The blue side of diabetes: assessing the impact of depression in people with type 2 diabetes using real-world data

The aim of the thesis is to assess the impact of depression in people with type 2 diabetes. Using Healthcare Utilization Databases, I estimated in a large population-based cohort with type 2 diabetes the incidence of depression over 10 year-period, identified the demographic and clinical predictors of depression, and determined the extent to which depression is a risk factor for acute and long-term complications and mortality. In the context of COVID-19 pandemic, I evaluated whether the presence of a history of depression in type 2 diabetes increased the Emergency Department (ED) access rate for diabetes-related complications, and I investigated changes in the incidence of depression during the first year of the pandemic. Findings from the first study indicated that developing depression was associated with being a woman, being over 65 years, living in rural areas, having insulin as initial diabetes medication and having comorbid conditions; the study also confirmed that depression was associated with an increased risk for acute and long-term diabetes complications and all-cause mortality. The second observational study showed a higher rate of ED access for diabetes-related complications during the pandemic in people with type 2 diabetes and a history of depression than in those without a history of depression, similar to what was observed in a pre-pandemic period. As shown in the third population-based study, the incidence of depression decreased in 2020 compared to 2019, mainly during the first and the second waves of the COVID-19 pandemic, when people probably had difficulty reaching healthcare services. This new real-world evidence will help healthcare professionals identify timely patients at high risk of developing depression. Lastly, policymakers and physicians will benefit from new evidence of the effects of the COVID-19 pandemic on depression in people with type 2 diabetes to ensure a high level of care during crisis periods.

Epidemiology and population genetics of Podosphaera fusca and Golovinomyces orontii, causal agents of cucurbit powdery mildew

In 2010, 2011 and 2012 growing seasons, the occurrence of the ascomycetes Podosphaera fusca and Golovinomyces orontii, causal agents of powdery mildew disease, was monitored on cultivated cucurbits located in Bologna and Mantua provinces to determine the epidemiology of the species. To identify the pathogens, both morphological and molecular identifications were performed on infected leaf samples and a Multiplex-PCR was performed to identify the mating type genes of P. fusca isolates. The investigations indicated a temporal succession of the two species with the earlier infections caused by G. orontii, that seems to be the predominant species till the middle of July when it progressively disappears and P. fusca becomes the main species infecting cucurbits till the end of October. The temporal variation is likely due to the different overwintering strategies of the two species instead of climatic conditions. Only chasmothecia of P. fusca were recorded and mating type alleles ratio tended to be 1:1. Considering that only chasmothecia of P. fusca were found, molecular-genetic analysis were carried out to find some evidence of recombination within this species by MLST and AFLP methods. Surprisingly, no variations were observed within isolates for the 8 MLST markers used. According to this result, AFLP analysis showed a high similarity within isolates, with SM similarity coefficient ranging between 0.91-1.00 and also, sequencing of 12 polymorphic bands revealed identity to some gene involved in mutation and selection. The results suggest that populations of P. fusca are likely to be a clonal population with some differences among isolates probably due to agricultural practices such as fungicides treatments and cultivated hosts. Therefore, asexual reproduction, producing a lot of fungal biomass that can be easily transported by wind, is the most common and useful way to the spread and colonization of the pathogen.