Wave Of Pandemic Research Articles

Influence of Increased Online Information on Consumption Patterns during COVID-19: Case of Priority Medical Devices

Influence of Increased Online Information on Consumption Patterns during COVID-19: Case of Priority Medical Devices

Impact of the 2nd, 3rd and 4th waves of the COVID-19 pandemic on wait times in head and neck cancer: A retrospective study in a French expert center

BackgroundTreatment delay in head and neck cancer is a major problem, with impact on survival. The COVID-19 (coronavirus disease 2019) pandemic, evolving in waves around the world, caused diagnostic and therapeutic delays in certain cancers. The main objective of the present study was to analyze whether there was a change in wait times during three successive waves in our center. MethodThis was a single-center retrospective study of patients with a first diagnosis of head and neck cancer. Three groups, corresponding to waves 2, 3 and 4, were compared to a control group corresponding to a pre-pandemic period. Study data comprised median times between first consultation and tumor board meeting (C1-TB) and between tumor board meeting and treatment (TB-T). The significance threshold was set at P<0.005. ResultsNinety-six patients were included in the control group, and 154 in the “waves 2-3-4” group. There was no increase in C1-TB interval (respectively 35 and 26days, P=0.046) or TB-T interval (respectively 27 and 28days, P=0.723). ConclusionIntervals between first consultation and tumor board meeting and between tumor board meeting and treatment did not increase during the 2nd, 3rd and 4th waves of COVID-19 in our center.

Low pathogenic human coronaviruses during the first waves of COVID-19 in Italy.

Low-pathogenic human coronaviruses (HCoVs) infect the upper respiratory tract and cause mild, cold-like respiratory illness. Although several studies have shown evidence of the global distribution of HCoVs, information about their distribution in Italy are often focused only on hospitalized children and elderly with respiratory symptoms. In this study, a total of 916 swab samples collected during the first two SARS-CoV-2 pandemic waves in Abruzzo region (central Italy) was selected for molecular screening of low pathogenic HCoVs by real-time RT-PCR. We identified low-pathogenic HCoV in nine samples. Positive samples underwent whole genome sequencing for genome characterization; indeed, we also report the whole genome sequence of a HCoV-229E strain.

Understanding the Risk of Social Vulnerability for the Chinese Diaspora during the COVID-19 Pandemic: A Model Driving Risk Perception and Threat Appraisal of Risk Communication-A Qualitative Study.

During the first wave of the COVID-19 pandemic, immigrants were among the most socially vulnerable in Western countries. The Chinese diaspora in Canada were one such group due to the widespread cultural stigma surrounding their purported greater susceptibility to transmit and become infected by COVID-19. This paper aims to understand the social vulnerability of the Chinese diaspora in the Greater Toronto Area, Canada, during the first wave of COVID-19 from an explanation of their risk perception and threat appraisal of risk communication. We conducted secondary data analysis of 36 interviews using critical realism. The participants self-identified as being of Chinese descent. The results were used to develop a model of how social vulnerability occurred. In brief, cognitive dissonance was discovered to generate conflicts of one's cultural identity, shaped by social structures of (i) stigma of contagion, (ii) ethnic stigma, and (iii) public sentiment, and mediated by participants' threat appraisal and (iv) self-reliance. We assert that risk communicators need to consider their audiences' diverse socialization in crafting messages to modify behaviors, create a sense of responsibility, and mitigate public health threats. A lack of awareness of one's cognitive dissonance driven by cultural vulnerability may heighten their social vulnerability and prevent them from taking action to protect themself from high-risk events.

Obesity differs from diabetes mellitus in antibody and T-cell responses post-COVID-19 recovery.

Obesity and type 2 diabetes (DM) are risk factors for severe coronavirus disease 2019 (COVID-19) outcomes, which disproportionately affect South Asian populations. This study aims to investigate the humoral and cellular immune responses to SARS-CoV-2 in adult COVID-19 survivors with overweight/obesity (Ov/Ob, BMI ≥ 23 kg/m2) and DM in Bangladesh. In this cross-sectional study, SARS-CoV-2-specific antibody and T-cell responses were investigated in 63 healthy and 75 PCR-confirmed COVID-19 recovered individuals in Bangladesh, during the pre-vaccination first wave of the COVID-19 pandemic in 2020. In COVID-19 survivors, SARS-CoV-2 infection induced robust antibody and T-cell responses, which correlated with disease severity. After adjusting for age, sex, DM status, disease severity, and time since onset of symptoms, Ov/Ob was associated with decreased neutralizing antibody titers, and increased SARS-CoV-2 spike-specific IFN-γ response along with increased proliferation and IL-2 production by CD8 + T cells. In contrast, DM was not associated with SARS-CoV-2-specific antibody and T-cell responses after adjustment for obesity and other confounders. Ov/Ob is associated with lower neutralizing antibody levels and higher T-cell responses to SARS-CoV-2 post-COVID-19 recovery, while antibody or T-cell responses remain unaltered in DM.

Community antibiotic prescribing in patients with COVID-19 across three pandemic waves: a population-based study in Scotland, UK

ObjectivesThis study aims to examine community antibiotic prescribing across a complete geographical area for people with a positive COVID-19 test across three pandemic waves, and to examine health and demographic...

A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study.

Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18months before the lockdown, (12 March 2020) to 18months after the lockdown. The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76years (SD: 5.7, range: 68-102years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.

Factors associated with plans for early retirement among Ontario family physicians during the COVID-19 pandemic: a cross-sectional study

BackgroundHigher numbers of family physicians (FPs) stopped practicing or retired during the COVID-19 pandemic, worsening the family doctor shortage in Canada. Our study objective was to determine which factors were associated with FPs’ plans to retire earlier during the COVID-19 pandemic.MethodsWe administered two cross-sectional online surveys to Ontario FPs asking whether they were “planning to retire earlier” as a result of the pandemic during the first and third COVID-19 pandemic waves (Apr-Jun 2020 and Mar-Jul 2021). We used logistic regression to determine which factors were associated with early retirement planning, adjusting for age.ResultsThe age-adjusted proportion of FP respondents planning to retire earlier was 8.2% (of 393) in the first-wave and 20.5% (of 454) in the third-wave. Planning for earlier retirement during the third-wave was associated with age over 50 years (50–59 years odds ratio (OR) 5.37 (95% confidence interval (CI):2.33–12.31), 60 years and above OR 4.18 (95% CI: 1.90-10.23)), having difficulty handling increased non-clinical responsibilities (OR 2.95 (95% CI: 1.79–4.94)), feeling unsupported to work virtually (OR 1.96 (95% CI: 1.19–3.23)) or in-person (OR 2.70 (95% CI: 1.67–4.55)), feeling unable to provide good care (OR 1.82 (95% CI: 1.10–3.03)), feeling work was not valued (OR 1.92 (95% CI: 1.15–3.23)), feeling frightened of dealing with COVID-19 (OR 2.01 (95% CI: 1.19–3.38)), caring for an elderly relative (OR 2.36 (95% CI: 1.69–3.97)), having difficulty obtaining personal protective equipment (OR 2.00 (95% CI: 1.16–3.43)) or difficulty implementing infection control practices in clinic (OR 2.10 (95% CI: 1.12–3.89)).ConclusionsOver 20% of Ontario FP respondents were considering retiring earlier by the third-wave of the COVID-19 pandemic. Supporting FPs in their clinical and non-clinical roles, such that they feel able to provide good care and that their work is valued, reducing non-clinical (e.g., administrative) responsibilities, dealing with pandemic-related fears, and supporting infection control practices and personal protective equipment acquisition in clinic, particularly in those aged 50 years or older may help increase family physician retention during future pandemics.

Fear and travel: extending our understanding of pandemic (non-) travel

PurposeTravel decreased dramatically during the initial wave of the COVID-19 pandemic, only to return rapidly to prepandemic levels once the degree of fear toward the virus began to diminish among potential travelers. This USA-based 16-month repeated-measure cross-sectional survey study aims to explore the degree to which fear of COVID affected people’s decisions to stay home rather than to travel during the pandemic.Design/methodology/approachThe research used survey data. An extensive data set, composed of over 9,500 respondents, collected through Mechanical Turk over a 16-month time period, was used to compare respondent fear of the pandemic both with their attitudes toward future travel and with Smith Travel Research data reflecting actual pandemic travel patterns.FindingsThe results demonstrate how fear of COVID was closely and negatively linked to both travel intentions and travel behavior.Research limitations/implicationsData were collected from US respondents only.Practical implicationsThe findings significantly extend earlier studies and provide guidance for those studying travel consumer behavior regarding trends that should be monitored in the case of a future pandemic or other fear-inducing crisis. For hospitality and tourism managers and marketers, understanding fear as a leading indicator of future travel behavior can result in more timely promotional efforts and staffing and training decisions.Social implicationsMeasuring and understanding consumer fear levels as this relates to travel decisions can help in the future to adjust the message that is sent to the public, perhaps reducing the amount of travel taken during periods when this is unwise and or unsafe.Originality/valueThis paper extends previous work that had been based upon cross-sectional reviews, providing a broader and more valuable study of an important and timely consumer behavior travel topic.

Impact of the second wave of COVID-19 pandemic on food security among Ho indigenous community of Jharkhand, India

Abstract Background Food insecurity and hunger are global concerns further exacerbated by the unprecedented COVID-19 pandemic. There is a need to understand the depth of this impact, especially among smallholder farmers, and recognize specific coping strategies that offered resilience to inform preparedness in future. The present cross-sectional study assessed the impact of the second wave of COVID-19 pandemic on different dimensions of food security among smallholder farmers of Ho indigenous community of Jharkhand, India. It also explored potential resilient attributes of their food systems. Results Most of the respondents (67.2%) reported reduced food consumption at the household (HH) level. Majority faced difficulty in accessing food from different food sources; however, easier access to government food security programmes was highlighted. Around 40% reported change in their ability to purchase farming inputs. Market vendors reported disruptions in food procurement owing to travel restrictions; however, no change was reported for home-produced foods in agricultural lands/kitchen gardens. Prices of indigenous foods produced locally decreased/remained same; however, for cereals, pulses, and other HH staples, prices increased during second wave. Difficulty in accessing wild food environment (OR: 1.7, CI 0.40, 7.75), change in food prices (OR: 19.9, CI 5.25, 76.02), decrease in HH income (OR: 9.2, CI 2.99, 28.60) were found to be significantly associated with reduction in HH food consumption (p &lt; 0.01). The coping strategies adopted by the community included sale of cultivated and wild produce in local weekly markets to ensure additional income. Conclusions The findings highlight the need to reinforce the traditional ecological knowledge of the Ho community and focus on practices around their food systems, engrained into their socio-cultural ecosystems that may offer resilience against future stresses. In addition, the need of systemic support to ensure the social and economic well-being of the community needs to be prioritized.

Pandemic Equation and COVID-19 Evolution

The Pandemic Equation describes multiple pandemic waves and has been applied to describe the COVID-19 pandemic. Using the generalized approaches of solid-state physics, we derive the Pandemic Equation, which accounts for the effects of pandemic mitigation measures and multiple pandemic waves. The Pandemic Equation uses slow and fast time scales for “curve flattening” and describing vaccination and mitigation measures and the Scaled Fermi–Dirac distribution functions for describing transitions between pandemic waves. The Pandemic Equation parameters extracted from the pandemic curves can be used for comparing different scenarios of the pandemic evolution and for extrapolating the pandemic evolution curves for the periods of time on the order of the instantaneous Pandemic Equation characteristic time constant. The parameter extraction for multiple locations could also allow for uncertainty quantification for such pandemic evolution predictions.

Insights into the Impact of Organizational Factors and Burnout on the Employees of a For-Profit Psychiatric Hospital during the Third Wave of the COVID-19 Pandemic.

In this paper, we provide insights into the interplay among the organizational, job, and attitudinal factors and employees' intentions to resign during the third wave of the COVID-19 pandemic at a mental health hospital. We point out shortcomings in the relationship dynamics between executive administration and operational staff and propose a pathway to develop more effective leadership frameworks to increase job satisfaction. We integrate qualitative data from case information and open-ended questions posed to employees at a mental health hospital and quantitative data from a small-scale survey (n = 19). We highlight that the ability to achieve objectives, work autonomy, burnout, affective commitment, distributive and procedural justice, and job satisfaction are critical in determining individuals' intentions to resign. Individuals identified disconnectedness and moral distress as critical aspects, while highlighting empathy, compassion, satisfaction, and confidence as pivotal elements. Mental healthcare settings could benefit from enhancing the staff's ability to achieve objectives, work autonomy, affective commitment, and both distributive and procedural justice. Addressing burnout and implementing measures to increase job satisfaction are equally vital. Efficiently restructuring dynamics between various leadership levels and staff can significantly improve employee retention.

The role of political ideology on variety-seeking behavior during crisis-induced threats: Evidence from the COVID-19 pandemic

In an era marked by heightened political polarization and escalating crises, our study provides timely, empirics-first insights into how political ideology influences consumers’ variety-seeking behaviors when they experience crisis-induced threats—specific events that are perceived to endanger physical and financial well-being—versus normal conditions. We advance knowledge by investigating the interplay between political ideology, variety seeking, and crisis-induced threats using a large-scale dataset of over 32 million U.S. grocery transactions before and during the initial wave of the COVID-19 pandemic, as well as county-level voting results. In doing so, we seek to answer three questions: (1) How does political ideology influence variety seeking under normal conditions? (2) How do crisis-induced threats influence variety seeking? and (3) How does political ideology influence variety seeking under crisis-induced threats? Our findings reveal that, under normal conditions, conservatives show greater variety seeking than liberals. Yet, during crisis-induced threats, conservatives decrease their variety seeking, whereas liberals increase theirs. These results complement existing studies that, using lab experiments and surveys, have identified various mechanisms––oftentimes competing––that influence variety seeking. We advance this work with externally validated and robust empirical evidence on how consumers’ variety seeking behaviors change substantially during crisis-induced threats versus normal conditions. These insights provide retail practitioners with marketing-relevant insights and strategies, tailored to the political composition of their consumer base, that can enhance their crisis preparedness and responses.

Network analysis on psychopathological symptoms, psychological measures, quality of life and COVID-19 related factors in Chinese psychiatric patients in Hong Kong

BackgroundPsychiatric patients are susceptible to adverse mental health impacts during COVID-19, but complex interplays between psychopathology and pandemic-related variables remain elusive. This study aimed to investigate concomitant associations between psychopathological symptoms, psychological measures and COVID-19 related variables in Chinese psychiatric patients during the peak of fifth pandemic wave in Hong Kong.MethodsWe employed network analysis to investigate inter-relationships among psychopathological symptoms (including depression, anxiety, post-traumatic stress disorder-like [PTSD-like] symptoms, insomnia, psychotic symptoms), cognitive complaints, health-related quality of life, loneliness, resilience and selected pandemic-related factors in 415 psychiatric outpatients between 28 March and 8 April, 2022. Network comparisons between genders, diagnosis (common mental disorders [CMD] vs. severe mental disorders [SMD]), and history of contracting COVID-19 at fifth wave were performed as exploratory analyses.ResultsOur results showed that anxiety represented the most central node in the network, as indicated by its highest node strength and expected influence, followed by depression and quality of life. Three comparatively strong connections between COVID-19 and psychopathological variables were observed including: fear of contagion and PTSD-like symptoms, COVID-19 stressor burden and PTSD-like symptoms, and COVID-19 stressor burden and insomnia. Network comparison tests revealed significant network structural difference between participants with history of contracting COVID-19 and those without, but showed no significant difference between genders as well as between CMD and SMD patients.ConclusionsOur findings suggest the pivotal role of anxiety in psychopathology network of psychiatric patients amidst COVID-19. Pandemic-related variables are critically associated with trauma/stress and insomnia symptoms. Future research is required to elucidate potential network structural changes between pandemic and post-COVID periods.

Psychological distress among unemployed migrants settling in southwestern Spain: A cross-sectional study.

Migrants living in the informal settlements of Southern Spain tend to have precarious employment and poor living conditions, making then vulnerable to mental health issues. This study aimed to assess psychological distress in a sample of unemployed migrants residing in informal settlements in the province of Huelva (southern Spain), during the fourth wave of the COVID-19 pandemic. A descriptive cross-sectional study was conducted during the months of April to June 2021, through a heteroadministered questionnaire, in informal settlements. The measurement instrument was the General Health Questionnaire (GHQ-12), used to analyze psychological distress, and other sociodemographic and health-related variables. Univariate and bivariate descriptive data analysis were performed, using the nonparametric statistics Mann-Whitney U test, Kruskal-Wallis H test, and Tau β correlation. A categorical regression analysis was performed to study the relationship between psychological distress and the rest of the variables. The sample consisted of 317 subjects, 83.9% of whom were males, and the mean age was 33.4 years (SD = 10.7 years). The mean score obtained in the GHQ-12 questionnaire was 13.69 points (SD = 3.86). Significant differences were found between levels of psychological distress and substance abuse (H = 14.085; P = .049), people who wished to stay in Spain (t = 6987; P = .049), people who experienced isolation due to COVID-19 contact (t = 1379.5; P = .001), people who needed medical assistance due to COVID-19 (t = 7.990; P = .018), and those who reported having chronic illnesses (t = 2686.5, P = .02). The mean score of psychological distress indicates general high levels of psychological distress. Participants who had experienced isolation due to COVID-19 contact, who consumed substances, and who had chronic illnesses reported the highest levels of psychological distress.

Enhancing Precision of Telemonitoring of COVID-19 Patients through Expert System Based on IoT Data Elaboration

The emergence of the highly contagious coronavirus disease has led to multiple pandemic waves, resulting in a significant number of hospitalizations and fatalities. Even outside of hospitals, general practitioners have faced serious challenges, stretching their resources and putting themselves at risk of infection. Telemonitoring systems based on Internet of things technology have emerged as valuable tools for remotely monitoring disease progression, facilitating rapid intervention, and reducing the risk of hospitalization and mortality. They allow for personalized monitoring strategies and tailored treatment plans, which are crucial for improving health outcomes. However, determining the appropriate monitoring intensity remains the responsibility of physicians, which poses challenges and impacts their workload, and thus, can hinder timely responses. To address these challenges, this paper proposes an expert system designed to recommend and adjust the monitoring intensity for COVID-19 patients receiving home treatment based on their medical history, vital signs, and reported symptoms. The system underwent initial validation using real-world cases, demonstrating a favorable performance (F1-score of 0.85). Subsequently, once integrated with an Internet of Things telemonitoring system, a clinical trial will assess the system’s reliability in creating telemonitoring plans comparable with those of medics, evaluate its effectiveness in reducing medic–patient interactions or hospitalizations, and gauge patient satisfaction and safety.

Relation Between Sociodemographic Factors and Increased Internet Usage During the First Three Waves of the COVID-19 Pandemic and Earthquakes: Croatian Online Survey

Aim: To determine the effect of COVID-19 pandemic and earthquakes on the overall Internet usage (IU) and Internet-specific activities (ISA) among adult Croatian population and their relation with sociodemographic factors. Subjects and Methods: A total of 1,118 participants (220 men and 898 women; mean age: 35.14 ± 12.31 years; range 18 - 78) participated in an online self-report survey providing sociodemographic data and replying to questions on COVID-19 and earthquake-related stress factors and overall IU and ISA before and during the period of the first three pandemic waves and earthquakes. Results: Overall IU (p &lt; 0.001), online gaming (OG) (p &lt; 0.001), pornography viewing (PV) (p &lt; 0.001), social media use (SM) (p &lt; 0.001), and online shopping (OS) (p &lt; 0.001) during the pandemic and earthquakes were significantly increased in the group that used the Internet before this prolonged stress experiences. Furthermore, overall IU increased in women (p &lt; 0.001), less educated (p = 0.001), and single participants (p = 0.027). OG was associated with younger age (p = 0.001), lower education (p &lt; 0.001), single status (p = 0.006), child-free status (P = 0.001), and urban residence (p = 0.032). Increased PV was associated with younger age (p &lt; 0.001), male sex (p &lt; 0.001), lower education (p &lt; 0.001), single status (p = 0.001) and child-free status (p &lt; 0.001). Increased SM was associated with female sex (p &lt; 0.001) and lower education (p &lt; 0.001). Conclusion: To reduce the negative impacts of prolonged stress, clinicians and public health authorities should take into consideration sociodemographic risk factors associated with IU and ISA.

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City.

Hospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality. In a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions), and crude and risk-adjusted inpatient mortality rates, also stratified by ICU use, in the first COVID wave across hospital quartiles (23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017-2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality. ICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1-4, respectively. The risk-adjusted mortality rates for ICU admissions were 36.4 (CI = 34.7,38.2), 43.6 (CI = 41.5,45.8), 45.9 (CI = 43.8,48.1), and 45.7 (CI = 43.6,48.0) per 100 admissions, and those for non-ICU admissions were 8.6 (CI = 8.3,9.0), 10.9 (CI = 10.6,11.3), 12.6 (CI = 12.1,13.0), and 12.1 (CI = 11.6,12.7) per 100 admissions by hospital quartile 1-4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.17 (95% CI = 1.10, 1.26), 2.63 (95% CI = 2.31, 3.00), and 3.26 (95% CI = 2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.28 (95% CI = 1.22, 1.34), 2.60 (95% CI = 2.40, 2.82), and 3.44 (95% CI = 3.11, 3.63) for inpatient mortality. Our findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.

Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches.

The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018-2019) with the phase following the pandemic's second wave (2021-2022). An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021-2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018-2019 and two in 2021-2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55-8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09-3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44-7.17, p = 0.004). Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.

Sepsis-related mortality: long-term trends in Northeastern Italy, including pandemic years

Background Global estimates of sepsis mortality are based on multiple causes of death (MCOD, any mention of the condition on death certificates); however, MCOD data are sparse and mainly referring to the pre-pandemic period. Objectives To investigate recent trends in sepsis-related mortality, associated sites of infection, and comorbidities in Veneto (Northeastern Italy). Methods Mortality records from 2008 to 2022 were extracted, and sepsis-related mortality was assessed based both on the underlying cause of death (UCOD) and on MCOD. The average annual percent change in age-standardised rates was estimated by join point regression through the whole study period. MCOD records were investigated to retrieve infection sites and comorbidities. Results Sepsis was mentioned in 63,479 death certificates, growing from 4.9% out of all deaths in 2008 to 12.9% in 2022. Age-standardised mortality rates increased yearly by 8.2% (95%CI 2.1–14.7%) based on the UCOD and by 5.9% (95%CI 5.3–6.5%) based on MCOD. Sharp peaks in monthly mortality were observed in correspondence with flu epidemics, COVID-19 pandemic waves, and periods of extreme heat. The percentage of sepsis-related deaths associated to urinary tract infections, and with mention of neurodegenerative disorders and chronic kidney disease increased over time. Conclusion Raised awareness of physicians, ageing of the population, spread of antimicrobial resistance further fuelled by the COVID-19 pandemic are among reasons of increasing sepsis-related mortality in Italy. Continuous monitoring of sepsis by means of MCOD data and other surveillance tools is warranted.