthcare utilization databases, is a valuable tool to assess the health impact of global contingencies. [ABSTRACT FROM AUTHOR]

Aim: Covid-19 pandemic and its relative containment measures have affected populations' quality of life and psychological well-being worldwide. The fear related to the pandemic and the imposed containment measures has acted as a trigger causing a global increase in negative mental health states. Thus, we aimed to explore the relationship between fear of covid-19 and mental health via QoL (the first and the second lockdown in Italy, 2020). Subject and methods: Through a quantitative cross-lagged path model research design, the study investigates people's fear of Covid-19, quality of life, and negative mental states in a population of 444 Italian adults (Mean=40.7; Standard Deviation=16.9; 80% women), in the period between the first and the second waves of the pandemic. Results: Results show that participants' Covid-19 fear decreased between waves, contributing to a decrease in negative mental states (stress, anxiety and depression), thus improving the perceived quality of life. Furthermore, quality of life emerged as able to buffer the impact of fear of Covid on people's psychological distress in short and medium terms, confirming its central role in regulating mental distress. Conclusion: The study suggests important guidelines for developing interventions to support the populations' well-being and mental health. [ABSTRACT FROM AUTHOR]

In the context of the evolving global health landscape shaped by the COVID-19 pandemic, tuberculosis (TB) is gaining renewed attention as a reemerging threat even in low-endemic countries. Immunological tests such as the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are pivotal in identifying tuberculosis infection (TBI). However, their inability to distinguish between past and ongoing infection poses a diagnostic challenge, possibly leading to the unnecessary treatment of a significant portion of the population with potential side effects. This review delves into the concept of incipient tuberculosis (ITB), a dynamic, presymptomatic stage characterized by heightened Mycobacterium tuberculosis complex (MTC) metabolic activity and replication that result in minimal radiological changes, signifying a transitional state between TBI and TB. Key focus areas include epidemiological factors, underlying pathogenesis, imaging findings, and the ongoing challenges in the identification of individuals with ITB through the development of new biomarkers and the use of whole-genome sequencing-based analyses to implement early treatment strategies. [ABSTRACT FROM AUTHOR]

This article aims to frame the state violence and socio-ecological injustice perpetrated against prisoners through the lens of both critical environmental justice studies and the concept of the Wasteocene. We seek to uncover the socio-ecological relationships that have historically shaped the enforcement of the prison and waste systems through a focus on the Italian context during the Covid-19 pandemic. We explore the case of a jail in Campania, a region in the South of Italy infamous for its troubled waste management that has caused uncountable and entangled health, social, and economic harms. The jail is adjacent to an area with a long history of waste disposal practices and numerous legal conflicts and corruption scandals: all characteristics that make this case emblematic of the broader problem of carceral environmental injustice. We argue that carceral institutions are generative sites for examining the dynamics of violence, expendability, and wasting relationships that are built into their structures and core functions We also maintain that the Covid-19 pandemic has both uncovered and exacerbated such dynamics and therefore stands as a framing device that further corroborates our argument. We conclude with lessons and observations for scholars studying environmental concerns and carceral systems through a multidisciplinary lens. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic led to a significant reorganization of health services, potentially affecting the quality of care for major public health concerns such as proximal femoral fractures. This study aimed to investigate potential changes in the timing of various steps in the patient journey after a hip fracture during the pandemic in Piedmont, a region in Northern Italy. Methods: A retrospective study was conducted on the discharge records of patients aged 65 or older who were admitted for hip surgery following a femur fracture in 2019 and 2020. The study examined four-time steps: duration from hospital admission to surgery, length of hospital stay, interval between hospital discharge and admission to the rehabilitation facility, and duration of stay at the rehabilitation facility. To mitigate biases linked to sex and age factors, groups well-balanced across 2019 and 2020 were created using propensity score estimation. Results: The dataset consisted of two cohorts of 583 patients each for the years 2019 and 2020. The average duration from admission to surgery was approximately 1.9 days in both years, with 75% of patients undergoing surgery within 2 days of hospital admission. The average hospital stay reduced from 13.49 days in 2019 to 11.34 days in 2020. The gap between hospital discharge and admission to rehabilitation was approximately 10–12 days, and the average duration of stay at the rehabilitation facility was about 31.6 days. Discussion: The study indicates that healthcare systems can exhibit resilience and adaptability, even during a global pandemic, to ensure high-quality and safe standards of care. However, further long-term studies are needed to fully understand the pandemic's impact on primary health outcomes following hip replacement surgery and subsequent rehabilitation. The potential role of telemedicine in reducing the time between steps also warrants further investigation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and the measures to face it have placed children and their caregivers in front of many challenges that could represent sources of stress. This work aims to explore the point of view of children through drawing, as a spontaneous means of expression, relating it to parents' perceptions of children's difficulties, strengths, and mentalization skills. The sample consists of 18 children (mean age = 8.22, SD = 1.79). Parents were asked to complete: a socio-demographic questionnaire with information on the impact of COVID-19 on the family, the Strengths and Difficulties Questionnaire, and the Everyday Mindreading Scale. Children were asked to draw three moments: "Before" the pandemic, "During" the lockdown, and "After," when the COVID-19 will be passed. The drawings were coded by constructing a content and expressive analysis grid, adapting coding systems found in the literature. Data were collected at the beginning of the summer of 2020, just after the first lockdown period (from March to May 2020 in Italy). The results of the present work are in line with previous studies that reported experiences of wellbeing and tranquility of children in time spent at home with family during the pandemic. From the drawings emerges that children feel sufficiently able to master the situation, as reflected by including themselves in drawings and providing many details of the house in "During" drawings. The literature also reports a feeling of sadness/loneliness caused by the lack of friends, an element that we also find in the tendency to represent friends significantly more in the drawings concerning the future. Some contents of drawings (inclusion of friends, relatives, and parents) appeared associated with emotional, interpersonal, and mentalizing abilities of children, as perceived by parents. Exploring children's representations of a stressful event like the pandemic through drawings allows to focus both on their difficulties and on their resources, with useful implications for the educational support. [ABSTRACT FROM AUTHOR]

Introduction: Psychological distress in pregnant and postpartum women increased during the COVID‐19 pandemic. However, the impact of the pandemic in perinatal women at the end of the health emergency has been rarely studied. This study is aimed at investigating the psychological health of pregnant and postpartum women at the end of the COVID‐19 public health emergency, hypothesizing that the COVID‐19‐related fears influence perinatal psychological distress via the mediation of the COVID‐19‐related posttraumatic impact and loneliness. Methods: A total of 200 women in the perinatal period, of which 125 were pregnant and 75 were postpartum, participated in an online survey at the end of the COVID‐19 public health emergency in Italy. Depression, anxiety, stress, loneliness, posttraumatic impact of COVID‐19 pandemic and COVID‐19‐related fears were assessed. To test the hypotheses, robust serial mediation analyses were performed. Results: Increased levels of COVID‐19‐related fears were associated with an increase in perinatal depression, anxiety and stress indirectly through the serial mediation of COVID‐19 posttraumatic impact and loneliness. Loneliness played a stronger role in mediating the relationship between COVID‐19‐related fears and depression than anxiety and stress outcomes. Conclusions: This study should be considered exploratory for its methodological characteristics and nonreplicability of the pandemic condition. However, this study suggests the importance of assessing posttraumatic reactions to 'collective' crises in pregnant and postpartum women for research and clinical practice. In addition, it sustains the role of loneliness as a transversal construct that should be greatly considered in targeting psychological interventions for women in the perinatal period. [ABSTRACT FROM AUTHOR]

The COVID-19 emergency underlined the importance of an effective public health communication to limit the spread of the outbreak. Physicians as "public experts" can play a crucial part in health risk communication, even if their role is challenged by transformations into the information system. Therefore, the major objective of this study was to investigate public perception of medical experts' opinions regarding the COVID-19 emergency. The Italian public debate involving medical experts in the Twitter sphere during the SARS-CoV-2 pandemic has particularly been examined. A content analysis was performed on 2,040 randomly selected tweets. The results of content analysis show that the medical experts who tend to mitigate the risk received a higher number of tweets supporting their positions when compared to the experts whose statements were aimed at intensifying the risk. Since a public expert is a communicator, but also an advisor who can affect how laypersons perceive and react to risk events, this study can provide more knowledge about the public perception of different communication strategies incorporated by medical experts. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of the COVID-19 pandemic on national surveillance of viral hepatitis in Italy. Interrupted time series analysis. Using an interrupted time series analysis with a customised AutoRegressive Integrated Moving Average model on hepatitis cases reported to the Integrated Epidemiological System of Acute Viral Hepatitis from 2006 to 2022, we examined trends in incidence, time to diagnosis and time to epidemiological investigations for hepatitis A, hepatitis B and hepatitis C. The quarterly incidence of hepatitis B (−0.251, P = 0.05) and hepatitis C (−0.243, P = 0.003) significantly decreased with the onset of the pandemic. Surveillance times for hepatitis B (5.496, P < 0.001) and hepatitis C (35.723, P < 0.001), measured as days lost per quarter, significantly increased 12 and 24 months after the pandemic's start. This aligns with a notable rise in quarterly incidence at 36 months for both (0.032, P = 0.030 for hepatitis B; 0.040, P < 0.001 for hepatitis C). The decrease in reported cases could be due to an increase in infection prevention control and containment measures put in place in a pandemic context. However, a delay in the initiation of epidemiological investigations was observed, which could lead to a further increase in incidence in the future. [ABSTRACT FROM AUTHOR]

Standardized personality tests compare the test taker's scores to those of a large sample of individuals representing normative expectations. However, what is psychologically normal in one historical context may not be similarly normal in another, so the recent spread of a new coronavirus, SARS-Cov-2 (COVID-19), may have implications for what should normally be expected of a nonclinical person taking a personality test shortly after this dramatic event. To address this research question, we administered the Personality Assessment Inventory (PAI) and the Rorschach Performance Assessment System (R-PAS) to 60 nonclinical volunteers from Italy and compared their scores with the official normative reference values of the two tests, which had been established before COVID-19. The results of a series of two-sample t-tests indicated that our newly collected sample appeared somewhat less psychologically healthy compared with normative expectations, and these discrepancies were more pronounced on the PAI than on the R-PAS. Implications and future perspectives are discussed. [ABSTRACT FROM AUTHOR]

To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. ClinicalTrials.gov Identifier: NCT04694482 [ABSTRACT FROM AUTHOR]

Background: Previous research has identified some tensions that public organizations may encounter during crises. However, there remains a scarcity of research examining how public health care organizations effectively navigate these tensions to reconcile the diverse interests, needs, and demands from various stakeholders. Purposes: The study seeks to shed light on the dynamics underlying the tensions experienced by public hospitals during the COVID-19 pandemic. It illustrates how different hospitals' actors have navigated these tensions, identifying solutions and approaches that fostered collaborative endeavors among internal and external stakeholders. Methodology: The study draws on qualitative analyses of 49 semistructured interviews and the notes from two focus groups involving key informants at one of the largest university hospitals in Italy. We also rely on the verbatim transcripts from meetings involving the members of the temporary emergency team constituting the taskforce. Findings: The results highlight the tensions that emerged throughout the different waves of the COVID-19 pandemic and how various actors have managed them in a way to reconcile opposing forces while unleashing adaptability and creativity. Practice Implications: Hospital managers would benefit from developing a paradoxical mindset for crisis preparedness, allowing them to embrace existing tensions and devise creative solutions to favor resilience and change. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article examines the distortion of data and its visualization in the context of Covid-19 in Italy. While data visualization has become prevalent across various scientific disciplines, it often suffers from being overly intricate, inappropriate for the data type, or capable of causing perceptual biases and data falsification. The surplus of digital data and its subsequent visualization can lead to the manipulation of information, crafting narratives that diverge from official communications and aim to undermine their credibility and accuracy. This article highlights the necessity for properly disseminating data literacy and investigates data visualization's epistemological and methodological dimensions, focusing specifically on the Italian scenario. Misrepresentation of COVID-19 data is characterized by the distortion and misrepresentation of the pandemic data collected, processed, and presented. Through an empirical case study, the article underscores the imperative to develop and utilize data visualization techniques that faithfully and accurately depict data. [ABSTRACT FROM AUTHOR]

The outbreak of the Covid-19 crisis has triggered political tensions involving different levels of government. Italy constitutes a paradigmatic example of such problems. The powers assigned to regional presidents as a result of the dynamics of presidentialization make them key players in Italy's fragmented multilevel system. The article aims to demonstrate that the conflict between national and regional governments during the pandemic has been based mainly on polity reasons, that is regional governments' ambition to strengthen their autonomy, rather than on policy arguments. The Covid-19 crisis in Italy has taken the form of an intergovernmental conflict over the balance of authority between central and regional governments. This state of affairs has complicated the attempts at establishing a satisfactory level of coordination between the levels of government, has resulted in a fragmented response to the crisis, and has triggered a systemic conflict between levels of government. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) is currently representing a global health threat especially for fragile peoples, such as cancer patients. A few studies have described that people with a breast cancer more likely to be infected with COVID-19. Here, we performed a meta-analysis to assess the proportion of breast cancer patients with SARS-CoV-2 infection during the COVID-19 pandemic. A comprehensive literature search of the PubMed, Web of Sciences, Scopus, MedRxiv, SID, and CNKI database was performed. A total of 26 studies with a total of 6,537 infected cancer patients and 1,093 breast cancer patients with COVID-19 met our inclusion criteria. Pooled data showed that the proportion of breast cancer patients with SARS-CoV-2 infection was 17.1% (95% CI 0.144-0.201) in total infected cancer patients. Stratified analysis showed that the proportion in Caucasian and Asian infected breast cancer patients was 17.6% and 14.5%, respectively. Moreover, the proportion was the highest in France (19.3%) followed by US (19.2%), China (14.8%) and UK (13.8%). Our combined data indicated that the proportion of breast cancer patients with SARS-CoV-2 infection during the COVID-19 pandemic was 17.1%. However, we need to more high-quality and multicenter studies from different ethnicities to draw more accurate findings. [ABSTRACT FROM AUTHOR]