Deaths In Italy Research Articles

A Model-Based Estimation of RSV-Attributable Incidence of Hospitalizations and Deaths in Italy Between 2015 and 2019.

Respiratory syncytial virus (RSV) incidence is known to be underestimated in adults due to its infrequent diagnostic testing and lower sensitivity of single nasal/nasopharyngeal swab PCR testing outside of the early childhood period. RSV can trigger acute cardiac events as well as cause respiratory disease. Consequently, we used a model-based study to estimate RSV-attributable hospitalization and mortality incidence among adults in Italy between 2015 and 2019. Through a database predisposed by CREA Sanità, by extracting monthly data from the Italian hospitalization collection data of the Ministry of Health and the Italian National Institute of Statistics (ISTAT) data (mortality), we estimated yearly RSV-attributable incidence of events for different cardiorespiratory outcomes. We used a quasi-Poisson regression model, which accounted for periodic and aperiodic time trends and viral activity proxies. The yearly RSV-attributable cardiorespiratory hospitalization incidence increased with age and was highest among adults aged≥75 years (1064-1527 cases per 100,000 person-years). Similarly, the RSV-attributable cardiorespiratory mortality rate was highest among persons aged≥75 years (59-85 deaths per 100,000 person-years). Incidence rates for RSV-attributable hospitalizations and RSV-attributable mortality were on average 2-3 times higher for cardiorespiratory than respiratory disease alone. Incidence rate based on RSV-specific ICD codes only were 405-1729 times lower than modeled estimates accounting for untested events. RSV causes a substantial disease burden among adults in Italy and contributes to both respiratory and cardiovascular conditions. Our results emphasize the need for effective RSV prevention strategies, particularly among older adults.

Deaths related to post-COVID in Italy: a national study based on death certificates.

SARS-CoV-2 infection has been associated with the onset or persistence of symptoms in the long-term after the acute infection is resolved. This condition known as Post-COVID, might be particularly severe and potentially life-threatening. However, little is known on the impact of post-COVID condition on mortality. Aim of the present study is to assess and quantify Post-COVID deaths in Italy in years 2020 and 2021, based on an analysis of death certificates. Data from the Italian National Cause of Death Register were analyzed. ICD-10 code U09.9, released by the World Health Organization in September 2020, was used to identify the 'Post-COVID' condition. Numbers of post-COVID deaths from October 2020 to December 2021 were analyzed. Rates of post-COVID deaths were calculated for the year 2021. Between October 2020 and December 2021, 4,752 death certificates reporting post-COVID condition were identified. Of these, 14.9% (n = 706) occurred between October and December 2020 and 85.1% (n = 4,046) in 2021. In 46.0% of post-COVID-related deaths, the underlying cause of death was COVID-19. Other frequent underlying causes were heart disease (14.3% of cases), neoplasms (9.2%), cerebrovascular diseases (6.3%) and Alzheimer's disease and other dementias (5.5%). The mortality rate related to post-COVID conditions in year 2021 was 5.1 deaths per 100 thousand inhabitants and it increased with increasing age. Men showed a higher mortality rate than women (4.3 deaths per 100 thousand in women and 6.0 deaths per 100 thousand in men). Post-COVID conditions contributed to a substantial number of deaths in Italy. Strategies to identify the population at risk of severe long-term consequences of SARS-CoV-2 infection and interventions aimed at reducing this risk must be developed.

SIC Position paper: Treat to prevent the first event - intensive LDL cholesterol lowering in patients at very high cardiovascular risk without a previous cardiovascular event. From ESC guidelines to clinical practice

Cardiovascular (CV) diseases account for over 4 million deaths every year in Europe and over 220 000 deaths in Italy, representing the leading cause of morbidity and mortality worldwide. The European Society of Cardiology (ESC) guidelines have visionary included in the at very high CV risk group patients without previous acute ischemic events, such as those with subclinical atherosclerosis, chronic coronary syndrome or peripheral arterial disease, familial hypercholesterolemia, diabetes mellitus with target organ damage or multiple associated risk factors, and those with high calculated CV risk score, recommending to consider them and to achieve the same LDL-cholesterol targets as for secondary prevention patients. The aim of this position paper is to provide an updated overview of ESC guidelines that focuses on these patient categories to raise awareness within the clinical community regarding CV risk reduction in this specific epidemiological context.

Suicide on Italian Instagram: Insights and implications for prevention and support

AbstractInstagram is the social network with the largest number of adolescent users in Italy; it is also the social network with the largest number of suicide‐related posts. Suicide is the third leading cause of death in Italy in the 15–19 age group. This study aims to describe Italian posts on Instagram related to suicide and to investigate whether there are differences in the number of likes, comments, and hashtags in relation to the characteristics of the posts. We searched for Italian‐language Instagram posts by typing ‘#suicidio’, an Italian translation of the English word ‘suicide’, and found 303 posts between January and May 2022. Most of the posts were written by ordinary people, while only a small percentage of posts were written by professionals; moreover, the content was predominantly biographical and pro‐suicide, and most posts had no reference to adolescence. Posts with a neutral approach received the most likes, while posts with a negative or positive approach to suicide or that contained references to psychiatric disorders had the most hashtags. These results provide insight regarding guidelines that can be implemented for suicide online prevention and encourage psychologists to enhance online prevention and support using the online community inherent to the Instagram social network.

An empirical analysis of the effect of economic activity and COVID-19 restrictions on road traffic accidents in Italy

Road traffic accidents are one of the leading causes of death for the young segment of the population. Prevention strategies can mitigate the occurrence of road accidents, and successful actions should take into account the most relevant causes of accidents. We use a comprehensive dataset which reports information from police records on all road traffic accidents with injures and/or deaths in Italy between 2014 and 2020 to explore the relationships among economic forces, driving behaviours and accident frequency and severity. More specifically, the natural experiment setting provided by the 2020 COVID-19-related movement restrictions allows to capture the effect of traffic intensity and other factors on the frequency of serious accidents and mortality. The empirical findings confirm a direct relationship between the level of economic activity and the frequency of accidents, whereas there is no clear link with their severity. Instead, lockdown periods are associated with a relatively higher occurrence of fatal road traffic accidents, due to both riskier driving behaviours at times of reduced traffic, and changes in transportation habits reflected by a higher probability of accidents involving bicycles and motorcycles.

Understanding Reasons for Cancer Disparities in Italy: A Qualitative Study of Barriers and Needs of Cancer Patients and Healthcare Providers.

The second leading cause of death in Italy is cancer. Substantial disparities persist in the level of care and outcomes for cancer patients across various communities, hospitals, and regions in Italy. While substantial progress has been made in medical research and treatment options, these advancements tend to disproportionately benefit the wealthier, better-educated, and more privileged areas and portions of the population. Therefore, the primary aim of the current study is to explore possible reasons for inequalities in access to and utilisation of care from the perspective of cancer patients, who are recipients of these treatments, and healthcare providers, who are responsible for their administration. After being recruited through social media platforms, patients' organisations, and hospital websites, cancer patients (n = 22) and healthcare providers (n = 16) from various Italian regions participated in online focus group discussions on disparities in access to and provision of care. Video and audio recordings of the interviews were analysed using Thematic analysis. Among cancer patients, 7 themes were identified, while 6 themes emerged from the healthcare providers highlighting encountered barriers and unmet needs in cancer care. Most of these emerging themes are common to both groups, such as geographical disparities, information deficiencies, and the importance of psycho-oncological support. However, several themes are specific to each group, for instance, cancer patients highlight the financial burden and the poor interactions with healthcare providers, while healthcare providers emphasise the necessity of establishing a stronger specialists' network and integrating clinical practice and research. Current findings reveal persistent challenges in cancer care, including long waiting lists and regional disparities, highlighting the need for inclusive healthcare strategies. The value of psycho-oncological support is underscored, as well as the potential of the Internet's use for informational needs, emphasising the imperative for improved awareness and communication to overcome disparities in cancer care.

Il ruolo del pediatra nella prevenzione del suicidio in adolescenza

Suicide is the second leading cause of death in Italy in young people between the ages of 15 and 29. Mental health problems are increasing among children and adolescents. Very often paediatricians have to manage young patients with psychiatric problems who express their psychopathology in new ways and they may feel unprepared in this respect. This article describes the phenomenon of suicide and suicidality in adolescence with particular attention to risk and protective factors. Approaches to suicide prevention are reviewed focusing on the role that the paediatrician can play in the chain of prevention (e.g. by educating the family to be attentive to possible mental health problems, reducing stigma of mental illness and identifying youth at high risk with timely referral to specialised services for further evaluation and treatment). Indeed, the scientific literature suggests that talking to adolescents about suicide in a health assessment context does not increase the risk of suicide but, in contrast, can be protective as it allows young people to verbalize and share their sufferings thus facilitating their access to appropriate help.

Population-level benefits of increasing influenza vaccination uptake among Italian older adults: results from a granular panel model.

The impact of seasonal influenza vaccination (SIV) on mortality is still controversial; some studies have claimed that increasing vaccination coverage rates is beneficial, while others have found no significant association. This study aimed to construct a granular longitudinal dataset of local VCRs and assess their effect on pneumonia- and influenza-related (P&I) mortality among Italian adults aged ≥ 65 years. NUTS-3 (nomenclature of territorial units for statistics) level data on SIV coverage were collected via a survey of local data holders. Fixed- and random-effects panel regression modeling, when adjusted for potential confounders, was performed to assess the association between local SIV coverage rates and P&I mortality in older adults. A total of 1,144 local VCRs from 2003 to 2019 were ascertained. In the fully adjusted fixed-effects model, each 1% increase in vaccination coverage was associated (P < 0.001) with a 0.6% (95% CI: 0.3-0.9%) average over-time decrease in P&I mortality. With an annual average of 9,293 P&I deaths in Italy, this model suggested that 56 deaths could have been avoided each year by increasing SIV coverage by 1%. The random-effects model produced similar results. The base-case results were robust in a sensitivity analysis. Over the last two decades, Italian jurisdictions with higher SIV uptake had, on average, fewer P&I deaths among older adults. Local policy-makers should implement effective strategies to increase SIV coverage in the Italian senior population.

ChatGPT: unlocking the potential of Artifical Intelligence in COVID-19 monitoring and prediction.

The COVID-19 pandemic has had an unprecedent impact of everyday life with deleterious consequences on global health, economics, and society. Thus, accurate and timely information is critical for monitoring its spread and mitigating its impact. ChatGPT is a large language model chatbot with artificial intelligence, developed by OpenAI, that can provide both textual content and R code for predictive models. It may prove to be useful in analyzing and interpreting COVID-19-related data. This paper explores the application of ChatGPT to the monitoring of the COVID-19 pandemic, presenting R code for predictive models and demonstrating the model's capabilities in sentiment analysis, information extraction, and predictive modelling. We used the prediction models suggested by ChatGPT to predict the daily number of COVID-19 deaths in Italy. The prediction accuracy of the models was compared using the following metrics: mean squared error (MSE), mean absolute deviation (MAD) and root mean squared error (RMSE). ChatGPT suggested three different predictive models, including ARIMA, Random Forest and Prophet. The ARIMA model outperformed the other two models in predicting the daily number of COVID-19 deaths in Italy, with lower MSE, MAD, and RMSE values as compared to the Random Forest and Prophet. This paper demonstrates the potential of ChatGPT as a valuable tool in the monitoring of the pandemic. By processing large amounts of data and providing relevant information, ChatGPT has the potential to provide accurate and timely insights, and support decision-making processes to mitigate the spread and impact of pandemics. The paper highlights the importance of exploring the capabilities of artificial intelligence in the management of public emergencies and provides a starting point for future research in this area.

Retrospective Analyses of COVID-19 and Population Ageing Effects on Italian Mortality during the Pandemic.

The spread of COVID-19 led to an extremely high number of deaths in Italy in 2020 with respect to previous years. Because the total number of deaths may depend on both the population structure and the mortality rate by age groups, a detailed overview of the Italian pandemic situation is here provided by following two main lines of inquiry: (i) checking for similarities and differences among mortality rates per age groups before and during the COVID-19 spread; (ii) analyzing the responsiveness of the Italian population structure to different mortality rates. Real-based evidence led us to conduct analyses for two groups associated with different population stages of life, referred to as younghood and adulthood periods. We focus on the Italian pandemic from February 2020 to March 2021. Our study helps to understand why elders dramatically impacted the total number of deaths. In addition, it reveals how badly the 2020 Italian population structure would have reacted to mortality rates already faced in the past. Finally, politicians, scientists, and journalists' statements and other ways of communicating information about COVID-19 are questioned in the light of scientific data available at that time.

Correlation between relative age-standardized mortality rates and COVID-19 mortality over time in Italy.

This study was planned to estimate the contribution of coronavirus disease 2019 (COVID-19) related mortality on excess deaths recorded in Italy since the beginning of the pandemic. Official data on weekly number of COVID-19 related deaths in Italy were retrieved from the website of the Italian Ministry of Health, whilst information on weekly relative age-standardised mortality rates (rASMRs) in Italy during the COVID-19 pandemic was downloaded from the UK Office for National Statistics website. Univariate and multivariate correlation was conducted to explore the association between these two variables throughout the pandemic. Significant univariate correlation was found between rASMR and number of official COVID-19 related deaths throughout the pandemic period. Such correlation was especially high during predominance of pre-Alpha and Alpha variants, remained significant during Delta variant predominance, but become no longer significant during Omicron variant predominance. In multivariable analysis, we estimated that COVID-19 may have contributed to 72% of the excess mortality recorded in Italy throughout the pandemic. The impact was higher during pre-Alpha and Alpha periods (i.e., 78% and 89%, respectively), decreased to 41% during Delta variant predominance, and became no longer significant after emergence of the Omicron variant. These results would suggest that COVID-19 may have largely contributed to excess mortality in Italy until the recent emergence of the Omicron variant, by which time previous loss of vulnerable people and radical changes in delivering healthcare may have paradoxically contributed to improve the cumulative death rate in the country.

Excess mortality and COVID-19 deaths in Italy: A peak comparison study.

During a sanitary crisis, excess mortality measures the number of all-cause deaths, beyond what we would have expected if that crisis had not occurred. The high number of COVID-19 deaths started a debate in Italy with two opposite positions: those convinced that COVID-19 deaths were not by default excess deaths, because many COVID-19 deaths were not correctly registered, with most being attributable to other causes and to the overall crisis conditions; and those who presented the opposite hypothesis. We analyzed the curve of the all-cause excess mortality, during the period of January 5, 2020-October 31, 2022, compared to the curve of the daily confirmed COVID-19 deaths, investigating the association between excess mortality and the recurrence of COVID-19 waves in Italy. We compared the two curves looking for the corresponding highest peaks, and we found that 5 out of the 6 highest peaks (83.3%) of the excess mortality curve have occurred, on average, just a week before the concomitant COVID-19 waves hit their highest peaks of daily deaths (Mean 6.4 days; SD 2.4 days). This temporal correspondence between the moments when the excess mortality peaked and the highest peaks of the COVID-19 deaths, provides further evidence in favor of a positive correlation between COVID-19 deaths and all-cause excess mortality.

988 UNCLEAR SUDDEN DEATH IN THE YOUNG: DIFFERENT DISTRIBUTION AMONG THE ITALIAN REGIONS

Abstract Introduction Sudden death (SD) in the young due to cardiovascular diseases remains a focus of the public health system. It occurs unexpectedly in apparently healthy people. In addition, several of the diseases that cause sudden death in the young can be diagnosed and treated prior to the first lethal event; on the other hands, a post mortem approach, by the means of clinical autopsy and molecular autopsy, may clarify the underling disease to better develop futher prevention by a familial approach. The attention on this issue has greatly sensitized doctors and public opinion. Aim The aim of the manuscript was to evaluate the frequency of sudden deaths in Italy in the decade 2008-2017. Methods and Data sources The searches were carried out by consulting the database of the National Institute of Statistics (ISTAT). We counted in the ISTAT database all the deceased under the age of 40 due to unclear causes in the decade 2008-2017. Results We counted 7159 young patients with DS, unevenly distributed throughout the Italian territory. In detail, 10% (1373) were in the North-West, 14% (988) in the North-East, 13% (934) in the Center, 44% (3178) in the South and 10% (686) in the islands. The analysis showed how the unclear SD in Italy have decreased over time. Southern Italy had the highest number (357) of SD at the start of the observation which slightly dropped to 272 in 2017. Despite this significant reduction, the South remains the place where the largest number of unclear SD are counted. Most likely, the initial studies conducted in the Veneto region sensitized doctors to SD in young people and athletes, leading a wider screening through cardiological examination and electrocardiogram for prevention; furthermore a widespread recurrence to clinical autopsy, to reach a clear diagnosis, allows the awareness that other cases could occur in the same family. Grief coping approach and cultural competency may explain the regional difference. The new methods available to genetics, such as next generation sequency (NGS), have allowed an increase in diagnoses even in the deceased and have identified possible pathogenic genes in family members. Conclusions Sudden death in young people represents an important challenge, considering the number of events that occur in our country and the different distribution in the Italian regions. Medical community need to better address this issue, by implementing both prevention and post-mortem analysis, to reduce the sudden death burden, especially in southern region. Thiene G. Sudden cardiac death in the young: a genetic destiny? Clin Med (Lond). 2018 Apr 1;18(Suppl 2):s17-s23. Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med. 2021 Mar;135(2):483-495.Webster G, Carberry T, Berger S. Screening for prevention of sudden death in the young: what is new? Curr Opin Cardiol. 2020 Jan;35(1):80-86.

No excess mortality among working-age Italians during the Omicron wave of Covid-19.

This study provides updated estimates of the excess deaths in Italy with a focus on the working-age population. Over-dispersed Poisson regression models, fitted on 2011-2019 mortality data, and including terms for age, calendar year and a smooth function of the week of the year, were used to estimate the expected number of deaths during the Covid-19 pandemic. The excess deaths were then obtained by the difference between observed and expected deaths and reported according to the pandemic periods defined by the predominant circulating variant of SARS-CoV-2. Around 170,700 excess deaths at all ages were estimated between March 2020 and March 2022 in Italy with most of the excess occurring during the pre-Delta and Delta period, and 2930 excess deaths (+2.5%) during the Omicron wave. The excesses among the working age population were: 10,425 deaths (+11.8%) during the pre-Delta period, 2460 (+9.4%) during the Delta wave, 283 (+2.2%) during the transition period to Delta. Mortality was lower than expected during the Omicron wave (-6.1%). Over the periods preceding the Omicron wave, Covid-19 caused around 12,800 excess deaths among individuals of working age, accounting for over 10% excess death. This excess was no longer observed during the Omicron wave.

COVID-19 Medical and Pharmacological Management in the European Countries Compared to Italy: An Overview.

(1) Background: Italy accounts for more than 150,000 deaths due to the COVID-19 pandemic, leading the top rank in SARS-CoV-2-caused deceases in Europe. A survey on the different ways by which the COVID-19 pandemic emergency was managed in the foreign European countries compared to Italy is the purpose of this paper. (2) Methods: A literature search and various mathematical algorithms to approach a rank scoring scale were used to describe in detail the different approaches used by European countries to manage the COVID-19 pandemic emergency. (3) Results: The study showed that Italy stands at the bottom ranking for COVID-19 management due to its high mortality rate. Possible causes of the observed huge numbers of hospitalization and deaths were (a) the demographic composition of the European country; (b) its decentralized healthcare system organization; (c) the role of correct pharmacology in the early stages before hospitalization. Post-mortem examinations were of paramount importance to elucidate the etiopathogenesis of COVID-19 and to tailor a suitable and proper therapy in the early symptomatic stages of COVID-19, preventing hospitalization. (4) Conclusions: Factors such as the significant impact on elderly people, the public health organization prevalently state-owned and represented mainly by hospitals, and criticism of the home therapy approach toward SARS-CoV-2-infected people, may have concurred in increasing the number of COVID-19 deaths in Italy.

A systematic review of the variants of Sars-Cov-2

Before the end of December 2019, the epidemic was mainly localized in Wuhan, Hubei Province, China. Most of the cases in this stage were related to exposure to Huanan seafood market. "The virus is transmitted through human-to-human contact and rapidly spread across the world, and soon turned into a pandemic." Its symptoms can be divided to two main groups of majors (fever, cough, and dyspnea) and minors (anosmia, dysgeusia, headache, gastrointestinal symptoms, and skin lesions). Ever since, it has caused worldwide social and economic disruption, there are no universally recognized clinically useful antiviral drugs against COVID-19 so far (actually remdesivir showed good efficacy in many trials, but it needs to be further realized). Although there are several effective vaccines to prevent infection with SARS-CoV-2, efforts to develop medications and vaccines are continuing. Recently, a novel coronavirus, severe acute respiratory syndrome SARS-CoV-2, causing coronavirus disease 2019 (COVID-19), emerged in late 2019. During February 1-July 13, 2020, were identified 4,080 transmission pairs in Georgia, USA, by using contact tracing information from COVID-19 cases reported to the Georgia Department of Public Health. The novel coronavirus disease 2019 (COVID-19) outbreak and Italy has caused 6088 cases and 41 deaths in Republic of Korea and 3144 cases and 107 deaths in Italy by 5 March 2020. Currently, the following variants; Alpha, Beta, Gamma, Delta and Omicron were originated from United Kingdom, South Africa, Brazil/Japan, and India, respectively. The classification of SARS-CoV-2 variants is based on the mutations in the structure-based inclusions. Transmission varied not only by time and place but also by persons' sex and race. Younger adults (20–50 years of age) were involved in most transmission events.

The temporal correlation between positive testing and death in Italy: from the first phase to the later evolution of the COVID-19 pandemic.

Background and aim:After the global spread of the coronavirus disease 2019 (COVID-19), research has concentrated its efforts on several aspects of the epidemiological burden of pandemic. In this frame, the presented study follows a previous analysis of the temporal link between cases and deaths during the first epidemic wave (Phase 1) in Italy (March-June 2020).Methods:We here analyze the COVID-19 epidemic in the time span from March 2020 to June 2021.Results:The elaboration of the curves of cases and deaths allows identifying the temporal shift between the positive testing and the fatal event, which corresponds to one week from W2 to W33, two weeks from W34 to W41, and three weeks from W42 to W67. Based on this finding, we calculate the Weekly Lethality Rate (WLR). The WLR was grossly overestimated (~13.5%) in Phase 1, while a mean value of 2.6% was observed in most of Phase 2 (starting from October 2020), with a drop to 1.4% in the last investigated weeks.Conclusions:Overall, these findings offer an interesting insight into the magnitude and time evolution of the lethality burden attributable to COVID-19 during the entire pandemic period in Italy. In particular, the analysis highlighted the impact of the effectiveness of public health and social measures, of changes in disease management, and of preventive strategies over time. (www.actabiomedica.it)

The skill of nursing students trained in the evaluation of electrocardiographic trace: a comparison with emergency nurses.

Cardiovascular diseases represent the main cause of death in Italy. Early recognition of pathological electrocardiographic (ECG) trace is an important skill for nurses. The theoretical knowledge and the practical skills on the recognition of pathological ECG trace of trained nursing students were compared with those of emergency nurses. The study involved 35 nursing students and 41 nurses from the emergency room, emergency medicine and ambulance service. Students were previously trained through a theoretical and practical ECG course. The data were collected using two questionnaires aimed at evaluating in the two groups the ability to recognize electrocardiographic signs. The tools were uploaded to an online platform and remotely administered. Both the students and the nurses showed a satisfactory theoretical knowledge of the ECG trace, with a statistically significant difference in favor of the nurses. Regarding practical skills, both groups showed difficulty in recognizing pathological electrocardiographic signs, particularly blockages and acute coronary syndromes. Nursing students' knowledge of ECG did not differ much from that of nurses. Training through simulation probably played a key role in improving the skill of ECG evaluation among students. More theoretical and practical courses on ECG should be recommended in Nursing Programme.

Health-related lifestyles: how they have changed after the COVID-19 pandemic occurring in Italy

Abstract Background The COVID-19 pandemic has fully affected the global community and will generate long-term consequences on social and individual life overall. Methods Since their start, the two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have investigated health-related lifestyles. The continuous monthly data collection allows observation of changes in the short, medium and long terms. We compared prevalence of tobacco and alcohol use, physical activity, PA, or inactivity, PI, before and after March 2020, to evaluate temporal trends with particular concern to changes due to the pandemic. Results Sedentariness has been growing among inactive adults but in pandemic time, we observed a 10% significant reduction compared to 2019, due to a significant increase of spare time PA from 42% (2019) to 45% (2020) and a reduction of spare time PI from 42% to 39%. Despite a stable trend, elderly increased significantly PI, from 40% (2019) to 43% (2020). PI goes from 46% to 52% among Southern residents and from 45% to 53% in poorly educated people. Since 2008, at-risk alcohol consumption gradually increased in adults because of binge-drinking and between meals modalities. In 2018, a tendency inversion started and finds confirmation during the pandemic: binge-drinking decreases significantly from dal 9.5% (2019) to 8.2% (2020), between meals from 9.4% to 8.6%. During the pandemic, elderly increase alcohol consumption significantly, from 39% (2019) to 45% (2020), attributable to changes in moderate use by women: 17% in 2019 vs. 25% in 2020 overall; from 20% to 30% in highly educated and from 15% to 21% in poorly educated. It seems the pandemic did not change smoking percentages. Conclusions Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases that, even in pandemic, represent the main burden to disability and deaths in Italy. Key messages Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases. Having an ongoing Behavioral Risk Factor Surveillance System is an opportunity to misure and evaluate the impact of a shock as Covid-19 pandemic.

COVID-19 and estimates of actual deaths in Italy. Scenarios for urban planning in Lombardy

This research investigates the direct effects of the Covid-19 pandemic in Italy, focusing on Lombardy, the most affected region by the pandemic both in the first wave of infection (March–April 2020) as well as in the second wave (October–November 2020). We analyzed the data of the death tolls provided by the Italian National Institute of Statistics in April 2020 with the aim to provide reliable estimates and maps of deaths due to Covid-19 at the local scale, and hence better guiding decisions on spatial planning.Firstly, we performed a statistical analysis at the national level, carried out on a region-by-region basis, to compare the total number of deaths in 2020 to the average values of the previous five years. We focused on the last three weeks of March when the lockdown restrictions have been fully applied. We observed that the mortality rate has been much higher than the average recorded in recent years (2015–2019), both in Italy and Lombardy. Additionally, we estimated that the ‘excess deaths’ in March 2020 are more than fourfold (325% in Italy) the official number of deaths due to Covid-19 reported by the Ministry of Health. This leads to the dramatic consideration that most of the Covid-19-related deaths occurred at home.Lastly, using geo-referenced data by Geographic Information System analysis at the municipality scale, we investigated the Covid-19 effects by grouping the deceased into five age-groups, aiming to map the correlation between geography and population age. Lombardy is a wide region, characterized by various territories, such as mountains, flat landscapes, metropolitan and touristic areas. The Covid-19 pandemic affected each area in a specific way. For each of them, according to the demographic pyramid's reconfiguration, we should assume an urban planning scenario that is place-based, sustainable and resilient.