Search

Problem After Italy's first national restriction measures in 2020, a robust approach was needed to monitor the emerging epidemic of coronavirus disease 2019 (COVID-19) at subnational level and provide data to inform the strengthening or easing of epidemic control measures. Approach We adapted the European Centre for Disease Prevention and Control rapid risk assessment tool by including quantitative and qualitative indicators from existing national surveillance systems. We defined COVID-19 risk as a combination of the probability of uncontrolled transmission of severe acute respiratory syndrome coronavirus 2 and of an unsustainable impact of COVID-19 cases on hospital services, adjusted in relation to the health system's resilience. The monitoring system was implemented with no additional cost in May 2020. Local setting The infectious diseases surveillance system in Italy uses consistent data collection methods across the country's decentralized regions and autonomous provinces. Relevant changes Weekly risk assessments using this approach were sustainable in monitoring the epidemic at regional level from 4 May 2020 to 24 September 2021. The tool provided reliable assessments of when and where a rapid increase in demand for health-care services would occur if control or mitigation measures were not increased in the following 3 weeks. Lessons learnt Although the system worked well, framing the risk assessment tool in a legal decree hampered its flexibility, as indicators could not be changed without changing the law. The relative complexity of the tool, the impossibility of real-time validation and its use for the definition of restrictions posed communication challenges. Probleme Apres avoir pris ses premieres mesures de restriction nationales en 2020, l'Italie avait besoin d'une approche solide pour surveiller l'epidemie naissante de maladie a coronavirus 2019 (COVID-19) au niveau regional, et fournir les donnees permettant de renforcer ou d'alleger les mesures destinees a l'endiguer. Approche Nous avons adapte l'outil d'evaluation rapide des risques du Centre europeen de prevention et de controle des maladies en y integrant des indicateurs quantitatifs et qualitatifs issus des systemes de surveillance nationaux existants. Pour definir le risque lie a la COVID-19, nous avons associe la probabilite d'une transmission incontrolee du coronavirus 2 du syndrome respiratoire aigu severe, a l'impact immediat des cas de COVID-19 sur les services hospitaliers, en procedant a des ajustements selon la resilience du systeme de soins de sante. Le dispositif de surveillance a ete mis en reuvre en mai 2020 sans entrainer de couts supplementaires. Environnement local En Italie, le systeme de surveillance des maladies infectieuses repose sur des methodes uniformes de collecte de donnees dans les provinces autonomes et regions decentralisees a travers le pays. Changements significatifs Les evaluations des risques realisees toutes les semaines avec cette approche ont permis de surveiller l'epidemie a l'echelle regionale du 4 mai 2020 au 24 septembre 2021. L'outil a identifie les dates et lieux susceptibles de connaitre une augmentation rapide de la demande en services de soins de sante si aucune mesure supplementaire de controle et de lutte n'etait prise dans les trois semaines. Lecons tirees Bien que le systeme ait fonctionne, inscrire l'outil d'evaluation des risques dans un decret legislatif a reduit sa flexibilite, car les indicateurs ne pouvaient etre modifies sans reformer la loi. La relative complexite de l'outil, l'impossibilite de proceder a une validation en temps reel et son usage pour imposer des restrictions ont pose des problemes de communication. Situacion Tras las primeras medidas nacionales de restriccion en Italia en 2020, se necesitaba un enfoque solido para supervisar la epidemia emergente de la coronavirosis de 2019 (COVID-19) a nivel subnacional y proporcionar datos que informaran sobre el refuerzo o la flexibilizacion de las medidas de contencion de la epidemia. Enfoque Se adapto la herramienta de valoracion rapida de riesgos del Centro Europeo para la Prevencion y el Control de las Enfermedades, al incluir indicadores cuantitativos y cualitativos de los sistemas nacionales de vigilancia existentes. Se definio el riesgo de la COVID-19 como una combinacion de la probabilidad de transmision descontrolada del coronavirus del sindrome respiratorio agudo grave de tipo 2 y de un efecto no sostenible de los casos de la COVID-19 en los servicios hospitalarios, y se ajusto en relacion con la capacidad de recuperacion del sistema sanitario. El sistema de supervision se aplico sin costes adicionales en mayo de 2020. Marco regional El sistema de vigilancia de las enfermedades infecciosas en Italia aplica metodos de recopilacion de datos coherentes en todas las regiones y provincias autonomas descentralizadas del pais. Cambios importantes Las valoraciones semanales de los riesgos mediante este enfoque fueron sostenibles en la supervision de la epidemia a nivel regional entre el 4 de mayo de 2020 y el 24 de septiembre de 2021. La herramienta proporciono valoraciones fiables de cuando y donde se produciria un rapido aumento de la demanda de servicios sanitarios si no se incrementaban las medidas de contencion o mitigacion en las tres semanas siguientes. Lecciones aprendidas Aunque el sistema funciono bien, el hecho de enmarcar la herramienta de valoracion de los riesgos en un decreto legal dificulto su flexibilidad, ya que los indicadores no se podian modificar sin cambiar la ley. La relativa complejidad de la herramienta, la imposibilidad de validacion en tiempo real y su uso para la definicion de las restricciones plantearon problemas de comunicacion., Introduction In its first response to the emerging epidemic of coronavirus disease 2019 (COVID-19), the Italian government implemented national restriction measures with strict physical distancing and restrictions on public movements [...]

Background and aims. The most common thyroid disorders, with an increasing detection worldwide, are the thyroid nodules and thyroiditis, which leads to an increase of thyroid cancer incidence. In two different countries with a different exposure to risk factors for thyroid cancer, such as Cyprus and Romania, the rank of thyroid cancer among other neoplasms is very different: the 3rd most prevalent cancer among females in Cyprus and the 12th in Romania, respectively. Environmental chemicals, such as bisphenol A have a proven effect on the thyroid function. However, the relation between the exposure to the endocrine disrupt or and the development of thyroid nodules, with a potential of malignant transformation has not been previously studied. The aim of the study was to investigate the potential factors that lead to the difference of thyroid nodules incidence in the mentioned countries. Methods. A pilot case-control study has been conducted in 2014-2015 in the "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania and the Endocrinology Department of Archbishop Makarios III Hospital, Nicosia, Cyprus. Females older than 20 years with no medical history were recruited. Cases were women with ultrasound-confirmed thyroid nodules of size >3mm. Controls were women without thyroid nodules after ultrasound confirmation. All participants provided blood samples for measurements of the thyroid stimulating hormone (TSH), free thyroxin (FT4), anti- thyroglobulin (ATg) and anti-thyroidperoxidase (ATPO); urine samples. Demographics, anthropometries and other relevant information were provided through the administration of a questionnaire. Results. In Romania we selected 51 patients with thyroid nodules (case group) and 41 without thyroid nodules (control group) and in Cyprus 57 cases, respectively 65 controls. After the statistical analysis of the data collected we observed statistically significant differences between the populations of the two countries regarding BMI and the value of the thyroid hormones and antibodies. Conclusions. Using the data observed in this study, differences were found between Cyprus and Romania among females with thyroid nodules the BMI, and the level o f thyroid hormones had statistically significant differences. This study reports preliminaiy data, further analysis of environmental exposures to chemical factors that might have a certain influence over the thyroid in the two countries will follow. [ABSTRACT FROM AUTHOR]

BackgroundOn 20 February 2020, a locally acquired coronavirus disease (COVID-19) case was detected in Lombardy, Italy. This was the first signal of ongoing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the country. The number of cases in Italy increased rapidly and the country became the first in Europe to experience a SARS-CoV-2 outbreak.AimOur aim was to describe the epidemiology and transmission dynamics of the first COVID-19 cases in Italy amid ongoing control measures.MethodsWe analysed all RT-PCR-confirmed COVID-19 cases reported to the national integrated surveillance system until 31 March 2020. We provide a descriptive epidemiological summary and estimate the basic and net reproductive numbers by region.ResultsOf the 98,716 cases of COVID-19 analysed, 9,512 were healthcare workers. Of the 10,943 reported COVID-19-associated deaths (crude case fatality ratio: 11.1%) 49.5% occurred in cases older than 80 years. Male sex and age were independent risk factors for COVID-19 death. Estimates of R 0 varied between 2.50 (95% confidence interval (CI): 2.18-2.83) in Tuscany and 3.00 (95% CI: 2.68-3.33) in Lazio. The net reproduction number R t in northern regions started decreasing immediately after the first detection.ConclusionThe COVID-19 outbreak in Italy showed a clustering onset similar to the one in Wuhan, China. R 0 at 2.96 in Lombardy combined with delayed detection explains the high case load and rapid geographical spread. Overall, R t in Italian regions showed early signs of decrease, with large diversity in incidence, supporting the importance of combined non-pharmacological control measures.