Uncertainty in Health Emergencies: Communicating Risks During COVID-19 Response

The world’s fragmented response to the COVID-19 pandemic created fertile ground for mixed messages and inconsistency. The authors analyzed Google-trending insights from five countries (Italy, Spain, the United States, the United Kingdom, and France) across three-week time (1–23 March 2020) to document trends in population health anxiety in response to the initial global spreading of the outbreak. The results are expressed in the form of Uncertainty Index (UI), which reflects the total number of Google searches/COVID-19 prevalence and standardized per million inhabitants. The United Kingdom experienced the highest level of health anxiety (UI = 11.5), followed by France (UI = 4.6) and Spain (UI = 3.2). The United States suffered the highest rate of uncertainty in the early stage of the pandemic; the Italian population experienced a balanced level of anxiety. Institutionalizing risk communication during COVID-19 should represent an integral part of the country emergency response.

Access to COVID-19 Vaccination during the Pandemic in the Informal Settlements of Rome

With the advent of vaccines, the world has a chance to see a real end to the COVID-19 pandemic. To make this possible, however, it is necessary that all groups of people are considered. Contexts of informal settlements and populations such as the homeless and migrants are often forgotten by vaccination campaigns. In this study, carried out as a result of a collaboration with MEDU, a non-profit association aimed at bringing healthcare to vulnerable populations, we provide important data related to the vaccination campaign carried out in the informal settlements of Rome. The objectives of this work are to (1) evaluate vaccination coverage in these contexts, (2) assess the gap with the vaccination coverage of the Italian population and try to hypothesize the causes, and (3) provide recommendations for how humanitarian associations can respond to reduce this gap. We observed important differences in vaccination coverage depending on the type of settlement. The percentage of vaccinated people in these contexts at the beginning of October range between 14.4% and 55.5%, underlining an important gap with the vaccination rate of Italy’s population, which is close to 80%. The data also show that particular attention must be paid to the transiting and irregular people as they are more at risk for a lack of access to vaccination. With this study, in which we provide recommendations that integrate MEDU’s fieldwork experience with the advice of the Framework report, we hope we can help those who work in similar contexts, to carry out a fair and effective vaccination campaign.

Abdominal Aortic Screening Is a Priority for Health in Smoker Males: A Study on Central Italian Population

Abdominal aortic aneurysm (AAA) is a major public health problem. In the last decade, in some European countries, abdominal aortic screening (AAS) is emerging as a potential prevention for the rupture of AAA. The goals of our study were to estimate AAA prevalence and risk factors in males and females in a central Italian population, also defining the cost-effectiveness of AAS programs. A pilot study screening was conducted between 1 January 2015 and 31 December 2019 in the municipality of Teramo (Abruzzo Region, Italy) in a group of men and women, ranging from the age of 65 to 79, who were not previously operated on for AAA. The ultrasound was performed by means of Acuson sequoia 512 Simens with a Convex probe. The anterior posterior of the infra-renal aorta was evaluated. The odds ratio values (ORs) were used to evaluate the risk of AAA, and the following determinants were taken into consideration: gender, smoke use, hypertension, and ischemic heart disease. We also estimated the direct costs coming from aneurysmectomy (surgical repair or endovascular aneurysms repair—EVAR). A total of 62 AAA (2.7%, mean age 73.8 ± 4.0) were diagnosed, of which 57 were in men (3.7%, mean age 73.6 ± 4.0) and 5 were in women (0.7%, mean age 74.3 ± 4.1). Male gender and smoke use are more important risk factors for AAA ≥ 3 cm, respectively: OR = 5.94 (2.37–14.99, p < 0.001) and OR = 5.21 (2.63–10.30, p < 0.000). A significant increase in OR was noted for AAA ≥ 3 cm and cardiac arrhythmia and ischemic heart disease, respectively: OR = 2.81 (1.53–5.15, p < 0.000) and OR = 2.76 (1.40–5.43, p = 0.006). Regarding the cost analysis, it appears that screening has contributed to the reduction in costs related to urgency. In fact, the synthetic indicator given by the ratio between the DRGs (disease related group) relating to the emergency and those of the elective activity went from 1.69 in the year prior to the activation of the screening to a median of 0.39 for the five-year period of activation of the screening. It is important to underline that the results of our work confirm that the screening activated in our territory has led to a reduction in the expenditure for AAA emergency interventions, having increased the planned interventions. This must be a warning for local stakeholders, especially in the post-pandemic period, in order to strengthen prevention.

Beliefs in Misinformation and Conspiracy Theories About COVID- 19: a Triangular Relationship Between Analytic Thinking, Depressive States, and Misperception

Beliefs about misinformation and conspiracy theories are often associated with a state of mind. With the spread of the pandemic there has been an outbreak of depression cases among the population. In this paper, we attempt to test the relationship between affective states and beliefs in misinformation about COVID-19 during the early phase of the pandemic. We do this through a survey carried out on a random and representative sample of the Italian population that allows us to go and verify the co-evolution of many factors: i.e., beliefs in misinformation, symptoms of depression, perceptions and misperceptions about COVID-19, ways in which citizens got informed about the pandemic, and sociodemographic characteristics (e.g., age, gender, education). The results show that the relationship between affective state and beliefs in misinformation exists but is more complex than hypothesized.

Burden of COVID-19 and Vaccination Coverage in the Italian Population as of October 2021

Following the pandemic scenario, researchers from all over the world, including Italians, have undertaken fervent research activity using the epidemiological data available on the sites of government and national and international research institutes. The objectives of our study were: (1) to analyze the load and trend of the COVID-19 pandemic in Italy, from the beginning to October 2021; (2) to analyze vaccination coverage by age groups and types of vaccines administered and check how the vaccination campaign has influenced the course of the disease and deaths; (3) to evaluate the Italian situation in the European context, comparing the incidence and mortality of Italy with respect to European countries; (4) finally, to evaluate how much vaccination coverage may have had an effect on mortality in the various European countries. Databases were structured to archive Italian and European COVID-19 data provided by Our World in Data, and data came from the Ministry of Health, to evaluate percentage of vaccines administered. The monthly trend of the cumulative incidence per 100,000 inhabitants in the period January 2020–October 2021 was evaluated. It is important to underline 3 peaks of incidence and mortality rates that occurred during the three waves of COVID-19: March–April–May 2020, October–November–December 2020, and March–April–May 2021. There is a slight increase in incidence in August 2021 and in mortality in September 2021. The three mortality rate peaks, related to the three waves of COVID-19, are always higher in Italy than in Europe, particularly in April 2020, December 2020, and March 2021. From May 2021 to October 2021, the mortality trend reversed, and it turned out to be higher in Europe than in Italy. Regarding vaccination, Italy currently has an important coverage, not only in the most fragile population, where it exceeds 90%, but also in the 12–19 age group, with percentages above 65%. The Pfizer/BioNTech vaccine was used widely in all age groups (first and second dose), with highest administration in 12–19 age groups and 80+, while the lowest was recorded in the 70–79 age group. In conclusion, these data confirm the importance of vaccination in the management of the COVID-19 pandemic.

Quantitative Methods for the Prioritization of Foods Implicated in the Transmission of Hepatititis E to Humans in Italy

Hepatitis E is considered an emerging foodborne disease in Europe. Several types of foods are implicated in the transmission of the hepatitis E virus (HEV) to humans, in particular, pork and wild boar products. We developed a parametric stochastic model to estimate the risk of foodborne exposure to HEV in the Italian population and to rank the relevance of pork products with and without liver (PL and PNL, respectively), leafy vegetables, shellfish and raw milk in HEV transmission. Original data on HEV prevalence in different foods were obtained from a recent sampling study conducted in Italy at the retail level. Other data were obtained by publicly available sources and published literature. The model output indicated that the consumption of PNL was associated with the highest number of HEV infections in the population. However, the sensitivity analysis showed that slight variations in the consumption of PL led to an increase in the number of HEV infections much higher than PNL, suggesting that PL at an individual level are the top risky food. Uncertainty analysis underlined that further characterization of the pork products preparation and better assessment of consumption data at a regional level is critical information for fine-tuning the most risky implicated food items in Italy.

The Cognitive Consequences of the COVID-19 Pandemic on Members of the General Population in Italy: A Preliminary Study on Executive Inhibition

The pandemic period which has characterized the last two years has been associated with increasingly worsening psychological conditions, and previous studies have reported severe levels of anxiety, mood disorder, and psychopathological alteration in the general population. In particular, worldwide populations have appeared to present post-traumatic stress symptoms (PTSS). Surprisingly, no studies have evaluated the effect of COVID-related PTSS on cognitive functioning. This study focused on the association between high levels of PTSS related to COVID-19 and alterations in executive functioning by considering executive inhibitions in populations not infected by the virus. Ninety respondents from the Italian population participated in the study. A higher percentage of PTSS was reported. Moreover, respondents with high post-traumatic symptomatology presented deficits in the inhibition of preponderant responses, demonstrating an executive deficit which could be expressed by a difficulty in controlling goal-directed actions. This was underlined by worse performances in elaborating incongruent stimuli in the Stroop task and no-go stimuli in the Go/No-Go task. This report presents preliminary findings underlining the effect of the COVID-19 pandemic on cognitive functions. The results confirmed a persistently higher post-traumatic symptomatology related to the COVID-19 pandemic in the Italian population and highlighted an association with cognitive inhibition impairment.

Vitamin D Status in a Rural Italian Population

Vitamin D is known as an antirachitic factor, although it also plays a critical role in several nonskeletal diseases. In our study, we evaluated vitamin D status and sex, age and seasonal association in a general population cohort living in central Italy. Data from 1174 men and 2274 women aged 20–81 were analyzed, and stored serum samples were assayed for 25-hydroxyvitamin D (25(OH)D). Vitamin D was low in both sexes with values significantly lower in women than in men; furthermore, its deficiency was highly correlated with age. The younger men had just sufficient 25(OH)D levels (32.3 ng/mL ± 13.2), which decreased with increasing age. The younger women showed insufficient 25(OH)D levels (24.8 ng/mL ± 11.9) that, as with men, further decreased with increasing age. This study demonstrated that hypovitaminosis D may be a very frequent condition also in a rural central Italian area with remarkable solar irradiation throughout the year. Our data clearly indicated an evident seasonal trend: at the end of the winter, serum 25(OH)D levels of the examined cohort were below the official sufficient value for both adult sexes. Sufficient levels were just reached in summer for men and only at the end of summer for young women.

VDR Polymorphisms in Autoimmune Connective Tissue Diseases: Focus on Italian Population

Vitamin D is an important hormone involved in various physiologic processes, and its activity is linked to binding with vitamin D receptor (VDR). Genetic polymorphisms in the VDR gene could modulate the expression or function of the receptor and, consequently, alter the effects of vitamin D. Variants in VDR gene have been associated with susceptibility to many illnesses sensitive to vitamin D administration and to autoimmune disorders, but no data are available regarding autoimmune connective tissue diseases in Italian population. We analyzed three VDR polymorphisms in 695 Italian patients with autoimmune connective tissue diseases (308 with systemic lupus erythematosus (SLE), 195 with primary Sjogren’s syndrome (pSS), and 192 with rheumatoid arthritis (RA)) and in 246 healthy controls with the aim to evaluate a possible association of VDR SNPs with susceptibility to these diseases in the Italian population. Genotyping of rs2228570, rs7975232, and rs731236 in VDR gene was performed by an allelic discrimination assay. A case/control association study and a genotype/phenotype correlation analysis have been performed. We observed a higher risk to develop SLE for rs2228570 TT genotype ( P = 0.029 , OR = 1.79 ). No association was observed between susceptibility to pSS or RA and this SNP, although this variant is significantly less present in RA patients producing autoantibodies. For rs7975232 SNP, we observed a significant association of the variant homozygous genotype with SLE ( P = 0.009 , OR = 1.82 ), pSS ( P = 0.046 , OR = 1.66 ), and RA ( P = 0.028 , OR = 1.75 ) susceptibility. Moreover, we reported associations of this genotype with clinical phenotypes of SLE and pSS. Lastly, the GG genotype of rs731236 was associated with a lower RA susceptibility ( P = 0.045 , OR = 0.55 ). Our results show that the explored VDR polymorphisms are significantly associated with autoimmune connective tissue disorders and support the hypothesis that the genetic variability of VDR gene may be involved in susceptibility to these diseases in Italian population.

Three-Dimensional Dental Analysis for Sex Estimation in the Italian Population: A Pilot Study Based on a Geometric Morphometric and Artificial Neural Network Approach

Dental dimorphism can be used for discriminating sex in forensic contexts. Geometric morphometric analysis (GMA) allows the evaluation of the shape and size, separately, of uneven 3D objects. This study presents experiments using a novel combination of GMA and an artificial neural network (ANN) for sex classification, applied to premolars of Caucasian Italian adults (50 females and 50 males). General Procrustes superimposition (GPS) and the partial least square (PLS) method were performed, respectively, to study the shape variance between sexes and to eliminate landmark variations. The “set-aside” approach was used to assess the accuracy of the proposed neural networks. As the main findings of the pilot study, the proposed method applied to the first upper premolar correctly classified 90% of females and 73% of males of the test sample. The accuracy was 0.84 and 0.80 for the training and test samples, respectively. The sexual dimorphism resulting from GMA was low, although statistically significant. GMA combined with the ANN demonstrated better sex classification ability than previous odontometric or dental morphometric methods. Future research could overcome some limitations by considering a larger sample of subjects and other kinds of teeth and experimenting with the use of computer vision for automatic landmark positioning.