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Additional file 1. Table S1. Diagnostic codes used to identify comorbidities/risk factors for influenza: a) in people ≥ 5 years old; b) in children < 5 years old. Table S2. Performance of the excess hospitalization model per age group and cause. Table S3. Performance of the excess deaths model per age group and cause. Table S4. Estimated influenza-associated excess pneumonia or influenza, respiratory, and all-cause excess hospitalizations, in absolute and per 100,000 people, by age group and epidemic season in Spanish public hospitals between 2008/2009 and 2017/2018. Table S5. Estimated influenza-associated excess pneumonia or influenza, respiratory, and respiratory or cardiovascular deaths, in absolute and per 100,000 people, by age group and epidemic season in Spain between 2008/2009 and 2017/2018. Table S6. P-value associated to the ILI variables of estimated influenza-associated excess hospitalization. Table S7. P-value associated to the ILI variables of estimated influenza-associated excess deaths.

Additional file 1: Listing S1. List of analyzed comorbidities and ICD9/10 codes used. Listing S2. List of ICD-9-MC and ICD-10-ES codes used as “severity markers”. Listing S3. Evolution in the incidence rate of hospitalizations by respiratory syncytial virus definition and age group.

Additional file 1: Table S1. List of analyzed risk factors andICD9/10 codes used. Table S2. Unit costs considered for each healthcare visit.

Il capitolo è la sintesi delle attività sviluppate all'interno del progetto CISAS per quanto attiene lo studio del microbioma umano e le influenze che l'ambiente può avere su di esso. Il capitolo fornisce al lettore numerosi spunti sulle relazioni tra microbioma e salute umana, tracciando i possibili scenari di sviluppo di tecnologie non invasive per lo studio delle comunità batteriche che popolano l'intestino umano.

Questo libro raccoglie i frutti di un'appassionata ricerca scientifica multidisciplinare dedicata agli effetti sull'ecosistema e sulle popolazioni dei fenomeni di degrado ambientale prodotti dalle attività umane. L'attenzione è centrata sui Siti di bonifica di Interesse Nazionale, dove l'inquinamento passato e attuale ha segnato la storia di ampi territori e delle comunità, che chiedono di conoscere e sempre più spesso sono disponibili a intervenire per contribuire a risolvere i problemi esistenti e a partecipare alle decisioni sul futuro. Il lettore troverà approfondimenti sugli studi che identificano le associazioni tra la presenza di contaminanti in aria, suolo, acque, alimenti e la salute delle popolazioni residenti. Si tratta di studi di geochimica, ecotossicologia, epidemiologia ambientale sulle popolazioni e sulle coppie madre-bambino, e molto altro. Vengono anche illustrate tecniche di campionamento e studi sperimentali promettenti, modelli statistici e matematici per l'interpretazione di dati complessi. Gli sforzi compiuti dalle discipline scientifiche ambientali, epidemiologiche e matematiche sono trattati in capitoli specifici e vengono collegati per spiegare come possono contribuire alle decisioni che riguardano le operazioni di bonifica, di protezione della salute e dell'ecosistema. Infatti, mentre la ricerca prosegue e si approfondisce, vanno identificate soluzioni per il risanamento dei territori e il costante monitoraggio della situazione e dei miglioramenti ottenuti. La comunicazione e la partecipazione dei cittadini vengono presentate come insieme di metodi e strumenti consolidati, che rendono possibile la condivisione delle decisioni sul destino sociale ed economico dei territori inquinati. Lo studio della relazione tra l'ambiente e la salute degli ecosistemi e delle comunità rappresenta il filo rosso di un'ampia ricerca in corso da cinque anni, cui hanno partecipato più di 150 ricercatori di numerosi Istituti del Consiglio Nazionale delle Ricerche, di Università, Agenzie ambientali e Istituzioni sanitarie, che proseguirà in sintonia con le richieste e le necessità di un periodo storico che chiede sempre maggiore attenzione alla cura, alla protezione, alla conservazione del patrimonio di natura, cultura e persone che compongono la nostra società.

The aim of this study is to assess the effect of contact time, contact distance and the use of personal protective equipment on the determination of SARS-CoV-2 infection in healthcare workers (HCWs). This study consists of an analysis of data gathered for safety reasons at the Sapienza Teaching Hospital Policlinico Umberto I in Rome through the surveillance system that was put into place after the worsening of the COVID-19 pandemic. The studied subjects consist of HCWs who were put under health surveillance, i.e., all employees who were in contact with subjects who were confirmed to have tested positive for SARS-CoV-2. The HCWs under surveillance were monitored for a period encompassing ten days after the date of contact, during which they undertook nasopharyngeal swab tests analysed through RT-PCR (RealStar® SARS-CoV-2 Altona Diagnostic–Germany). Descriptive and univariate analyses have been undertaken, considering the following as risk factors: (a) no personal protective equipment use (PPE), (b) Distance &lt, 1 m between the positive and contact persons, (c) contact time &gt, 15′. Finally, a Cox regression and an analysis of the level of synergism between factors, as specified by Rothman, were carried out. We analysed data from 1273 HCWs. Of these HCWs, 799 (62.8%) were females, with a sample average age of 47.8 years. Thirty-nine (3.1%) tested positive during surveillance. The overall incidence rate was 0.4 per 100 person-days. Time elapsed from the last exposure and a positive RT-PCR result ranged from 2 to 17 days (mean = 7, median = 6 days). In the univariate analysis, a distance &lt, 1 m and a contact time &gt, 15′ proved to be risk factors for the SARS-CoV-2 infection, with a hazard ratio (HR) of 2.62 (95% CI: 1.11–6.19) and 3.59 (95% IC: 1.57–8.21), respectively. The synergism analysis found the highest synergism between the “no PPE use” x “Contact time”. The synergy index S remains strongly positive also in the analysis of the factors “no PPE use” x “Distance” and “Time of contact” x “Distance”. This study confirms the absolute need to implement safety protocols during the pandemic and to use the correct PPE within health facilities in order to prevent SARS-CoV-2 infection. The analysis shows that among the factors considered (contact time and distance, no use of PPE), there is a strong synergistic effect.

Background Indoor allergens are risk factors for asthma: Thus, the characterization of indoor air quality is important for studying environment–health relationships in children. In particular, Dermatophagoides pteronyssinus is the dominant allergen for asthma. We cross-sectionally investigated the relationships among respiratory symptoms and function, airway inflammation, allergen sensitization, and indoor allergen concentration. Methods One hundred and thirty-two children aging 10-14 years and living in a Southern Mediterranean area were evaluated by parental questionnaires. Spirometry, exhaled nitric oxide (FeNO), skin prick tests, total, and specific serum IgE analyses were performed along with the evaluation of home dust samples for the content in Der p 1 allergen. Three clusters were created on the basis of the presence/absence of wheeze in the last 12 months (Wh12m) and Der p 1-specific IgE level. Results Cluster 1 (Wh12m+/high Der p 1 IgE) presented higher FeNO and poorer pulmonary function (lower FEV1 and FEF25%-75%), while its symptom score was not different from Cluster 2 (Wh12m+/low Der p 1 IgE). Cluster 3 (Wh12m−/low IgE) showed the lowest FeNO values and pulmonary function similar to Cluster 2. Within Cluster 1, both Der p 1-specific IgE and FeNO were positively correlated with dust Der p 1. Conclusions Similar asthma phenotypes may occur in children despite differences in their atopic state. In atopic children, sensitizing allergens in the indoor environment may increase airway inflammation worsening pulmonary function. Moreover, environmental exposures may contribute to the development of asthma-like symptoms also in the absence of atopic sensitization, thus contributing to asthma overdiagnosis.

Background Azacitidine belongs to the group of antimetabolites (an analogue of cytidine) used in myelodysplastic syndrome (MS) and in acute myeloid leukaemia (AML), with expected progression free survival(according to the characteristics product summary) of 24.6 months for patient with MS and AML with blasts ≤30%. Purpose To describe the clinical cases of patients affected by MS and AML. Material and methods We performed a retrospective study enrolling all patients with MS and AML treated in our hospital. We looked at the medical records and AIFA monitoring folders, and compared effectiveness with progression free survival in the characteristics product summary. Results 21 patients were treated with azacitidine: 9 patients were affected by ALM and 12 patients were affected by MS. In the first group, we had 8 responders and 1 non-responder (treatment outcome determined with follow-up at 6 months); in the second group there were 4 non-responders. According to clinical studies with a protocol of azacitidine 1–6 +1, the administration method used was: intramuscularly for 6 days (Monday–Saturday) with a break on Sunday and the last administration on the following Monday, repeated every 28 days. We observed a longer progression free survival in two patients. The patient affected by MS, 68 years old, had white blood cells 1600, haemoglobin 8.4 and platelets 25 000 at the start of treatment. He was classified as intermediate–high risk with blasts 5–10%. The patient was treated with azacitidine for 60 months, with an increase in progression free survival of 35.4 months. The patient dropped out of therapy for progression; he is alive and is doing supportive care. The patient affected by ALM, 76 years old, had white blood cells 30 400, haemoglobin 7.9 and platelets 41 000 at the start of treatment. Blasts were >20%. The patient was treated with azacitidine for 59 months, with an increase in progression free survival of 34.4 months. He is still being treated with azacitidine. Conclusion We have shown a high efficacy for azacitidine in increasing the progression free survival in most patients treated, with two over level clinical cases (10% of the patients studied). No conflict of interest