Background: In August 2020, Sputnik V was registered as Gam-COVID-Vac by the Russian Ministry of Health, and since December 2020 it has been distributed in 61 countries worldwide. On 25 February 2021, the Republic of San Marino started its vaccination campaign, which includes Sputnik V. Our aim was to describe the adverse events following immunization (AEFIs) with this vaccine through participant-based active surveillance in the country. Methods: Beginning from 4 March to 8 April 2021, a nationwide study was conducted on San Marino's population aged 18À89 years who received one or two doses of Sputnik V. E-questionnaire dissemination occurred through e-mails, QR-codes or live/phone interviews~7 days after the first and second vaccine dose. A descriptive analysis was conducted to quantify AEFI incidence on both occasions, stratifying results by type and severity of symptoms. Findings: Mean age of the 2558 vaccine recipients was 66 §14 years. First-dose AEFI incidence was 53.3% (systemic reactions at 42.2%), while second-dose AEFI incidence was 66.8% (systemic reactions at 50.4%) (n = 1288). In general, 76.0% of two-dose recipients reported some AEFIs after either vaccine dose, and 2.1% suffered severe reactions; in 60-to 89-year-olds (n = 1021), AEFI incidence was 70.0%, with 53.0% of subjects describing systemic reactions and 0.8% reporting severe symptoms. The most frequent symptoms were local pain, asthenia, headache and joint pain. Interpretation: Our results, albeit preliminary, suggest that Sputnik V has a high tolerability profile in the population aged 60 years in terms of short-term AEFIs.

The dramatic lifestyle changes forced by COVID-19-related lockdown promoted weight gain, with a stronger impact on obese subjects, at higher risk of severe infection. The PubMed database was searched to identify original studies assessing: (1) the extent and risk factors of lockdown-induced weight increase; and (2) the impact of obesity on the risk of hospital admission in children and adolescents. A systematic literature review and meta-analyses were performed. Twenty out of 13,986 identified records were included. A significant weight increase was reported in the majority of subjects, with no apparent gender or age differences. It was induced by a higher consumption of hypercaloric/hyperglycemic/junk food and/or the reduction of physical activity, often associated with an altered sleep–wake cycle. On the other hand, obesity increased the risk of hospitalization (OR = 4.38; 95% C.I. 1.46–13.19; p = 0.009; I2 = 96%) as compared to the normal weight population. COVID-19 and obesity represent epidemic conditions with reciprocal detrimental impact. Urgent public health interventions, targeting the various age and social strata, and involving governmental authorities, health care personnel, teachers and families are warranted to increase awareness and actively promote healthy lifestyles to contrast pediatric obesity and its detrimental consequences at a global level.

Background: Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine. Methods: A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method. Results: In our sample, 83.2% stated that they were vaccinated as soon as possible (“vaccinators”), 8.0% delayed vaccination (“delayers”), and 6.7% refused to be vaccinated (“no-vaccinators”). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master’s degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of “delayers” or “no-vaccinators”. Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators). Conclusion: In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments.

Background Emergency Departments (EDs) are increasingly pivotal, with a constant increment in their use, despite stable or declining fundings. Crowding can lead to disruptions and the COVID-19 epidemic has further burdened ED services. However, the pandemic has seen an increased use of telemedicine and digital health tools, which may be notably beneficial for EDs. This study offers a review of the latest available digital health technologies and their effectiveness to improve ED performance. Methods We performed a narrative review to identify digital and technological innovations in EDs. The themes of interest were defined in 4 areas: Patient Assessment, Patient Experience, Resource Allocation, and Discharge. Data was analyzed by 5 independent reviewers who focused on different macro-areas. Disagreement on data was discussed with 2 independent tiebreakers. Results Our search yielded 25 articles addressing 4 topics: Patient Assessment, Resource Allocation, Patient Experience, Discharge. We found that digital tools and Artificial Intelligence are powerful tools to detect, collect, and process data from patients, to improve healthcare delivery in EDs. The Resource Allocation category showed to be key in optimizing services already in place. New technologies showed effective to improve Patient Experience by curbing pain and anxiety. Innovative technologies demonstrated efficacy after Discharge when patients need guidance from clinicians for follow-up care. Conclusions Our review shows evidence of increasing effectiveness of innovative tools in reducing wait time and improving performance and patient experience in EDs. Technology applied to resource allocation appeared to be the most effective category. Prediction algorithms could be used to improve workforce allocation and bed management. Critical care systems must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for patients and healthcare professionals. Key messages • Digital innovation will have a significant impact on several dimensions of healthcare in the near future. • Healthcare systems and EDs must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for both patients and healthcare professionals.

In 2020 COVID-19 led to an unprecedented stream of papers being submitted to journals. Scientists and physicians all around the globe were in need for information about this new disease. In this climate, many articles were accepted after extremely fast peer-reviews to provide the scientific community with the latest discoveries and knowledge. Unfortunately, this also led to articles retraction due to authors’ misconduct or errors in methodology and/or conclusions. The aim of this study is to investigate the number and characteristics of retracted papers, and to explore the main causes that led to retraction. We conducted a systematic review on retracted articles, using PubMed as data source. Our inclusion criteria were the following: English-language retracted articles that reported original data, results, opinions or hypotheses on COVID-19 and Sars-CoV-2. Twenty-seven retracted articles were identified, mainly reporting observational studies and opinion pieces. Many articles published during the first year of the pandemic have been retracted, mainly due to the authors' scientific misconduct. Duplications, plagiarism, frauds and absence of consent, were the main reasons for retractions. In modern medicine, researchers are required to publish frequently, and, especially during situations like the COVID-19 pandemic, when articles were rapidly published, gaps in peer-reviews system and in the path to scientific publication arose.