Letizia Lorusso

Introduction Real-world clinical registry data from addiction treatment centers are a valuable source for investigating the association between substance use disorder (SUD) and cardiovascular disease (CVD), but are frequently affected by missing data arising from irregular attendance and heterogeneous data collection. Inadequate handling of missing data may introduce substantial bias in the estimation of epidemiological associations, particularly when missingness varies markedly across variables. Aim To compare the performance of non-parametric missing data imputation methods in a mixed-type real-world clinical registry and evaluate their impact on cardiovascular risk estimates across variables with increasing levels of missingness. Methods A retrospective cohort of 4,895 unique patients admitted to the San Patrignano addiction treatment center (Bologna, Italy) between 2015 and 2024 was analyzed using 40 variables (8 continuous, 32 categorical). The outcome variable was withheld from the imputation model throughout. Three imputation methods were assessed: missForest, kNN, and guided hot-deck, all tuned by grid search. MissForest was evaluated using built-in error estimates: NRMSE for quantitative and PFC for categorical variables, whereas kNN and guided hot-deck were assessed through method-specific proxy indicators. A binary cardiovascular outcome was defined as the presence of cardiovascular disease-related conditions. Odds ratios (ORs) and 95% confidence intervals (95%CI) were estimated using complete-case analysis and after imputation for variables characterized by different levels of missingness: cocaine use (1%), obesity (12%), total cholesterol (39%) and overdose history (73%). To quantify the sensitivity of epidemiological estimates to the imputation strategy, two summary indicators were calculated: ΔOR=(OR_max-OR_min)/OR_cc and ΔIC=(IC_maxwidth-IC_minwidth)/IC_widthcc where and denote the odds ratio and confidence interval width obtained from the complete-case analysis. All statistical analyses were done in R (version 4.5.0). Results kNN showed a more favorable proxy-based profile than guided hot-deck, with lower continuous and categorical proxy values (0.032 and 0.072 vs. 0.091 and 0.226, respectively), while missForest yielded NRMSE=0.604, indicating a relatively high value, and PFC=0.110. The impact of imputation on epidemiological estimates increased with missingness proportion. For low-missingness variables (cocaine 1%, obesity 12%), OR estimates were stable across all methods (OR range: 4.0–4.1; ΔOR=0.26; ΔIC=0.44). For total cholesterol (39% missing), modest differences emerged across imputation strategies (ΔOR=0.62; ΔIC=0.55), although the epidemiological interpretation remained unchanged. The largest variability was observed for overdose history (73% missing), where OR estimates ranged from 1.8 to 3.3 (ΔOR=0.62; ΔIC=0.55). Nevertheless, overdose was consistently identified as a positive risk factor across all methods. Conclusions The practical impact of missing data imputation depended strongly on the amount of information recovered from incomplete variables. For low-to-moderate missingness, complete-case and imputed analyses yielded consistent estimates across algorithms. Differences in point estimates and confidence interval widths emerged only above 70% missingness, without changing the direction or substantive interpretation. Because reconstruction-performance metrics may be structurally heterogeneous across methods, they are best restricted to within-method tuning. In this setting, the operational value of imputation was more appropriately assessed through its impact on downstream epidemiological inference, with ΔOR and ΔIC providing an interpretable framework for comparing imputation strategies in real-world registry studies.

West Nile virus (WNV) transmission has intensified and expanded in Italy, but quantitative evidence on how local climatic and environmental conditions influence human risk in southern regions remains limited. This study examined the association between meteorological, environmental, and host-related factors and West Nile virus (WNV) cases at the municipal level in Apulia in 2023. Human WNV cases were georeferenced at the municipal level and linked to monthly indicators (minimum and maximum temperature, precipitation, surface water extent, green area coverage, land-use change, avian occurrence). A Bayesian spatio-temporal Poisson model with a conditional autoregressive structure was fitted to monthly counts of human WNV cases, with equine WNV cases, climatic, environmental and avian indicators included as covariates. Eight human WNV cases were reported between August and October and four equine WNV cases between September and November, with partial spatial and temporal overlap. In univariable analyses, the strongest associations were observed for meteorological variables, particularly temperature. In the final multivariable model, higher maximum temperature at a two-month lag was associated with increased WNV risk (RR = 1.53; 95% CrI: 1.18–2.23), while minimum temperature was excluded due to collinearity with maximum temperature. Green area coverage and water body extent showed uncertain effects. Model-based maps indicated that elevated fitted risk was concentrated in a narrow temporal window between August and October, expanding sharply across the region in September before receding, rather than describing a stable, spatially fixed hotspot. This exploratory analysis suggests that reported human WNV infections in Apulia in 2023 were temporally concentrated during the late summer/early autumn period and that maximum temperature at a two-month lag was positively associated with the outcome in the selected model. The findings are hypothesis-generating and should be interpreted with caution given the very small number of events, but they illustrate the feasibility of integrating multisource epidemiological, climatic, environmental, and veterinary data to support locally tailored early-warning efforts in southern Italy.

Background: Socioeconomic disparities may affect COVID-19 booster vaccination uptake, potentially undermining public health efforts. This study assessed the association between first booster dose coverage and municipal socioeconomic deprivation in the Apulia region of southern Italy. A secondary objective was to evaluate whether SARS-CoV-2 incidence modified this relationship. Methods: We conducted a retrospective observational study including Apulian residents aged ≥5 years from 1 January 2021, to 31 December 2022. First booster doses were identified using an algorithm based on dose chronology and national guidelines. Vaccination and infection data were retrieved from regional databases. Socioeconomic deprivation was measured using the Social and Material Vulnerability Index (SMVI) developed by the Italian National Institute of Statistics (ISTAT). Booster coverage was calculated at the municipal level. A multivariable Poisson’s regression model was used to estimate the association between SMVI and booster uptake, adjusting for age group, primary vaccine type, SARS-CoV-2 incidence, and municipal vaccination rates. Analyses were stratified by sex. Results: A total of 2,732,258 individuals received a first booster dose. Booster coverage decreased with increasing SMVI. Among females, a significant reduction was observed in the highest deprivation category (RR > 102 vs. <99: 0.95; 95% CI: 0.94–0.97) and it was similar in males (RR: 0.95; 95% CI: 0.93–0.96). A significant interaction between age and deprivation was found in both sexes, with a sharper decline in younger individuals. Municipal vaccination rates were positively associated with booster uptake. SARS-CoV-2 incidence was positively associated with uptake only in males. Conclusions: The analysis revealed a significant association between lower socio-cultural level and lower adherence to the first booster dose of the COVID-19 vaccine. The decline is more pronounced among subjects younger than 50 years with high levels of vulnerability. The findings of this study suggest that to overthrow vaccine hesitancy, knowledge of the social setting allows for targeted communications to the different groups in the population. Further research is needed to define different approaches in the different social groups.

Personality traits, decision-making styles, and socio-demographic information help understand the characteristics of women requesting voluntary termination of pregnancy (VTP) and monitor the timing and quality of this service However, our current data do not allow for an in-depth exploration of additional, less evident factors that might influence the decision. The aim was to characterise a sample of women requesting VTP in terms of socio-demographic, personality, and decision-making style variables, and to examine the associations among these factors. We conducted a cross-sectional study administering the General Decision-Making Style (GDMS) test, the Big Five Questionnaire (BFQ) and the Personality Inventory for DSM-5 (PID-5) to women requesting VTP certification. BFQ scores were generally high, especially for “Conscientiousness” and “Openness”. “Agreeableness” and “Openness” scores were lower in women with low vs. high education (diff = −8.2 [−13.9, −2.4] and diff = −7.5 [−15.0, −0.1]); “Extraversion” was higher in employed women. PID-5 scores for “Detachment” and “Psychoticism” were higher in medium vs. high education (diff = 1.6 [0.05, 3.2] and diff = 1.9 [0.1, 3.8]), but not at pathological level; “Negative affect” was lower in women with children (diff = −1.6 [−3.1, −0.2]). GDMS scores were not associated with socio-demographic factors. “Avoidant” and “Spontaneous” styles were negatively associated with “Conscientiousness” and “Emotional Stability”; “Rational” style was positively associated with “Conscientiousness” and “Disinhibition”. High BFQ and low PID-5 scores suggest no personality dysfunction in women undergoing VTP. No predominant decision-making style emerged, but associations between personality traits, decision-making, and socio-demographic factors such as educational level, employment and parity, were observed.

Purpose: Engagement in physical and social activities is crucial for successful aging. Methods: This study evaluates fall probability, quality of life and cognitive status following 12-month intervention. The intervention consisted in a monitoring scenario in which older adults were equipped with a smartwatch to track step count and home sensors to measure micro-environmental parameters. We evaluated the intervention overall and regrouped based on participants’ daily step count: low (< 4500 steps/day) and high (≥ 4500 steps/day). Results: The intervention had an increase in Tinetti Balance Assessment scores indicating a reduced fall probability. The low steps group benefited the most, suggesting that even light activities positively impacted balance and mobility. Quality of life significantly improved after 6 months, particularly in the high steps group. Cognition measured with the Mini-Mental State Examination improved in the high steps group compared to the low steps and the control group. Conclusions: Providing wearable technology can promote physical activity and positively influence overall health, even in older individuals with low activity levels. This real-world approach without external enforcement highlights the potential for simple technological interventions to promote active aging.

Background/Objectives: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants. In the 2024–2025 season, passive newborn immunization with nirsevimab, a long-acting anti-RSV monoclonal antibody, was introduced for the first time in Italy. However, the immunization campaign was not uniformly implemented on a regional basis due to supply and organizational difficulties. The aim of the study was to assess the real-world impact of nirsevimab prophylaxis during the 2024–2025 bronchiolitis season in four regions of Italy. Methods: This multicenter observational study included infants <12 months hospitalized for bronchiolitis across four Italian centers. Hospitalizations due to RSV and non-RSV bronchiolitis were compared across the 2023–2024 and 2024–2025 seasons, in relation to the timing and coverage of nirsevimab’s introduction in each of the four regions. Results: Early and widespread nirsevimab administration was associated with a significant reduction in RSV hospitalizations and severity of disease. Centers located in regions that had delayed implementation of immunization observed higher RSV burden and intensive care unit admissions. Admissions for non-RSV bronchiolitis remained stable. Conclusions: Timely and universal administration of nirsevimab significantly reduced RSV hospitalizations and severity, while delayed implementation resulted in limited benefit. These findings support early and uniform prophylaxis to mitigate health disparities and seasonal pressure on pediatric healthcare systems.

Background: In Italy, voluntary termination of pregnancy (VTP) is a legally protected healthcare service. However, in Apulia, a southern region, access remains uneven due to ongoing healthcare rationalization, which has reduced service availability, particularly in decentralized areas. Conscientious objection among providers may also contribute, although the number of VTPs per provider has decreased over time. This study examines whether women access VTP services outside their healthcare catchment area (CA) and how socioeconomic deprivation and individual factors may influence mobility. Methods: We applied a ranking method, based on spatial and temporal distance between hospitals and municipalities to define the catchment area (CA) around hospitals of the Apulia region that offers VTP service. A Poisson multivariable clustered model was applied to evaluate the association among demographic and socioeconomic factors and the choice of the VTP service. Results: The analysis revealed that 54.7% of VTPs were performed outside the women’s catchment area. This mobility was significantly more frequent among women from medium and low socioeconomically deprived areas compared to very low deprived areas (RR = 1.20; 95%CI: [1.02–1.42]) and (RR = 1.28; 95%CI: [1.03–1.57]). Higher education level (RR = 1.09; 95% CI: [1.04–1.14]) and employment (RR = 1.09; 95%CI: [1.03–1.14]) were also associated with higher rates of undergoing a VTP outside of CA, with variations observed across local health authorities. Conclusions: These findings have shown the influence of socioeconomic conditions and educational level on women’s access to VTP services, suggesting that structural inequalities continue to shape healthcare choices and mobility.