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Preventive and Social Medicine in Outbreak Era

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 40210

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Prof. Dr. Vincenzo Russo

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Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” – Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples – Italy
Interests: cardiovascular pharmacology; cardiovascular risk factors; arrhythmic disorders; cardiac pacing; COVID-19; thrombosis and hemostasis; muscular dystrophy; syncope
Special Issues, Collections and Topics in MDPI journals

Dr. Francesco Saverio Mennini

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1.CEIS EEHTA, DEF Department, Faculty of Economics, University of Rome “Tor Vergata”, 00133 Rome, Italy
2.Institute of Leadership and Management in Health, Kingston University, London KT1 2EE, UK
Interests: health economics; HTA; pharmacoeconomics; public health; health policy; microeconomics

Dr. Luca Coppeta

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Guest Editor

Department of Occupational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
Interests: occupational medicine; vaccination; biological hazards; HCWs
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

COVID-19, with its clear epidemiological and social virulence, has triggered behavioral reactions, typical of health emergencies, which in a short period of time have significantly affected the health care model of our country. Indeed, all efforts have been directed, on one hand, toward slowing down the spread of infection and, on the other hand, assisting citizens affected by this disease in the best possible way. All this “works” in the short term with the primary objective of restoring social life and returning to “normal” as soon as possible. However, a health and social system aspiring to lay the foundations for real economic, organizational, and financial sustainability in a time of crisis must be able to provide itself with a vision in terms of programming and planning, which goes beyond the mere logic of the emergency and therefore of the short term, looking at the challenges awaiting in the medium and long term. In recent years, the public health scenario in Europe has changed significantly: scientific progress, continually evolving research, and the development of new technologies and innovative drugs and medical devices have led to a marked improvement in patients’ quality of life and life expectancy.

The intent of this Special Issue is to gather the experiences and the first analyses related to the COVID-19 pandemic—in particular from the different branches that fall into the broader category of social medicine: occupational medicine, forensic medicine, hygiene and preventive medicine in the first place, followed by cardiology, emergency medicine, ophthalmology, and all the branches that fight daily to reduce the social assistance burden of diseases with a high disabling impact.

Prof. Dr. Vincenzo Russo
Dr. Francesco Saverio Mennini
Dr. Luca Coppeta
Guest Editors

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Keywords

COVID-19
pandemic
health medicine
public medicine
cardiovascular risk factors
infectious diseases
telemedicine
disability
syncope
implanted devices
occupational medicine

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Published Papers (12 papers)

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Editorial

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3 pages, 267 KiB

Open AccessEditorial

COVID-19 Outbreak: A Call to Arms for the World Healthcare Systems

by Vincenzo Russo and Francesco Saverio Mennini

Int. J. Environ. Res. Public Health 2023, 20(24), 7175; https://doi.org/10.3390/ijerph20247175 - 13 Dec 2023

Viewed by 1538

Abstract

Coronavirus Disease 2019 (COVID-19) outbreak has placed a strong pressure on worldwide healthcare systems over the last years, testing their capacity to withstand stress [...] Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

Research

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9 pages, 507 KiB

Open AccessArticle

COVID-19 Post-Exposure Evaluation (COPE) Study: Assessing the Role of Socio-Economic Factors in Household SARS-CoV-2 Transmission within Campania Region (Southern Italy)

by Ivan Gentile, Martina Iorio, Emanuela Zappulo, Riccardo Scotto, Alberto Enrico Maraolo, Antonio Riccardo Buonomo, Biagio Pinchera, Giuseppina Muto, Carmela Iervolino, Riccardo Villari, Nicola Schiano Moriello, Maria Michela Scirocco, Maria Triassi, Mariano Paternoster, Vincenzo Russo, Giulio Viceconte and Federico II COVID-Team

Int. J. Environ. Res. Public Health 2022, 19(16), 10262; https://doi.org/10.3390/ijerph191610262 - 18 Aug 2022

Cited by 2 | Viewed by 1396

Abstract

Campania is the sixth poorest region of Italy, and it is the region with the highest income inequality. The secondary attack rates of SARS-CoV-2 among households are found to be substantially heterogeneous among published studies and are influenced by socio-economic factors. We conducted a retrospective study to describe the role of socio-economic factors in the household transmission of SARS-CoV-2 among patients living in Campania Region and referring to “Federico II” Hospital. We interviewed 413 subjects followed-up for COVID-19 between the 8 March 2020 and the 24 May 2021 with the aim to collect demographic, clinical, economic, and social data regarding their household and the index cases. The variables associated with SARS-CoV-2 attack rate higher than 50% among households were higher age (p = 0.023) and higher Charlson Comorbidity Index of the index case (p = 0.023) and, for household characteristics, higher number of families per house (p = 0.02), location of the houses in Naples’ suburbs (Chi² = 5.3, p = 0.02) and in Caserta City area (Chi² = 4, p = 0.04), and renting the house compared to owning it (Chi² = 5.83, p = 0.01). This study confirms the finding described by other authors that household transmission of SARS-CoV-2 is correlated with the income inequality of the analyzed geographical area as well as with the indicators of health and economic wealth of the families, and this correlation also applies to the Campania Region. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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7 pages, 446 KiB

Open AccessArticle

First Surveillance of Violence against Women during COVID-19 Lockdown: Experience from “Niguarda” Hospital in Milan, Italy

by Giulio Nittari, Getu Gamo Sagaro, Alessandro Feola, Mattia Scipioni, Giovanna Ricci and Ascanio Sirignano

Int. J. Environ. Res. Public Health 2021, 18(7), 3801; https://doi.org/10.3390/ijerph18073801 - 6 Apr 2021

Cited by 13 | Viewed by 3317

Abstract

Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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11 pages, 805 KiB

Open AccessArticle

Trends in Healthcare Access in Japan during the First Wave of the COVID-19 Pandemic, up to June 2020

by Koji Makiyama, Takayuki Kawashima, Shuhei Nomura, Akifumi Eguchi, Daisuke Yoneoka, Yuta Tanoue, Yumi Kawamura, Haruka Sakamoto, Stuart Gilmour, Shoi Shi, Kentaro Matsuura, Shinya Uryu and Masahiro Hashizume

Int. J. Environ. Res. Public Health 2021, 18(6), 3271; https://doi.org/10.3390/ijerph18063271 - 22 Mar 2021

Cited by 17 | Viewed by 4692

Abstract

We evaluated the impact of the new coronavirus disease (COVID-19) on healthcare access in Japan in terms of the number of outpatients and hospitalized patients as well as the length of hospital stays, during the first wave of the pandemic, up to June 2020. This observational study evaluated the monthly average number of outpatients per day at hospitals, the average number of hospitalized patients per day, and the average length of hospital stays per patient, from December 2010 to June 2020, using the hospital reports data, which are open aggregated data on the utilization of hospitals from the Ministry of Health, Labour and Welfare. These numbers were compared with those from the same period of previous years, using a quasi-Poisson regression model. We found a nationwide decrease in the number of outpatients in general hospitals and hospitalized patients, particularly in long-term care beds in Japan, as well as the excess length of hospital stays among psychiatric care patients during the first wave of the COVID-19. This limited access to healthcare demonstrated the importance of the long-term health monitoring of vulnerable populations and the need for urgent management support to healthcare facilities in preparation for possible prolonged pandemics in the future. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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10 pages, 1111 KiB

Open AccessArticle

Nursing Teleconsultation for the Outpatient Management of Patients with Cardiovascular Disease during COVID-19 Pandemic

by Vincenzo Russo, Roberta Cassini, Valentina Caso, Chiara Donno, Annunziata Laezza, Maria Naddei, Alfonso Fiorelli, Paolo Golino and Gerardo Nigro

Int. J. Environ. Res. Public Health 2021, 18(4), 2087; https://doi.org/10.3390/ijerph18042087 - 21 Feb 2021

Cited by 23 | Viewed by 5333

Abstract

Introduction: During the COVID-19 outbreak, non-urgent clinic visits or cardiac interventional procedures were postponed to a later date, and the implementation of telemedicine has guaranteed continuity of care for patients with chronic diseases. The aim of our study was to describe the medical interventions following nursing teleconsultation for the outpatient management of patients with cardiovascular diseases during the COVID-19 pandemic. Materials and Methods: All patients who did not attend the follow-up visit from 4 to 15 April 2020 at our institution and who were re-scheduled due to the COVID-19 lockdown were selected to be enrolled in the study. Each patient was followed by a semi-structured telephonic interview performed by a nurse. The outcomes of our study were to assess the patients’ adherence to nursing teleconsultation and the usefulness of nursing teleconsultation to detect clinical conditions in need of medical intervention. Results: In total, 203 patients (81%) underwent nursing teleconsultation in a mean time of 7 ± 3 days from the outpatient visit lost due to the COVID-19 lockdown. Furthermore, 53 patients (26%) showed poor adherence to nursing teleconsultation. Among the 150 patients (mean age 67 ± 10 years; 68% male) who completed the telephonic interview, the nursing teleconsultation revealed the need of medical intervention in 69 patients (46%), who were more likely at very high cardiovascular risk (77% vs. 48%; p < 0.0003) and who showed a higher prevalence of dyslipidemia (97% vs. 64%; p < 0.0001) and coronary artery disease (75% vs. 48%, p < 0.0008) compared to those not in need of any intervention. The up-titration of the lipid-lowering drugs (n: 32, 74%) was the most frequent medical intervention following the nursing teleconsultation. The mean time between the nursing teleconsultation and the date of the rescheduled in-person follow-up visit was 164 ± 36 days. Conclusions: Nursing teleconsultation is a simple and well-tolerated strategy that ensures the continuity of care and outpatient management for patients with cardiovascular diseases during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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9 pages, 313 KiB

Open AccessArticle

Cardiovascular Comorbidities and Pharmacological Treatments of COVID-19 Patients Not Requiring Hospitalization

by Vincenzo Russo, Gaetano Piccinocchi, Vincenzo Mandaliti, Saverio Annunziata, Giovanni Cimmino, Emilio Attena, Nicola Moio, Pierpaolo Di Micco, Sergio Severino, Roberta Trotta and Michele Del Guercio

Int. J. Environ. Res. Public Health 2021, 18(1), 102; https://doi.org/10.3390/ijerph18010102 - 25 Dec 2020

Cited by 15 | Viewed by 3310

Abstract

Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings. Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between 9 March and 1 May 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described. Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 ± 17 years; 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74; 95% CI 1.05 to 13.34; p = 0.04) and hypertension (RR: 1.69; 95% CI 1.05 to 2.7; p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43; 95% CI 1.01 to 5.8; p = 0.03) was significantly associated with heparin administration. Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin–angiotensin–aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

7 pages, 271 KiB

Open AccessArticle

Contact Screening for Healthcare Workers Exposed to Patients with COVID-19

by Luca Coppeta, Giuseppina Somma, Lorenzo Ippoliti, Cristiana Ferrari, Iacopo D’Alessandro, Antonio Pietroiusti and Marco Trabucco Aurilio

Int. J. Environ. Res. Public Health 2020, 17(23), 9082; https://doi.org/10.3390/ijerph17239082 - 5 Dec 2020

Cited by 22 | Viewed by 2584

Abstract

In China and Italy, many cases of coronavirus disease 2019 (COVID-19) have occurred among healthcare workers (HCWs). Prompt identification, isolation and contact tracing of COVID-19 cases are key elements in controlling the COVID-19 pandemic. The aim of this study was to evaluate the rate of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection among HCWs exposed to patients with COVID-19 in relation to the main determinants of exposure. To assess the risk of exposure, we performed active symptom monitoring in 1006 HCWs identified as contacts of COVID19 cases. The presence of symptoms was statistically associated with a positive nasopharyngeal swab result. Only one subject was asymptomatic at the time of positive test. These data suggest that clinical history may help in the selection of subjects to be investigated by means of reverse transcriptase-polymerase chain reaction (RT-PCR) in the case of a shortage of diagnostic resources. We found that close contact (within 2 m for 15 min or more) was not statistically related to contagion. Regarding the use of personal protective equipment (PPE), only the use of facial masks was inversely related to the chance of becoming infected (p < 0.01). In conclusion, our data show that unprotected contacts between HCWs should be considered a major route of HCW contagion, suggesting that the use of facial masks should be implemented even in settings where known patients with COVID-19 are not present. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

6 pages, 288 KiB

Open AccessArticle

Rubella Immunity among Italian Female Healthcare Workers: A Serological Study

by Luca Coppeta, Cristiana Ferrari, Ilaria Iannuzzi, Iacopo D’Alessandro, Ottavia Balbi, Antonio Pietroiusti and Marco Trabucco Aurilio

Int. J. Environ. Res. Public Health 2020, 17(21), 7992; https://doi.org/10.3390/ijerph17217992 - 30 Oct 2020

Cited by 12 | Viewed by 2221

Abstract

Rubella, also known as German measles or three-day measles, is an infectious disease caused by virus of the genus Rubivirus, which may be prevented by vaccination. The infection is potentially dangerous for non immune subjects, although 20–50% of infected subjects are asymptomatic. Healthcare workers (HCWs) have an increased potential exposure to rubella in comparison to the general population, putting them and their patients at risk of infection and its complications. In 2019, 20 cases of rubella have been reported in Italy. According to the Italian National Immunization and Prevention Plan, HCWs should provide a written certification of vaccination for rubella or serological evidence of protective antibodies. The aim of the study was to evaluate the rubella immunization status in female HCWs of the teaching hospital Policlinic Rome Tor Vergata (PTV) of childbearing age. For this purpose, we retrospectively checked the serologic values of rubella-specific IgG antibodies analyzing the clinical records of the HCWs of undergoing the occupational health surveillance program from January 1st to June1st 2020. Five hundred fourteen HCWs with a mean age of 23.19 (range 19–37, DS: 2.80) were included: 90.3% (464) showed a protective antibody titre. The mean value of the anti-rubella IgG was 49.59 IU/mL. Our study shows a non-protective anti rubella IgG titre in a substantial percentage of HCWs (9.7%). As vaccine protection decreases over the years and the risk of congenital rubella syndrome (CRS) in vaccinated subjects should not be underestimated, we suggest routine screening of the immunological status followed by the administration of a third dose of vaccine if the antibody titre becomes non-protective. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

Review

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8 pages, 872 KiB

Open AccessReview

The Impact of COVID-19 Pandemic on Hospitalization and Interventional Procedures for Cardiovascular Diseases during the First Wave in Italy

by Vincenzo Russo, Luigi Cante, Egidio Imbalzano, Pierpaolo Di Micco, Roberta Bottino, Andreina Carbone and Antonello D’Andrea

Int. J. Environ. Res. Public Health 2023, 20(1), 472; https://doi.org/10.3390/ijerph20010472 - 28 Dec 2022

Cited by 4 | Viewed by 2268

Abstract

Coronavirus disease 2019 (COVID-19) has been responsible for an epidemic of devastating proportion, and it has represented a challenge for worldwide healthcare systems with the need of resources reallocation in order to face epidemic spread. Italy was one of the hardest hit countries by COVID-19, and the Italian government adopted strict rules to contain the spread of the COVID-19 pandemic, such as national lockdown and home quarantine; moreover, the Italian healthcare system had to rapidly re-organize the diagnostic and therapeutic pathways, with a reallocation of health resources and hospital beds, in order to manage COVID-19 patients. The aim of the present review is to provide an overview of the effects of the first pandemic wave on cardiovascular assistance in Italy with the purpose of evaluating the strengths and weaknesses of the Italian health system. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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Other

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8 pages, 426 KiB

Open AccessBrief Report

Health and Economic Impact of Atrial Fibrillation of Workers in Italy: Social Security Benefits

by Marco Trabucco Aurilio, Francesco Saverio Mennini, Claudia Nardone, Andrea Piccioni, Matteo Bolcato, Vincenzo Russo, Valerio Sciannamea, Raffaele Migliorini, Luca Coppeta and Andrea Magrini

Int. J. Environ. Res. Public Health 2022, 19(3), 1883; https://doi.org/10.3390/ijerph19031883 - 8 Feb 2022

Cited by 2 | Viewed by 1942

Abstract

Background: The aim of this research was to analyze trends in social security applications in Italy as a result of the onset of atrial fibrillation, analyzing data pertaining to the classification of professions and assessing the economic impact on the social security system. Methods: We analyzed all applications for invalidity allowances and invalidity pensions throughout Italy over a 10-year period from 01.01.2009 to 31.12.2019, giving specific attention to all reports indicating atrial fibrillation as the principal diagnosis (Cod. ICD-9-CM 427.31). We then extracted the relative expenditure data for said benefits. The results of all analyses have been collated in tables. Results: Over the period in question, a total of 3468 applications for assistance were filed throughout Italy indicating a diagnosis of atrial fibrillation, of which 58% were rejected, 41% qualified for an invalidity allowance, and only 1.1% qualified for a pension. On average, every year, 1100 workers received social security benefits as a result of a diagnosis of atrial fibrillation, which equates to an average annual expenditure of EUR 10 million. A comparison of the data from the first observation year (2009) with data from the last (2019) shows a rising trend in the number of beneficiaries and consequently in expenses. Conclusions: The social security assistance provided by the Italian government by means of the National Institute of Social Security is fundamental to social cohesion and to those who are either permanently disabled from working or those with a significantly diminished earning capacity. This assistance is associated with a significant financial cost, which requires careful monitoring. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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7 pages, 1556 KiB

Open AccessBrief Report

The Impact of COVID-19 Outbreak on Syncope Units Activities in Italy: A Report from the Italian Multidisciplinary Working Group on Syncope (GIMSI)

by Vincenzo Russo, Giulio Boggian, Maria Giulia Bolognesi, Domenico Maria Carretta, Simone Cencetti, Domenica De Laura, Enzo Hrovatin, Paolo Pastori, Caterina Tomaselli, Erika Parente, Martina Rafanelli, Andrea Ungar and on behalf of COVID-19 GIMSI Study Group

Int. J. Environ. Res. Public Health 2021, 18(17), 9194; https://doi.org/10.3390/ijerph18179194 - 31 Aug 2021

Cited by 7 | Viewed by 2687

Abstract

The aim of our study was to evaluate the impact of the COVID-19 outbreak on Syncope Units (SUs) Activities in Italy. Methods: Data about types of SU activities and admissions were obtained from 10 SUs throughout Italy, certified by the Italian Multidisciplinary Working Group on Syncope (GIMSI), from 10 March 2020 to 31 December 2020 and compared with the same time frame in 2019. Results: A remarkable reduction in overall non-invasive diagnostic tests (−67%; p < 0.001) and cardiac invasive procedure. Elective cardiac pacing procedures disclosed a significant decrease (−62.7%; p < 0.001); conversely, the decrease of urgent procedures was not significant (−50%; p = 0.08). There was a significantly increased rate of patients who underwent both telemedicine follow-up visits (+225%, p < 0.001) and cardiac implantable electronic devices (CIEDs) remote monitoring follow-up visits (+100%; p < 0.001). Conclusion: The COVID-19 outbreak was associated with a remarkable decrease in all clinical activities of Syncope Units in Italy, including both non-invasive tests and cardiac invasive procedures; conversely, a significant increase in telehealth activities was shown. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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9 pages, 318 KiB

Open AccessBrief Report

Hospital-Acquired SARS-Cov-2 Infections in Patients: Inevitable Conditions or Medical Malpractice?

by Rosario Barranco, Luca Vallega Bernucci Du Tremoul and Francesco Ventura

Int. J. Environ. Res. Public Health 2021, 18(2), 489; https://doi.org/10.3390/ijerph18020489 - 9 Jan 2021

Cited by 52 | Viewed by 6540

Abstract

Despite numerous measures to contain the infection and limit its spread, cases of SARS-CoV-2 infections acquired in hospitals have been reported consistently. In this paper, we will address issues of hospital-acquired COVID-19 in hospitalized patients as well as medico-legal implications. After having conducted a literature search, we will report on papers on hospital-acquired SARS-CoV-2 infections. Ten scientific papers were selected and considered suitable for further analysis. According to several reports, the SARS-CoV-2 hospital-acquired infection rate is 12–15%. Hospital-acquired COVID-19 represents a serious public health issue, which is a problem that could create reluctance of patients to seek hospital treatment for fear of becoming infected. Healthcare personnel should do all that is necessary to address the problem and prevent further spreading, such as rigorous compliance with all procedures for containing the spread. From a medical-legal point of view, multiple aspects must be considered in order to understand whether the infection is a result of “malpractice” or an inevitable condition. Full article

(This article belongs to the Special Issue Preventive and Social Medicine in Outbreak Era)

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