During the SARS-CoV-2 pandemic, a surge in overall deaths has been recorded in many countries, most of them likely attributable to COVID-19. However, COVID-19 confirmed mortality (CCM) is considered an unreliable indicator of COVID-19 deaths because of national health care systems' different capacities to correctly identify people who actually died of the disease. 1,2 Excess mortality (EM) is a more comprehensive and robust indicator because it relies on all-cause mortality instead of specific causes of death. 3 We analyzed the gap between the EM and CCM in 67 countries to determine the extent to which official data on COVID-19 deaths might be considered reliable. MethodsIn this cross-sectional study, we retrieved aggregated country-level data on population and COVID-19 overall confirmed cases, deaths, and testing as of December 31, 2020, from Our World in Data. Data on countries' overall deaths from 2015 to 2020 were obtained from the World Mortality Data set (eAppendix in the Supplement). This research was based on public use datasets that do not include identifiable personal information and, per the Common Rule, was exempt from Institutional Review Board review and approval. For the same reason, no informed consent was required. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Negative binomial regression models were used to estimate projected deaths in 2020 using mortality data from 2015 to 2019. Two-sided 95% CIs for country-specific projected deaths were calculated applying the normal approximation to the Poisson distribution. EM in the pandemic period (ie, February 26 to December 31, 2020) was estimated as the difference between cumulative observed deaths and projected deaths. Countries' testing capacity was assessed with their cumulative test-to-case ratio (eAppendix in the Supplement). The association between countryspecific cumulative CCM and EM per 100 000 population of 2020 was displayed using a scatterplot, in which the identity line discriminates countries with EM exceeding CCM from those with EM lower than CCM. A color was assigned to countries based on their decile of testing capacity. All analyses were performed using R version 4.0.4 (R Project for Statistical Computing). Details on the analytic approach are available in the eAppendix in the Supplement. ResultsMost of the 67 countries experienced an increase in mortality during 2020 (Table ). Among countries with increased mortality (ie, those located above 0 on the y-axis in the Figure ), a small number appeared under the identity line, showing lower-than-expected mortality after subtracting COVID-19 deaths. Countries located above the identity line can be visually classified into 2 groups: 1 with several Latin American and East European countries, which exhibit a large gap between EM and CCM (eg, Mexico, 212 excess deaths vs 96 COVID-19 deaths per 100 000 population); the other, more heterogeneous group showed a moderate EM beyond CCM (eg, Greece, 57 excess deaths vs 45 CO...
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Background: Health-related quality of life (HRQoL) in childhood is a multidimensional construct with many sub dimensions of subjective experience, including physical activity (PA), psychological well-being, social interaction, and school performance, that represents a fundamental health outcome to assess a child’s physical and psycho-social functioning. Our study aims to explore the potential predictors of children’s health-related quality of life, using a convenience sample from the Imola Active Break Study (I-MOVE), considering demographic, anthropometric measures, PA level measured by Actigraph accelerometers, parent-reported/self-reported HRQoL, and body image. Methods: A cross-sectional analysis was conducted among 151 primary school children in Italy. HRQoL was assessed using the Italian version 4.0 of the Paediatric Quality of Life (PedsQL) questionnaire. Results: Children who spent more time partaking in moderate PA were associated with a higher total PedsQL score (p < 0.03). Mother’s body mass index (BMI) was the only variable statistically significant associated with the physical health domain of PedsQL. Parent’s proxy-report perception concerning children’s psychosocial health was statistically relevant. The children’s gender, age, and BMI had no association with any of the HRQoL outcomes. Discussion: Parent proxy-report psychosocial health and mother’s BMI should be considered as predictors of HRQoL for the psychosocial and physical domain. PA should be implemented in order to improve the HRQoL of primary school children.
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