Epidemiologia, Volume 6, Issue 1 (March 2025) – 15 articles

Background/Objectives: Sedentary behavior (SB) and physical activity (PA) are key determinants of health in occupational settings. This study aimed to analyze the levels of SB, PA, and their associations with health outcomes among Chilean workers using data from the National Health Survey-2017. Methods: A secondary analysis of 2042 workers aged ≥18 years was conducted. Occupations were classified using ISCO-08, and SB/PA were assessed using the Global Physical Activity Questionnaire (GPAQ). Health outcomes included musculoskeletal symptoms, hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular risk. Results: Of the participants, 49.8% were women, and the mean age was 45 years (±13.7). The median SB was 120 min/day, with 32.6% accumulating ≥4 h/day. “Managers” exhibited the highest SB (median: 270 min/day). The median total PA was 123 min/day, and “Skilled agricultural, forestry, and fishery workers” reported the highest PA (median: 330 min/day). The SB (≥4 h/day) was significantly associated with musculoskeletal symptoms (OR: 1.61, 95% CI: 1.21–2.14) and hypertension (OR: 1.53, 95% CI: 1.07–2.18). PA showed no significant protective effect. Conclusions: SB and PA vary significantly across occupational groups. SB is associated with musculoskeletal symptoms. Health promotion programs should be tailored to specific occupational groups. Full article

The objective of this study was to examine the impact of varying levels of non-pharmaceutical interventions (NPIs) on COVID-19 transmission in nursing homes during the first wave of the pandemic. Background/Objectives: The primary aim involved exploring qualitative insights from staff and management regarding the implementation of NPIs. The secondary aim was to determine the cumulative incidence of PCR-confirmed COVID-19 cases among residents. Incident rate ratios (IRRs) were the calculated levels of NPI restrictiveness. Methods: We used a mixed methodology to identify factors that might have affected COVID-19 expansion in nursing homes in the canton of Geneva, Switzerland. For the qualitative component, we interviewed the Attending Physicians and/or Director of each nursing home. In the quantitative component, we calculated incident rate ratios (IRRs) for infection between the three levels of COVID-19-related measures taken in these nursing homes, and the cumulative incidence of PCR-confirmed COVID-19 cases in their resident population. This study was conducted in 12 nursing homes located in the canton of Geneva, Switzerland, between 1 March 2020, and 1 June 2020. Results: Most nursing homes mandated NPIs for their staff and residents during the first wave of COVID-19. We found an equal distribution of maximally (n = 4), moderately (n = 4), and minimally (n = 4) restrictive NPIs for nursing home workers and residents. The extent of NPIs implemented was not shown to be significantly associated with the cumulative incidence of COVID-19 cases among residents (maximally restrictive IRR = 3.90, 95%CI 0.82–45.54, p = 0.184; moderately restrictive IRR = 3.55, 95%CI 0.75–41.42, p = 0.212; minimally restrictive IRR = reference). Conclusions: Nursing homes in our study showed high variability in which NPIs, and to what extent, they implemented, with no significant relationship between the restrictiveness of NPIs and COVID-19 incidence among nursing home residents. This suggests that other factors influence the transmission of COVID-19 in these settings. Future research should explore additional determinants and the balance between strict NPIs and the overall well-being of residents. Full article

Introduction: The COVID-19 pandemic caused significant disruptions to medical training worldwide, particularly for junior doctors, as in-person clinical training was replaced by online education. This study aims to assess the impact of the pandemic on medical training in Greece, focusing on the perceptions of junior doctors across various specialties and exploring the implications for future clinical practice. Methods: We conducted a cross-sectional online survey of 465 junior doctors, all of whom were members of the Athens Medical Association, from 14 September to 14 October 2022. Participants completed a questionnaire assessing the perceived impact of the pandemic on their training, the effectiveness of online education, and potential consequences for clinical preparedness. Factor analysis was conducted to identify underlying patterns related to perceptions for the impact on medical training. Multiple linear regression models were used to assess potential associations among the extracted factors and participants’ sociodemographic characteristics. Results: Among the 465 participants, the mean age was 32.1 (SD = 7.0) years and 300 (64.5%) were female. Among the responders, the majority (n = 241, 51.8%) conducted training in Internal Medicine, 155 (33.3%) in a surgical specialty and 69 (14.8%) in other specialties, including Psychiatry, Radiology and Laboratory Medicine. Two out of five medical students reported that their medical training was mostly affected during the first wave of the pandemic, from March to June 2020 (n = 201, 43.2%). Factor analysis revealed the existence of two factors with high reliability and acceptable validity, interpreted as “perceptions towards online training” and “perceptions for the consequences of the pandemic on medical training”. Age and medical specialty were found to be significantly associated with both factors. Conclusion: Training was severely disrupted, with potential long-term implications for clinical competence; therefore Government and Universities should consider the lessons learned from the pandemic and compensate for the time and opportunities lost. Measures must be taken to safeguard medical education and training in the event of such outbreaks in the future. Full article

Background/Objectives: In recent years, non-contact room disinfection devices using ultraviolet light and hydrogen peroxide have emerged as disinfection methods. However, data on their usefulness in neonatal intensive care units (NICUs) are limited. Therefore, the aim of the present study was to evaluate the effectiveness of environmental disinfection in controlling methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in a NICU/growing care unit (GCU). Methods: Daily cleaning/disinfection of the patient environment was changed from using a cloth containing quaternary ammonium salts to an agent containing ethanol and surfactant, and terminal cleaning with a pulsed xenon ultraviolet light (PX-UV) non-contact disinfection device was added for patients with confirmed MRSA and those on contact precautions. MRSA incidence and environmental culture results were then compared before and after the method change. Results: The MRSA infection rate was 2.81/1000 patient days before the method change and 0.90/1000 patient days after the change (p = 0.008). Environmental cultures were positive in 12/137 (8.8%) before the change and 0 after the change. There were no adverse events in the neonates due to PX-UV irradiation of the environment. Conclusions: Daily cleaning and disinfection with ethanol and surfactant-containing cleaning disinfectants and a final cleaning with a PX-UV non-contact disinfection device reduced environmental MRSA contamination. In addition to adherence to hand hygiene and contact precautions, reducing MRSA present in the environment may contribute to MRSA control in NICUs and GCUs. Full article

Background/Objectives: The 1742–1743 plague epidemic had a profound impact on populations along the Royal Road (Camino Real), the principal trade route connecting Buenos Aires and Lima. This study aimed to quantify the demographic and socioeconomic consequences of the epidemic in Cordova and Santa Fe, with a focus on excess mortality and its broader implications for marginalized groups. Methods: This research utilized parish death records and complementary historical sources to calculate excess mortality in Cordova and Santa Fe during the epidemic. Mortality rates were compared across pre-epidemic (1740–1741), epidemic (1742–1743), and post-epidemic (1744–1745) periods. Additional data on demographic variables such as age, gender, marital status, and ethnicity were analyzed to identify patterns of vulnerability and resilience. Results: Excess mortality during the epidemic was significant, with death rates in Cordova peaking at 12 times the pre-epidemic average in May 1743, while Santa Fe experienced a 45% increase in mortality, peaking in December 1743. Marginalized groups, including enslaved and Indigenous populations, were disproportionately affected, exacerbating existing social inequalities. The epidemic also disrupted socioeconomic structures and highlighted systemic vulnerabilities in both urban centers. Conclusions: This study demonstrates the critical role of excess mortality as a metric for understanding the demographic and socioeconomic impacts of historical epidemics. By integrating quantitative and qualitative analyses, it underscores the intersection of public health crises with social structures in colonial Latin America. The findings offer insights into resilience and recovery mechanisms relevant to both historical and contemporary public health strategies. Full article

Background/Objectives: Emergency department (ED) crowding has become a pressing global concern exacerbated by the COVID-19 pandemic. No studies have addressed this issue in Europe during the post-pandemic period so far. This study examined ED visit volumes, patient acuity, hospital admission rates, emergency vehicle arrivals, and crowding metrics before, during, and after the pandemic. Methods: We conducted a retrospective descriptive study including data on all ED visits in the Lombardy Region of Italy from January 2019 to December 2023. Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023. Results: During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1–17.4]), compared to 3.8 h (IQR [1.6–8.6]) in 2019 (p-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4–4.9]), compared to 2.4 h (IQR [1.3–4.4]) in 2019 (p-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (p-value < 0.01). Conclusions: In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system. Full article

Background and Objectives: Inadequate pain treatment in pediatric patients can cause long-term physical and psychological issues. Accurate detection of pain presence and intensity is crucial, especially in Neonatal and Pediatric Sub-Intensive Care Units. Due to uncertainties about the best pain assessment tool in these settings, it is necessary to review the literature to identify the available evidence. Methods: A scoping review was performed to address the question: What tools are available for pain assessment in non-sedated, non-intubated pediatric patients in sub-intensive care? Searches were conducted in databases including PubMed, Scopus, Embase, CINAHL, Cochrane Library, Web of Science, Open Dissertation, as well as CENTRAL and ClinicalTrials.gov registries. Results: The review included 27 studies, revealing various tools for pain assessment in pediatric sub-intensive settings. All studies favored the use of multidimensional scales, combining physiological and behavioral indicators. Conclusions: This review offers a comprehensive overview of the tools for pain assessment in pediatric patients in sub-intensive care settings but does not determine a single best tool. Most studies focused on the validation, translation, and adaptation of these tools. Further research is needed on the practical application of these tools and the perceptions of those administering them. Full article

Background: HIV-related opportunistic infections like Pneumocystis jirovecii Pneumonia (PCP) remain a major contributor to child morbidity and mortality globally. PCP accounts for over 60% of AIDS in the first year of life and is responsible for a third of AIDS in children globally. Cotrimoxazole prophylaxis, which is an intervention directed towards tackling this burden, has not attained remarkable coverage despite advocacy towards scale-up. This work was therefore aimed at evaluating the efficacy of cotrimoxazole in the prevention of PCP among children exposed to and infected with HIV by carrying out a systematic review. Methods: Key scientific databases were searched for primary studies not older than 15 years old without language restrictions. Randomized Control Trials (RCTs) and Cohorts comparing the effectiveness of cotrimoxazole versus placebo in the prevention of PCP among children (<17 years) exposed to and infected with HIV were selected. Studies with a duration of follow-up not less than 3 months long were included. A meta-analysis was conducted on RevMan 5.3 statistical application software following data extraction, and the data quality and risk of bias were also assessed. Exactly Ten (10) studies were selected and analyzed. Findings: It was observed that cotrimoxazole had beneficial effects in terms of a reduction in mortality among HIV-exposed and infected children, as 72 fewer children in 1000 (based on an absolute 95% CI) will die as a result of cotrimoxazole compared to a placebo. Cotrimoxazole also significantly reduces hospital admissions (p-value of 0.008). The adverse events associated with cotrimoxazole are comparable to a placebo when co-administered with ARTS (p = 0.90), which did not impact adherence. Conclusion: The benefits of cotrimoxazole prophylaxis far outweigh its risks. Therefore, scaling up the intervention is recommended as a prophylactic for wider coverage, especially in resource-limited settings. Full article

Background: This article examines the infectious disease surveillance system in the Lombardy region of Italy, with a focus on its response mechanisms to respiratory syndromes. This study aims to describe the alert system and the organizational procedures in place, assessing their effectiveness in managing health crises. Methods: This study is based on the analysis of Lombardy’s regional resolution No. 1125, developed by regional public health experts. Surveillance levels were categorized based on incidence thresholds and healthcare system impacts, establishing specific indicators and activation protocols. Information flows are managed through real-time data portals, enabling the real-time monitoring of COVID-19, influenza, and other infectious respiratory diseases. Results: A multi-level response system was established, with levels ranging from ordinary regimes to critical epidemic activation. Each level includes specific actions, such as resource reallocation, emergency department support, and the suspension of elective procedures. The use of technological tools, such as electronic health records, streamlined reporting processes, and real-time data flow management, has strengthened the region’s response capabilities. Conclusions: This study underscores the value of a structured, multi-level response system for infectious disease management, showing that a unified regional approach improves crisis response efficiency. It suggests that sharing activation indicators and protocols within the scientific community can help harmonize national and international responses to future pandemics. The system, while effective in its current context, may require adaptation for future health challenges. Full article

Introduction: COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health. Objective: To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality. Methods: Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard. Results: From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend. Conclusion: The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023. Full article

Even today, healthcare-associated infections (HCAIs) remain the most frequent and serious complications in healthcare, with a significant clinical and economic impact. The authors of this manuscript address the causes and conditions that determine this situation and describe them in comparison with the situation in the Grand Duchy of Tuscany more than two centuries ago and with the instructions that were issued at the time to contain the typhus epidemic of 1817, increase hospital sanitation, and disinfect houses. Today, we know that a crucial element in the fight against healthcare-associated infections (HCAIs) is the definition and implementation of best care practices and other measures, according to a combined program that must be tailored to each healthcare setting. In the early nineteenth century, these approaches originated from experience and chemical knowledge that were becoming established, opening the way to the ideas and experiments of Ignác Fülöp Semmelweis and later of Joseph Lister, who traced the path for the birth of hygiene. Two centuries later the pioneering vision of the Grand Duchy of Tuscany at the beginning of the 19th century, when preventive measures in the field of public health were still backward and underdeveloped, is still enlightening and surprisingly topical. Full article

Synthetic turf has become a popular alternative to natural grass due to low upkeep costs; however, its health impacts have not been clearly elucidated. This review examines and consolidates the existing literature on rubber crumb in infill in synthetic turf and its associated adverse health outcomes, along with recommendations for future research. A database search was conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar of studies on exposures to rubber crumb in infills in synthetic turf. The search focused on epidemiological and toxicological laboratory studies (including exposure simulation and animal studies), as well as government reports. Non-English studies and those addressing injuries (musculoskeletal and burn injuries) were not considered. Eighteen laboratory studies examined concentrations of PAHs found in synthetic turf rubber infill. The total level of PAHs detected in samples varied between 0.4 mg/kg and 3196 mg/kg. The PAH levels were influenced by the age of the synthetic turf, with the older synthetic surface fields containing lower concentrations (compared to newly laid turfs). Synthetic turfs composed of industrial rubber crumb infill also had a lower PAH composition relative to end-of-life tyre-derived infill. In the six studies that investigated the metal content and composition of rubber crumb infill, Aluminium (5382 mg/kg), Zinc (5165 mg/kg), and Iron (489.6 mg/kg) had the highest median concentrations. There were minor differences in heavy metal concentrations found in newly installed synthetic turf compared to older turfs and synthetic sporting fields exposed to direct sunlight (versus indoor fields). There were two epidemiological studies on synthetic turf rubber crumb infill (one ecological and one cross-sectional study), which found no significant associations between synthetic turf exposure and the incidence of leukemia, non-Hodgkin lymphoma, and Hodgkin lymphoma. Similarly, one metabolomic study of urine samples from athletes taken pre- and post-match on synthetic turf, and two studies simulating dermal, ingestion, and inhalation exposure concluded that there was no elevated health risk associated with playing on synthetic turf pitches. Currently, there is very limited evidence of an association between synthetic turf use and adverse health outcomes. Considering the ubiquitous use of synthetic grass globally and the scarcity of epidemiological studies, there is a vital need for further research based on longitudinal study designs and more robust exposure assessments, to help improve our understanding of any potential health risks associated with synthetic turf infill exposures. Full article

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important health issue that is estimated to have caused 130,000 deaths worldwide in 2021. As more instances of cross-species transmission of MRSA have been reported, concerns have been raised regarding the spread of livestock-associated MRSA to humans. The prevalence of MRSA in livestock varies globally. This study systematically reviews the prevalence of MRSA at the farm and animal levels in Japan. Methods: Relevant studies published in English or Japanese between 2000 and 2023 were retrieved from four databases. Pooled prevalences at the farm and animal levels in Japanese farms were calculated using a random-effects model. Subgroup and meta-regression analyses were also performed to explore sources of heterogeneity. Results: The 13 studies included in this meta-analysis yielded an MRSA prevalence of 3.54% (95% confidence interval [CI] 0.65–8.30%) at the individual pig level, 13.07% (95% CI 5.42–23.04%) at the pig farm level, 0.0% (95% CI 0.00–0.04%) at the individual cattle level, and 0% (95% CI 0.00–0.44%) at the individual chicken level. A significant increase in MRSA prevalence over time was evident at the individual pig level by both subgroup analysis (p = 0.020) and meta-regression (p = 0.019). Conclusions: Our results indicated that the proportion of pigs that can be a source of MRSA infection in humans has been steadily increasing in Japan. Despite some limitations, our findings strongly imply a need for more attention to pig-to-human MRSA transmission in Japan. Full article

Epidemiological studies indicate that heart failure (HF) prevalence and associated mortality are significantly higher among Eastern European countries as compared to their Western European counterparts. The significant financial burden on the healthcare system matches these sobering data. Thus, efficient programs for patients with HF have been called for. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) represents a widely used, cost-effective, and readily available test that can be used to evaluate HF risk. However, it should not be used as a universal assessment, given the existing variability in proposed cut-off scores for various subgroups of patients. Thus, the clinical context needs to always be considered, and alternative diagnoses need to be ruled out. Based upon evidence from the literature for the above assumptions, the advantages and limitations of using NT-proBNP in primary care settings, along with other HF diagnostic modalities, are discussed in this paper. Also, this paper argues that an effective primary care network, in collaboration with specialist providers, may avoid a delay in HF diagnoses, may help provide on-time treatments, and may ultimately cut unnecessary healthcare expenditures associated with HF hospitalizations. Therefore, the present paper proposes an algorithm for diagnosing HF in primary care settings and discusses specific knowledge and skills that family physicians should be well equipped with in order to successfully respond to the needs of their patients with HF. Full article

Irisin is a protein resulting from a proteolytic cleavage of fibronectin type III domain-containing protein 5 (FND5). The ability of irisin to modulate adipocyte and control glucose metabolism in human metabolic diseases gave rise to the hypothesis that irisin could have a pivotal role in aging-related diseases. Although in animal models, increased levels of irisin have been positively associated with better health outcomes, in humans, its role remains controversial. To provide an overview of the main finding on irisin in older adults, a comprehensive search was performed through the MEDLINE-PubMed, Web of Science, Scopus, and Cochrane databases for studies conducted in older adults (≥60 years) published since 2012. After grouping and analyzing the articles based on diseases associated with older adults, the main conclusion of this narrative review is that the included studies did not yield consistent evidence regarding the association between irisin and health or disease in older adults. Further studies are necessary to clarify the effective role of this protein in promoting health and longevity. Full article