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Epidemiologia
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Recent Advances in Acute Diseases and Epidemiological Studies
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Recent Advances in Acute Diseases and Epidemiological Studies

A special issue of Epidemiologia (ISSN 2673-3986).

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 17290

Editors

Dr. Giuseppe Stirparo

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Guest Editor
Agenzia Regionale Emergenza Urgenza (AREU), Via Campanini 6, 20124 Milan, Italy
Interests: medical education; cardiopulmonary resuscitation; emergency medical service; public health measures; surveillance
Special Issues, Collections and Topics in MDPI journals
Dr. Giuseppe Ristagno

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Guest Editor
1. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
2. Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Interests: cardiac arrest; cardiopulmonary resuscitation; emergency medicine; critical care; trauma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute diseases play a very significant role in the global population in terms of mortality and disability. The factors that may influence patient outcomes are numerous and may be related to environmental, organisational and epidemiological factors. In recent years, the study of these diseases has been strongly influenced by COVID-19; however, in the light of the reduced pandemic spread, we would like to share this Special Issue, aiming to amass a collection of the latest advancements in the field of acute diseases and of epidemiological investigations.

This Special Issue is relevant as there is a need for an epidemiological update on various acute diseases—such as stroke, heart attack, major trauma and cardiac arrest—especially considering the new environmental and organisational evidence that has been accumulated in recent years, particularly in the context of the integration of organisational elements into clinical guidelines.

Articles related to the epidemiology of acute diseases, with a focus on emergency medical system organisation and clinical outcomes, are welcome. In addition, research on the following public health elements related to these topics will be sought after: health literacy of the general population, population-based interventions to prevent mortality from these diseases and information campaigns.

Dr. Giuseppe Stirparo
Dr. Giuseppe Ristagno
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Epidemiologia is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pre-hospital emergency care
  • epidemiology
  • emergency medical services
  • time-dependent pathologies
  • health services
  • surveillance
  • public health

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Published Papers (6 papers)

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Research

Jump to: Review

14 pages, 2181 KB  
Article
Machine Learning for Coronary Heart Disease Prediction: Comparative Analysis of Framingham and Cleveland Subset of the UCI Dataset with SHAP-Based Interpretability
by Shreyas Raman, Devansh Thakkar, Jacques Calixte, Rahul Kumar, Kyle Sporn, Kiran Marla, Divyam Goel, Rhea Gopali, Nitin Chetla, Saif Pasha, Nikitha Ravisankar, Ryung Lee and Ciprian Ionita
Epidemiologia 2026, 7(3), 75; https://doi.org/10.3390/epidemiologia7030075 - 1 Jun 2026
Viewed by 626
Abstract
Introduction: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with coronary artery disease (CAD), also known as ischemic heart disease (IHD), responsible for approximately 13% of global deaths in 2021. Studies applying machine learning (ML) and deep learning (DL) to heart [...] Read more.
Introduction: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with coronary artery disease (CAD), also known as ischemic heart disease (IHD), responsible for approximately 13% of global deaths in 2021. Studies applying machine learning (ML) and deep learning (DL) to heart disease classification have demonstrated promising results in risk prediction and feature extraction. Background/Objectives: In this study, we develop an AI/ML framework to predict and classify ischemic heart disease risk using publicly available datasets, the Framingham Heart Study and the Cleveland subset of the UCI Heart Disease dataset, along with explanations for how predictions were made by a process called SHAP (SHapley Additive exPlanations). Methods: We implemented a leakage-controlled machine learning pipeline that included data cleaning, stratified 80/20 train-test splitting, training-fold-only feature scaling and class balancing, 5-fold hyperparameter tuning, SHAP interpretability, and Brier score-based calibration assessment. Logistic regression, random forest, K-nearest neighbors, XGBoost, and a feedforward neural network were evaluated on the Framingham dataset and the Cleveland subset of the UCI Heart Disease dataset. Performance was assessed using accuracy, precision, recall, F1-score, Matthews correlation coefficient, AUROC, and Brier score. Results: After leakage-controlled evaluation, Framingham performance was more modest than in the preliminary analysis. Logistic regression achieved the highest AUROC on the Framingham dataset (0.7234), while random forest achieved the lowest Brier score (0.1750), and the feedforward neural network achieved the highest accuracy (0.7719). On the Cleveland subset, logistic regression achieved the strongest threshold-based performance (accuracy 0.8667, precision 0.8571, recall 0.8571, F1-score 0.8571, MCC 0.7321), whereas K-nearest neighbors achieved the highest AUROC (0.9531) and lowest Brier score (0.0942). SHAP highlighted systolic blood pressure, smoking status, and hypertension as influential predictors (Framingham) and number of major vessels, chest pain type, thallium stress-test result (thal; normal, fixed defect, or reversible defect), and age (Cleveland) as top predictors. Conclusions: Optimal model performance is dataset-dependent, and SHAP enhances clinical interpretability. Broader access to high-quality, de-identified medical data could accelerate reproducible ML research in cardiology. Full article
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
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12 pages, 242 KB  
Article
Unfolding Success Factors and Barriers in Adapting Slovenia’s Health Promotion Centre Model to Bergamo Province: A PIET-T Feasibility Assessment with Time-Dependent Care Implications
by Giacomo Crotti, Antonio Antonelli, Federica Bonomi, Giulio Borghi, Giulia Parisi, Isabella Trezzi, Nicola Rizzardi, Radivoje Pribakovic Brinovec, Maja Zupanc, Alberto Zucchi and Nicoletta Castelli
Epidemiologia 2026, 7(1), 21; https://doi.org/10.3390/epidemiologia7010021 - 3 Feb 2026
Viewed by 875
Abstract
Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We [...] Read more.
Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
13 pages, 2202 KB  
Article
Trends in Congenital Syphilis Incidence and Mortality in Brazil’s Southeast Region: A Time-Series Analysis (2008–2022)
by Alexandre Castelo Branco Araujo, Orivaldo Florencio de Souza, Betina Bolina Kersanach, Julia Silva Cesar Mozzer, Victor Lopes Feitosa, Vinicius Andreata Brandão, Filomena Euridice Carvalho de Alencar, Norma Suely Oliveira, Andrea Vasconcellos Batista da Silva and Luiz Carlos de Abreu
Epidemiologia 2025, 6(2), 22; https://doi.org/10.3390/epidemiologia6020022 - 5 May 2025
Viewed by 3236
Abstract
Congenital syphilis (CS) is an important infectious cause of miscarriage, stillbirth, and neonatal morbidity and mortality. Despite the advances in diagnosis and treatment, CS continues to challenge health systems with increasing incidence and mortality rates in recent years worldwide. Given this, the present [...] Read more.
Congenital syphilis (CS) is an important infectious cause of miscarriage, stillbirth, and neonatal morbidity and mortality. Despite the advances in diagnosis and treatment, CS continues to challenge health systems with increasing incidence and mortality rates in recent years worldwide. Given this, the present study aims to comparatively analyze the temporal trends in CS incidence and mortality in Brazil’s Southeast Region from 2008 to 2022. This is an ecological time-series study using secondary data on congenital syphilis from the states of Espírito Santo, Minas Gerais, Rio de Janeiro, and São Paulo. The data was extracted from the Brazilian Health System Informatics Department. Incidence and mortality rates were calculated per 100,000 live births. Joinpoint regression models were employed to identify trends in annual percentage change and average annual percentage change with 95% confidence intervals. The temporal trend of CS incidence in Brazil’s Southeast Region increased 12.8% between 2008 and 2022. Minas Gerais, São Paulo, Espírito Santo, and Rio de Janeiro showed increasing temporal trends of 21.4%, 14.1%, 14.0%, and 10.9%, respectively. The temporal trend of CS mortality in Brazil’s Southeast Region rose 11.9% between 2008 and 2022. Minas Gerais, São Paulo, and Rio de Janeiro exhibited increasing mortality temporal trends of 21.9%, 20.8%, and 10.1%, respectively. In contrast, Espírito Santo showed reduced mortality, with no deaths in 2021 and 2022. The temporal trend of CS incidence increased in all states of Brazil’s Southeast Region between 2008 and 2022, highlighting the need to reassess control measures. The temporal trend of CS mortality also increased during the same period, except in Espírito Santo. Considering that CS is preventable with adequate prenatal care and low-cost measures, these findings can serve as instruments to support strengthening public health policies. Full article
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
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15 pages, 2865 KB  
Article
Does Calm Always Follow the Storm? A Comprehensive Temporal Analysis of Emergency Department Visits in Northern Italy Before and After the COVID-19 Pandemic
by Maria José De la Rosa, Andrea Duca, Lorenzo Querci, Francesca Cortellaro, Martina Calderaro, Paolo Pausilli, Annalisa Bodina, Andrea Albonico, Gabriele Perotti, Carlo Signorelli and Massimo Lombardo
Epidemiologia 2025, 6(1), 10; https://doi.org/10.3390/epidemiologia6010010 - 1 Mar 2025
Cited by 4 | Viewed by 2314
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
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Review

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11 pages, 530 KB  
Review
The Impact of ACLS Training in the Management of Cardiac Arrest: A Narrative Review
by Pasquale Di Fronzo, Giovanni Gaetti, Daniel Marcassa, Valeria Gervasi, Oumaiema Dardour, Andrea Pedretti and Luca Gambolò
Epidemiologia 2025, 6(4), 61; https://doi.org/10.3390/epidemiologia6040061 - 6 Oct 2025
Cited by 1 | Viewed by 3446
Abstract
Background: Cardiac arrests can occur both in and out of hospital settings. Over the years, several protocols have been developed to standardize the behavior of healthcare professionals called upon to deal with these emergencies. Advanced Cardiac Life Support (ACLS) algorithms enable healthcare professionals [...] Read more.
Background: Cardiac arrests can occur both in and out of hospital settings. Over the years, several protocols have been developed to standardize the behavior of healthcare professionals called upon to deal with these emergencies. Advanced Cardiac Life Support (ACLS) algorithms enable healthcare professionals to effectively manage cardiac arrest and achieve better patient outcomes, particularly at the time of discharge. Methods: We conducted a narrative review. Three databases (PubMed, Embase, Cochrane) were searched for relevant articles. The articles were screened and analyzed in accordance with the PRISMA guidelines. Results: A total of 1252 articles were initially identified. After screening, 11 papers were included in the review. From the selected studies, it has emerged that ACLS training had several positive effects, including an overall decrease in mortality rates. Adherence to ACLS protocols throughout an event is associated with increased Return of Spontaneous Circulation (ROSC) in the setting of In-Hospital Cardiac Arrest (IHCA). Advanced Life Support (ALS) response interval in out-of-hospital cardiac arrest was associated with decreased survival and a favorable neurological outcome. ALS response ≤ 10 min was associated with improved survival and favorable neurological outcomes. Conclusions: This review underscores the importance of adherence to ALS/ACLS guidelines in the resuscitation of patients who suffer in-hospital and out-of-hospital cardiac arrest. Full article
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
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21 pages, 1435 KB  
Review
Evaluation of Pain in the Pediatric Patient Admitted to Sub-Intensive Care: What Is the Evidence? A Scoping Review
by Antonio Bonacaro, Carlotta Granata, Chiara Canini, Lucrezia Anderle, Federica Ambrosi, Maria Chiara Bassi, Giacomo Biasucci, Andrea Contini, Giovanna Artioli, Elisa La Malfa and Massimo Guasconi
Epidemiologia 2025, 6(1), 9; https://doi.org/10.3390/epidemiologia6010009 - 20 Feb 2025
Cited by 1 | Viewed by 4972
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Recent Advances in Acute Diseases and Epidemiological Studies)
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