Disease In Greece Research Articles

Social Exclusion of People Who Abstain from Mandatory COVID-19 Vaccination for Medical Reasons: A Contemporary Ethical Conflict

The measures of obligatory vaccination against COVID-19 disease in Greece, have failed to cater to people, who for serious medical reasons, were prohibited by their private doctors to be vaccinated. This fact, however, leads to their unwilling social seclusion, since they cannot obtain the vaccination certificate that ensures access to all social activities. They are, therefore, faced with the dilemma of consenting to vaccination, disregarding possible health or even fatal consequences, or social exclusion and isolation. This research study aims to discuss this ethical conflict, between what is considered ethical for society in contrast to restriction of personal will and health. It wishes to rediscover the very essence of the commitment to protecting human rights-health and social well-being. This dilemma will be viewed and examined under the scope of core ethical values and principles met in Hippocrates’ oath and the fundamental ethical theory of Utilitarianism. The study will try, drawing from these ethical theories and definitions, to test these questions and conclude on what the indicative ethical choice is. The study wishes to propose suggestions of measures that can be taken to ensure equal operations for all citizens, based on medical ethics and self-disposition principles. It will also propose actions that should be put in the equation, sensitive groups. We feel that a balanced ethical approach that does not accentuate disparities within and among different groups, could ensure health equality, better social resilience, and commitment to effective prospective preparedness.

Evaluation of Biological Plant Protection Products for Their Ability to Induce Olive Innate Immune Mechanisms and Control Colletotrichum acutatum, the Causal Agent of Olive Anthracnose.

Olive anthracnose is the most important fungal disease of the olive fruit worldwide, with the fungus Colletotrichum acutatum as the main cause of the disease in Greece. A total of 11 commercial biological plant protection products (bioPPPs) (Amylo-X®, Botector®, FytoSave®, LBG 01F34®, Mevalone®, Polyversum®, Remedier®, Serenade® ASO, Sonata®, Trianum-P®, Vacciplant®), with various modes of action against the fungus C. acutatum, were evaluated by bioassays using detached fruits of two important olive Greek varieties, cv. Koroneiki and cv. Kalamon. Subsequently, the most effective bioPPPs were evaluated for their ability to induce plant defense mechanisms, by determining the expression levels of ten Olea europaea defense genes (Pal, CuaO, Aldh1, Bglu, Mpol, Lox, Phely, CHI-2, PR-10, PR-5). Remedier®, Trianum-P®, Serenade® ASO, Sonata®, and Mevalone® were the most effective in reducing disease severity, and/or inhibiting the conidia production by the fungus at high rates. Post bioPPPs application, high expression levels of several olive plant defense genes were observed. This study provides insights into commercial bioPPPs' effectiveness in controlling olive anthracnose, as well as biocontrol-agents-mediated modulation of olive defense mechanisms.

HTA116 Cost-Effectiveness of Nirmatrelvir/Ritonavir for the Treatment of Outpatient Sars-Cov-2 in Adult Patients at Risk for Developing Severe Disease in Greece

HTA116 Cost-Effectiveness of Nirmatrelvir/Ritonavir for the Treatment of Outpatient Sars-Cov-2 in Adult Patients at Risk for Developing Severe Disease in Greece

Detection of Virulence-Associated Genes among Brucella melitensis and Brucella abortus Clinical Isolates in Greece, 2001-2022.

Brucellosis remains an important zoonotic disease in several parts of the world; in Greece, although it is declining, it is still endemic, affecting both the financial and public health sectors. The current study was undertaken to investigate the presence and distribution of virulence-associated genes among Brucella spp. clinical strains isolated during 2001-2022. Species identification was performed using conventional methodology and Bruce-ladder PCR. The presence of the virulence genes mviN, manA, wbkA, perA, omp19, ure, cbg and virB was investigated using PCR. During the study period, a total of 334 Brucella isolates were identified, of which 328 (98.2%) were detected from positive blood cultures; 315 (94.3%) of the isolates were identified as B. melitensis, whilst the remaining 16 (4.8%) and 3 (0.9%) were identified as B. abortus and B. suis, respectively. Notably, two of the B. melitensis were assigned to the REV-1 vaccine strain type. The presence of the omp19, manA, mviN and perA genes was confirmed in all 315 B. melitensis isolates, while ure, wbkA, cbg and virB genes were detected in all but 9, 2, 1 and 1 of the isolates, respectively. All eight virulence genes were amplified in all B. abortus and B. suis isolates. The detection rate of virulence genes did not differ significantly among species. In conclusion, brucellosis is still considered a prevailing zoonotic disease in Greece, with the majority of the isolates identified as B. melitensis. The eight pathogenicity-associated genes were present in almost all Brucella isolates, although the ure gene was absent from a limited number of B. melitensis isolates.

Twenty-year incidence rates of cardiovascular disease in Greece: A geospatial analysis in the Attica study context, 2002-2022

Aim: The aim of this study was to explore the geographical disparities in CVD incidence across the Attica region, over a 20-year period. Material and Methods: The 10-year and the 20-year CVD incidence data were provided by the ATTICA study, which was conducted during 2002-2022 in 3042 individuals living in Attica region. After excluding those lacking complete locality information and those lost in the 10-year and the 20-year follow-up, data for 1935 and 1902 individuals respectively, were used for the current analysis. CVD incidence rates at municipality level were mapped and hot spot analysis was implemented to recognize statistically significant spatial clusters in Attica region. Results: Mapping CVD incidence rates revealed a notable rise during the 20 years in most municipalities. The rise in female-specific CVD incidence appeared primarily in suburban areas, while a significant rise in male-specific CVD incidence was noticed in urban areas. Statistically significant spatial clusters of high values were indicated in the most urbanized municipalities of the study area, whereas clusters of low values were noticed in the more distant rural municipalities, which maintained lower CVD incidence rates during the monitoring period. Conclusions: A spatial heterogeneity of the sex-specific 20-year CVD incidence rate was observed in the Attica region of Greece.

Overview of Mpox Outbreak in Greece in 2022-2023: Is It Over?

In May 2022, for the first time, multiple cases of mpox were reported in several non-endemic countries. The first ever case of the disease in Greece was confirmed on 8 June 2022, and a total of 88 cases were reported in the country until the end of April 2023. A multidisciplinary response team was established by the Greek National Public Health Organization (EODY) to monitor and manage the situation. EODY's emergency response focused on enhanced surveillance, laboratory testing, contact tracing, medical countermeasures, and the education of health care providers and the public. Even though management of cases was considered successful and the risk from the disease was downgraded, sporadic cases continue to occur. Here, we provide epidemiological and laboratory features of the reported cases to depict the course of the disease notification rate. Our results suggest that measures for raising awareness as well as vaccination of high-risk groups of the population should be continued.

Male breast cancer survival data and clinicopathological characteristics: A single-centre experience.

e18837 Background: Male breast cancer represents an uncommon entity accounting for less than 1% of all breast cancers. Although the understanding of biology, clinical presentation and management are evolving, a large knowledge gap still remains. Due to disease’s rarity, there is a significant paucity of data and most clinicians confront male cases by extrapolating from breast cancer in women. In this study we aim to report our institutional experience across a 17-year period about male breast cancer patients treated at the same centre. Methods: Clinical, histopathological, treatment and survival data of male breast cancer patients diagnosed between 2006 and 2022 at Second Department Medical Oncology in Saint Savvas Anticancer Hospital were identified and analyzed. Results: A total number of 24 male breast cancer patients were detected. The median age at diagnosis was 63 years. All participants had invasive ductal carcinoma. None of them presented with metastatic disease, while the majority had stage II disease (62,5%). All, except two cases, underwent mastectomy with either axillary or sentinel lymph node dissection. Regarding hormone receptors, 96% were ER positive and 25% were PR negative, while 79% were negative for HER-2 overexpression. As far as HER-2 low status is concerned, 42% (10 out of 24) were categorized as low expressors. From genetic point of view, data were available only for 9 cases, 2 of which were BRCA-2 mutant. Adjuvant chemotherapy (anthracycline and taxane based mainly) was administered in 75% (18 out of 24) of patients. At the time of last follow up (January 2023), only 5 participants presented disease progression, with metastatic lesions in bones, liver and lymph nodes. The median disease-free survival (DFS) was 48 months. In our cohort 5 deaths were recorded and the median overall survival (OS) was 58,5 months. Conclusions: Male breast cancer is a unique entity that remains understudied. Our institutional data provide a useful overview about this rare disease in Greece. Ongoing effort is required to conduct clinical trials or to include male patients in large, randomized cohorts in order to improve medical care.

CELESTIA: Cost-Effectiveness Analysis of Empagliflozin Versus Sitagliptin in Patients with Type 2 Diabetes in Greece.

Globally, the prevalence of diabetes is on the rise, with the number of affected individuals predicted to cross 700 million by 2045. In Greece, in 2015, almost 700,000 people received prescribed medication for type 2 diabetes. The CELESTIA study aims to assess the cost-effectiveness of empagliflozin compared to branded sitagliptin in type 2 diabetes patients both with and without established cardiovascular disease in Greece from a third payer perspective. The IQVIA Core Diabetes Model was used and analyses were conducted from the Greek healthcare payer perspective. Patients received either empagliflozin or sitagliptin until HbA1c threshold of 8.5% (69 mmol/mol) was exceeded. Subsequently, patients were assumed to intensify to insulin therapy. Baseline cohort characteristics and treatment effects were derived from clinical trial data. Literature data were used for input (utilities, treatment costs and costs of diabetes-related complications costs). A lifetime time horizon (50 years) was applied, and costs and benefits were discounted at an annual rate of 3.5%. Over a lifetime horizon, for empagliflozin, the estimated ICER was of €6,587 and €966 per quality-adjusted life years gained versus sitagliptin, in patients without established cardiovascular disease and in patients with established cardiovascular disease, respectively. Probabilistic sensitivity analysis confirmed the robustness of the analysis. The analysis demonstrated that for type 2 diabetes patients, empagliflozin is a cost-effective treatment option versus branded sitagliptin in Greece.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation.

Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD). To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups. A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. The majority of caregivers were females (67.2%), with a median age of 58years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively). Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.

Perceived barriers to gluten-free diet adherence by people with celiac disease in Greece.

In people with celiac disease (CD), many factors affect adherence to a gluten-free diet (GFD), and these may well differ among countries. In Greece, such data for the adult population are lacking. Thus, the present study aimed to explore the perceived barriers to compliance with a GFD that are faced by people with CD living in Greece, also taking into account the impact of the COVID-19 pandemic. Nineteen adults (14 females) with biopsy-proven CD, mean age 39±9 years and median time on GFD 7 (Q1-Q3: 4-10) years, participated in 4 focus groups, conducted through a video conference platform during the period October 2020 to March 2021. Data analysis followed the qualitative research methodology. Eating outside the home was reported as the domain where most difficulties were faced: these were related to a lack of confidence in finding safe gluten-free food and to the lack of social awareness about CD/GFD. All participants highlighted the high cost of gluten-free products, which was mostly managed by receiving state financial support. Regarding healthcare, the vast majority of participants reported little contact with dietitians and no follow up. The COVID-19 pandemic eased the burden of eating out, as staying at home and allocating more time to cooking was experienced as a positive effect, although the shift to online food retailing impacted food variability. The main impediment to GFD adherence seems to stem from low social awareness, while the involvement of dietitians in the healthcare of people with CD warrants further investigation.

Differences between Weekly Physical Activity among People with Alzheimer’s Disease in Greece

Objective: Dementia is one social challenge with global prevalence. Creating personalized programs that enhance physical activity (PA) is an efficient approach for patients suffering from Alzheimer’s disease (AD), and a distinction between sexes to organize such programs is needed. Therefore, the present study focuses on differences in PA between male and female patients with AD and compared the number of performed steps in these patients during week and weekend days. Methods: In total, 21 patients with AD, who attended the daily center for dementia of the Psychogeriatric Association for Alzheimer in Athens and met the established criteria based on information obtained from neuropsychiatric examinations, were included in this study. The Mini-Mental State Examination Test was conducted, and data concerning the daily performed steps were obtained by using a portable pedometer, which the participants wore for 7 days. Results: The cognitive status and physical activity among male and female individuals were found to be similar. The results were similar for both week and weekend days. However, there was a significant correlation between the Mini-Mental State Exam scores and daily steps. Our findings suggest that PA is independently associated with sexes and weekdays in patients with mild to severe dementia. Conclusion: PA is an important factor in everyday life. Our findings suggest that there are no differences between the sexes regarding their physical activity. However, there was a significant link between the cognitive status and PA. Because of the small number of included participants, additional research is required to generalize our findings

Twenty-first century epidemiology of dyslipidemia in Greece: EMENO national epidemiological study

BackgroundGreece was recently reclassified from low- to medium-risk country in terms of cardiovascular disease, with 27% of cardiovascular deaths attributed to hypercholesterolemia. EMENO nationwide survey (2013-2016) assessed the epidemiology of dyslipidemia in the general population in Greece. MethodsA random sample of adults was drawn by multistage stratified random sampling based on 2011 census. Standardized questionnaires and blood tests for total cholesterol (TC), low-density (LDL-C), and high-density lipoprotein cholesterol (HDL-C), and triglycerides were used. Hypercholesterolemia was defined as TC ≥ 240/200 mg/dL and/or the use of lipid-lowering drugs, hyper-LDL-cholesterolemia as LDL-C ≥160/130/100 mg/dL and/or the use of drugs, hypo-HDL-cholesterolemia as HDL-C <40 mg/dL, and hypertriglyceridemia as triglycerides ≥150 mg/dL. Weighted analysis was applied to adjust for study design, age/sex distribution discrepancies between sample and population and nonresponse. ResultsOf 6,006 individuals recruited, 4,298 were analyzed (mean [SD] age 49.2 [18.5] years, men 48.5%, BMI 28.2 [5.7] kg/m2). Mean TC, LDL-C, HDL-C, and TG were 193.9 [44.4], 118.5 [37.6], 49.1 [14.9], and 130.8 [94.4] mg/dL, respectively. The prevalence of hypercholesterolemia was 27.6/52.4% for thresholds ≥240/200 mg/dL, and of hyper-LDL-cholesterolemia was 26.3/46.7/74% for thresholds ≥160/130/100 mg/dL, with no differences between sexes. The prevalence of hypo-HDL-cholesterolemia was 27.5% (men/women 38.1/17.5%, p < 0.001) and of hypertriglyceridemia was 27.8% (men/women 32.6/23.4%, p < 0.001). Lipid-lowering drugs were used by 14.1% of the participants (men/women 12.6/15.6%, p < 0.001). ConclusionsMore than 50% of adults in Greece have some type of dyslipidemia (mainly TC ≥ 200 mg/dL) and 14% are treated. Nationwide programmes are needed to manage dyslipidemia and halt the increasing rate of cardiovascular disease in Greece.

Oral Health Condition and Cardiovascular Disease in Greece: Results of a Questionnaire Research

Objective: The aim of the current report was to examine the association between indices of oral health condition and cardiovascular disease in an adult Greek population. Material and Methods:1,026 individuals derived from two medical and one dental practice consisted the study sample. The participants underwent an oral and dental clinical examination and answered a questionnaire regarding oral health, dental care habits, cardiovascular disease, socio-economic and educational status. Odd ratios for all cardiovascular diseases (CVD) and the subgroup stroke, myocardial infarction and hypertension were assessed with a logistic regression model adjusted for age, gender, smoking, educational and socio-economic status. Results: After carrying out the logistic regression analysis model, an association between moderate/severe gingival inflammation (GI) and all CVD in general was observed (p=0.04, OR=1.87), and hypertension (p=0.03, OR= 1.73). There was also an association between severe PlI and all CVD (p=0.022, OR=1.78), and hypertension (p=0.015, OR=1.88). Moreover, an association was found between BOP all CVD (p=0.01, OR= 1.89), and hypertension (p=0.005, OR= 1.98). Conclusion: The results indicated that oral health and, especially gingival inflammation (GI), plaque accumulation (PlI) and presence of bleeding on probing (BOP) were associated with CVD and hypertension.

Thyroid dysfunction in Greece: Results from the national health examination survey EMENO.

BackgroundNationwide data on thyroid disease prevalence in Greece is lacking. Using the national health examination survey EMENO data resources, we aimed to estimate the prevalence of hypothyroidism and hyperthyroidism and associated risk factors in adults living in Greece.MethodsA random sample of the adults (≥18 years) living in Greece was drawn by multi-stage stratified random sampling based on the 2011 census. During home visits, trained interviewers administered a standardized questionnaire to study participants. All participants answered questions concerning demographic parameters (e.g., age, sex, degree of urbanization, income) and questions concerning smoking habits, alcohol, dietary habits and psychological parameters such as anxiety and thyroid disease. Weighted logistic regression models were fitted to assess factors associated with thyroid disease.ResultsIn total, 6006 individuals were recruited in the Greek Health Examination Survey EMENO (response rate 72%) of whom 5981 were eligible for this study. The prevalence of thyroid disease was 9%, where 0.4% was related to hyperthyroidism and 8.6% to hypothyroidism. The prevalence of thyroid disease was higher in women (14.9%) than men (2.7%) (p<0.001). The highest rates of thyroid disease were observed in former iodine-deficient areas. A decrease in the prevalence of thyroidopathies with increasing alcohol consumption was found. Thyroid disease was associated with anxiety in men. Multivariable regression analysis showed that age, geographic area, and smoking were related to thyroid disease.ConclusionThe prevalence of thyroid disease in Greece is higher in women. Age, habits, and characteristics of geographic areas determine the distribution of thyroidopathies in Greece.

Serological evidence of possible Borrelia afzelii lyme disease in Greece

Suggestions that Lyme disease exists in Greece remain controversial and no study to date has definitively identified the presence of a Borrelia species that infects humans. We examined patients throughout Greece suspected for Lyme disease by enzyme-linked immunosorbent assay (ELISA) and by western blotting for Borrelia burgdorferi sensu lato species. We found one patient positive for Borrelia burgdorferi and two patients positive for Borrelia afzelii specific IgG antibodies. Both B. afzelii patients were suffering by neurological manifestations and had never traveled abroad. We provide serological evidence of two autochthonous Lyme disease cases in Greece, possibly caused by B. afzelii.

PDB38 Budget IMPACT Analysis of Empagliflozin for the Treatment of Patients with Type 2 Diabetes Mellitus and High Risk or Established Atherosclerotic Cardiovascular Disease in Greece

Based on the latest treatment recommendations, the use of sodium–glucose cotransporter-2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists is suggested for patients with type 2 diabetes mellitus (T2DM) and high risk or established atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to estimate the budgetary impact of increasing the use of empagliflozin for the management of these patients in Greece from a public payer perspective. A 5-year (2020-2024) budget impact model was developed to delineate the financial implications of increasing empagliflozin use versus GLP-1 agents for the treatment of T2DM patients with high risk or established ASCVD. Epidemiological data were retrieved from literature and local clinical expert. Market share scenarios with and without the increased market uptake of empagliflozin applied to the eligible Greek patient population. Pharma’s projection estimates were used for building up the market shares of the analyses. Costs related to drug acquisition were considered and unit costs were retrieved from Greek official sources (€, 2020). Key outcomes were total and per patient incremental costs, calculated by comparing the respective total and patient-level budget expenditures with and without the increased use of empagliflozin. The total and patient-level savings resulting from the increased use of empagliflozin compared to the current market treatment mix were estimated at €48,314,161 (-9.03%) and €372, respectively, over 5 years. On average, annual total and patient-level savings of €9,662,832 (-8.79%) and €74 were calculated. Over time, the gradual increase in empagliflozin market share was associated with greater cost savings for the public payer, ending with the highest total savings (€14,474,508 [-11.80%]) by 2024 (at empagliflozin highest share: 50%). This budget impact analysis suggests the increased use of empagliflozin versus GLP-1s represents a cost-saving strategy for the treatment of T2DM patients with high risk or established ASCVD in Greece.

PCN94 Cost-Effectiveness of Trifluridine/Tipiracil (FTD/TPI) As a Third-LINE Treatment of Metastatic Gastric Cancer, Including Adenocarcinoma of the Gastroesophageal Junction, Among Patients WHO Have Received at Least Two PRIOR Therapies for Metastatic Disease in Greece

PCN94 Cost-Effectiveness of Trifluridine/Tipiracil (FTD/TPI) As a Third-LINE Treatment of Metastatic Gastric Cancer, Including Adenocarcinoma of the Gastroesophageal Junction, Among Patients WHO Have Received at Least Two PRIOR Therapies for Metastatic Disease in Greece

PCN57 Budget IMPACT Analysis of Trifluridine/Tipiracil (FTD/TPI) As a Third-LINE Treatment of Metastatic Gastric Cancer, Including Adenocarcinoma of the Gastroesophageal Junction, Among Patients WHO Have Received at Least Two PRIOR Therapies for Metastatic Disease in Greece.

PCN57 Budget IMPACT Analysis of Trifluridine/Tipiracil (FTD/TPI) As a Third-LINE Treatment of Metastatic Gastric Cancer, Including Adenocarcinoma of the Gastroesophageal Junction, Among Patients WHO Have Received at Least Two PRIOR Therapies for Metastatic Disease in Greece.

Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece

Background: Patients with end-stage renal disease (ESRD) require specialized therapeutic interventions. The decreased renal function that modulates the physiology and presence of comorbidities is often associated with variations in the pharmacological response, thus increasing the risk of adverse drug events or reactions (ADE/ADRs) from co-administered drugs. Methods: A cross-sectional study to record comorbidities, drug–drug interactions (DDIs), ADE/ADRs in patients with chronic kidney disease of stage five in Greece. The study enrolled 60 patients of mean age 64.8 ± 12.9 years, undergoing hemodialysis three times a week. Demographic and social factors, comorbidities, laboratory test data, medication regimens, DDIs and the reporting of ADE/ADRs were analyzed. Results: Cardiovascular diseases and diabetes were the main comorbidities. In total, 50 different DDIs of various clinical significance were identified. CNS, GI-track, and musculoskeletal-system-related ADE/ADRs were most often reported by patients. ADE/ADRs as clinical outcome from DDIs were associated in 64% of the total identified DDIs. There was a positive trend between number of medications, ADE/ADRs report and DDIs. Conclusions: The impact of ADE/ADRs in ESRD patients should be always considered. Guidelines as well as continuous training in the context of evidence-based clinical practice by healthcare personnel on therapy administration and prevention of adverse events are important.

Modeling and Forecasting the COVID-19 Temporal Spread in Greece: An Exploratory Approach based on Complex Network Defined Splines.

Within the complex framework of anti-COVID-19 health management, where the criteria of diagnostic testing, the availability of public-health resources and services, and the applied anti-COVID-19 policies vary between countries, the reliability and accuracy in the modeling of temporal spread can prove to be effective in the worldwide fight against the disease. This paper applies an exploratory time-series analysis to the evolution of the disease in Greece, which currently suggests a success story of COVID-19 management. The proposed method builds on a recent conceptualization of detecting connective communities in a time-series and develops a novel spline regression model where the knot vector is determined by the community detection in the complex network. Overall, the study contributes to the COVID-19 research by proposing a free of disconnected past-data and reliable framework of forecasting, which can facilitate decision-making and management of the available health resources.