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Clinical outcomes of COVID-19 patients are worsened by the presence of co-morbidities, especially cancer leading to elevated mortality rates. SARS-CoV-2 infection is known to alter immune system homeostasis. Whether cancer patients developing COVID-19 present alterations of immune functions which might contribute to worse outcomes have so far been poorly investigated. We conducted a multi-omic analysis of immunological parameters in peripheral blood mononuclear cells (PBMCs) of COVID-19 patients with and without cancer. Healthy donors and SARS-CoV-2-negative cancer patients were also included as controls. At the infection peak, cytokine multiplex analysis of blood samples, cytometry by time of flight (CyTOF) cell population analyses, and Nanostring gene expression using Pancancer array on PBMCs were performed. We found that eight pro-inflammatory factors (IL-6, IL-8, IL-13, IL-1ra, MIP-1a, IP-10) out of 27 analyzed serum cytokines were modulated in COVID-19 patients irrespective of cancer status. Diverse subpopulations of T lymphocytes such as CD8+T, CD4+T central memory, Mucosal-associated invariant T (MAIT), natural killer (NK), and γδ T cells were reduced, while B plasmablasts were expanded in COVID-19 cancer patients. Our findings illustrate a repertoire of aberrant alterations of gene expression in circulating immune cells of COVID-19 cancer patients. A 19-gene expression signature of PBMCs is able to discriminate COVID-19 patients with and without solid cancers. Gene set enrichment analysis highlights an increased gene expression linked to Interferon α, γ, α/β response and signaling which paired with aberrant cell cycle regulation in cancer patients. Ten out of the 19 genes, validated in a real-world consecutive cohort, were specific of COVID-19 cancer patients independently from different cancer types and stages of the diseases, and useful to stratify patients in a COVID-19 disease severity-manner. We also unveil a transcriptional network involving gene regulators of both inflammation response and proliferation in PBMCs of COVID-19 cancer patients.

In real-world approximation problems, precise input data are economically expensive. Therefore, fuzzy methods devoted to uncertain data are in the focus of current research. Consequently, a method based on fuzzy-rough sets for fuzzification of inputs in a rule-based fuzzy system is discussed in this paper. A triangular membership function is applied to describe the nature of imprecision in data. Firstly, triangular fuzzy partitions are introduced to approximate common antecedent fuzzy rule sets. As a consequence of the proposed method, we obtain a structure of a general (non-interval) type-2 fuzzy logic system in which secondary membership functions are cropped triangular. Then, the possibility of applying so-called regular triangular norms is discussed. Finally, an experimental system constructed on precise data, which is then transformed and verified for uncertain data, is provided to demonstrate its basic properties.

Hemiplegic migraine (HM) is a clinically and genetically heterogeneous condition with attacks of headache and motor weakness which may be associated with impaired consciousness, cerebellar ataxia and intellectual disability. Motor symptoms usually last

Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0–11 for tattooing, 0–14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father’s education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.

In this paper a novel training technique is proposed to offer an efficient solution for neural network training in non-trivial and critical applications such as the diagnosis of health threatening illness. The presented technique aims to enhance the generalization capability of a neural network while preserving its sensitivity and precision. The implemented method has been devised in order to slowly increase, during training, the generalization capabilities of a Radial Basis Probabilistic Neural Network classifier, as well as preventing it from over-generalization and the consequent lack of resulting classification performances. The developed method was tested on Electrocardiograms. These latter are generally considered non-trivial both due to the difficulty to recognize some anomalous heart activities, and due to the intermittent nature of abnormal beat occurrences. The implemented training method obtained satisfactory performances, sensitivity and precision while showing high generalization capabilities.

Background Low T3 syndrome is frequent in patients admitted to intensive care units for critical illness and pneumonia. It has been reported also in patients with COVID-19, Hodgkin disease and chronic lymphocytic leukemia. We analyzed the clinical relevance of Low T3 syndrome in COVID-19 patients and, in particular, in those with associated hematological malignancies. Methods Sixty-two consecutive patients, hospitalized during the first wave of SARS-CoV-2 outbreak in Sant’Andrea University Hospital in Rome, were subdivided in 38 patients (Group A), showing low levels of FT3, and in 24 patients (Group B), with normal FT3 serum values. During the acute phase of the disease, we measured serum, radiologic and clinical disease severity markers and scores, in search of possible correlations with FT3 serum values. In addition, in 6 COVID-19 patients, 4 with Low T3 syndrome, including 2 with a hematological malignancy, and 2 with normal FT3 values, we performed, high-dimensional single-cell analysis by mass cytometry, multiplex cytokine assay and gene expression profiling in peripheral blood mononuclear cells (PBMC). Results Low FT3 serum values were correlated with increased Absolute Neutrophil Count, NLR and dNLR ratios and with reduced total count of CD3+, CD4+ and CD8+ T cells. Low FT3 values correlated also with increased levels of inflammation, tissue damage and coagulation serum markers as well as with SOFA, LIPI and TSS scores. The CyTOF analysis demonstrated reduction of the effector memory and terminal effector subtypes of the CD4+ T lymphocytes. Multiplex cytokine assay indicates that mainly IL-6, IP-10 and MCAF changes are associated with FT3 serum levels, particularly in patients with coexistent hematological malignancies. Gene expression analysis using Nanostring identified four genes differently expressed involved in host immune response, namely CD38, CD79B, IFIT3 and NLRP3. Conclusions Our study demonstrates that low FT3 serum levels are associated with severe COVID-19. Our multi-omics approach suggests that T3 is involved in the immune response in COVID-19 and coexistent hematological malignancy and new possible T3 target genes in these patients have been identified.

The coronavirus disease 2019 (COVID-19) pandemic has led to the adoption of restriction measures that have had notable consequences on the health and wellbeing of individuals. This survey was carried out on a sample of 905 Albanian undergraduates to assess their knowledge about COVID-19 and their health-related behaviors and communication changes during lockdown. The students were invited to complete a pre-validated questionnaire during lessons. The results show that the majority of the surveyed students were able to answer correctly about the main epidemiological features of the disease. The level of knowledge was proven to be proportional to the students’ education level (enrollment year and age). No considerable relationship emerged with respect to diet or smoking. On the other hand, a relevant portion of the sample (37.6%) declared decreased physical activity (PA). Finally, a notable increase in the intensity and frequency of communication with their peers and with their parents was declared by 34.7% and 50.8% of the sample, respectively. Lifestyle variables were found to be mutually related, as were communication outcomes. The participants showed a satisfactory awareness regarding the COVID-19 epidemic. However, the registered reduction in PA may represent a public health issue and should be addressed with adequate policies. The use of electronic media seems to have increased communication habits in this population group.

Over the past two decades, health litigation has followed an exponentially incremental trend. As insurance companies tend to limit their interest because of the high risk of loss, health facilities increasingly need to internalize dispute management. This study was conducted through a retrospective analysis of existing files concerning the civil litigation of the Sant’Andrea Hospital in Rome. All claims from 1 June 2010 to 30 June 2019 were included. Paid claims were further classified according to the areas of health care inappropriateness found. Authors indexed 567 different claims along the study period, with an average number of 59 per year (range 38–77). The total litigation involved 47 different units, more than 40% concerned 5 high-incidence wards or services. Concerning the course of disputes, 91 cases were liquidated before a judicial procedure was instituted, while 177 cases landed in a civil court. Globally, 131 different claims hesitated in compensation, for a total of 16 million 625 thousand euros, 41% of which was related to the internal medicine area. Dealing with the inappropriateness analysis, clinical performance alone involved 76 cases, for a total of 10 million 320 thousand euros, while organization defects involved 20 disputes equivalent to 1 million 788 thousand euros. The aim of this study was to enhance the clinical risk management at our facility through a litigation analysis.

Background: Control measures adopted during the COVID-19 pandemic had a considerable impact on human daily life and lifestyles. Adherence to the recommended measures is influenced by knowledge and attitudes towards the disease. This cross-sectional study aimed to assess the level of knowledge regarding COVID-19, the related control measures, and lifestyle behaviors adopted during the pandemic in a sample of elderly Italian people. Methods: A web-based questionnaire investigating socio-demographic characteristics, knowledge of COVID-19, the related preventive measures, and lifestyle changes that occurred during the pandemic, were distributed to ≥65 years old people living in South Italy. Results: A satisfactory level of knowledge about COVID-19 and the related control measures has been found in the enrolled sample. However, a decrease in physical activity, as well as worsening sleeping and dietary habits, were found in roughly 60% of participants. Females were impacted greater by these lifestyle changes. Conclusions: Participants in this study showed a good level of knowledge regarding COVID-19 and its prevention. Nevertheless, they reported an increase in unhealthy habits that may have important health consequences in the long term and should be addressed by public health interventions targeted at older people.

(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O’Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.

Data concerning overweight and obesity in children and adolescent populations are alarming and represent one of the most serious public health problems of our time. Moreover, it is demonstrated that the school environment may play an important role in health promotion with regard to nutritional aspects. This article reports the results of a study conducted in the Apulia region (Southern Italy), aimed at providing an integrated surveillance of the behaviors related to nutrition habits in students and the hygienic and nutritional conditions of the school’s canteens attended by enrolled students. To this purpose, a sample of 501 students attending primary school (third class—children approximately eight years old) replied to a validated questionnaire, and official controls (OC), of both food and nutritional safety, were performed in 22 primary schools. A team of healthcare professionals carried out the study, and the implementation of all the prescribed improvement actions were subsequently verified through follow-up OC. The results of our study show a critical situation in the student sample, with 41.3% of children having a weight excess (overweight or obesity). With regard to the children’s behaviors, only 59.8% of children ate at least one fruit or had a fruit juice for breakfast, and 10.8% did not have breakfast at all. Overall, 40.1% of the total children played outdoors the afternoon before the survey and 45% reported going to school on foot or by bicycle. During the afternoon, 83.5% of the sample watched television or used video games/tablets/mobile phones, while 42.3% played sports. The schools had an internal canteen with on-site preparation of meals in 36.4%, the remaining 63.6% received meals from external food establishments. With regard to OC, for the hygienic–sanitary section, eleven prescriptions were issued, in the great part related to the structure and organization of the canteen. For the nutritional section, nine corrective actions were prescribed, mainly related to official documents and management. The follow-up OC showed that all prescriptions were subsequently addressed. Eating at school was less frequent among obese and overweight students compared with those with normal weight. Although this evidence needs to be further confirmed, it highlights the potential role that the school canteens may play in health promotion and prevention of nutritional disorders. On the other hand, in order to fulfill its health promotion task, the school canteens have to comply with official regulations and guidelines, therefore, OC during the management of the food service at school are needed.

Background Nonthyroidal Illness Syndrome (NTIS) can be detected in many critical illnesses. Recently, we demonstrated that this condition is frequently observed in COVID-19 patients too and it is correlated with the severity the disease. However, the exact mechanism through which thyroid hormones influence the course of COVID-19, as well as that of many other critical illnesses, is not clear yet and treatment with T4, T3 or a combination of both is still controversial. Aim of this study was to analyze body composition in COVID-19 patients in search of possible correlation with the thyroid function. Methods and findings We report here our experience performed in 74 critically ill COVID-19 patients hospitalized in the intensive care unit (ICU) of our University Hospital in Rome. In these patients, we evaluated the thyroid hormone function and body composition by Bioelectrical Impedance Analysis (BIA) during the acute phase of the disease at admission in the ICU. To examine the effects of thyroid function on BIA parameters we analyzed also 96 outpatients, affected by thyroid diseases in different functional conditions. We demonstrated that COVID-19 patients with low FT3 serum values exhibited increased values of the Total Body Water/Free Fat Mass (TBW/FFM) ratio. Patients with the lowest FT3 serum values had also the highest level of TBW/FFM ratio. This ratio is an indicator of the fraction of FFM as water and represents one of the best-known body-composition constants in mammals. We found an inverse correlation between FT3 serum values and this constant. Reduced FT3 serum values in COVID-19 patients were correlated with the increase in the total body water (TBW), the extracellular water (ECW) and the sodium/potassium exchangeable ratio (Nae:Ke), and with the reduction of the intracellular water (ICW). No specific correlation was observed in thyroid patients at different functional conditions between any BIA parameters and FT3 serum values, except for the patient with myxedema, that showed a picture similar to that seen in COVID-19 patients with NTIS. Since the Na+/K+ pump is a well-known T3 target, we measured the mRNA expression levels of the two genes coding for the two major isoforms of this pump. We demonstrated that COVID-19 patients with NTIS had lower levels of mRNA of both genes in the peripheral blood mononuclear cells (PBMC)s obtained from our patients during the acute phase of the disease. In addition, we retrieved data from transcriptome analysis, performed on human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM)s treated with T3 and we demonstrated that in these cells T3 is able to stimulate the expression of these two genes in a dose-dependent manner. Conclusions In conclusion, we demonstrated that measurement of BIA parameters is a useful method to analyze water and salt retention in COVID-19 patients hospitalized in ICU and, in particular, in those that develop NTIS. Our results indicate that NTIS has peculiar similarities with myxedema seen in severe hypothyroid patients, albeit it occurs more rapidly. The Na+/K+ pump is a possible target of T3 action, involved in the pathogenesis of the anasarcatic condition observed in our COVID-19 patients with NTIS. Finally, measurement of BIA parameters may represent good endpoints to evaluate the benefit of future clinical interventional trials, based on the administration of T3 in patients with NTIS.

At the end of 2020, the Italian Ministry of Health launched a national vaccination campaign to counteract the COVID-19 pandemic. The present study aimed at appraising levels of knowledge about and acceptance of COVID-19 vaccination in a sample of Italian undergraduates during the first phase of the immunization plan. A web-based questionnaire was administered to students attending universities in Bari, Naples, and Rome during the period February–April 2021. Of the total of 3226 participants, 91.9% were keen to receive a COVID-19 vaccination. More than 80% gave correct answers to questions about COVID-19 vaccine administration, functioning, and effects on community health. However, only 63.8% identified the correct composition of the available vaccines. Knowledge was found to be related to sociodemographic features and COVID-19 vaccination acceptance (p &lt, 0.05). COVID-19 vaccination acceptance was found to be related to having a previous vaccination against influenza (OR 3.806, CI 95% 1.181–12.267, p = 0.025) and knowledge (OR 4.759, CI 95% 2.106–10.753, p = 0.000). These results show a good level of awareness about COVID-19 vaccination in this population, which may indicate the effectiveness of communication strategies accompanying the COVID-19 immunization campaign in Italy.

Background: From March to May 2020, lockdown measures were adopted in Italy to contain the epidemic of the novel Coronavirus. People were forced to restrict their movement and social contacts, therefore having a higher risk of inactivity. This study, carried out among Italian undergraduates, explored their sedentary and physical activities (PA) during the lockdown with respect to their previous habits. Methods: An electronic questionnaire was administered once to students attending three Italian universities after the end of lockdown. Results: A total of 1430 students (mean age 22.9 &plusmn, 3.5 years, 65.5% females) completed the questionnaire. All the sedentary behaviors increased significantly, and all the physical activities decreased significantly during the lockdown. Time spent using electronic devices showed the highest increase (+52.4 min/day), and walking the greatest decrease (&minus, 365.5 min/week). Being younger than 22 years old, female, and previously active, attending the universities of Naples and Rome and having at least one graduate parent were associated with the achievement of recommended levels of PA even during the lockdown. Conclusions: This study highlights the reduction of PA among Italian undergraduates in the course of home-confinement due to the CoViD-19 pandemic. The practice of adequate PA during the lockdown was mainly associated with the previous adoption of an active lifestyle. Promoting active lifestyles during the non-pandemic period may have had positive effects also in case of lockdown.

Starting from 2013, the number of unvaccinated people alarmingly increased in Italy, therefore, in 2017 a new Vaccine National Plan was approved. Healthcare workers (HCWs), especially public health professionals (PHPs, i.e., workers in in the sector of hygiene and preventive medicine), have an important role in informing and promoting vaccinations. In this context, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) conducted a national survey to assess knowledge, attitude, and practices towards recommended vaccinations among PHPs. The survey was conducted during October 2019 with an anonymous questionnaire distributed to PHPs attending the 52&deg, SItI National Congress. Overall, 57.1% of operators answered correctly to all seven recommended vaccinations, 12.8% reported to be vaccinated for all seven recommended vaccinations, while 30% were naturally immunized. A higher immunization coverage was reported for anti-hepatitis B (88.9%) and measles (86.1%), and 81.3% of the participants reported being offered the influenza vaccination during the 2018/2019 season. The majority of our sample indicated that hepatitis B (95%) and influenza (93.7%) were the recommended vaccines for HCWs, while less was known regarding varicella, pertussis, diphtheria, and tetanus boosters every 10 years. PHPs who were vaccinated (or who intended to be vaccinated) were more likely to recommend vaccinations to their patients and provided a reassuring example to those hesitant patients. Finally, this is the first study that identified good algorithms (using the techniques of machine learning as Random Forest and Deep Learning) to predict the knowledge of PHPs regarding recommended vaccinations with possible applications in other national and international contexts.

Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in ...

In Italy, wine production is considered a sector of excellence, where the wines&rsquo, appreciable sensory features are favored by environmental factors, including weather and climate conditions, which benefit territories with a specific vocation. The whole chain involves many economic and agri-food sector operators, and requires an in-depth assessment of specific risks for identifying critical points, keeping the entire production process under control, and ensuring product traceability. This article describes the results of a pilot study conducted in the Prosecco DOCG (Designations of Controlled and Guaranteed Origin) area, concerning the detection of residues of plant protection products in fifty wine bottles. Although considerably below the maximum residue levels, all the samples tested were positive, ranging from two to five active substances detected in each sample. In addition to the provisions of the European Community legislation, this paper critically evaluates some best practices models that are already used by the Wine Federations of Italy, with the aim of identifying advantages of and areas for improvement in production methods, applicable to raw materials reception, rasping, storage, and bottling phases, in order to guarantee product safety and quality.

The uncontrolled spread of the coronavirus disease 2019 (COVID-19) has called for unprecedented measures, to the extent that the Italian government has imposed a quarantine on the entire country. Quarantine has a huge impact and can cause considerable psychological strain. The present study aims to establish the prevalence of psychiatric symptoms and identify risk and protective factors for psychological distress in the general population. An online survey was administered from 18&ndash, 22 March 2020 to 2766 participants. Multivariate ordinal logistic regression models were constructed to examine the associations between sociodemographic variables, personality traits, depression, anxiety, and stress. Female gender, negative affect, and detachment were associated with higher levels of depression, anxiety, and stress. Having an acquaintance infected was associated with increased levels of both depression and stress, whereas a history of stressful situations and medical problems was associated with higher levels of depression and anxiety. Finally, those with a family member infected and young person who had to work outside their domicile presented higher levels of anxiety and stress, respectively. This epidemiological picture is an important benchmark for identifying persons at greater risk of suffering from psychological distress and the results are useful for tailoring psychological interventions targeting the post-traumatic nature of the distress.

Physical activity (PA) and exercise are fundamental to maintaining health in older adults. World Health Organization guidelines state that older adults should practice at least 150 min/week of moderate/vigorous intensity PA to obtain health benefits. We assessed PA levels among older adults in southern Italy and evaluated possible associated determinants. The study was carried out between September and November 2019 in the metropolitan area of Bari. We collected information from participants over 65 years using a self-administered questionnaire. We investigated associations between sociodemographic characteristics, health conditions, and inactivity/PA levels. A total of 383 individuals completed the questionnaire. Mean body mass index indicated that 45.4% of participants were overweight. Mean time spent in PA was 476.2 &plusmn, 297.8 min/week, with women reporting lower levels than men (370.8 &plusmn, 210 vs. 555.2 &plusmn, 334.3 min/week, p = 0.08). Weekly sitting time was positively related to age. Attending religious or recreational activities was related to moderate PA. Educational level was positively associated with PA while dog ownership represented an obstacle to achieving recommended PA levels in our population. Participants generally met the recommended levels of PA, especially men, the educational level was the main determinant. Interventions aimed at promoting PA among older adults with lower education levels and women are needed in this setting.

Background: Health literacy (HL) is a fundamental ability to successfully deal with health and illness issues. This study aimed to assess HL among undergraduates from healthcare and non-healthcare degree courses of two Italian universities and the association between their HL, lifestyles, and BMI assumed as health outcome. Methods: The Health Literacy Assessment Tool (HLAT-8) and the Newest Vital Sign (NVS) were used to assess health literacy dimensions. Demographic and anthropometric data, adherence to Mediterranean diet (MD), physical activity levels, and smoking habits were assessed in the enrolled sample to highlight possible associations. Results: A total sample of 806 undergraduates (46% males, mean age 21.01 &plusmn, 1.78 years) was recruited. Higher HL scores were found among healthcare rather than non-healthcare students (28.7 &plusmn, 4.5 vs. 26.7 &plusmn, 4.2 for HLAT-8 and 4.9 &plusmn, 1.5 vs. 3.9 &plusmn, 1.8 for NVS, p &lt, 0.01). However, healthcare undergraduates were more likely to report unhealthy behaviors. Body Mass Index (BMI) was associated with literacy and numeracy skills only in non-healthcare undergraduates. Significant associations were found between HL scores and adherence to MD in both groups. In the regression analysis, educational field and MD were shown to be predictors of HL scores. Conclusions: Attending a healthcare related degree course was associated with higher HL scores but not with healthy behaviors. This issue should be addressed considering the role that healthcare professionals may have in educating patients towards a healthy lifestyle. Adherence to MD seems to be related to higher HL scores.

Efficient energy production from biomass is a central issue in the context of clean alternative energy resource. In this work we propose a novel model based on spiking neural networks cubes in order to model the chemical processes that goes on in a digestor for the production of usable biogas. For the implementation of the predictive structure, we have used the NeuCube computational framework. The goals of the proposed model were: develop a tool for real applications (low-cost and efficient), generalize the data when the system presents high sensitivity to small differences on the initial conditions, take in account the "multi-scale" temporal dynamics of the chemical processes occurring in the digestor, since the variations present in the early stages of the processes are very quick, whereas in the later stages are slower. By using the first ten days of observation the implemented system has been proven able to predict the evolution of the chemical process up to the 100th day obtaining a high degree of accuracy with respect to the experimental data measured in laboratory. This is due to the fact that the spiking neural networks have shown to be able to modeling complex information processes and then it has been shown that spiking neurons are able to handle patterns of activity that spans different time scales. Thanks to such properties, our system is able to capture the multi-scale trend of the time series associated to the early-stage evolutions, as well as their interaction, which are crucial in the point of view of the information content to obtain a good long-term prediction.

This paper presents an algorithm for grouping strokes. This method includes two stages. Firstly, a set of strokes is transformed into a set of hypotheses that a group of strokes matches the pattern. For this purpose, a method for comparing small groups of strokes is proposed. Then, the set of hypotheses is selected with the use of a decision tree to get a proposition of a word.

In March 2020, the World Health Organization (WHO) declared that the COVID-19 outbreak recorded over the previous months could be characterized as a pandemic. The first known Italian SARS-CoV-2 positive case was reported on 21 February. In some countries, cases of suspected &ldquo, COVID-19-like pneumonia&rdquo, had been reported earlier than those officially accepted by health authorities. This has led many investigators to check preserved biological or environmental samples to see whether the virus was detectable on dates prior to those officially stated. With regard to Italy, the results of a microbiological screening in sewage samples collected between the end of February and the beginning of April 2020 from wastewaters in Milan (Northern Italy) and Rome (Central Italy) showed presence of SARS-CoV-2. In the present study, we evaluated, by means of a standardized diagnostic method, the SARS-CoV-2 infection prevalence amongst patients affected by severe acute respiratory syndrome (SARI) in an academic hospital located in Central Italy during the period of 1 November 2019&ndash, 1 March 2020. Overall, the number of emergency room (ER) visits during the investigated period was 13,843. Of these, 1208 had an influenza-like syndrome, but only 166 matched the definition of SARI as stated in the study protocol. A total of 52 SARI cases were laboratory confirmed as influenza: 26 as a type B virus, 25 as a type A, and 1 as both viruses. Although about 17% of the total sample had laboratory or radiological data compatible with COVID-19, all the nasopharyngeal swabs stored underwent SARS-CoV-2 RT-PCR and tested negative. Based on our result, it is confirmed that the COVID-19 pandemic spread did not start prior to the &ldquo, official&rdquo, onset in central Italy. Routine monitoring of SARI causative agents at the local level is critical for reporting epidemiologic and etiologic trends that may differ from one country to another and also among different influenza seasons. This has a practical impact on prevention and control strategies.

Data transmission is the most critical operation for mobile sensors networks in term of energy waste. Particularly in pervasive healthcare sensors network it is paramount to preserve the quality of service also by means of energy saving policies. Communication and data transmission are among the most critical operation for such devises in term of energy waste. In this paper we present a novel approach to increase battery life-span by means of shorter transmission due to data compression. On the other hand, since this latter operation has a non-neglectable energy cost, we developed a compression efficiency estimator based on the evaluation of the absolute and relative entropy. Such algorithm provides us with a fast mean for the evaluation of data compressibility. Since mobile wireless sensor networks are prone to battery discharge-related problems, such an evaluation can be used to improve the electrical efficiency of data communication. In facts the developed technique, due to its independence from the string or file length, is extremely robust both for small and big data files, as well as to evaluate whether or not to compress data before transmission. Since the proposed solution provides a quantitative analysis of the source's entropy and the related statistics, it has been implemented as a preprocessing step before transmission. A dynamic threshold defines whether or not to invoke a compression subroutine. Such a subroutine should be expected to greatly reduce the transmission length. On the other hand a data compression algorithm should be used only when the energy gain of the reduced transmission time is presumably greater than the energy used to run the compression software. In this paper we developed an automatic evaluation system in order to optimize the data transmission in mobile sensor networks, by compressing data only when this action is presumed to be energetically efficient. We tested the proposed algorithm by using the Canterbury Corpus as well as standard pictorial data as benchmark test. The implemented system has been proven to be time-inexpensive with respect to a compression algorithm. Finally the computational complexity of the proposed approach is virtually neglectable with respect to the compression and transmission routines themselves.

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant’Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes.

Internal organs, like lungs, are very often examined by the use of screening methods. For this purpose, we present an evaluation model based on a composition of fuzzy system combined with a neural network. The input image is evaluated by means of custom rules, which use type-1 fuzzy membership functions. The results are forwarded to a neural network for final evaluation. Our model was validated by using X-ray images with lung nodules. The results show the high performances of our approach with sensitivity and specificity reaching almost 95% and 90%, respectively, with an accuracy of 92.56%. The new methodology lowers the computational demands considerably and increases detection performances.

The spread of coronavirus disease 2019 (COVID-19) has called for unprecedented measures, including a national lockdown in Italy. The present study aimed at identifying psychological changes (e.g., changes in depression, stress, and anxiety levels) among the Italian public during the lockdown period, in addition to factors associated with these changes. An online follow-up survey was administered to 439 participants (original sample = 2766), between 28 April and 3 May 2020. A paired sample t-test tested for differences in stress, anxiety, and depression over the period. Multivariate regression models examined associations between sociodemographic variables, personality traits, coping strategies, depression, and stress. Results showed an increase in stress and depression over the lockdown, but not anxiety. Negative affect and detachment were associated with higher levels of depression and stress. Higher levels of depression at the start of the lockdown, as well as fewer coping strategies and childlessness, were associated with increased depression at follow-up, whereas higher levels of stress at the start of the lockdown and younger age were associated with higher stress at follow-up. These results may help us to identify persons at greater risk of suffering from psychological distress as a result lockdown conditions, and inform psychological interventions targeting post-traumatic symptoms.

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18&ndash, 22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82&ndash, 0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Background: Low T3 syndrome is a frequent finding in critical illness The prevalence and clinical relevance of the Low T3 syndrome in coronavirus infections ha

In energy generation systems including a photovoltaic park, fluctuations are the norm: both production and demand levels can vary on hourly basis. Hence, energy management and dispatching systems have to cope with the possibility of inadequate production while satisfying as much as possible user demands. We put forward a management solution that models the behaviour of each production plant and consumption device, and determines energy allocation. For this, gathered data are wavelet transformed to let us retain only the useful characteristics of data on both large and small scales of the signal. Models are handled by several neural networks which perform predictions in advance of 48-h, with a granularity of half an hour. Moreover, according to realtime user demands, the management solution determines energy flows between production plants and consumption devices. Therefore, while in some cases it might be necessary to postpone the activation of some consumption devices, in others we can take advantage of a production surplus. Thanks to the proposed solution proper actuators can be programmed beforehand to improve the fairness to users, and use peaks of energy production, thus reducing green energy shortage, and extra costs.

In Italy, at the end of 2020, a voluntary immunization plan against COVID-19 was introduced, involving elderly among the first target categories. The aim of this study was to assess, through an online questionnaire, the acceptance of COVID-19 vaccination in a sample of older adults from southern Italy. Of a total of 1041 respondents (41.7% males, mean age 76.6 ± 6.5), 965 (92.7%) were vaccinated or willing to be vaccinated against COVID-19, although less than half of the sample was favorable to vaccinations and agreed with mandatory immunization. Acceptance of COVID-19 vaccination was found to be positively related with higher educational level (OR = 1.875, CI95% = 1.113–3.161, p = 0.018) and having social/mass media as a main source of information (OR = 2.415 CI95% = 1.358–4.296, p = 0.003). On the contrary, an inverse relationship was found between acceptance of COVID-19 vaccination and having fulfilled the questionnaire after the introduction of green pass (OR = 0.218, CI95% = 0.129–0.369, p &lt, 0.001). Therefore, although this evidence needs to be further confirmed, it is possible to agree with previous studies reporting that compulsory measures, such as green pass implementation, must be accompanied by effective education and information strategies of the target population.

Background: According to the cancer stem cells (CSCs) hypothesis, a population of cancer cells with stem cell properties is responsible for tumor propagation, drug resistance, and disease recurrence. Study of the mechanisms responsible for lung CSCs propagation is expected to provide better understanding of cancer biology and new opportunities for therapy. Methods: The Lung Adenocarcinoma (LUAD) NCI-H460 cell line was grown either as 2D or as 3D cultures. Transcriptomic and genome-wide chromatin accessibility studies of 2D vs. 3D cultures were carried out using RNA-sequencing and Assay for Transposase Accessible Chromatin with high-throughput sequencing (ATAC-seq), respectively. Reverse transcription polymerase chain reaction (RT-PCR) was also carried out on RNA extracted from primary cultures derived from malignant pleural effusions to validate RNA-seq results. Results: RNA-seq and ATAC-seq data disentangled transcriptional and genome accessibility variability of 3D vs. 2D cultures in NCI-H460 cells. The examination of genomic landscape of genes upregulated in 3D vs. 2D cultures led to the identification of 2D cultures led to the identification of Beta-1,4-galactosyltranferase 1 (B4GALT1) as the top candidate. B4GALT1 as the top candidate. B4GALT1 was validated as a stemness factor, since its silencing caused strong inhibition of 3D spheroid formation. Conclusion: Combined transcriptomic and chromatin accessibility study of 3D vs. 2D LUAD cultures led to the identification of B4GALT1 as a new factor involved in the propagation and maintenance of LUAD CSCs.

Background The aim of the study was to explore lifestyle of undergraduate students in southern Italy and to investigate their determinants. Methods An anonymous, web-based questionnaire investigating weight and its perception, smoking and alcohol use, achievement of recommended levels of physical activity and time spent daily in screen-based sedentary behaviors was administered to students attending two universities in southern Italy. Age, gender, city, type of degree course attended, occupational status and residential status were considered as possible demographic determinants. Results The majority of the participants reported a normal weight (71.2%), were non-smokers (66.6%), occasional alcohol consumers (60.5%) and insufficiently active (62.6%), with a reported mean screen time exceeding 2 h per day. Gender, city, type of degree course and occupational status were found to be associated with lifestyle by regression analysis. Normal weight, overweight and obese students were generally properly aware of their weight condition; however, weight misperceptions were registered among normal and underweight undergraduates. Conclusions This study highlighted some critical issues regarding lifestyles of university students that suggest the need for health promotion interventions targeted mainly on physical activity.

We present here a novel algorithm based on a MapReduce approach to facilitate the discovery of novel therapeutic targets. The proposed algorithm has been enabled to scan a set biological pathways in order to discover non-trivial (less common) routes. Such routes represent a chain of biochemical interactions among different biological actors. These actors can be represented by quite distant nodes along the devised pathway. Our approach detects nodes that are far from the initial target nodes, also showing the number of times that a given route has been found inside the selected set of biological pathways.

Background: Evidence on influenza vaccine effectiveness (VE) in preventing mortality and morbidity in the elderly is weak. Our aim was to measure the VE against severe outcomes in the elderly.Metho...

Background: The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. Objective: The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital. Methods: The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant’Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost. Results: Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient. Conclusion: The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.

The evolution of the Internet of Things and the related market has renewed the concept of media recording and sharing by means of a new kind of home-consumer devices, capable of continuous and autonomous media capture and upload. Such technologies have already begun to tamper with people’s privacy and discretion expectations, also raising many concerns about the potential legal implications. This work proposes an overall context-related privacy preserving system, based on context recognition. Our approach has been specifically developed considering contexts characterized by a high degree of similarity. The presented methodology has been devised in order to enforce privacy rules using image recognition techniques jointly with radio beacon technology. The reported results show that, in the peculiar environment considered in this paper, the use of radio beacon technology can help to increase the performances of image recognition techniques, both in terms of computational performances and elapsed time.

This paper analyses the idea of applying Swarm Intelligence in the process of managing the entire 2D board game in a real-time environment. For the proposed solution Game Management System is used as a cloud resource with a dedicated intelligent control agent. The described approach has been analysed on the basis of board games like mazes. The model and the control algorithm of the system is described and examined. The results of the experiments are presented and discussed to show possible advantages and disadvantages of the proposed method.

(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19&ndash, 69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p &lt, 0.01, 50% versus 31% under or equal to 40 years old, p &lt, 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p &lt, 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2–15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

The paper proposes a new approach to heart activity diagnosis based on Gram polynomials and probabilistic neural networks (PNN). Heart disease recognition is based on the analysis of phonocardiogram (PCG) digital sequences. The PNN provides a powerful tool for proper classification of the input data set. The novelty of the proposed approach lies in a powerful feature extraction based on Gram polynomials and the Fourier transform. The proposed system presents good performance obtaining overall sensitivity of 93%, specificity of 91% and accuracy of 94%, using a public database of over 3000 heart beat sound recordings, classified as normal and abnormal heart sounds. Thus, it can be concluded that Gram polynomials and PNN prove to be a very efficient technique using the PCG signal for characterizing heart diseases.

Integrated generation systems are increasingly considered suitable to supply remote areas, less developed countries, and small isolated communities with power. The energy management investigated in this paper concerns a smart grid encompassing a photovoltaic park. We propose a novel cloud-distributed solution to determine the best energy dispatch, i.e., where energy is going to be used and whether to change the operating points for some consumption devices. Neural networks have been used to predict both energy production and consumption, making it possible to strategically set the activation time of loading devices and to minimize energy flow changes. Moreover, cloud computing resources make it possible to have fast and distributed computation on the big amount of data gauging power production and consumption.

In this paper we present an application of Computational Intelligence methods in gaming systems. We have applied Bio-Inspired Methods to automatically create various maze layouts for board games. The handling of board games is performed on cloud resources, where intelligent agents control the process of board creation, composition and recomposition in real time, depending on the player’s moves. The developed solution has been based on swarm techniques. Applied algorithms simulate the natural process of adaptation to various conditions to perform board games construction and system management. Due to the nature of the applied algorithms swarms are simulated and their results let us handle the creation and real-time management of games. The devised solutions are efficient in real conditions where several users operate supported by cloud resources. DOI: http://dx.doi.org/10.5755/j01.itc.46.1.13872

We conducted a scoping review of literature to improve our understanding of the accuracy of infectious disease monitoring in migrants in the Europe. We searched PubMed for papers relevant to the topic including: case reports, observational and experimental studies, reviews, guidelines or policy documents; published after 1994. We identified 532 papers, 27 of which were included in the review. Legislation and right to access health care influence both the accuracy of rates and risk measures under estimating the at risk population, i.e., the denominator. Furthermore, the number of reported cases, i.e., the numerator, may also include cases not accounted for in the denominator. Both biases lead to an overestimated disease occurrence. Restriction to healthcare access and low responsiveness may cause under-detection of cases, however a quantification of this phenomenon has not been produced. On the contrary, screening for asymptomatic diseases increases ascertainment leading to increased detection of cases. Incompleteness of denominator data underestimates the at-risk population. In conclusion, most studies show a lower probability of under-reporting infectious diseases in migrants compared with native populations.