Background
Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population.
Methods
A web-based ...questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access.
Results
A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons.
Conclusions
Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.
•Two biomimetic complexes were precipitated and the thermal behavior was studied.•Evolved gas analysis by MS allowed to prove the supposed decomposition mechanism.•The different influence of the ...reaction atmosphere was proved by the fragmentation pattern.•Based on a previous paper, the behavior suggests a thermal decomposition that is not dependent from the central metal ion.
Mass spectrometry evolved gas analysis (EGA-MS) was applied to characterize cobalt and zinc biomimetic complexes with a polycarboxylate ligand, imidazole-4,5-dicarboxylic acid (H2imdc). The precipitated Co(Himdc)2(H2O)2 and Zn(Himdc)2(H2O)2 complexes were studied to determine their thermal stability and to prove their decomposition mechanism by evolved gas analysis (EGA-MS). The results confirmed that the decomposition mechanism, already proposed for the analog copper and nickel complexes, can be assumed as representative for these structures, independently from the central coordinating metal.
Abstract
Background
Non-ST-elevation myocardial infarction (NSTEMI) is a condition that is associated with a high morbidity and mortality burden. The aim of the present study is to analyze clinical ...characteristics and outcomes of a large contemporary population of NSTEMI patients according to treatment strategy in a large administrative database.
Methods
This retrospective observational study included patients living in the region of Tuscany, aged 18 years or older who were discharged from a regional hospital with a diagnosis of NSTEMI (principal diagnosis ICD-9-CM codes 410.7 or 411.1 in HDA) between January 2016 and December 2018. According to management strategy patients were classified in two main groups: a conservative strategy (CON) group and an invasive strategy (INV) group which was further categorized in three subgroups: a PCI group, a CABG group and a group were patients were invasively managed but medically treated.
Results
The study population was composed by 15.208 patients. Mean age was 76±9 years, with 50% aged 75+ years, females were 38.5%. Management strategies groups composition was: CON strategy 24.9% and among INV strategy (75.1%) 67.3% were treated by PCI, 8.8% by CABG and 24% were invasively managed but medically treated. Compared to INV managed patients, patients in the CON group were older (mean age 85 vs 72 years, p<0.0001), more frequently female (54% vs 33%, p<0.0001), had a higher cardiovascular and non-cardiovascular comorbidity burden (eg. hypertension, diabetes, heart failure, atrial fibrillation, renal insufficiency, cancer, dementia and COPD, all <0.0001). In-hospital, 30-days and 1-year all-cause mortality rates (Figure) were 3%, 4.9% and 15.3% resulting significantly higher in the CON management strategy group compared to the INV strategy group: 8.9% vs 1.1; 14.0 vs 1.9%; all p<0.0001. Analyzing all-cause mortality rates among the three INV subgroups we found no differences both in-hospital and at 30 days, while at 1-year we found, all-cause mortality there was a significant difference among the three groups with a slightly higher mortality rate in the INV medically treated group compared to the PCI and the CABG subgroups: 8.9% vs 7.2% vs 7.5% respectively, p=0.011.
Conclusions
Real-world evidence show that patients with NSTEMI have significantly different characteristics and outcomes according to management strategy. Patients managed non-invasively have more complex features and worse outcomes both in-hospital and post-discharge. Patients which were managed invasively but medically treated represent an interesting subgroup which may deserve further evaluation.
Funding Acknowledgement
Type of funding sources: None.
Background
Fear of contracting COVID-19 and the large-scale preventing measures may have influenced health service utilization. The aim of the study was to assess the indirect impact of COVID-19 ...pandemic on the utilization of the emergency medical services (EMS) of Tuscany Region (Italy).
Methods
The study was carried out on administrative data from the public healthcare system of Tuscany (38 general hospitals and 4 university teaching hospitals). Variations in the utilization of out-of-hospital (i.e. calls for emergency medical assistance and dispatch of mobile medical care units) and in-hospitals (emergency department(ED) visits and hospitalizations from the ED) EMS during the first pandemic wave were analyzed (February - July 2020) in relation with corresponding periods of the previous three years. Furthermore, in order to understand changes in illness severity of patients using the EMS, standardized ratios for hospitalizations requiring ICU and in-hospital mortality were analyzed.
Results
Significant decreases in the expected volumes of utilizations were observed in each of the considered EMS starting from the week in which the first case of COVID-19 was confirmed in Italy till the last week of the first wave. In particular, during the peak period of COVID-19 pandemic wave a reduction of 73,041 (-67%, 95%CI -69%; -66%) in ED admissions and of 682 (-38% 95%CI -55%; -43%) in hospitalization from ED were observed. Significant decreases in hospitalizations for life threatening medical conditions were observed. No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the COVID-19 epidemic peak period (SR 1.1 95%CI 0.72-1.90; SR 1.0 95%CI 0.83-1.23).
Conclusions
A large and generalized decrease in EMS utilization was observed during the first wave of COVID-19 pandemic. Furthermore, findings suggest that seriously ill patients avoid seeking care as less seriously ill patients did.
Key messages
The falling in the utilization of emergency medical services during pandemic could portend substantial harm to public health, and not simply the absence of real health need.
The preparedness of the healthcare delivery system should not focus solely on confronting the pandemic disease, but also on ensuring access to high quality emergency care for other diseases.
Background
Since the outbreak of COVID-19 has raged, large-scale measures for prevent disease transmission have been implemented worldwide. If effectively implemented, these measures may have led to ...a reduction of the spread of other respiratory infectious diseases at community level. The aim of the present study was to evaluate the indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in the elderly during the first epidemic wave of COVID-19 in Tuscany, Italy.
Methods
A population based study was carried out on data from the Tuscany healthcare system. Hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumptions of antibacterials for CAP in people aged 65 years and older were considered as outcome measures. Percentage changes in the outcome measures were calculated considering corresponding periods of the 2020 and 2017-19. 95% confidence intervals and the statistical significance of the percentage changes were calculated using the Poisson model.
Results
A total of 3,346 new CAP hospitalizations occurred in people aged 65 years and older in the whole study time-frame. Significant reductions in the weekly hospitalization rates for CAP were observed starting from the week in which the national containment measures were imposed, this negative deviation continued even after the lift of the national lock-down until the end of the first wave of COVID-19 in July (maximum weekly decrease of 46%). All the antibacterial classes for CAP showed a significant decrease in their outpatient consumptions during the COVID-19 epidemic period.
Conclusions
The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in the elderly during the first wave of COVID-19 pandemic. Furthermore, findings suggests that individual prevention measures that remained mandatory after the lift of the national lock-down also had a relevant role in the reducing CAP incidence.
Key messages
The potential benefits of pandemic containment measures can extend beyond the prevention of COVID-19 to include the reduction of the burden of respiratory infectious diseases
Taking into account the indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic.
BackgroundOver the past decade, transcatheter aortic valve implantation (TAVI) has emerged as a novel and less invasive alternative to traditional surgical aortic valve replacement (SAVR) for the ...management of severe aortic stenosis (AS) in higher-risk elderly patients.PurposeOur aim was to evaluate the frequency of polypharmacy (treatment with more than four medications per person) and to analyse the ATC class of medications prescribed in a fragile population.Material and methodsWe analysed the data of patients whose medical procedures included TAVI or SAVR, between January 2016 and October 2017.We identified a total of 903 patients who underwent TAVI (n=228) or SAVR (n=675), whose clinical characteristics were assessed by calculating the Charlson comorbidity index (CCI).ResultsPatients in the TAVI group were more likely to be older (p<0.0001), female (p<0.01) and to have a higher CCI (p=0.05).No significant difference in polypharmacy was observed between the two groups at discharge, after 6 and 9 months from the hospitalisation. In particular, the patients in polypharmacy, immediately after discharge, were 29% in the TAVI group and 35% in the SAVR group (p=0.07). After 6 months from discharge, the percentage of patients in polypharmacy had increased to over 80% in both groups and this data was confirmed after 9 months. In both groups, the most prescribed drugs at discharge were the antithrombotic agents (50.1% TAVI, 40.3% SAVR; p=0.005), followed by the drugs for peptic ulcer and gastroesophageal reflux disease (29.4% TAVI, 33.6% SAVR; p=0.24), high-ceiling diuretics (19.3% TAVI, 33.6% SAVR; p<0.0001) and beta-blocking agents (20.2% TAVI, 28.1% SAVR; p=0.018). The same evaluations on the prescribed medications were also made after 6 and 9 months.ConclusionThis first analysis found that polypharmacy was common in over one-third of our participants at discharge (both TAVI and SAVR group).We found no association between polypharmacy and the type of AS treatment, but we observed some difference in the drug class between the two groups.The next steps will be to investigate the presence of inappropriate drug combinations and to implement an inter-professional approach at discharge for improving polypharmacy issues.References and/or acknowledgementsAll authors have declared that they have no support or funding to report.No conflict of interest.
Abstract
Purpose
The aim of the present study was to analyze, in a large administrative database, the clinical characteristics and prognosis of a contemporary population of patients with Non–ST ...elevation myocardial infarction (NSTEMI) according to the treatment strategy.
Methods
This retrospective observational study included patients residing in the Tuscany region, aged 18+ years, discharged from a regional hospital with a diagnosis of NSTEMI (main diagnosis ICD–9–CM codes 410.7 or 411.1 in HDA) between 2016 and 2018. Patients were classified into two main groups: a conservative strategy (CON) group and an invasive strategy (INV) group that was further classified into three subgroups: a PCI group, a CABG group, and a group where patients were managed invasively but not revascularized.
Results
The study population consisted of 15,208 patients. The median age was 76 ± 9 years, females were 38.5%. Groups composition according to management strategies is shown in Figure 1. Compared to INV patients, patients in the CON group were older (mean age 85 vs 72 years, p < 0.0001), more frequently female (54% vs 33%, p < 0.0001), had a higher cardiovascular and non–cardiovascular comorbidity burden. All–cause mortality rates in hospital and 1–year MACCE (Figure 2 and 3) were 3% and 24.1%, resulting significantly higher in the CON strategic management group than in the INV strategic group: 8.9% vs 1.1; 34.0 vs 21.1%; p = 0.0001. Between the three INV subgroups we found no differences in hospital mortality, while at 1 year there was a significant difference in MACCE with a higher rate in the CABG group compared to the PCI subgroups and in that of invasively managed but not revascularized patients: CABG: 42.8% vs 19.3% vs 18.2% respectively, p = 0.0001
Conclusions
Real–world data show that patients with NSTEMI have significantly different characteristics and prognosis according to treatment strategy. Patients managed non–invasively have more complex characteristics and worse prognosis both in the hospital and after discharge. Patients who have been managed invasively but treated with medical therapy represent an interesting subgroup worthy of further study.
As of March 12th Italy has the largest number of SARS-CoV-2 cases in Europe as well as outside China. The infections, first limited in Northern Italy, have eventually spread to all other regions. ...When controlling an emerging outbreak of an infectious disease it is essential to know the key epidemiological parameters, such as the basic reproduction number R0, i.e. the average number of secondary infections caused by one infected individual during his/her entire infectious period at the start of an outbreak. Previous work has been limited to the assessment of R0 analyzing data from the Wuhan region or Mainland China. In the present study the R0 value for SARS-CoV-2 was assessed analyzing data derived from the early phase of the outbreak in Italy. In particular, the spread of SARS-CoV-2 was analyzed in 9 cities (those with the largest number of infections) fitting the well-established SIR-model to available data in the interval between February 25–March 12, 2020. The findings of this study suggest that R0 values associated with the Italian outbreak may range from 2.43 to 3.10, confirming previous evidence in the literature reporting similar R0 values for SARS-CoV-2.
•The SIR model was applied to the early spread of SARS-CoV-2 in Italy•The SIR model fits well the reported COVID-19 cases in Italy•We assessed the basic reproduction number R0•We compared our results with previous literature findings and found that the basic reproduction number associated with the Italian outbreak may range from 2.43 to 3.10
SOMMARIO: 1. Interpretazione musicale e interpretazione giuridica. Il rapporto tra religione, musica e diritto - 2. Innovazioni liturgiche e musicali nella Riforma di Lutero: il corale luterano - 3. ...La dimensione spirituale del canto nella riforma liturgica di Giovanni Calvino. Il Salterio ginevrino - 4. Liturgia e musica nella Chiesa riformata anglicana - 5. La musica quale elemento identitario delle Chiese riformate. Considerazioni conclusive.
Lutheran Chorale, Calvinist Psalter, Anglican Anthem. Religious identities and liturgical music in the Protestant context
ABSTRACT: The paper examines the function played by music in the normative interventions regarding the Lutheran, Calvinist and Anglican liturgy in particular. The plurality of interpretations of the evangelical message that led to the birth of the Churches of the Reformation, in fact, finds precisely in the specific ritual innovations, including musical ones, the representation of an identifying and distinctive theological conception with respect to the Church of Rome.
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