Background Aim of the present study is to describe characteristics of COVID-19-related deaths and to compare the clinical phenotype and course of COVID-19-related deaths occurring in adults (<65 years) and older adults (≥65 years). Method Medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged < 65 years and 2,664 aged ≥65 years) were revised to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Results Older adults (≥65 years) presented with a higher number of comorbidities compared to those aged <65 years (3.3 ± 1.9 vs 2.5 ± 1.8, p < .001). Prevalence of ischemic heart disease, atrial fibrillation, heart failure, stroke, hypertension, dementia, COPD, and chronic renal failure was higher in older patients (≥65 years), while obesity, chronic liver disease, and HIV infection were more common in younger adults (<65 years); 10.9% of younger patients (<65 years) had no comorbidities, compared to 3.2% of older patients (≥65 years). The younger adults had a higher rate of non-respiratory complications than older patients, including acute renal failure (30.0% vs 20.6%), acute cardiac injury (13.5% vs 10.3%), and superinfections (30.9% vs 9.8%). Conclusions Individuals dying with COVID-19 present with high levels of comorbidities, irrespective of age group, but a small proportion of deaths occur in healthy adults with no preexisting conditions. Non-respiratory complications are common, suggesting that the treatment of respiratory conditions needs to be combined with strategies to prevent and mitigate the effects of non-respiratory complications.

Health-care-associated infection (HAI) is a major issue of patient safety with a substantial impact on morbidity, mortality, and use of additional resources worldwide. In April 2004, the WHO Regional Office for Europe organised the first international consultation to address the issue of HAI in eastern and central Europe. The main objectives of the consultation were to identify the primary needs and obstacles for the prevention and control of HAI at country level, to design the essential components of an international strategy to effectively address the issue of HAI, and to identify specific priorities and recommendations for interventions by the WHO and other international institutions. An update on HAI activities and related networks throughout Europe, together with the outcome of the meeting, are presented, with special emphasis on future considerations for a European WHO strategy on HAI prevention.

Health literacy can be defined as the knowledge, motivation and competence to access, understand, appraise and apply information to make decisions in terms of healthcare, disease prevention and health promotion. Health literacy is a European public health challenge that has to be taken seriously by policy-makers. It constitutes an emerging field for policy, research and practice. However, recent research has shown that health literacy advancement is still at its infancy in Europe, as reflected in the scarce scientific health literacy literature published by European authors. From a total of 569 articles published until 2011 on this subject, the first author of only 15% of them is from Europe. This article conveys recommendations of different European stakeholders on how to accelerate the health literacy agenda in Europe. A general introduction on the current status of health literacy is provided, followed by two cases applying health literacy in the areas of prevention of communicable diseases and promotion of digital health. The current EU strategies integrating health literacy are listed, followed by examples of challenges threatening the further development of health literacy in Europe. Recommendations as to how European stakeholders involved in research, policy, practice and education can promote health literacy are given. It is vital that the European Commission as well as European Union Member States take the necessary steps to increase health literacy at individual, organizational, community, regional and national levels.

This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID-19). Methods: Medical charts of 3,694 of patients dying with COVID-19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities. Results: Obesity was present in 411/3,694 (11.1%) patients dying with COVID-19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio [OR], 1.33; 95%

Objectives: To determine (i) the extent of malnutrition and the risk factors for severe malnutrition in Guinea Bissau, a post-conflict country experiencing longterm consequences of civil war; and (ii) the feasibility and effectiveness of a shortterm intervention characterized by outpatient treatment with locally produced food for the treatment of severe malnutrition during the rainy season. Design and setting: Social, clinical, nutritional information were collected for children reaching the paediatric outpatient clinic of the Hospital 'Comunità di Sant'Egidio' in Bissau, Guinea Bissau, from 1 July to 12 August 2003. Severely malnourished children (weight-for-age ,23SD) in poor health status were admitted for daily nutritional and pharmacological treatment until complete recovery. Social and health indicators were analysed to define risk factors of severe malnutrition. Results: In total, 2642 children were visited (age range: 1 month-17 years). Fever, cough and dermatological problems were the main reasons for access. Social data outlined poor housing conditions: 86?4 % used water from unprotected wells, 97?3 % did not have a bathroom at home, 78?2 % lived in a mud house. Weight-for-age was ,22SD in 23?0 % of the children and ,23SD in 10?3 %; thirty-seven children (1?4 %) were severely malnourished and admitted for day care. All recovered with a weight gain of 4?45 g/kg per d, none died or relapsed after 1 year. Severely malnourished children were mainly infants, part of large families and had illiterate mothers. Conclusion: Short-term interventions performed in post-conflict countries during seasons of high burden of disease and malnutrition are feasible and successful at low cost; day-care treatment of severe malnutrition with locally produced food is an option that can be tested in other settings.Malnutrition in all its various forms (stunting, wasting and growth faltering) remains, with diarrhoea, malaria and respiratory infections, one of the most common causes of morbidity and mortality among children worldwide (1)(2)(3) . Approximately 54 % of deaths in children less than 5 years of age are associated with malnutrition and mortality risk increases with severity of acute malnutrition.International guidelines for the treatment of severe malnutrition (4)(5)(6) indicate inpatient treatment with medical and supportive care as the preferred choice, at least in the first acute phase of treatment, if medical complications and/or anorexia are present. Most developing countries have limited inpatient facilities and scarce financial and human resources to allocate for this purpose. Moreover, childhood malnutrition is widespread in post-conflict countries; these countries experience long-term impacts in the field of health (7,8) that go beyond the acute effects of war, with difficulty in setting up stable health systems and specialized nutrition centres. The civilian population becomes exposed to a higher burden of diseases due to the lack of secure water supplies, sanitation, food and stable power plants, th...