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Prevalence and features of SARS-CoV-2 infection in prisons in tuscany

World Journal of Experimental Medicine 2024年第1期14卷 70-77页

作者： Cristina Stasi Martina Pacifici Caterina Milli Francesco Profili Caterina Silvestri Fabio Voller Epidemiology Unit Regional Health Agency of TuscanyFlorence 50141Italy Department of Medicine Surgery and NeuroscienceUniversity of SienaSiena 53100Italy

BACKGROUND Prisons can be a reservoir for infectious diseases,including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),due to the very intimate nature of the living spaces and the large number of people forced to share them.AIM To investigate the SARS-CoV-2 epidemiology in prisons,this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs.METHODS This is an observational cohort study.Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results.Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility.Another section included information on the diagnosis of the disease according to the International Classification of Diseases,Ninth Revision,and Clinical Modification.RESULTS Up until the 31 May 2021,79.2%of the prisoner cohort(n=1744)agreed to a nasopharyngeal swab test(n=1381).Of these,1288 were negative(93.3%)and 85 were positive(6.2%).A significant association[relative risk(RR)]was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians[RR=2.4,95%confidence interval(CI):1.2-4.8].A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder(RR=4,95%CI:1.8-9.1).The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in tuscany(standardized incidence ratio 0.7,95%CI:0.6-0.9).CONCLUSION In the prisoner cohort,screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

关键词： SARS-CoV-2 Epidemiology Prison Prevalence Foreigners Swab tests

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Attempt to calculate the prevalence and features of chronic hepatitis C infection in tuscany using administrative data

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World Journal of Gastroenterology 2016年第44期22卷 9829-9835页

作者： Caterina Silvestri Simone Bartolacci Pasquale Pepe Mirko Monnini Fabio Voller Francesco Cipriani Cristina Stasi Observatory of Epidemiology Regional Health Agency of Tuscany Department of Experimental and Clinical Medicine University of Florence

AIM To evaluate this prevalence in Tuscan populations that was known and unknown to the Tuscan Regional health Service in 2015.METHODS Tuscan health administrative data were used to evaluate hepatitis C virus(HCV) infected people known to the Regional health Service. Residents in tuscany with a HCV exemption code(070.54) were identified. Using the universal code attributed to each resident, these patients were matched with hospital admission codes identified by the International Classification of Diseases, Ninth Revision(ICD-9), Clinical Modification, and with codes for dispensing drugs to patients by local and hospital pharmacies. Individuals were considered only once. Capture-recapture analysis was used to evaluate the HCV-infected population unknown to the Regional health Service.RESULTS In total, 14526 individuals were living on 31/12/2015 with an exemption code for HCV. In total, 9524 patients were treated with pegylated interferon + ribavirin and/or direct-acting antiviral drugs during the last 10 years, and 13879 total hospital admissions were noted in the last 15 years. After data linkage, the total number was 25918. After applying the Capture-Recapture analysis, the number of unknown HCV-infected people was 23497. Therefore, the total number of chronic HCVinfected people was 38643, excluding those achieved sustained virological response to previous treatment.CONCLUSION Our results show a prevalence of HCV infected people of 1%. Tuscan administrative data could be useful for calculating health care costs and health planning in the coming years.

关键词： Hepatitis C Public health Fibrosis Antiviral treatment Epidemiology

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Emerging Trends in Epidemiology of Hepatitis B Virus Infection

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Journal of Clinical and Translational Hepatology 2017年第3期5卷 272-276页

作者： Cristina Stasi Caterina Silvestri Fabio Voller Observatory of Epidemiology Regional Health Agency of Tuscany Florence Italy Department of Experimental and Clinical Medicine University of Florence Florence Italy Observatory of Epidemiology Regional Health Agency of Tuscany Florence Italy

Although a vaccine against hepatitis B virus (HBV) has been available since 1982,the prevalence of adults with chronic HBV infection in sub-Saharan Africa and East Asia is still estimated at 5-10%.A high rate of chronic infections is also found in the Amazon and the southern parts of eastern and central Europe.In the Middle East and the Indian subcontinent,the prevalence is 2-5%.Less than 1% of the population of Western Europe and North America is chronically infected.Given the high prevalence of infections (such as hepatitis) among inmates,prison is considered a reservoir for facilitating such infections.Based on these premises,this current review examines and discusses emerging trends in the epidemiology of HBV infection,with particular attention to HBV infection in prison.The hepatitis B surface antigen (HBsAg) prevalence in prisoners in west and central Africa is very high (23.5%).The Centers for Disease Control and Prevention has highlighted the importance of HBV blood screening and subsequent anti-HBV vaccination in the prison population.The vaccination was recommended for all inmates,representing an opportunity to prevent HBV infection in a high-risk population.In these subjects,an accelerated hepatitis B immunisation schedule may result in rapid seroconversion for early short-term protection.Therefore,it is necessary to seek collaboration among public health officials,clinicians and correctional authorities to implement a vaccination programme.

关键词： Chronic hepatitis B virus infection Public health Anti-HBV vaccine Epidemiology Prison

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Sexual Behavior and Awareness of Sexually Transmitted Diseases Among Street-Based Female Sex Workers in the Florence Area, Central Italy

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International Journal of Dermatology and Venereology 2022年第4期5卷 226-230页

作者： Barbara Giomi Caterina Silvestri Stefano Bravi Cristina Stasi Lisa Bertini Leslie Mechi Serena Mordini Nicoletta Zocco Fabio Voller Francesco Cipriani Unit for STD and AIDS Department of DermatologyUniversity of FlorenceFlorence 50134Italy Observatory of Epidemiology Regional Health Agency of TuscanyFlorence 50141Italy Interdepartmental Hepatology Center MASVE Department of Experimental and Clinical MedicineUniversity of FlorenceFlorence 50134Italy CAT Social Cooperative Road Unit SATIS Regional Project Florence 50134Italy Department of Prevention Central Tuscany Local UnitFlorence 50135Italy.

Objective:Street-based female sex workers are more likely to practice unprotected sex with multiple partners increases their risk of infection with sexually transmitted diseases.This study was performed to evaluate the understanding of and risk factors for sexually transmitted diseases among street-based female sex workers.Methods:A survey consisted of a sociodemographic section and a health section was conducted from June to August in two consecutive years(2012-2013)using an anonymous questionnaire compiled by street-based female sex workers in the area of Florence(Central Italy).A descriptive analysis of sociodemographic,epidemiological,and anamnestic variables was performed using common methods for proportions;associations between variables were assessed using univariate and bivariate logistic regression.Results:Totally 122 street-based female sex workers(mean age,24.1 years;age range,17-45 years)were enrolled,and were from Europe(63.1%)(mainly from Romania[48.4%]and Albania[13.1%]),Africa(31.2%)(specifically Nigeria),and South America(5.7%).Of the 122 street-based female sex workers,63%were married/engaged and 37%were single.More than half had been living in Italy and Florence for more than 1 year;72.8%stated that they possessed a residence permit and the others were illegal migrants.Eighteen(15%)street-based female sex workers also worked in the industry in neighboring European countries.Their level of education was generally high:58.1%had completed secondary school(lower secondary school and upper secondary school).A total of 81.4%stated that they perceived an actual fear of contracting human immunodeficiency virus;in fact,43.3%had never been tested for any sexually transmitted diseases except for human immunodeficiency virus.Conclusion:Despite the long-time involvement of street-based female sex workers in the commercial sex industry,the large numbers of clients and a strong perception of concerns about sexually transmitted diseases.This study confirms a low rate of condom use and blood screening,and corre

关键词： female sex street workers foreigners sexually transmitted diseases

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Evaluation of the prognostic value of liver stiffness in patients with hepatitis C virus treated with triple or dual antiviral therapy:A prospective pilot study

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World Journal of Gastroenterology 2015年第10期21卷 3013-3019页

作者： Cristina Stasi Alessia Piluso Umberto Arena Elena Salomoni Paolo Montalto Monica Monti Barbara Boldrini Giampaolo Corti Fabio Marra Giacomo Laffi Stefano Milani Anna Linda Zignego Department of Experimental and Clinical Medicine University of Florence health agency of tuscany Gastrointestinal Endoscopy Unit Ospedale SS Cosma e Damiano Department of Biomedical Experimental and Clinical sciencesUniversity of Florence

AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral response.METHODS:LS was measured in all patients before treatment was administered.The therapeutic approach was based on hepatic,virological,and immunological evaluations and considered the fact that patients with severe fibrosis(F3)or compensated cirrhosis(F4)in Child-Pugh class A are the primary candidates for triple therapy.In total,65 hepatitis C virus(HCV)patients were treated with Peg-interferon/ribavirin(Peg-IFN/RBV);24patients were classified as genotypes 1/4(36.92%),and41 patients were classified as genotypes 2/3(63.08%)(dual therapy).In addition,20 HCV treatment-experienced genotype 1 patients were treated with Peg IFN-RBV and boceprevir(triple therapy).Wilcoxon rank-sum tests were used to compare the groups.RESULTS:LS significantly differed between dual therapy and triple therapy(P=0.002).The mean LS value before dual therapy treatment was 8.61±5.79k Pa and was significantly different between patients achieving a sustained virologic response(SVR)24weeks after therapy and those who did not(7.23±5.18 k Pa vs 11.72±5.99 k Pa,respectively,P=0.0003).The relative risk of non-response to therapy was 4.45(95%CI:2.32-8.55).The attributable risk of non-response to therapy was 49%.The mean LSvalue before triple therapy treatment was 13.29±8.57k Pa and was significantly different between patients achieving and not achieving SVR24(9.41±5.05 vs19.11±9.74,respectively;P=0.008).The relative risk of non-response to therapy was 5.57%(95%CI:1.50-20.65).The attributable risk of non-response to therapy(70%)was increased compared with dual therapy patients.Pre-treatment stiffness>12 k Pa was significantly associated with non-SVR(P<0.025)in both groups.CONCLUSION:Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.

关键词： Antiviral therapy Chronic hepatitis C Fibrosis Liv

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Irritable bowel syndrome and chronic constipation: Fact and fiction

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World Journal of Gastroenterology 2015年第40期21卷 11362-11370页

作者： Massimo Bellini Dario Gambaccini Paolo Usai-Satta Nicola De Bortoli Lorenzo Bertani Santino Marchi Cristina Stasi Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa Gastrointestinal Unit P. Brotzu Hospital Department of Experimental and Clinical Medicine University of Florence Epidemiological Observatory Regional Health Agency of Tuscany

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.

关键词： Irritable bowel syndrome Chronic constipation Func

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Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy

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World Journal of Gastroenterology 2014年第27期20卷 8807-8820页

作者： Massimo Bellini Dario Gambaccini Cristina Stasi Maria Teresa Urbano Santino Marchi Paolo Usai-Satta Gastrointestinal Unit Department of Gastroenterology University of Pisa 56124 Pisa Italy Department of Experimental and Clinical Medicine University of Florence 50134 Florence Italy Epidemiological Observatory Health Agency of Tuscany 50141 Florence Italy Gastrointestinal Unit P. Brotzu Hospital09124 Cagliari Italy

Irritable bowel syndrome(IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient's quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain(gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome Ⅲ criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities.Nevertheless, the severity of the patient's symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms(fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge.

关键词： Irritable bowel syndrome Pathogenesis Diagnosis Th

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health effects of air pollution:a Southern European perspective

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Chinese Medical Journal 2020年第13期133卷 1568-1574页

作者： Giovanni Viegi Sandra Baldacci Sara Maio Salvatore Fasola Isabella Annesi-Maesano Francesco Pistelli Laura Carrozzi Stefania La Grutta Francesco Forastiere National Research Council(NCR)Institute for Biomedical Research and Innovation(IRB) 90146 PalermoItaly National Research Council(NCR)Institute of Clinical Physiology(IFC) 56126 PisaItaly Department of Epidemiology of Allergic and Respiratory Diseases Sorbonne Universite and INSERMInstitut Pierre Louis d'fpidemiologie et de Sante PubliqueF75012 ParisFrance Department of Cardiothoracic and Vascular University Hospital of Pisa56124 PisaTuscanyItaly Department of Surgical MedicalMolecular Pathology and Critical AreaUniversity of Pisa56126 PisaTuscanyItaly

Objective:To summarize the main updated evidence about the health effects of air pollution,with a special focus on Southern Europe.Data sources:Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.Study selection:Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.Results:Air pollution is an avoidable risk factor that causes a huge burden for society,in terms of death,health disorders,and huge socio-economic costs.The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts(particulate matter[PM]).The European Environment agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016:374,000 for PM2.5,68,000 for nitrogen dioxide,and 14,000 for ozone.In Italy,time series and analytical epidemiological studies showed increased cardiorespiratory hospital admissions and mortality,as well as increased risk of respiratory diseases in people living in urban areas.Conclusions:Based on abundant evidence,the World health Organization,which hosts the Global Alliance against Chronic Respiratory Diseases(GARD),the scientific respiratory societies,and the patients’associations,as well as others in the health sector,must increase their engagement in advocacy for clean air policies.

关键词： Environment Respiratory disorders Epidemiology

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Temporal Trends in Radiation Dose Associated with Coronary Computed Tomography Angiography

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Open Journal of Radiology 2014年第1期4卷 101-110页

作者： Paolo Marraccini Alessandro Mazzarisi Clara Carpeggiani Mathis Schluter Marco Brambilla Massimiliano Bianchi Lorenzo Faggioni Giuseppe Coppini Carlo Bartolozzi Eugenio Picano Clinical Institute of Physiology CNR Pisa Italy CNR tuscany Region G Monasterio Foundation Pisa Italy Department of Radiology Pisa University Pisa Italy health Physics Unit Ospedale Maggiore Novara Italy

Background: In 2010, the International Atomic Energy agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.

关键词： Ischemic Heart Disease X Ray Cardiac Computed Tomography Cardiovascular Imaging Radiation Dosing

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Clinical epidemiology of chronic viral hepatitis B:A tuscany real-world large-scale cohort study

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World Journal of Hepatology 2018年第5期10卷 409-416页

作者： Cristina Stasi Caterina Silvestri Roberto Berni Maurizia Rossana Brunetto Anna Linda Zignego Cristina Orsini Stefano Milani Liana Ricciardi Andrea De Luca Pierluigi Blanc Cesira Nencioni Donatella Aquilini Alessandro Bartoloni Giampaolo Bresci Santino Marchi Franco Filipponi Piero Colombatto Paolo Forte Andrea Galli Sauro Luchi Silvia Chigiotti Alessandro Nerli Giampaolo Corti Rodolfo Sacco Paola Carrai Angelo Ricchiuti Massimo Giusti Paolo Almi Andrea Cozzi Silvia Carloppi Giacomo Laffi Fabio Voller Francesco Cipriani Observatory of Epidemiology Regional Health Agency of TuscanyFlorence 50141Italy Center for Systemic Manifestations of Hepatitis Viruses(MaSVE) Internal Medicine and Liver UnitDepartment of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Web Solutions Data Visualization and Scientific DocumentationRegional Health Agency of TuscanyFlorence 50141Italy Hepatology Unit Department of Clinical and Experimental MedicineUniversity Hospital of PisaPisa 56100Italy Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences“Mario Serio”Careggi University HospitalFlorence 50134Italy Infectious Disease Unit Hospital of LuccaLucca 55100Italy Infectious Diseases Unit Department of Medical BiotechnologiesSiena University HospitalSiena 53100Italy Infectious Disease Unit “S.Maria Annunziata”HospitalPonte a Niccheri 50012Italy Infectious Disease Unit Hospital of GrossetoGrosseto 58100Italy Infectious Disease Unit Hospital of PratoPrato 59100Italy Infectious and Tropical Diseases Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50134Italy Gastroenterology and Metabolic Disorders Department of SurgeryCisanello University HospitalPisa 56100Italy Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryCisanello University Hospital of PisaPisa 56100Italy Liver Surgery and Transplantation Unit Department of Surgical PathologyMedicineMolecular and Critical AreaCisanello University HospitalPisa 56100Italy Internal Medicine Unit “San Jacopo”HospitalPistoia 51100Italy Infectious Diseases and Hepatology Unit Department of Internal and Specialized MedicineUniversity Hospital of SienaSiena 53100Italy Gastroenterology Unit San Giuseppe HospitalEmpoli 50053Italy Internal Medicine and Liver Unit Department of Experimental and Clinical MedicineCareggi University HospitalFlorence 50135Italy Department of Prevention Central Tuscany Local UnitFlorence 5

AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design. We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units. Information in the case report forms included main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations, and eligibility for treatment or ongoing therapy and liver transplantation. RESULTS Of 4015 chronic viral hepatitis patients, 1096(27.3%) were HBV infected. The case report form was correctly completed for only 833 patients(64% males, 36% females; mean age 50.1 ± 15.4). Of these HBV-infected patients, 73% were Caucasian, 21% Asian, 4% Central African, 1% North African and 1% American. Stratifying patients by age and nationality, we found that 21.7% of HBV-infected patients were aged < 34 years(only 2.8% were Italian). The most represented routes of transmission were nosocomial/dental procedures(23%), mother-to-child(17%) and sexual transmission(12%). The most represented HBV genotypes were D(72%) and A(14%). Of the patients, 24.7% of patients were HBe Ag positive, and 75.3% were HBe Ag negative. Of the HBV patients 7% were anti-HDV positive. In the whole cohort, 26.9% were cirrhotic(35.8% aged < 45 years), and 47% were eligible for or currently undergoing treatment, of whom 41.9 % were cirrhotic. CONCLUSION Only 27.3% of chronic viral hepatitis patients were HBV infected. Our results provide evidence of HBV infection in people aged < 34 years, especially in the foreign population not protected by vaccination. In our cohort of patients, liver cirrhosis was also found in young adults.

关键词： Hepatitis B virus infection Liver fibrosis Cirrhosis Public health Epidemiology

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