bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety and depression among individuals in mandatory institutional quarantine in Tunisia
Authors: Cherif I , Kharroubi G , Haj Amor S , Zribi M , Ouali U , Bettaieb J
Published: October 2021

Background

The COVID-19 pandemic is a challenging public health issue that have impacted people's health and livelihoods worldwide. Restrictive measures, such as quarantine, have been implemented in many countries in order to limit the spread of the virus. We aimed in this study to assess the impact of institutional mandatory quarantine on mental health in Tunisia and to determine factors associated with the occurrence of anxiety and or depression.

Methods

A cross sectional phone survey was conducted in Tunisia from April to November 2020 among people who were placed in mandatory institutional quarantine. Generalized anxiety disorder and depression were assessed using the Generalized anxiety disorder scale (GAD-7) and the Centre for Epidemiological Studies Depression Scale (CES-D-10). Bivariate and multivariate analyses were used to determine factors associated with the occurrence of depression and or anxiety symptoms.

Results

In the present study, 506 participants were enrolled with an age ranging from 18 to 83 years and a sex ratio equal to 1.9. More than third of participants (38.3%) had experienced anxiety and/or depressive symptoms. Being a woman, younger age, being a student, spending longer time on COVID-19 news, fear of infection in the quarantine facility, having experienced stigma, financial struggle due to the COVID-19 pandemic and dissatisfaction by the accommodations conditions of the quarantine facility were independently associated with occurrence of depression and or anxiety symptoms.

Conclusions

A high percentage of participants have experienced anxiety or depressive symptoms during the quarantine period. Providing mental health support and updated and relevant information to quarantined individuals is necessary. Improving the accommodation conditions in the quarantine facilities is also needed.

Key messages

More than third of participants had experienced anxiety and/or depressive symptoms. Good quality communication and mental health support are necessary in quarantine facilities.
COVID-19 aftermath: Safe return to the office during the pandemic
Authors: Chrysikou E , Savvopoulou E , Hernandez Garcia E
Published: October 2021

Issue/problem

COVID-19 has affected almost all aspects of our human activity globally. Changing our working norm is one of them. This project explored strategies and control measures that could be adopted in different countries for preventing or limiting the transmission of the SARS-CoV-2 virus in indoor office workplaces, focusing on space and the well-being of workers.

Description of the problem

Research took place in May-July 2020. Methods used comprised both systematic and narrative literature reviews as well as stakeholder consultations with executives involved in the office supply chain. Suggestions were split in: a) top-down suggestions, i.e. governmental and NGO guidance and b) bottom-up guidance, generated by industry. Surface contaminated? Protocols to reduce the psychological stress of employees returning to work, ventilation and virus transmission were indicative the questions along with a broader series of aspects involving employee wellbeing.

Results

Results were organised under four themes: a) advice on surface interactions and virus viability; b) behavioural advice focusing on the return-to-work effects on the psychological state of workers along with control measures; c) suggestions on preparing buildings to return-to-work during the pandemic and study of indoor environment parameters and their effect on office workers and d) advice on thermal and ventilation conditions and virus transmission.

Lessons

The public health effect of COVID-19 on workspace is more relevant than ever globally as people return to work. This review demonstrated the complexity of decision making and the series of conflicting priorities that arose, especially infection control vs employee mental health or increased business costs for modifications during economic recession. The necessity of future studies focusing on interdisciplinary knowledge arose.

Key messages

Focusing not only on practical steps preparing office buildings but on the mental health of office workers and how this transition back to work in such a stressful period can be easier. Lessons learned from medical architecture and it’s applicability on office spaces.
Changes in sleep quality during COVID-19: Results of the Russian online survey on spring 2020
Authors: Antsiferova A , Kontsevaya A , Mukaneeva D , Drapkina O
Published: October 2021

Introduction

The Russian Federation reported one of the largest number of COVID-19 infections. Major restrictions (social distancing, travel bans, event cancellation, changes to work practices) were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Purpose is to estimate the impact of COVID-19 on sleep among adults in Russia.

Methods

The NMRC TPM conducted a national online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Data were collected during the period of tightest restriction through the country between 26 April 2020 and 6 June 2020. A link on the online survey was distributed through the regional center of public health. Sleep quality was assessed by comparing the period before the COVID-19 and the last 7 days.

Results

In spring 2020, 2432 completed questionnaires from 62 regions of Russia were received. There was a predominance of female respondents (86.6%), the average age was 33.6±14.9 years and 38.2±13.1 years for men and women, respectively. The majority of completed questionnaires were received from the Republic of Tatarstan (n = 804), Irkutsk (n = 474), Sakhalin (n = 225) and Tver regions (n = 152). Compare pre-COVID to during COVID there was a significant decline in the number of days per week participants reported not getting enough sleep (3.21±2.44 to 2.86±2.57; p < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70±2.24 to 2.13±2.48; P < 0.001). The number of days participants waking up earlier than wanted before and during the pandemic has not changed (2,6 Đ, 2,59 (p < 0,5)).

Conclusions

Effective health promotion strategies directed at adopting or maintain positive health related behaviors such as targeted social media messaging and balanced media reporting, should be used to maintain healthy sleep during these unprecedented times.

Key messages

Changes in sleep quality during COVID-19 identified as a result of the online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Effective health promotion strategies directed at adopting or maintain positive health related behaviors should be used to maintain healthy sleep during COVID-19 pandemic.
Forecasting the economic consequences of COVID-19 on longstanding illnesses in Wales
Authors: Kadel R , Allen J , Dyakova M , Bellis M
Published: October 2021

Introduction

The unemployment rate following the COVID-19 pandemic in Wales is increasing and there is a positive link between unemployment and longstanding illnesses. This study aimed to project the percentage of adults with longstanding illnesses and chronic health conditions following COVID-19 associated with the economic consequences.

Methods

We retrieved historical data on the unemployment rates and status of longstanding illnesses among adults from the Office for National Statistics (ONS) and National Survey for Wales (NSW), and used time-series models to project the unemployment rates and percentage of adults with longstanding illnesses and chronic health conditions over a three year period (2020/21 - 2022/23).

Results

Without reparative interventions, the unemployment rate is expected to increase sharply from 3.8% in 2019 to about 7% in 2020 following COVID-19 and then gradually increase over the projected period. With increased unemployment, longstanding illness (LSI) would be expected to increase gradually following COVID-19, with an estimated increase of around or exceeding 4% over three years depending on the LSI measure. There would be a higher increment in the percentage of adults with limiting LSI compared with adults with any LSI, suggesting implications for wider health and social care services. With current unemployment predictions, the percentage of adults with chronic health conditions is projected to increase following the COVID-19 pandemic over the projected period, with a higher increment for mental health and endocrine/metabolic conditions

Conclusions

The longstanding illnesses and chronic health conditions are expected to increase in the coming years following COVID-19 pandemic. Therefore, preventative measures for longstanding illnesses and chronic health conditions should be a priority for a sustainable recovery from the COVID-19.

Key messages

Without reparative interventions, the unemployment rate is expected to increase following the COVID-19 pandemic. The projected prevalence of limiting longstanding illness in adults following COVID-19 suggests implications for wider health and social care services.
COVID-19 - pandemic effect in the organized breast cancer screening program in Croatia
Authors: Kovačević J , Sovic S , Musil V , Kosic Bibic N , Zombori D , Juresa V
Published: October 2021

Background

COVID-19 pandemic effected preventive health services. The implementation of the breast cancer screening program (BSCP) in Croatia was paused for one and a half month in 2020. The aim of this research was to compare the results of BCSP rollout during and before pandemic.

Methods

Data of fourth, fifth and sixth BCSP round of women (about 700,000 women per round): invited in BCSP, responded to invitation and response rate were analysed.

Results

Of all women included in sixth round, 93.0% were invited (92.7% in fifth and 89.3% in fourth). Response rate (53.3%), including woman screened in BCSP and on the doctor's referral, was 5.7% lower compared to fifth and 5.4% lower compared to fourth round. Response rate on invitation letter was 44.9% in sixth, 42.3% in fifth and 40.1% in fourth round. There was 24,768 mammography check-ups in sixth, 41,040 in fifth and 80,846 in fourth round. There was 11.8% less mammography examinations in sixth round compared to fifth and 0.3% less compared to fourth round.

Conclusions

Lower response rate in the sixth BCSP invitation round was observed with similar invitation coverage. There was 11.8% less mammography examinations done in relation to the 5th and 0.3% less than in the 4th invitation round. Response rate to the invitation letter was higher in the sixth in relation to the previous rounds. Explanations for the observed differences could be lower number of mammography examinations done on the doctor's referral, less available terms in mammography units and consequently less second invitation letters sent because of the epidemiological measures. Intensive public health campaign and more mammography unit terms, including mobile mammography units, are needed in order to return the invitation and response rates to the pre-pandemic values.

Key messages

COVID-19 pandemic caused 5.7% lower response rate and 11.8% less mammography examinations in BCSP. In order to close the observed gap in the BCSP response rate, more mammography unit terms are needed to be available followed by the intensive public health campaign.
Reluctance and acceptability of Covid-19 vaccination among healthcare professionals
Authors: Baklouti M , Ben Ayed H , Ben lassoued F , Ketata N , Maamr H , Abdelmoula M , Feki H , Dammak J
Published: October 2021

Background

The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. healthcare professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. The aim of this study was to evaluate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors.

Methods

This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of (HCP) at the university hospitals of Southern Tunisia on April 2021.

Results

Overall, 223 cases were females (74.4%). The average age was 29.5 years ±8.26. In total, 178 HCP were doctors (59.3%), 147 HCP (49%) were working in medical services and 58 HCP (19.3%) were in intensive care units. The vaccination acceptance rate was 65.3% (196), while 73 cases (24.3%) were reluctant. Factors statistically associated with vaccine acceptability were female gender (Odds ratio (OR)=2.9;p=0.001), advanced age (30.23±8.27 vs 28.09±8.12;p=0.034), urbanity of residence (OR = 4.5;p<0.01) and direct contact with positive COVID-19 patients (OR = 1.9;p=0.007). Compared to paramedical staff, doctors were more willing to be vaccinated (OR = 4;p<0.01). Belief in the efficacy of the vaccine as effective with few adverse effects (OR = 2.04;p<0.01), as protective against the virus (OR = 4.5;p<0.01) as well as the only solution to stop the pandemic (OR = 2.6;p<0.01) and to decrease serious complications of the disease (OR = 28;p<0.01) were statistically associated with vaccination acceptance.

Conclusions

This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted. Thus, planning vaccination campaigns to raise awareness of the efficacy and the safety of vaccine is strongly recommended to promote vaccination in the general population.

Key messages

This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted.
The impact of COVID-19 on School of Medicine students’ performance: an interrupted time series study
Authors: Palladino R , Affinito G , Triassi M
Published: October 2021

Background

The COVID-19 pandemic has profoundly challenged the whole educational system. Shifting towards emergency remote teaching (ERT) has raised questions about its quality and effectiveness, especially for those university students enrolled on courses including interactive learning and clerkship modules as well. Therefore, we employed an interrupted time series analysis, to assess the impact of lockdown (March 2020) and subsequent shifting to ERT on exam enrollments and performance for students at the School of Medicine of the University “Federico II” of Naples, one of the largest universities nationwide, between January 2017 and February 2021.

Methods

We extracted data from 49 course modules within 14 courses of study offered by the School. Multilevel linear models were employed to account for the hierarchical structure of the data (multiple exam sessions within each module). Model covariates were time, term, course of study, and gender.

Results

In the summer term 2020 there was a 23% increase in students enrolled on exams, as compared with the previous year (2019: 16,237; 2020: 20,091), with a 0.92% (SD 0.04) pass rate and an average mark of 26.39 (SD 2.64), as compared with the 0.89% (SD 0.78) pass rate and an average mark of 26.50 (SD 2.55) for the previous year. Considering the whole study period, we found that for the winter term following the national lockdown (March 2020) there was a 0.38 increase in the pass rate (coeff. 0.38; 95%CI 0.04,0.71), as compared with the period before the lockdown, which however was not sustained over time (slope change: -0.04; 95%CI -0.09, 0.00). No differences were found when considering changes in the average exam mark (step change: -1.38; 95%CI -2.83,0.07, slope change: 0.03; 95%CI -0.01,0.06).

Conclusions

Although students promoted the online examination method as part of the ERT considering the increase in enrollment and the initial increase in pass rate, this change was not sustained by an improvement in their performance.

Key messages

The shifting toward emergency remote teaching as educational system response to COVID-19 in Italy has increased exam enrollment but not students’ performance at School of Medicine. Ensuring high quality of teaching during emergencies is fundamental. Mixed-methods follow-up studies should be conducted to evaluate students’ perception and identify ways for quality improvement.
The effect of temperature on the dynamics of the COVID-19 pandemic: the BERLIN example
Authors: Yapar D , Yanik C , Ozkan S
Published: October 2021

Background

Studies have shown, ambient temperature can affect the transmission and survival of coronaviruses. This study aimed to determine whether the number of COVID-19 cases and 14-day fatality rates (FR) in Berlin are associated with temperature.

Methods

Within the scope of this study, a total of 240 days of Berlin belonging to the dates 28.08.20- 24.04.21 were examined. Daily highest temperature, lowest temperature, daily average temperature, number of daily cases, number of deaths were accessed free from the berlin.de and weather.com site. In addition, the incubation period of COVID-19 was assumed to be 14 days, and the fatality rates of 14 days and the average temperatures of these days were calculated. The relationship between the data was evaluated with the Spearman correlation test.

Results

When the 240 days are examined, the average daily temperature varies between -7.5- 23.5 °C, the fatality rates of 14 days vary between 0- 7,3%. The period with the highest fatality rate of 14 days is between 29.1.21-11.2.21 (FR = 7.3%) and the average temperature of this period (-1.8 °C) is the 14 days with the lowest average temperature. Very strongly negative relationship (r = -0.920; p < 0.001) was determined between FR and 14-day average temperature. It was noted that as the daily temperature decreased, the number of deaths per day (r = -0.695; p < 0.001) and the number of daily cases (r = -0.296; p < 0.001) increased. 1 °C decrease in temperature was associated with an increase in daily new deaths by 1.29 (B = -1.29, 95% CI: -1.55, -0.1.09; p < 0.001, Adj. R2 = 0.3).

Conclusions

Our analysis results showed that the number of COVID-19 daily cases and 14-day fatality rate increased with a low temperature in the Berlin sample.

Key messages

Temperature showed a negative correlation between COVID-19 fatality rate. Further evaluation may be required globally with more data to determine temperature and COVID-19 cases.
Risk factors for admission to ICU among COVID-19 patients: A 6-month observational study in Spain
Authors: Arana-Aragón BM , Rueda-Nieto S , San Lázaro-Campillo I , Monteagudo JF , Zapata-Castaño N , Fernández-Paniagua L , Baumela-Puertas A , Torres-Cantero AM
Published: October 2021

Background

Admission to the Intensive Care Unit (ICU) is one of the most used indicators to estimate the magnitude of the current COVID-19 pandemic. This study was performed to assess the relationship between demographic, lifestyles and comorbidity factors on the severity of patients with SARS-CoV2 infection.

Methods

An observational study including data from the regional surveillance dataset on acute respiratory infections from September 2020 to February 2021 in one large tertiary hospital in Murcia, Spain. Demographic, clinical and lifestyle factors were collected. A descriptive analysis was carried out using SPSS. Chi-square tests were performed to assess the relationship between comorbidities and lifestyle factors. Binary logistic regression was calculated to estimate the probability of being admitted to ICU. Analysis were adjusted by sex, age, and lifestyle factors.

Results

Overall, 906 patients with COVID-19 were identified. The mean age was 64.3 years (SD = 16.5 years), and 523 of the patients were male (57.7%). A total of 104 (11.5%) patients required admission to ICU and 142 (15.7%) died during the hospitalisation process. The average length of stay at the hospital was 8 days (SD = 6). Acute renal failure (OR = 7.7; 95% CI: 1.7-33.0), being a smoker (OR = 7.02; 95% CI: 2.7-19, 0) and suffering from obesity (OR = 3.5; 95% CI: 1.2-10.3) were the main risk factors associated with admission to ICU.

Conclusions

Acute renal failure, obesity, and smoking were strongly associated with both severity and admission to intensive care among patients with COVID-19 infection. More research needs to be done to assess the role of these underlying factors in the severity of COVID-19 infections.

Key messages

The design of predictive models for ICU admission during the COVID-19 pandemic should be promoted. Features associated to vulnerability in COVID-19 patients must be identified.
Change of life habits and applying barrier measures after exposure to COVID-19, Mahdia (Tunisia)
Authors: Ben Youssef F , Sfar H , Omri N , Mlouki I , Jendoubi Med Hedi , El Mhamdi S
Published: October 2021

Introduction

The COVID-19 pandemic is causing considerable lifestyle changes through barriers measures, lockdown and social distancing. These changes include: Preoccupation with Covid-19 pandemic news, sleep disturbances and eating habits changes.

Aim

To assess the lifestyle changes after exposure to a risk of coronavirus contamination.

Methods

We conducted a cross sectional study during November and December 2020 among adults tested for COVID-19 in Mahdia (Tunisia).To assess the life habits changes (sleep, physical exercises and diet), the compliance with barrier measures and preoccupation with COVID-19 pandemic news, a reliable tool was developed and pretested by experts at the department of Preventive and Community Medicine

Results

A total of 277 participants were enrolled, the average age was 34.32 years ± 13.7. Among them 60.8% were women (sex-ratio = 0.51).Almost two thirds 62.2% were tested positive for Covid-19. Doctors presented 29.2% of the respondents. Among the study sample, 38.6% lived with elderly people. Approximately three quarters 77.8% reported an improvement in compliance with barrier measures. The majority 92.1% respected more the social distancing. As for hand washing and for mask wearing, 87.7% said to wash their hands more, and 95.3% were more concerned about wearing masks. A life habits change was observed among 16.7% of the respondents. Almost half of the participants 45.5% increased their physical activity, while 76.2% tried to get a healthy diet. Sleep disorders were registered among 48.7% of respondents. Preoccupation with the COVID news was observed in approximately half of the participants (57.8%).

Conclusions

The COVID19 pandemic affected different aspects of our lives. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.

Key messages

A life habits change was observed among 16.7% of the respondent, sleep disorder were registered among 48.7%, and 77.8% reported and improvement in applying barrier measures. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.
The Impact of Covid-19 Pandemic on Family Cohesion. Results from an International Study
Authors: Tsoutsi V , Dikeos D , Papadakaki M
Published: October 2021

Introduction

The lives and relationships of many have been influenced by changes imposed by Covid-19, especially the strict lockdown which was imposed during the first months of the pandemic. The aim of the current study was to document how the pandemic affects family relations.

Methods

Participants from 46 countries were asked to complete an online survey including the Penn State Worry Questionnaire (PSWQ) and the newly devised Athens family cohesion scale (AFCS), comparing the periods before and during the pandemic.

Results

Two-thirds of the participants (N = 481) were women; mean age 36.7 ±14.6 years old. Mean score of the PSWQ was 50.6 ±13.1. Worsening of family cohesion was reported by 22% of the participants, while 40.7% reported a better family cohesion after the pandemic started. Total score of AFCS was correlated negatively with PSWQ by linear regression analysis of AFCS on sex, age and PSWQ (beta= -0.058 ±0.023, p = 0.012), showing that family cohesion was better the lower the worry. Change of family cohesion was not found to be correlated to PSWQ nor to total score of AFCS.

Conclusions

Family cohesion during the pandemic seems to be related to the level of worry of the reporting individual; in the majority of cases family cohesion did not change (neither improved nor deteriorated) during the lockdown.

Key messages

Family cohesion generally is unchanged under strict situations such as the lockdown. Family cohesion is related to the levels of worry as reflected in the Penn State Worry Questionnaire.
HTA of novel biocontainment systems for ambulance transport: public health implications
Authors: Corradi M , Cattaneo A , Plicco C , Bossi E
Published: October 2021

Background

Biocontainment systems in healthcare settings are intended to ensure isolation of contagious or potentially contagious patients so as to protect healthcare providers and control infection spread. The need for safe and effective biocontainment systems has emerged during the COVID-19 outbreak. In particular, transport of potentially contagious patients poses technical, logistical and medical challenges that are to be addressed to protect population health and enable safe healthcare services delivery.

Methods

As novel biocontainment systems become available it is important to assess their operational effectiveness and safety and to define their organizational impact. We applied the Health Technology Assessment (HTA) framework to evaluate a novel rigid bio-containment system (Billy-Cab) integrated with the stretcher support, for ambulance transport of contagious patients.

Results

We applied the EUnetHTA core model to conduct an HTA report of Billy-Cab. A multi-disciplinary working group was established. We assessed available biocontainment under the nine dimensions of the EUnetHTA core model. We derived and pooled: 1) original data derived from clinical practice, 2) secondary data derived from systematic reviews of the literature, conducted according to the PRISMA guidelines, 3) original data derived from validated questionnaires, 4) economic original data.

Conclusions

Preliminary data allow to conclude selected biocontainment systems are effective in ensuring infection control during ambulance transport, with manageable organizational impact. In addition, the use biocontainment systems positively influence healthcare professionals' attitudes and performances. The HTA methodology offers substantial support to evaluate the introduction of innovative technologies during health emergencies and beyond.

Key messages

Selected biocontainment systems are effective in ensuring infection control during ambulance transport. HTA is to be applied to evaluate the introduction of innovative technologies during health emergencies and beyond.
Association of health professionals with Burnout Syndrome in Veracruz, Mexico
Authors: Villegas Dominguez J , Cruz Ramirez MZ , Yepez Ricardez MI , Quintana Neria A , Juventino Dorantes IC , Marquez Celedonio FG
Published: October 2021

Background

Inside the COVID19 pandemic, health personnel have modified their daily way of working, for which they have been exposed to greater risks that could facilitate the presence of burnout in them.

Objective

To determine the association of health professionals with burnout syndrome in Boca del Rio, Mexico.

Methods

This study was observational, cross-sectional, prospective, and analytical, during the period February-April 2021. Subjects residing from Boca del Rio, Mexico, older than 18 years with a formal job, were included. To measure the Burnout Syndrome, the MBI (Maslach Burnout Inventory) questionnaire was used, which measures emotional exhaustion, depersonalization and personal fulfillment. A non-probability sampling was carried out.

Results

240 subjects were included, 113 (54.6%) men, 110 (45.8%) married and 117 (48.75%) from the health area. The general prevalence of burnout was 10%. The factors associated with Burnout were being a professional with an OR of 8.68 (95% CI 2.53-30.21), as well as the male sex who registered an OR of 2.63 (95% CI 1.08-6.44), both with p values <0.05. The work seniority resulted with values of p > 0.05. Being health personnel, registered OR of 31.7 (CI95% 14.2-73.2) for emotional exhaustion at high level, OR of 11.8 (CI95% 6.15-23.4) for depersonalization at high level and OR of 0.3 (CI 95% 0.2-0.5) for personal fulfillment at a high level, all of the above with a value of p < 0.05

Conclusions

being a health worker during the COVID19 pandemic increases the probability of suffering from burnout

Key messages

Being a health worker during the COVID19 pandemic increases the probability of suffering from burnout. Being a health person increases emotional fatigue, depersonalization and reduces forgiving fulfillment.
Brazil: The impact of the epicenter of the COVID-19 pandemic among medical doctors
Authors: Guimarães-Teixeira E , Machado MH , Freire N , Tardim J , Murta J , Rocha AC , Cunha D , Parente V
Published: October 2021

Health-care workers (HCWs) on the frontlines of the 2019 Coronavirus Disease 2019 (COVID-19) have a high risk of acquiring and dying from the disease. Brazil is a country with high morbimortality and ranks highest in general mortality from COVID-19. A large proportion of medical doctors (MDs) is dying, impacting in the workforce. As part of the research by Fiocruz on working conditions among HCWs, we have conducted this study of death among MDs. We analyzed data from Federal Council of Medicine, the only national platform with details about deaths in MDs. A broad search of other sources, including the Ministry of Health, was done, but unfortunately, the data does not exist. A total of 622 MDs died from March 2020 to March 2021: 87.6% male and 75% over age 60. The Southeast had the highest percentage (34.7%), followed by the Northeast (27.2%), and rankings by state showed Rio de Janeiro (15.8%), followed by São Paulo, Pará, Paraná and Paraíba, totalizing 50.1%. The specialties with highest mortality were gynecology (12.2%), pediatrics (10.0%), internal medicine (9.3%), general surgery (7.8%) and cardiology (7.6%). May 2020 was the month of worst mortality (16.9%) followed by July and June. A slow decline was observed until October, when Brazil begun to experience the “second wave”. The vaccination of MDs began at the end of January 2021 and has not been sufficient time to evaluate the impact on morbimortality. The results of a study of 50 professional categories are under analysis and will be published soon as well as a study of “invisible” HCWs, who do not have specific training but are essential to supporting health care system, from primary care units to high-complexity hospitals. We hope that the results of these studies will improve links among managers, those who define public policies, and union leaders, achieving better workplace and living conditions, minimizing health and socioeconomic disparities.

Key messages

This study is about death by COVID-19 among medical doctors in Brazil, as part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ. This stdy is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.
Female mortality associated with HIV-infection: social context
Authors: Ivanova AE , Semyonova VG , Zubko AV
Published: October 2021

Against the background of the increased HIV-associated mortality in Russia, more negative trends are being registered in females. However, the social grounds for these dynamics are yet to be investigated. The study used official Rosstat mortality statistics and the European standard population to calculate age-specific and standardized indicators of HIV-associated mortality. To analyze socio-demographic status of HIV-related deaths, the authors used the Moscow Death Information System (RFS-EMIAS), based on data from medical death certificates issued by medical organizations in Moscow. In Russia, for over 15 years, until 2019, the increased HIV-associated mortality had remained unchanged with higher rates registered in females. The gender mortality ratio suggests that young people aged 15-30 are the least advantaged population group with similar female and male death rates. Regional differences in HIV-associated mortality in Russia are huge adding up to 10-fold. HIV-unfavorable and relatively advantaged regions hardly differ in gender distribution, meaning that factors determining HIV-related epidemiological situation in the region are universal without any gender specifics. Medical status of HIV patients: a combination of socially-significant pathology (Hepatitis C, drug addiction, Tuberculosis) with delayed treatment are closely related to the social status: usually, low education, unemployment or employment in low-skilled labor, and loneliness. The socio-demographic profile of HIV-associated deaths is gender-neutral without any significant differences between sexes in terms of education, unemployment or loneliness. The results may suggest that HIV-infection is a filter, more significant in terms of the risk of getting sick and falling victim of HIV-infection rather than gender specifics. Grounds for negative dynamics in the female HIV-associated mortality are rather determined by other factors than socio-demographic status.

Key messages

The socio-demographic profile of HIV-associated deaths is gender-neutral without any significant differences between sexes in terms of education. Grounds for negative dynamics in the female HIV-associated mortality are rather determined by other factors than socio-demographic status.
An age grouped time-varying compartmental model for CoViD-19 vaccination strategy
Authors: Cartocci A , Messina G , Nante N , Cevenini G , Barbini P
Published: October 2021

Background

Compartmental models are the simplest in the mathematical study of infectious disease dynamics. Using an age-stratified compartmental model allows us to understand which population groups to target and to what extent to act, in order to achieve predefined goals in line with policy and/or health choices. In fact, the vaccination strategies of most countries are age dependent. With this study we want to show that the optimal vaccination strategy should be different depending on the type of health or social objective to be achieved.

Methods

A time varying susceptible-infected-recovered-deceased (SIRD) compartmental models, stratified into ten age groups of ten years was developed on Italian data. An optimal vaccination strategy was obtained minimizing deaths or infectious starting from April 11, 2021, considering the total doses due to Italy by the European contract for each type of vaccine from April to June. The efficacy of each vaccine and the days between administration and the beginning of immunization were also considered.

Results

On April 11, about 75% of over-80 Italian population have received at least the first dose of vaccine. Concerning the minimization of death, the model gives the priority to the older people (>60-year-old). This confirms the Italian vaccination strategy by completing the remaining vaccinations of over-80s and then vaccinating those between 60 and 80. Instead, if the priority were to reduce the infected, the model would recommend vaccinating the most of over-80s and the classes aged 20-30 and 40-60.

Conclusions

In conclusion, the use of this model can help to vary vaccine strategies by adopting targeted approaches to effectively achieve specific objective. For example, given the different age destination of some vaccine types, a good vaccination strategy might have been to vaccinate the over 90s with one type of vaccine to protect them from high risk of death while simultaneously vaccinating younger people to contain the spread.

Key messages

The modelling approach is an excellent decision support tool for pandemic containment. The compartmentalized model stratified by age allows to act more efficiently on subpopulations.
Development of a web platform for COVID-19 integrated care: an experience from an Italian Region
Authors: Di Martino G , Di Biagio R , Soldato G , Del Papa J , Porfilio I , Stella A , Polidoro I , Fabiani L , Caponetti A , Ruotolo L
Published: October 2021

Issue

After the announcement of Public Health Emergency of International Concern about COVID19 by WHO, health authorities need to implement strategies to face the emergency. These responses included early diagnosis, patient isolation, quarantine and symptomatic monitoring of contacts. In this context, integrated care and telemedicine are the best instruments for COVID management.

Description of the problem

The COVID19 epidemic needs a real time integration of epidemiological, clinical and laboratoristic data, in order to better manage patients and to improve public health surveillance. Based on a tool previosly used by GPs for flu vaccination and diabetes integrated care, the Local Health Authority of Pescara, Abruzzo Region, Italy, developed a web-based platform (QuickwebConnect), accessible to public health practitioners (PHP), GPs, infectious diseases physicians and laboratories, in order to integrate information about COVID19 patients. This platform contain individual-level information on patients with laboratory-confirmed COVID19, symptoms, reported onset dates, and basic demographics. Information are in real time accessible to all actors involved in the process. In addition, GPs can use this tool to directly book diagnostic tests for symptomatic or suspected patients.

Results

With the use of this platform, the management of pandemic emergency was improved, allowing direct management of epidemic data both at person and population level. The real time evaluation of clinical and epidemiological data improved patients care, clinical survellance of COVID19 contacts and development of tailored preventive measure in areas with high incidence.

Lessons

COVID19 patients care need to be quick, needing the integrate support of different actors. In addition, public health actions have to be supported by strong data. The use of a cost-effective web platform allow physician and PHP to better manage patiens and develope focused interventions.

Key messages

Integrated care and telemedicine are best instruments for COVID management. The real time evaluation of data aimed to develop tailored preventive measure.
Use and effectiveness of Digital Contact Tracing during COVID-19 pandemic: a systematic review
Authors: Pegollo L , Mazza C , Girardi D , Maggioni E , Valente G , Gaeta M , Odone A
Published: October 2021

Background

Contact tracing (CT) is a pillar of infection control during outbreaks and its implementation has been great ally in the context of the COVID-19 pandemic that pressured national health systems. Digital CT (DCT) aids manual CT by logging proximity contacts and timely notifying contacts of positive cases, contributing to greater epidemic. We aim to systematically review and critically appraise the available evidence on adoption, effectiveness, acceptance and barriers to access of available CT apps.

Methods

We conducted a systematic literature review by means of Pubmed, Embase, Cochrane and Web of Science and applying the PRISMA guidelines. We classified studies according to selected characteristics (eg, original data, mathematical models, policy papers, overview of the experience with national CT apps) in order to better outline our results.

Results

Our queries yielded 1201 articles, of which 790 remained after duplicates' removal. After applying a priori selected inclusion criteria, 428 (54.17%) were eliminated after screening by title and abstract. 362 records were included in our study: of them 33.7% were original studies, 54.1% were opinion papers not reporting quantitative data, 14.91% were mathematical models, 6% were systematic reviews on DCT-related topics. Among original studies, 11.47% described national experiences and 25.40% discussed adoption dynamics.

Conclusions

DCT adoption still faces several cultural, normative and technical barriers, ranging from adoption mandates to privacy issues, to device compatibility. Overall, scant evidence is available on the impact of DCT in controlling infection spread and wide heterogeneity persists within studies in term of design and assessed outcomes Future research is needed based on shared evaluation frameworks.

Key messages

Digital contact tracing apps are a powerful but underestimated tool to counter epidemiological emergencies. Future epidemiological challenges will require a shared implementation and evaluation protocol for digital contact tracing apps.
Premature mortality attributable to tobacco smoking among Tunisian adults in 2016
Authors: Cherif I , Khiari H , Mallekh R , Hsairi M
Published: October 2021

Background

Tobacco smoking is a major risk factor for several debilitating health conditions, causing thus premature deaths and disability. Globally, 8 million deaths, mainly occurring in low and middle income countries, are attributable to tobacco use each year. We aimed in this study to estimate the premature mortality attributable to current cigarettes smoking among Tunisian adults aged 35-69 years.

Methods

The population attributable fraction (PAF) method was used to estimate the number of premature deaths attributable to smoking. The estimates for the total number of deaths in Tunisia in 2016 by causes were obtained from the health metrics database. The current cigarettes smoking prevalence was taken from a nationally representative household survey conducted in 2016 and the used relative risks were obtained from the cancer prevention study II of the American Cancer Society.

Results

A total of 3219 premature deaths were attributable to current cigarettes smoking accounting for 23.1% (34.2% in men and 2.1% in women) of the total number of deaths. The leading causes of premature mortality attributable to smoking were lung cancers (PAF= 79.6%), chronic obstructive pulmonary diseases (PAF= 54.5%) and upper aerodigestive tract cancers (PAF= 54.3%).

Conclusions

Nearly a quarter of premature deaths in Tunisia in 2016 were attributable to tobacco smoking. This underscores the need to enhance the MPOWER measures application mainly through the promotion of anti-tobacco awareness campaigns and the reimbursement of smoking cessation treatments.

Key messages

Tobacco smoking were responsible for a significant percentage of premature deaths mainly among Tunisian men in 2016. Our results highlight the urge to enhance the MPOWER measures application in Tunisia.
Estimated direct costs of renal cancer by stage and care phase: a whole disease modeljuj
Authors: Buja A , De Luca G , Gatti M , Bonaldi F , Gardi M , Bortolami A , Sepulcri M , Baldo V , Scioni M , Basso U
Published: October 2021

Background

Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which include costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines.

Methods

Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed “whole-disease” model that covers the probabilities of all potentially necessary diagnostic and therapeutic action involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management.

Results

In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced, and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease.

Conclusions

It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources.

Key messages

An estimation of the direct costs of renal cell carcinoma, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services. Our model could represent a useful tool for policy-makers in the optimization of resources allocation, especially in a time of budget constraints.
Investigation of Epidemiological Characteristics of Patients over Age 65 with Covid-19 ın a City
Authors: Gokce A , Ozer A , Soyiler V , Gundogdu ME
Published: October 2021

Background

The population aged ≥65 is important because of the higher mortality rate and a riskier clinical course of COVID-19 in this patient group. This study aimed to examine the epidemiological characteristics, clinical conditions and factors affecting the clinical status of patients over 65 with COVID-19 in the Bingol province.

Methods

Study was conducted between March and December 2020 in the Bingol province using the data of 3,521 patients over age 65 who were positive for SARS-CoV-2 as per RT-PCR results. The study commenced after obtaining necessary institutional permissions and the ethics committee approval. In the study, independent variables were age, gender, presence of chronic diseases whereas dependent variables were mortality status, presence of pneumonia. Chi-square test and binominal logistic regression analysis were used for statistical analysis. In all evaluations, p < 0.05 was considered significant.

Results

The median age of the patients participating in the study was 72(65-102) and the case fatality rate was 2%. The mortality rates were significantly higher in patients aged between 75-84 and those aged >85 as well as patients who had a chronic disease, diabetes and ischemic heart disease compared to the other groups (p < 0.05). According to the regression analysis, mortality rate was 2.6-fold higher in males than in females and 24.3-fold higher in patients with pneumonia than in those without pneumonia (p < 0.05).

Conclusions

Among the patients in the study group, mortality rate was found to be higher in males, those in the advanced age group and those with pneumonia and chronic diseases. Therefore, if possible, patients with these characteristics should be followed more closely in a hospital setting during the pandemic.

Key messages

Mortality rates are higher in patients with COVID-19 who have a chronic disease, diabetes or ischemic heart disease. Age, gender and presence of pneumonia are among the important factors in the course of COVID-19.