The definition, monitoring and evaluation of the observed and expected positive, symptomatic and deceased cases, the adverse reactions, and the antibody titres and their duration are the essential ...elements for estimating the benefit to risk ratio. Unfortunately, this is true only for a part of the world population, since the majority are still waiting for vaccines.1 The gap between available vaccines and vaccinated people raises concern around production and distribution of vaccines, and global health equity.2 Moreover, race/ethnic disparities in testing, infection rates and hospitalisation across the COVID-19 pandemic did not spare children.3 Additionally, social determinants affect child health in the COVID-19 era.4 In this scenario, the use of the Pfizer vaccine in the population of children aged 12–17 years old was recently approved by the Food and Drug Administration (FDA), the European Medicines Agency (EMA) and a few national drug agencies following the results of a phase III trial conducted with 2260 adolescents (1131 vaccinated as adults).5 Trials on the same population age range using the Moderna vaccine were also concluded and the use approved by the FDA and the EMA, while phase III trials starting from 6 months of age are also underway with other vaccines. Given the reduced individual benefit to risk ratio expected from vaccination against COVID-19 in adolescents compared with older age groups, the epidemiological situation, the coverage of at-risk groups and their possible trend should be carefully assessed before planning the mass vaccination of children and adolescents. With respect to the risks, in Israel 257 cases of myocarditis were reported in 5 million vaccinated children aged 12–17 years old.9 These 50 cases per million are many compared with the cases of thrombocytopaenia reported in adults after vaccination with a viral vector (1 per million), but represent a rate that is close to the expected rate in the general paediatric population, and concern an infection that is, in any case, curable and with a good outcome.10 COVID-19 vaccination therefore so far only seems to be measurable in terms of benefits, although these are of different magnitude between age groups.
Aim of the present study is to describe characteristics of COVID-19-related deaths and to compare the clinical phenotype and course of COVID-19-related deaths occurring in adults (<65 years) and ...older adults (≥65 years).
Medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged < 65 years and 2,664 aged ≥65 years) were revised to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death.
Older adults (≥65 years) presented with a higher number of comorbidities compared to those aged <65 years (3.3 ± 1.9 vs 2.5 ± 1.8, p < .001). Prevalence of ischemic heart disease, atrial fibrillation, heart failure, stroke, hypertension, dementia, COPD, and chronic renal failure was higher in older patients (≥65 years), while obesity, chronic liver disease, and HIV infection were more common in younger adults (<65 years); 10.9% of younger patients (<65 years) had no comorbidities, compared to 3.2% of older patients (≥65 years). The younger adults had a higher rate of non-respiratory complications than older patients, including acute renal failure (30.0% vs 20.6%), acute cardiac injury (13.5% vs 10.3%), and superinfections (30.9% vs 9.8%).
Individuals dying with COVID-19 present with high levels of comorbidities, irrespective of age group, but a small proportion of deaths occur in healthy adults with no preexisting conditions. Non-respiratory complications are common, suggesting that the treatment of respiratory conditions needs to be combined with strategies to prevent and mitigate the effects of non-respiratory complications.
Introduction. In Italy, minor migrants represent 21.8% of the non-EU citizens. The care of minor migrants might be challenging as this population is characterized by higher vulnerability and special ...needs. The study aim was to describe the perceptions on the provision of care, the bio-psycho-social needs of migrant children and the professional training needs. Methods. The study is qualitative descriptive. In May 2019 three focus group, involving health and social professionals, cultural mediators and NGOs operators, were organized. Results. The study explored different areas of the provision of care to minor migrants including bio-psycho-social needs, care provision, barriers to care and professionals’ training needs. Discussion and conclusions. The provision of care should consider the specific migration journey and narrative. In some cases healthcare is fragmented, generating obstacles to access especially in minors with lower levels of health literacy. Training plays a key role in the development of cultural competence.
The media can play an important role in influencing both the demand and supply of medical treatments, regardless of evidence of effectiveness. This can be highlighted by recent experiences in Italy ...following publicity for a new unproven treatment in Italy, which it was claimed was highly successful in treating a wide range of cancers. The media role in influencing both health authorities to fund large scale trials of the intervention and patients awareness and expectations of therapy are discussed. The changes in Italian media over the last 20 years have seen a reduction in the numbers of specialist medical journals, with increased emphasis placed on sensationalism rather than accuracy. The media though has the potential to play in future an important strategic role in disseminating accurate information on issues pertaining to health.
Objective
This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID‐19).
Methods
Medical charts of 3,694 of patients dying ...with COVID‐19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in‐hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities.
Results
Obesity was present in 411/3,694 (11.1%) patients dying with COVID‐19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio OR, 1.33; 95% CI: 1.04‐1.71) and shock (adjusted OR, 1.54; 95% CI: 1.19‐1.99). The associations of obesity with acute renal failure and shock were stronger in patients aged < 60 years (adjusted OR, 2.00; 95% CI: 1.09‐3.67 and OR, 2.37; 95% CI 1.29‐4.36) than in those aged 60 years or older (adjusted OR, 1.20; 95% CI: 0.90‐1.60 and OR, 1.22; 95% CI: 0.91‐1.65).
Conclusions
In patients dying with COVID‐19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure. These associations seem stronger in younger than in older adults. Strategies should be put in place in patients with COVID‐19 with obesity to prevent these complications.
BACKGROUND
Persons with Down syndrome (DS) are presumed to be at high risk of severe CoVID‐19, due to immune dysregulation and often compromised cardiopulmonary function. Aim of the present study is ...to assess epidemiological and clinical characteristics of individuals with DS deceased in Italian hospitals with CoVID‐19.
METHODS
We used a nationwide database of 3,438 patients deceased with RT‐PCR‐confirmed SARS‐CoV‐2 infection in Italy (10.4% of all deaths with CoVID‐19 in the country at the time of analysis). Data on demographics, pre‐existing comorbidities and in‐hospital complications leading to death were extracted from medical charts obtained from hospitals. Data on individuals with DS deceased with CoVID‐19 were obtained from this sample.
RESULTS
Sixteen cases of death in individuals with DS (0.5% of all charts analyzed) were identified. Acute respiratory distress syndrome occurred in all 16 cases. Compared with individuals without DS, those with DS deceased with CoVID‐19 were younger (52.3 ± 7.3 vs. 78.1 ± 10.6 years, p < .001) and presented a higher incidence of superinfections (31.2 vs. 13.0%, p = .029). Autoimmune diseases (43.8 vs. 4%, p < .001), obesity (37.5 vs. 11%, p = .009), and dementia (37.5 vs. 16.3%, p = .012) were more prevalent in individuals with DS. ICU admissions was similar in both groups (25 vs. 18.8%, p = .129).
CONCLUSIONS
Individuals with DS deceased with CoVID‐19 are younger than individuals without DS. Comorbidity burden and increased risk of complications (i.e., bacterial superinfections) can influence CoVID‐19 prognosis in individuals with DS. Specific strategies to prevent and mitigate the effects of CoVID‐19 in the population with DS are needed.
Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited ...sex-disaggregated data available.
A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27-June 11, 2020). Clinical characteristics and the times from symptoms' onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex.
Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39-2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29-2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13-1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55-0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25-0.63), yet both sexes had a high level of multimorbidity. The times from symptoms' onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45-5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13-1.90).
Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.
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