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Article ; Online: Direct impact of 2 years of COVID-19 on chronic disease patients

Luana Caselli / Elena Berti / Maria Luisa Moro / Daniela Fortuna

BMJ Open, Vol 13, Iss

a population-based study in a large hard-hit Italian region

2023 Volume 10

Abstract: Objectives We aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic period (2020–2021).Design Population-based ... ...

Abstract	Objectives We aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic period (2020–2021).Design Population-based retrospective study.Setting/participants Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%).Results COVID-19 incidence among chronic disease patients was 4.1% (74 067 cases) in 2020 and 7.3% (126 556 cases) in 2021, varying across pathologies, with obesity and dementia showing the highest incidence. Hospitalisation rate for pneumonia or acute respiratory distress syndrome among SARS-CoV-2-positive patients was 15.4%. COVID-19-related excess mortality, that is, deaths from COVID-19 as either main or contributing (1.5% of the total) cause of death, was observed during the three pandemic waves, with observed/expected death ratios ranging from +38% (March 2020) to +11% (December 2021). Increased risks of both COVID-19-related hospitalisation and death were associated with male gender, elderly age and many pre-existing pathologies, including cardiovascular, cerebrovascular and respiratory diseases, neurological and psychiatric disorders, and metabolic dysfunctions. The higher the number of concomitant pathologies, the greater the risk of COVID-19-related adverse outcomes: the likelihood of hospitalisation and death more than doubled for people with more than two comorbidities, compared with those with one underlying condition.Conclusions This study presents a thorough and up-to-date quantification of the direct impact of COVID-19 on chronic disease patients. The results obtained are particularly relevant considering that people with pre-existing chronic conditions accounted for almost all cases of COVID-19-related hospitalisation (82.6%) and death (91.5%) in a vast region of Italy, among ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mortality and healthcare assessment among patients with chronic disease over 2 years of COVID-19

Luana Caselli / Elena Berti / Maria Luisa Moro / Daniela Fortuna

BMJ Open, Vol 13, Iss

a population-based study in a large hard-hit Italian region

2023 Volume 12

Abstract: Objectives We aimed to provide a region-wide comprehensive account of the indirect effects of COVID-19 on patients with chronic disease, in terms of non-COVID-19 mortality, and access to both inpatient and outpatient health services over a 2-year ... ...

Abstract	Objectives We aimed to provide a region-wide comprehensive account of the indirect effects of COVID-19 on patients with chronic disease, in terms of non-COVID-19 mortality, and access to both inpatient and outpatient health services over a 2-year pandemic period.Design Population-based retrospective study.Setting Adult patients, affected by at least 1 of 32 prevalent chronic conditions, residing in the Emilia-Romagna Region in Italy, during the years 2020 (N=1 791 189, 47.7% of the overall adult regional population) and 2021 (N=1 801 071, 47.8%).Results Overall, non-COVID-19 mortality among patients with chronic disease during the pandemic (2.7%) did not differ substantially from the expected mortality (2.5%), based on a 3 years prepandemic period (2017–2019) and adjusting for the demographic and clinical characteristics of the population under study. Indeed, while the first pandemic wave was characterised by a significant non-COVID-19 excess mortality (March: +35%), the subsequent phases did not show such disruptive variations in non-COVID-19 deaths, which remained around or even below the excess mortality threshold. End-of-life care of patients with chronic disease, especially for non-COVID-19 cases, significantly shifted from hospitalisations (−19%), to homecare (ADI: +7%; w/o ADI: +9%). Overall, healthcare of patients without COVID-19 chronic disease decreased, with similar negative trends in hospitalisations (−15.5%), major procedures (−19.6%) and ER accesses (−23.7%). Homecare was the least affected by the pandemic, with an overall reduction of −9.8%. COVID-19 outbreak also impacted on different types of outpatient care. Rehabilitation therapies, specialist visits, diagnostic and lab tests were considerably reduced during the first pandemic wave and consequent lockdown, with access rates of patients without COVID-19 chronic disease below −60%.Conclusions This work thoroughly describes how a large and well-defined population of patients without COVID-19 chronic disease has been affected by the changes and ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: General and COVID-19-Related Mortality by Pre-Existing Chronic Conditions and Care Setting during 2020 in Emilia-Romagna Region, Italy

Nicola Caranci / Chiara Di Girolamo / Letizia Bartolini / Daniela Fortuna / Elena Berti / Stefano Sforza / Paolo Giorgi Rossi / Maria Luisa Moro

International Journal of Environmental Research and Public Health, Vol 18, Iss 13224, p

2021 Volume 13224

Abstract: In 2020, the number of deaths increased in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims to describe trends in ... ...

Abstract	In 2020, the number of deaths increased in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims to describe trends in mortality and to quantify excess mortality variability over time and in relation to demographics, pre-existent chronic conditions and care setting of the Emilia-Romagna region (Northern Italy). This is a registry-based cross-sectional study comparing the 2020 observed mortality with figures of the previous five years by age, sex, month, place of death, and chronicity. It includes 300,094 deaths in those 18 years of age and above resident in the Emilia-Romagna region. Excess deaths were higher during the first pandemic wave, particularly among men and in March. Age-adjusted risk was similar among both men and women (Mortality Rate Ratio 1.15; IC95% 1.14–1.16). It was higher among females aged 75+ years and varied between sub-periods. Excluding COVID-19 related deaths, differences in the risk of dying estimates tended to disappear. Metabolic and neuropsychiatric diseases were more prevalent among those that deceased in 2020 compared to the deaths that occurred in 2015–2019 and therefore can be confirmed as elements of increased frailty, such as being in long-term care facilities or private homes as the place of death. Understanding the impact of the pandemic on mortality considering frailties is relevant in a changing scenario.
Keywords	COVID-19 ; mortality excess ; chronic conditions ; care setting ; Italy ; Medicine ; R
Subject code	310
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The incidence and risk factors of selected drug prescriptions and outpatient care after SARS-CoV-2 infection in low-risk subjects

Carlo Gagliotti / Federico Banchelli / Angela De Paoli / Rossella Buttazzi / Elena Narne / Enrico Ricchizzi / Elena Schievano / Stefania Bellio / Gisella Pitter / Michele Tonon / Lorenzo Maria Canziani / Maurizia Rolli / Evelina Tacconelli / Elena Berti / Francesca Russo / Maria Luisa Moro

Frontiers in Public Health, Vol

a multicenter population-based cohort study

2023 Volume 11

Abstract: BackgroundKnowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on ... ...

Abstract	BackgroundKnowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations.MethodsThe present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU’s Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis.ResultsThere were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications.ConclusionThe outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial ...
Keywords	SARS-CoV-2 ; post-COVID ; COVID-19 sequelae ; outpatient care ; drug prescriptions ; low-risk subjects ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Use of multiple metrics to assess antibiotic use in Italian children’s hospitals

Carmen D’Amore / Marta Luisa Ciofi degli Atti / Carla Zotti / Rosa Prato / Giuliano Guareschi / Raffaele Spiazzi / Gaetano Petitti / Maria Luisa Moro / Massimiliano Raponi

Scientific Reports, Vol 11, Iss 1, Pp 1-

2021 Volume 8

Abstract: Abstract Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe ... ...

Abstract	Abstract Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients’ clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4–50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0–11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Increasing Number of Cases Due to Candida auris in North Italy, July 2019–December 2022

Journal of Clinical Medicine, Vol 12, Iss 1912, p

2023 Volume 1912

Abstract: Candida auris is an emerging fungus that represents a serious health threat globally. In Italy, the first case was detected in July 2019. Then, one case was reported to the Ministry of Health (MoH) on January 2020. Nine months later, a huge number of ... ...

Abstract	Candida auris is an emerging fungus that represents a serious health threat globally. In Italy, the first case was detected in July 2019. Then, one case was reported to the Ministry of Health (MoH) on January 2020. Nine months later, a huge number of cases were reported in northern Italy. Overall, 361 cases were detected in 17 healthcare facilities between July 2019 and December 2022 in the Liguria, Piedmont, Emilia-Romagna, and Veneto regions, including 146 (40.4%) deaths. The majority of cases (91.8%) were considered as colonised. Only one had a history of travel abroad. Microbiological data on seven isolates showed that all but one strain (85.7%) were resistant to fluconazole. All the environmental samples tested negative. Weekly screening of contacts was performed by the healthcare facilities. Infection prevention and control (IPC) measures were applied locally. The MoH nominated a National Reference Laboratory to characterise C. auris isolates and store the strains. In 2021, Italy posted two messages through the Epidemic Intelligence Information System (EPIS) to inform on the cases. On February 2022, a rapid risk assessment indicated a high risk for further spread within Italy, but a low risk of spread to other countries.
Keywords	Candida auris ; outbreak ; epidemic ; epidemiology ; Italy ; healthcare-associated infections ; Medicine ; R
Subject code	940
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Diagnostic testing for Clostridium difficile in Italian microbiological laboratories

Spigaglia, Patrizia / Fabrizio Barbanti / Maria Luisa Moro / Matteo Morandi / Paola Mastrantonio

Anaerobe. 2016 Feb., v. 37

2016

Abstract: A laboratory diagnosis survey of Clostridium difficile infection (CDI) was performed in Italy in 2012–2013. Questionnaires from 278 healthcare settings from 15 regions of Italy were collected and analysed. Eighty seven percent of the laboratories ... ...

Abstract	A laboratory diagnosis survey of Clostridium difficile infection (CDI) was performed in Italy in 2012–2013. Questionnaires from 278 healthcare settings from 15 regions of Italy were collected and analysed. Eighty seven percent of the laboratories declared to routinely perform CDI diagnosis, 99% of them only after the clinician's request. Among the 216 laboratories providing information on the size of the hospitals in which they were located, 65 had more than 500 beds (large hospitals), while 151 had less than 500 beds (small hospitals). The average percentage of positive tests for C. difficile toxins was 12.2%. Almost half of the laboratories (42%) used immunoenzymatic assay (EIA) for Tox A/B as a stand-alone method, while only 34% used an algorithm for CDI as indicated by the European guidelines. A low percentage of laboratories performed molecular assays or C. difficile culture, 25% and 29%, respectively. Most laboratories (161/278) declared to type C. difficile strains, the majority in collaboration with a reference laboratory. Among the 103 C. difficile clinical isolates collected during the study, 31 different PCR-ribotypes were identified. PCR-ribotype 356/607 (27%) was predominant, followed by 018 (12%). These two PCR-ribotypes show 87.5% of similarity in ribotyping profile. PCR-ribotypes 027 and 078 represented 8% and 4% of the strains, respectively. Four PCR-ribotypes (027, 033, 078 and 126) were positive for the binary toxin CDT. In particular, PCR-ribotype 033 produces only CDT, and it has recently been associated with symptomatic cases. The majority of strains were multidrug resistant. In particular, all strains PCR-ribotypes 356/607 and 018 were resistant to moxifloxacin, rifampicin, erythromycin and clindamycin. The results obtained highlight the need to raise awareness to the microbiological diagnosis of CDI among clinicians and to implement and harmonize diagnostic methods for CDI in Italian laboratories in the perspective of a future national surveillance.
Keywords	algorithms ; clindamycin ; Clostridium difficile ; diagnostic techniques ; erythromycin ; guidelines ; health services ; hospitals ; laboratory diagnosis ; monitoring ; moxifloxacin ; multiple drug resistance ; questionnaires ; ribotyping ; rifampicin ; surveys ; toxins ; Italy
Language	English
Dates of publication	2016-02
Size	p. 29-33.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	1237621-8
ISSN	1075-9964
ISSN	1075-9964
DOI	10.1016/j.anaerobe.2015.11.002
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: SPiNCAR

PLoS ONE, Vol 17, Iss 3, p e

A systematic model to evaluate and guide actions for tackling AMR.

2022 Volume 0265010

Abstract: Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union's recommendations based on the results of the ECDC site visit of ... ...

Abstract	Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union's recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal. Methods We developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discussed by the project's team during face-to-face kick-off meetings, then confirmed with Delphi methodology and finally validated through a pilot study. Results The final framework consists of seven different areas that reflect the PNCAR structure: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare-associated Infections (HAIs) control and prevention, Education and Training, Alliance among Stakeholders, Implementation. The total number of standards for the regional framework was 34 with 264 criteria and for the local version 36 criteria with 279 standards. Conclusion The ongoing use of this tool, developed on international evidences and recommendations that were tailored on the Italian specific context, allows monitoring the improvement achieved over time and plan the next steps.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Laboratory procedures for the diagnosis of tuberculosis

Maria Luisa Moro / Simona Nascetti / Filomena Morsillo / Matteo Morandi

Annali dell'Istituto Superiore di Sanità, Vol 46, Iss 2, Pp 178-

a survey in ten Italian Regions

2010 Volume 184

Abstract: The characteristics of laboratories performing tuberculosis (TB) diagnostic procedures were investigated in ten Italian Regions, through a mailed questionnaire. Three hundred and eighty laboratories answered (70.8% response rate), 250 of which performed ... ...

Abstract	The characteristics of laboratories performing tuberculosis (TB) diagnostic procedures were investigated in ten Italian Regions, through a mailed questionnaire. Three hundred and eighty laboratories answered (70.8% response rate), 250 of which performed directly at least one TB diagnostic procedure. Standard criteria concerning microscopy, culture, identification, and drug susceptibility testing were frequently not satisfied, particularly those related to the volume of activity (32% of laboratories performing microscopy examined < 10 samples and 36% of those performing culture performed < 20 cultures per week), processing time, biosafety requirements and participation to internal/external quality control programs. The survey's results highlight the need to promote the adoption of standardized procedures and to centralize the mycobacteriology testing in a reduced number of high quality laboratories, in order to improve diagnostic accuracy, resource management and quality of surveillance data.
Keywords	Mycobacterium tuberculosis ; laboratori ; test diagnostici ; indagine ; Medicine ; R ; Public aspects of medicine ; RA1-1270
Publishing date	2010-06-01T00:00:00Z
Publisher	Istituto Superiore di Sanità
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Laboratory procedures for the diagnosis of tuberculosis

Maria Luisa Moro / Simona Nascetti / Filomena Morsillo / Matteo Morandi

Annali dell'Istituto Superiore di Sanità, Vol 46, Iss 2, Pp 178-

a survey in ten Italian Regions

2010 Volume 184

Abstract	The characteristics of laboratories performing tuberculosis (TB) diagnostic procedures were investigated in ten Italian Regions, through a mailed questionnaire. Three hundred and eighty laboratories answered (70.8% response rate), 250 of which performed directly at least one TB diagnostic procedure. Standard criteria concerning microscopy, culture, identification, and drug susceptibility testing were frequently not satisfied, particularly those related to the volume of activity (32% of laboratories performing microscopy examined < 10 samples and 36% of those performing culture performed < 20 cultures per week), processing time, biosafety requirements and participation to internal/external quality control programs. The survey's results highlight the need to promote the adoption of standardized procedures and to centralize the mycobacteriology testing in a reduced number of high quality laboratories, in order to improve diagnostic accuracy, resource management and quality of surveillance data.
Keywords	Mycobacterium tuberculosis ; laboratori ; test diagnostici ; indagine ; Medicine ; R ; Public aspects of medicine ; RA1-1270
Publishing date	2010-06-01T00:00:00Z
Publisher	Istituto Superiore di Sanità
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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