PDF(Pubmed)
Abstract：
UNASSIGNED: The use of Non-Pharmaceutical Interventions (NPIs) during the COVID-19 pandemic is debated. Understanding the consequences these measures may have on vulnerable populations including children and adolescents is important.
UNASSIGNED: This is a multicenter, quasi-experimental before-after study involving 12 hospitals of the North Italian Emilia-Romagna Region, with NPI implementation as the intervention event. The 3 years preceding NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (SC) and a subsequent mitigation measures phase (MM) with milder restrictions. Interrupted Time Series (ITS) regression analysis was used to calculate PED Standardized Incidence Rate Ratios (SIRR) on the diagnostic categories exhibiting the greatest frequency and/or variation.
UNASSIGNED: In the 60 months of the study there were 765,215 PED visits. Compared to the pre-pandemic rate, overall PED presentations dropped by 58 and 39% during SC and MM, respectively. \"Symptoms, signs and Ill-defined conditions,\" \"Injury and poisoning\" and \"Diseases of the Respiratory System\" accounted for 74% of the reduction. A different pattern was instead seen for \"Mental Disorders,\" which exhibited the smallest decrease during SC, and is the only category which rose already at the end of SC. ITS analysis confirmed the strong decrease during SC (level change, IRR 0.17, 95%CI 0.12-0.27) and a significant increase in MM (slope change, IRR 1.23, 95%CI 1.13-1.33), with the sharpest decline (-94%) and rise (+36%) observed in the \"Diseases of the Respiratory System\" category. Mental Disorders showed a significant increasing trend of 1% monthly over the whole study period exceeding pre-pandemic levels at the end of MM. Females and adolescents showed higher increasing rates both in SC and MM.
UNASSIGNED: NPIs appear to have influenced PED attendance in different ways according to diagnostic categories, mirroring different mechanisms of action. These effects are beneficial in some cases and harmful in others, and establishing a clear balance between pros and cons is a difficult task for public health decision makers. The role of NPIs on PED use appropriateness deserves investigation. The rise in pediatric mental disorders independent of the pandemic makes interventions addressing these issues urgent.
UNASSIGNED: This is a multicenter, quasi-experimental before-after study involving 12 hospitals of the North Italian Emilia-Romagna Region, with NPI implementation as the intervention event. The 3 years preceding NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (SC) and a subsequent mitigation measures phase (MM) with milder restrictions. Interrupted Time Series (ITS) regression analysis was used to calculate PED Standardized Incidence Rate Ratios (SIRR) on the diagnostic categories exhibiting the greatest frequency and/or variation.
UNASSIGNED: In the 60 months of the study there were 765,215 PED visits. Compared to the pre-pandemic rate, overall PED presentations dropped by 58 and 39% during SC and MM, respectively. \"Symptoms, signs and Ill-defined conditions,\" \"Injury and poisoning\" and \"Diseases of the Respiratory System\" accounted for 74% of the reduction. A different pattern was instead seen for \"Mental Disorders,\" which exhibited the smallest decrease during SC, and is the only category which rose already at the end of SC. ITS analysis confirmed the strong decrease during SC (level change, IRR 0.17, 95%CI 0.12-0.27) and a significant increase in MM (slope change, IRR 1.23, 95%CI 1.13-1.33), with the sharpest decline (-94%) and rise (+36%) observed in the \"Diseases of the Respiratory System\" category. Mental Disorders showed a significant increasing trend of 1% monthly over the whole study period exceeding pre-pandemic levels at the end of MM. Females and adolescents showed higher increasing rates both in SC and MM.
UNASSIGNED: NPIs appear to have influenced PED attendance in different ways according to diagnostic categories, mirroring different mechanisms of action. These effects are beneficial in some cases and harmful in others, and establishing a clear balance between pros and cons is a difficult task for public health decision makers. The role of NPIs on PED use appropriateness deserves investigation. The rise in pediatric mental disorders independent of the pandemic makes interventions addressing these issues urgent.
摘要：
■在COVID-19大流行期间使用非药物干预（NPI）存在争议。了解这些措施可能对包括儿童和青少年在内的弱势群体产生的后果很重要。
■这是一个多中心，涉及北意大利艾米利亚-罗马涅地区12家医院的准实验性前后研究，以NPI实施为干预事件。NPI实施前的3年(2020年3月)构成了大流行前阶段。随后的2年进一步细分为学校关闭阶段（SC）和随后的缓解措施阶段（MM），并有较温和的限制。使用中断时间序列（ITS）回归分析来计算表现出最大频率和/或变化的诊断类别的PED标准化发生率比率（SIRR）。
■在研究的60个月中，有765,215次PED访问。与大流行前的比率相比，在SC和MM期间，总体PED演示文稿下降了58%和39%，分别。“症状，标志和不明确的条件，“伤害和中毒”和“呼吸系统疾病”占减少的74％。相反，对于“精神障碍”看到了不同的模式，“在SC期间表现出最小的下降，并且是在SC结束时已经上升的唯一类别。ITS分析证实了SC期间的强劲下降(水平变化，IRR0.17，95CI0.12-0.27）和MM的显着增加（斜率变化，IRR1.23，95CI1.13-1.33)，在“呼吸系统疾病”类别中观察到的急剧下降（-94％）和上升（+36％）。在整个研究期间，精神障碍显示出每月1％的显着增长趋势，超过了MM结束时的大流行前水平。女性和青少年在SC和MM中的增长率均较高。
■根据诊断类别，NPI似乎以不同的方式影响了PED出勤，反映不同的作用机制。这些影响在某些情况下是有益的，在其他情况下是有害的，对于公共卫生决策者来说，在利弊之间建立明确的平衡是一项艰巨的任务。NPI对PED使用适当性的作用值得研究。独立于大流行的儿科精神障碍的增加使得解决这些问题的干预变得紧迫。
■这是一个多中心，涉及北意大利艾米利亚-罗马涅地区12家医院的准实验性前后研究，以NPI实施为干预事件。NPI实施前的3年(2020年3月)构成了大流行前阶段。随后的2年进一步细分为学校关闭阶段（SC）和随后的缓解措施阶段（MM），并有较温和的限制。使用中断时间序列（ITS）回归分析来计算表现出最大频率和/或变化的诊断类别的PED标准化发生率比率（SIRR）。
■在研究的60个月中，有765,215次PED访问。与大流行前的比率相比，在SC和MM期间，总体PED演示文稿下降了58%和39%，分别。“症状，标志和不明确的条件，“伤害和中毒”和“呼吸系统疾病”占减少的74％。相反，对于“精神障碍”看到了不同的模式，“在SC期间表现出最小的下降，并且是在SC结束时已经上升的唯一类别。ITS分析证实了SC期间的强劲下降(水平变化，IRR0.17，95CI0.12-0.27）和MM的显着增加（斜率变化，IRR1.23，95CI1.13-1.33)，在“呼吸系统疾病”类别中观察到的急剧下降（-94％）和上升（+36％）。在整个研究期间，精神障碍显示出每月1％的显着增长趋势，超过了MM结束时的大流行前水平。女性和青少年在SC和MM中的增长率均较高。
■根据诊断类别，NPI似乎以不同的方式影响了PED出勤，反映不同的作用机制。这些影响在某些情况下是有益的，在其他情况下是有害的，对于公共卫生决策者来说，在利弊之间建立明确的平衡是一项艰巨的任务。NPI对PED使用适当性的作用值得研究。独立于大流行的儿科精神障碍的增加使得解决这些问题的干预变得紧迫。
