Worldwide there are no official statistics on mortality in nursing homes (NH) during the pandemic. In 2020, deaths among NH residents in Europe accounted for 37–66 % of all COVID-19-related deaths [ [1] Danis K. Fonteneau L. et al. ECDC Public Health Emergency TeamHigh impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020; 252000956 Google Scholar ]. Mortality among NH residents affected by COVID-19 increased with older age, male sex, physical and cognitive impairment, end-stage renal disease, immunocompromised status, and diabetes [ [2] Lu Y. Jiao Y. Graham D.J. et al. Risk Factors for COVID-19 deaths among elderly nursing home Medicare beneficiaries in the prevaccine period. J Infect Dis. 2022; 225: 567-577 Crossref PubMed Scopus (19) Google Scholar , [3] Levin A.T. Jylhävä J. Religa D. Shallcross L. COVID-19 prevalence and mortality in longer-term care facilities. Eur J Epidemiol. 2022; 37: 227-234 Crossref PubMed Scopus (18) Google Scholar ]. Nonetheless, data on causes of mortality among NH residents are sparse and incomplete. Our analyses focused on the Veneto Region, northeastern Italy, heavily affected during the early phases of the pandemic. The aim of the study was to compare overall and cause-specific mortality among NH residents in the pre-pandemic period, through the pandemic before and after mass vaccination.

Background In the Veneto Region, 421,000 coronavirus 2019 disease (COVID-19) cases and 11,000 deaths have been reported since 21 February 2020. The pandemic spread particularly in nursing homes (NH). Objective This study estimated the impact of SARS-CoV-2 infection among NH residents, focusing on the risk of hospitalisation and death due to COVID-19 compared with the general older population. It also provided evidence of risk changes over time. Methods Older people, resident in Veneto, were enrolled from the regional registry of the population. We collected also information about demographic characteristics, chronic diseases, COVID-19 positivity, NH institutionalization, hospitalisation and date of death. Patients were assigned to NH or non-NH residents groups through a propensity score 1:1 matching. The follow-up period was defined as 21 February 2020 - 3 May 2021 and then divided into three waves. Risk ratios (RRs) and 95% confidence interval were estimated by using Poisson models with robust estimation of variance. Results NH residents showed a higher risk of COVID-19 infection (RR = 6.28; 6.03-6.54), hospitalisation for COVID-19 (RR = 2.20; 2.05-2.36) and death with COVID-19 (RR = 6.07; 5.58-6.61). Conclusion NH residents shared common spaces with other patients and healthcare professionals and were more exposed to infections. Nonetheless, in Italy from late December 2020 to May 2021, 95% of NH residents and their healthcare professionals received at least one vaccine dose and RRs for all outcomes decreased in NH.

Aims The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality. Methods The regional mortality archive was linked to electronic medical records for all residents aged 18-84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR). Results During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37-0.55), highest in patients aged 45-54 years (MRR 1.56; 95% CI 1.09-2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30-20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality. Conclusions Suicide prevention strategies must be promptly initiated after patients' first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide.

The World Health Organization considers excess morbidity and mortality among people with mental disorders as a high public health priority. This study aims to estimate the mortality risk and causes of death among a large population-based cohort of psychiatric patients. All residents in Veneto (Northeastern Italy) aged between 18 and 84 years with a contact with Community Mental Health Centers in 2008 and a psychiatric diagnosis (n = 54,350) were followed-up for 10 years. Standardized Mortality Ratios (SMR) and excess mortality were computed, with the general regional population as a reference. Mortality was more than doubled (males SMR = 2.4; females SMR = 2.2) and the relative increase in mortality was much larger in young and middle-aged adults (18-44 and 45-64 years) across all diagnostic groups. The most frequent causes were circulatory diseases (27%) and neoplasms (26%). Although the risk was increased by about tenfold, deaths from suicide were limited to 6% and 4% of all decedents in males and females, respectively. Patients with schizophrenia showed a very high risk for mortality for diabetes and cardiovascular disorders. A large excess was found also for respiratory diseases and a two-fold increase for lung cancer in males and breast cancer in females. Although chronic physical disorders are known to be the main causes of mortality in such patients, they receive far less attention than suicide or accidents. Our results suggest that there is still a need to plan actions to prevent excess mortality and to improve the quality of life of patients with mental disorders.

In spite of a rapidly ageing population, there is a lack of population-based data on mortality among nursing home residents in Southern Europe. To assess mortality rates, their determinants, and causes of death in newly admitted nursing home residents in the Veneto region (northeastern Italy). 19,392 subjects aged ≥ 65 years admitted to regional nursing homes during 2015–2017 were recruited in a cohort mortality study based on linked health records. Risk factors for mortality were investigated by Cox regression. The distribution of causes of death was retrieved from death certificates. Mortality peaked in the first 4 months after admission; thereafter the monthly mortality rate fluctuated around 3% in males and 2% in females. Overall mortality was 23% at 6 months and 34% at 1 year. In addition to age, gender, and dependency, main risk factors for mortality were recent hospitalization (first 4 months after entry into the facility), and the burden of comorbidities (subsequent follow-up period). The most represented causes of mortality were similar in the first and in the subsequent period after admission: cardio-cerebrovascular diseases, neurodegenerative diseases, respiratory diseases, and infections. The first months after admission represent a period at high risk of mortality, especially for patients with a recent hospitalization. Causes reported in death certificates suggest mainly an acute deterioration of pre-existing chronic conditions. Health care plans should be personalized for newly admitted vulnerable patients. Palliative care needs should be recognized and addressed for high-risk non-cancer patients.

Background: In environmental surveys, risk perception may be a source of bias when information on health outcomes is reported using questionnaires. Using the data from a survey carried out in the largest chipboard industrial district in Italy (Viadana, Mantova), we devised a score of health risk perception and described its determinants in an adult population.Methods: In 2006, 3697 parents of children were administered a questionnaire that included ratings on 7 environmental issues. Items dimensionality was studied by factor analysis. After testing equidistance across response options by homogeneity analysis, a risk perception score was devised by summing up item ratings.Results: Factor analysis identified one latent factor, which we interpreted as health risk perception, that explained 65.4% of the variance of five items retained after scaling. The scale (range 0-10, mean +/- SD 9.3 +/- 1.9) had a good internal consistency (Cronbach's alpha 0.87). Most subjects (80.6%) expressed maximum risk perception (score = 10). Italian mothers showed significantly higher risk perception than foreign fathers. Risk perception was higher for parents of young children, and for older parents with a higher education, than for their counterparts. Actual distance to major roads was not associated with the score, while self-reported intense traffic and frequent air refreshing at home predicted higher risk perception.Conclusions: When investigating health effects of environmental hazards using questionnaires, care should be taken to reduce the possibility of awareness bias at the stage of study planning and data analysis. Including appropriate items in study questionnaires can be useful to derive a measure of health risk perception, which can help to identify confounding of association estimates by risk perception. (C) 2015 Elsevier B.V. All rights reserved.

Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30–54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30–54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.

Background: In the Genes Environment Interaction in Respiratory Diseases population-based multi-case control study, we investigated whether asthma, chronic bronchitis (CB) and rhinitis were associated with a reduced 6-minute walk distance (6MWD), and whether the 6MWD determinants were similar for subjects with/without respiratory diseases. Methods: Cases of asthma (n = 360), CB (n = 120), rhinitis (n = 203) and controls (no respiratory diseases: n = 302) were recruited. The variation in the 6MWD across the groups was analyzed by ANCOVA, adjusting for gender, age, height, weight and comorbidity. The 6MWD determinants were studied by linear regression, and heterogeneity across the cases and controls was investigated. Results: The 6MWD differed across cases and controls (p = 0.01). It was shorter for cases of asthma (–17.1, 95% CI –28.3 to –5.8 m) and CB (–20.7, 95% CI: –36.6 to –4.8 m) than for controls (604 ± 68 m on average), but not for cases of rhinitis. The negative association between age and the 6MWD was significant for cases of CB, but not for the other groups (p = 0.001). Conclusions: Even at the level of severity found in the general population, asthma and CB could influence the 6MWD, which seems to reflect the functional exercise level for daily physical activities. The negative association between ageing and the 6MWD was particularly strong in subjects with CB. Our report adds to the mounting evidence that CB is not a trivial condition, especially in the ageing adult population, and it supports the importance of monitoring functional capacity and of physical reconditioning in mild asthma.

Land grabbing appears to be driven by a variety of factors that seem destined to expand in the long term. The aim of this paper is to highlight the behavior and the role of China (a net food importer country) and India (which is facing a problem of energy insecurity) in the current escalation of the commercialization of land and to identify (through a correlation matrix) the drivers of land grabbing deals. Our analyses are based on the Land Matrix Database.

Inequalities between poorer and wealthier people in accessing healthcare services have been widely studied, but the mechanisms generating them are still to be fully understood. Among these, there is still a lack of evidence of relationships between health prevention/health promotion policies, welfare systems and social differences. We analysed 68 201 females from the PASSI Italian surveillance system for the years 2007-2010. The prevalence of women undergoing Pap testing was used as an example of access to preventive services. An odds ratio gradient was found with regard to different welfare system clusters: the probability of undergoing a screening test is higher for more advanced welfare systems. A strong association was found between having received a letter from the local health unit and having undergone the screening test. Significant differences still exist between high- and low-income women and their access to Italian preventive public services. As we expected, social determinants play an important role in health disparities, as these are also strongly influenced by typologies of welfare systems and by health policies.

Scientific literature recommends nurses to use the Geriatric Depression Scale (GDS) in the assessment of symptoms of depression among elderly with no cognitive deficits. The first purpose of this observational study was to determine the prevalence of depressive symptoms and the related antidepressant therapy in a sample of institutionalized elderly people administering the 30 questions GDS (GDS 30). The second aim was to estimate the time to complete the test. The survey is a cross-sectional multicenter study. 115 cognitively intact elderly residents in 5 retirement houses in the province of Vicenza (Italy) were administered the 30 items GDS by nursing staff: 80 females with a median age of 83 years (Inter Quartile Range RIQ: 80-85) and 35 males with a median age of 79 years (RIQ: 73-85). The prevalence of depression was 46% (95% Confidence Interval: 37-55%). The difference in depression between males and females was not significant (p=0.646). The median of the total answering time was equal to 306 seconds (RIQ: 257-315). The answering time of the GDS in people taking antidepressants is higher with respect to those who do not take them. The GDS 30 is an useful tool for nurses to identify in a fairly short amount of time institutionalised individuals with no cognitive deficit and risk of depression.

Understanding attitudes towards pollution in the population might help to prevent bias in questionnaire-based environmental studies, because subjects living closer to emission sources may be more concerned than those who live farther away, thus tending to over-report adverse health outcomes. Using data from a survey on parents of 3697 school-age children (response rate 99%) in an industrial area in northern Italy (Viadana), we devised a score on environmental concerns (EC), evaluated its psychometric properties and its association with several determinants. Six questions surveyed respondents9 concerns about electromagnetic fields (EMFs), traffic, lack of public parks, air pollution, indoor cigarette smoke and chemicals in food. Answers were coded as 0 (don9t know/not at all), 1 (a little), 2 (quite a lot), 3 (a lot). Explanatory factor analysis (EFA) and homogeneity analysis were performed. A summed score was computed (range 0-18). The association between a 1-unit increase in the score and potential determinants was estimated by relative risks (RRs), obtained by negative binomial regression. EFA identified one unique factor, explaining 61% of the variance. The homogeneity analysis revealed its good internal reliability (Cronbach9s α = 0.85) and confirmed the equidistance of the item options response. Item mean scores ranged from 2.0±1.0 (EMFs) to 2.8±0.7 (air pollution). Fathers, indoor-smokers, low educated and non-Italian parents reported less concerns (RRs=0.59, 0.68, 0.38, and 0.82, respectively) with respect to referral groups (p Respondents9 characteristics influence their level of EC. The devised score may be useful in future research to control for EC-related confounding.

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20–44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991–1993; n=6,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998–2000; n=18,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007–2010; n=10,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19–1.59) from 1998–2000 to 2007–2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhinitis.

La letteratura raccomanda agli infermieri l’impiego della Geriatric Depression Scale (GDS) nell’accertamento dei sintomi di depressione fra gli anziani senza deficit cognitivi. Lo scopo primario del presente studio osservazionale è stato quello di determinare la prevalenza di sintomi depressivi e della concomitante terapia antidepressiva in un campione di anziani istituzionalizzati somministrando la GDS a 30 domande (GDS 30). L’obiettivo secondario è stato quello di stimare il tempo impiegato per la compilazione del test. L’indagine è uno studio trasversale multicentrico. Ad un campione di 115 anziani cognitivamente intatti, residenti in cinque case di riposo della provincia di Vicenza, è stata somministrata la GDS 30 dal personale infermieristico. 80 femmine di età mediana pari a 83 anni [Range Inter-Quartile (RIQ): 80-85] e 35 maschi di età mediana pari a 79 anni (RIQ: 73-85). La prevalenza di depressione è risultata del 46% (Intervallo di Confidenza 95%: 37-55%). La differenza di depressione fra maschi e femmine non è risultata significativa (p=0,646). La mediana del tempo totale di compilazione è risultata pari a 306 secondi (RIQ: 257-315). I tempi di compilazione della GDS nei soggetti che assumono antidepressivi sono superiori rispetto a quelli di coloro che non li assumono. La GDS 30 rappresenta un utile strumento che l’infermiere può adottare per identificare in un tempo relativamente breve i soggetti istituzionalizzati senza deficit cognitivo ed a rischio di depressione.