Search

Abstract: Among invasive bacterial diseases, meningococcal meningitis is a serious and contagious disease caused by Neisseria meningitidis. The disease has a high lethality grade and could have long-term sequelae. This paper describes a case of meningitis that occurred in the territory under the jurisdiction of Local Health Authority ULSS 1 Dolomiti and the related management methods. The activities described concern rapid alerts, an epidemiological investigation, the administration of chemoprophylaxis and offering vaccinations, implemented according to the current Public Health protocol through different healthcare workers. This case report aims to support the management of possible similar cases, underlining the conditions that favoured the application of the envisaged measures, including an on-call ready availability service; the presence of population vaccination centres located in the area investigated; and a network sensitive to early warnings and collaboration within and between Local Health Authorities.

In 2013, in a bid to combat Vaccine Hesitancy (VH) and provide information on vaccines by communicating with the general public and the health community (e.g., healthcare workers and public health operators), the Italian Society of Hygiene and Preventive Medicine (S.It.I.) published the national website "VaccinarSì". The project was subsequently extended to ten Italian Regions. This led to the creation of the VaccinarSì Network, whose websites are publicly owned. The aim of this work was to present the framework of the websites of the VaccinarSì Network and to analyse user behaviour in the pre-COVID-19-era (dating from each website's publication until 31 January 2020) and in the COVID-19-era (from 1 February 2020 to 31 January 2021). Some metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were searched, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with their absolute (relative) frequencies and means. Statistical differences between the means of the two periods were evaluated through paired t -test. A two-tailed p -value less than 0.05 was considered to be statistically significant. When the total values recorded over the period were compared, an overall increase in metrics was observed-the number of individual users, visits and individual pageviews rose in a statistically significant way. Our study aimed to highlight how combining disciplines such as health education and digital communication via Information and Communication Technologies (ICT) represents the best strategy to support citizens. This approach gives them the tools to become independent and responsible players that are capable of voluntarily and consciously choosing to adhere to vaccination programs. The VaccinarSì Network's goal for the future is to reach an even wider audience. By building each user's critical knowledge, this network enables users to be active components of a wider, more empowered community.

In March 2020, the COVID-19 pandemic disrupted most of the routine outpatient activities in Italian hospitals and Prevention Departments, including those vaccinations which were not urgent and/or scheduled for children aged 0-6 years. Since June 2020, when the pandemic entered a milder phase, in the alpine Province of Belluno (Veneto, North-Eastern Italy), 12,152 doses of vaccine against tick-borne encephalitis have been administered by means of the innovative "drive-through" modality. No significant adverse events have occurred and popular demand has steadily grown, proving the "drive-through" approach to be safe, efficient and successful., (©2020 Pacini Editore SRL, Pisa, Italy.)

Objectives: to assess the impact of a cement plant emissions on mortality, hospitalizations, and cancer incidence in the residents of the municipality of Pederobba (Veneto Region, Northern Italy)., Design: retrospective residential cohort study., Setting and Participants: the study was conducted in Pederobba and in 7 neighbouring municipalities (Cavaso Del Tomba, Cornuda, Crocetta del Montello, Monfumo, Segusino, Valdobbiadene, Vidor). The cohort included 12,116 residents in Pederobba (151,784 person-years) and 49,004 residents in the neighbouring municipalities (660,268 person-years) in the period 1996-2017. On the basis of the model estimate of the annual average concentration of nitrogen dioxide (NO2), the municipality of Pederobba was divided into an area with higher exposure of NO2 and another one at lower exposure of NO2. Two comparisons were made: the first between the residents in Pederobba and residents in the neighbouring municipalities; the second between people residing in Pederobba in the higher and in the lower exposure areas., Main Outcome Measures: analysis of cause-specific mortality and hospitalization and cancer incidence, with particular attention to the diseases for which there is evidence of association with exposure to air-pollutants. For cancer incidence, available data were limited to the municipalities of Pederobba, Cavaso Del Tomba, Cornuda, Crocetta del Montello, and Monfumo for the period 1996-2015., Results: the comparison among Pederobba and the 7 neighbouring municipalities showed that within Pederobba residents there was: • a slight increase in the risk of death from all causes in women, due to circulatory diseases (HR 1.29; 95%CI 1.15-1.45), in particular ischaemic heart disease (HR 1.55; 1.27-1.89) and cerebrovascular diseases (HR 1.35; 1.06-1.72); • a moderate increase in hospitalizations for circulatory diseases, such as heart failure (HR 1.17; 1.00-1.37) and cerebrovascular diseases (HR 1.41; 1.17 -1.70), especially in elderly women; • a slight increase in hospitalizations for respiratory diseases, especially in older women (HR 1.19; 1.04-1.37); • no difference were observed in cancer incidence, neither for all nor for single cancer sites, in both genders.The comparison between residents in the higher exposure area and those in the lower exposure area showed no difference in mortality, hospitalizations, and cancer incidence., Conclusions: higher mortality and hospitalization rates from circulatory and respiratory causes detected in Pederobba compared to the neighbouring municipalities were not confirmed by the comparison between residents in the higher and in the lower exposure area. Overall, data did not show a clear, well-characterized relationship between the exposure to pollutants emitted by the cement plant and the onset of chronic diseases. The excess of mortality and hospitalization for cardiovascular and cerebrovascular diseases, reported especially in older women, deserves further investigation, because of the complex cause-effect relations of these diseases., Competing Interests: None declared

Competing Interests: Competing interests: None declared.

: The coronavirus disease (COVID-19) outbreak is rapidly progressing globally, and Italy, as one of the main pandemic hotspots, may provide some hard lessons for other countries. In this paper, we summarize the current organizational capacity and provide a pragmatic and narrative account of strategies and activities implemented by the Department of Prevention (Dipartimento di Prevenzione)-the regional entity of the Local Health Authority of the Italian National Health Service in charge of public health-since the beginning of the outbreak. We conduct a preliminary analysis of general strengths, weaknesses, opportunities, and threats (SWOT) of the response strategies from a local perspective. Furthermore, we provide firsthand insights on future directions and priorities to manage this unprecedented pandemic. Our case report gives a qualitative view of the healthcare response, based on the experience of frontline professionals, with the aim to generate hypotheses about factors which may promote or hinder the prevention and management of a pandemic locally. We highlight the importance of a public health approach for responding to COVID-19 and reshaping healthcare systems., Competing Interests: The authors declare no conflicts of interest.

In Italy, wine production is considered a sector of excellence, where the wines' appreciable sensory features are favored by environmental factors, including weather and climate conditions, which benefit territories with a specific vocation. The whole chain involves many economic and agri-food sector operators, and requires an in-depth assessment of specific risks for identifying critical points, keeping the entire production process under control, and ensuring product traceability. This article describes the results of a pilot study conducted in the Prosecco DOCG (Designations of Controlled and Guaranteed Origin) area, concerning the detection of residues of plant protection products in fifty wine bottles. Although considerably below the maximum residue levels, all the samples tested were positive, ranging from two to five active substances detected in each sample. In addition to the provisions of the European Community legislation, this paper critically evaluates some best practices models that are already used by the Wine Federations of Italy, with the aim of identifying advantages of and areas for improvement in production methods, applicable to raw materials reception, rasping, storage, and bottling phases, in order to guarantee product safety and quality.

Risk perception has a significant impact on decisions people make when facing a threat: a mismatch between actual hazard and perceived risk can lead to inappropriate behaviours and suboptimal compliance to recommended public health measures. The present study was conducted in the aftermath of a tuberculosis (TB) outbreak that occurred in 2019 in a primary school in Italy. The aim was to evaluate the impact of communication measures implemented by local health authorities (including face-to-face meetings between LHAs and the local population, weekly press announcements, implementation of a telephone hotline and of an information desk, and social media communication), on risk perception among parents of schoolchildren and school staff, and to identify factors related to a change in risk perception before and after the said activities. An anonymous questionnaire was administered to parents of schoolchildren ( n = 846) and to school staff ( n = 70). Participants were asked about the level of risk they had perceived at two distinct times: when they first became aware of the outbreak and following implementation of communication activities. A significant reduction of perceived risk was found in both groups ( p < 0.001) following the communication activities. The largest reduction was found among participants who reported having appreciated the meetings with the LHA healthcare staff. Our findings suggest that keeping an open approach, explaining the actual threat to the population and adapting communication to different listening skills, are essential for health authorities to successfully manage a public health emergency.

Glyphosate is the best-selling herbicide in the world and in 2015 the International Agency for Research on Cancer listed it among the &quot;probable carcinogens for humans&quot;, opening a scientific debate that is still going on. On these premises, in 2016, extraordinary samplings of glyphosate, its metabolite AMPA, and a similar compound, ammonium glufosinate, were carried out in 12 wells of the water network intended for domestic consumption in the territory of the Local Health Unit 2 - District of Pieve di Soligo, Province of Treviso, Veneto region, Italy. The area includes 13 municipalities at high-intensity "Prosecco d.o.c.g." wine production. Traces of glyphosate (maximum reached 0.08 µg/L) and AMPA (maximum reached 0.25 µg/L, beyond the legal limit of 0.1 µg/L for drinking water) were detected in 2 wells supplying an urban area. No samples contained traces of ammonium glufosinate. Following these findings, an inter-municipal order to suspend the use of glyphosate was introduced and then entered definitively in the rural police regulation concerning all the municipalities in the Prosecco d.o.c.g. area, which led to the elimination of glyphosate and AMPA also in the initially contaminated wells. The case shows that high-consumption herbicides can reach the drinking water network of a city surrounded by territories with high agricultural activity. Moreover, the combined intervention of the institutions was fundamental to eliminate a &quot;probable carcinogen&quot; from the urban drinking water and to promote the abandonment of potentially harmful agricultural practices in favor of solutions with reduced environmental and health impact.

Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.

Introduction: The Italian Committee of medical residents in Hygiene, Preventive Medicine and Public Health is a member of the Italian Society of Hygiene, Preventive Medicine and Public Health with the aim of developing a network among Italian resident in public health and promoting the educational path improvement through comparisons and debates between postgraduate medical schools. In this perspective, during last years account has been taken of some essential topics concerning education of public health medical residents, which represent future health-care and public health experts., Methods: Cross-sectional researches were conducted among Italian public health medical residents (PHMRs) through self-administered and web-based questionnaires. Each questionnaire was previously validated by pilot studies conducted during the 46th National Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health., Results: Seventy percent of Italian PHMRs considered the actual length of Public Health postgraduate medical school excessively long, with regard to predetermined educational goals. Confirming this statement, 90% of respondents were inclined to a reduction from 5 to 4 years of postgraduate medical school length, established by Law Decree 104/2013. Seventy seven percent of surveyed PHMRs stand up for a rearrangement on a national setting of the access contest to postgraduate medical schools. Moreover 1/3 of Italian schools performed less than 75%of learning and qualifying activities specified in Ministerial Decree of August 2005. In particular, data analysis showed considerable differences among Italian postgraduate schools. Finally, in 2015 only four Italian Universities (Napoli Federico II, Palermo, Pavia, Roma Tor Vergata) provide for the Second Level Master qualify for the functions of occupational doctor. This offer makes available 60 positions against a request of over 200 future Public Health medical doctors who have shown interest in the Master., Conclusions: In Italy, after the introduction of Ministerial Decree 285/2005, the educational course of PHMRs was significantly improved. The standardization of learning and qualifying activities allowed for the first time the attendance at medical directions or Local Health Units. Nevertheless, the excessive lenght of postgradute schools and the differences about training among Italian Universities are critical and actual issue. Moreover, the remarkable interest shown by PHMRs in the Master could suggest a poor job replacement prospect for young medical specialist in Hygiene, Preventive Medicine and Public Health.

Objective: evaluate, through active call, lifestyles of an asymptomatic population in order to identify hyperglycaemic subjects and/or high-blood pressure sufferers to dispatch to their GP to perform suitable checking, and subjects to invite to a cardiovascular disease prevention programme because of their lifestyles., Setting and Participants: between January 2009 and July 2012, all healthy residents in the Local Health Authority of Este (ULSS 17 Este) aged 45-59 years were invited to join a cardiovascular disease prevention programme., Design: all participants were evaluated through an administered lifestyle questionnaire. Parameters such as blood pressure (BP), glycaemia, waist circumference and body mass index were collected and recorded. Participants also received counseling, informational materials on lifestyle and were invited to individual or group health promotion initiatives in relation to personal risk factors., Results: among the invited, 55.5% (3,922/7,071) adhered. Women (58.8%) responded significantly better than men (51.9%) (p <0,01). Subjects without risks factors were 16.7%. Subjects with lifestyle risk factors but normal BP and glycaemia were 49.4%, while those adding altered values for BP and glycaemia were 25.2%. The 8.6% of the respondents were not eligible for the study., Conclusions: the preliminary results suggest that a preventive programme based on the citizens active call by the Department of Prevention could be an effective tool to identify asymptomatic individuals with unknown hypertension and/or hyperglycaemia and to offer lifestyle interventions to lower the risk of cardiovascular diseases.

Objective: This study describes and evaluates the application of a waiting list management program in ambulatory care., Design: Waiting list active management survey (telephone call and further contact); before and after controlled trial., Setting: Local Health Trust in Veneto Region (North-East of Italy) in 2008-09., Participants: Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively)., Intervention: Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care., Main Outcome Measures: The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care., Results: 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care., Conclusions: Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

Only 20% of terminally ill people with cancer in Italy are assisted by a network of palliative care, whereas the majority of them die in the hospital, against their will, and with very low doses of opioids. A palliative care service, is offered by the Nucleus of Palliative care within the Operative Unit of District Primary Care in the local health agency n. 7 of Pieve di Soligo. This service takes charge of the patient from hospital discharge until his/her death, working in concert with the inpatieint hospitals and other territorial health care structures. In this way, the patient and his/her family are followed by a team of professionals working together in coordination and collaboration. In 2010 the percentage of terminally ill persons enrolled in the program was 52%, much greater than the standard of 45% required by ministerial law (DM no 43 del 2007) for the local health agencies without a hospice. The duration of time spent at home during the last phases of the illness was over 90% of time in care, with an in-home mortality of 63%. The consumption of major opioids was amongst the highest in Italy. Thanks to the opening of a hospice, already planned, we will be able to take charge within the network of palliative care thos sick people who cannot remain in the home and extend the service to ill persons without cancer in conditions of advanced incurable disease and end of life.

Steps toward overcoming mandatory vaccination policy follow two main tracks: scientific and administrative. Scientific course checks starting conditions of the project in Veneto Region and monitors the effects of policy. Thanks to sensibilization regional programs and partecipation to national campaigns of vaccination, Veneto Region has achieved high coverage for all actively promoted vaccinations. Specific projects has been implemented in order to improve vaccination system quality, particularly with regard to infectious diseases and vaccine adverse events surveillance, training workers and informatization. On 23rd March 2007 Veneto Region passed the regional law number 7 called "Sospensione dell'obbligo vaccinale per l'età evolutiva" becoming in force for children born since January 1st 2008. The law provides for the institution of a scientific committee having the task of monitoring both vaccination coverage and preventable infectious diseases incidence after overcoming mandatory vaccination policy.

In order to contribute to the definition of good model for cancer screening programs, the paper reports an overview of Veneto Local Health Units' results according to required "gold standard" defined by the authors. The analysis was based on a standard attesting that the program is running stabely and a standard for the organisation requiring that general management is performed by a unique central unit, supplied with a unique software and a working group equipped with specific know-how. Ten of the 21 Locale Health Unit of Veneto Region chose to assign to Prevention Department (Public Health Department) all the three screening programs included in the National Prevention Plan. Among these we found the two achieving the defined gold standard (Thiene and Pieve di Soligo). Management model implemented in these units showed a framework for excellence.

A global and local discussion on Public Health relevance is taking place, including the future role and organization of its services. Noteworthy becomes the role played by Public Health Specialists. This work presents the results of a workshop, carried out following the Guilbert methodology, whose aim was to define Public Health Doctors functions and their related activities. The programme involved 30 professionals from Triveneto area (North Eastern Italy), working in Prevention Departments at National Health Service and Universities. The key-functions identified were: 1) Health status assessment and identification of community risk factors, 2) Health Promotion, 3) Prevention, 4) Protection, 5) Planning, 6) Communication, 7) Professional Training, 8) Alliances and resources for complex Public Health programs, 9) Crisis management in Public Health, 10) Research. For each function activities were identified, meaning concerning areas and contents that must be warranted by professionals. This experience allowed to share existing attitudes and experiences present in Triveneto area, and it can stand as a feasible instrument for different settings. Nevertheless, it appears mandatory explaining at each level in the society role and functions of Prevention Departments.

Aims and Background: Service mammography screening has been reported to have suboptimal performance compared to controlled trials. The aim of this study was to evaluate the sensitivity of the mammography screening program in four Local Health Units (ASL) and the possible causes of diagnostic error in cases further surfacing as interval cancers., Material and Methods: Interval cancers were identified by cross checking of screened women databases with hospital discharge records reporting breast cancer. Proportional interval cancer incidence (observed interval cancers/expected invasive cancers) was determined by matching the database of women screened during 1999-2002 to the hospital discharge records databases during 1999-2003. The ratio of observed interval cancer rate to underlying incidence was compared to international standards and with literature data. Screening mammograms reported as negative and followed by interval cancers were randomly mixed with true-negative controls, and the resulting set underwent blind review by an external radiologist who applied the conventional criteria recommended for the classification of the type of diagnostic error (occult, minimal signs, screening error)., Results: Matching of screening archives with the hospital discharge records databases allowed for the identification of 154 invasive interval cancers compared to 480 expected. The proportional observed/expected interval cancer incidence in the first and second year of the interval was 21% and 46%, respectively (ASL 1 = 14% or 38%, ASL 2 = 19% or 48%, ASL 3 = 30% or 53%, ASL 4 = 25% or 49%). Radiological review included 38 further interval cancer cases, identified after the time limits defined for proportional interval cancer incidence assessment, and could not include 18 interval cancers, not retrieved from ASL 4 archives: overall, 174 interval cancers were reviewed, of which 135 were classified as occult (77.3%) (ASL 1 = 83.3%, ASL 2 = 71.1%, ASL 3 = 78.6%, ASL 4 = 75%), 12 (6.9%) as minimal signs (ASL 1 = 6.6%, ASL 2 = 11.5%, ASL 3 = 2.4%, ASL 4 = 5%), and 27 (15.5%) as screening error (ASL 1 = 8.3%, ASL 2 = 17.3%, ASL 3 = 19.0%, ASL 4 = 25%)., Conclusions: Observed proportional interval cancer incidence was lower than commonly reported for service screening programs and currently recommended (< 30% in the first, < 50% in the second year of the interval). The analysis of interval cancer causes showed a screening error rate below the maximum acceptable standard (< 20% of interval cancers should be classified as screening error) in three of four programs and in average figures. Substantial differences observed among single programs (one did not comply to recommended standards) suggest that space is available for the improvement of overall performance by optimizing program organization and by further training of radiologists. Overall, the analysis showed a good sensitivity of the screening program in the Veneto Region, although the performance was inferior to that of excellence centers, and further action to improve it is possible. Assessment and review of interval cancers is an early indicator of screening efficacy which has not yet been fully adopted in Italian screening programs. Although using hospital discharge records to identify interval cancers may be affected by limited errors, such a procedure is particularly convenient, as data from hospital discharge records are available much in advance compared to cancer registries and are the most reliable source of information for areas uncovered by a cancer registry. Hospital discharge records-based procedures for interval cancers assessment should be employed routinely in screening programs.

Selective rubella vaccination in the 11 years old girls, has been carried out in the Regione Veneto (Venetian Land) since 1974. The rubella immunization rate in teh women born between 1962 and 1978, in five sanitary districts, is 68.25%; the trend of increasing vaccination is continuing. Important differences in the organization of vaccination campaign were found among the five districts.

The incidence of acquired rubella in the females who have been interested by the proposal of vaccination, according to the selective strategy adopted in Italy, allows to appraise the national adhesion to this proposal lower than 50%. The values registered in Venetia suggest an adhesion rate near 80%, which is confirmed by datas about the regional use of vaccine. The punctual verify of vaccinal covering rate in a little Sanitary District in the Province of Treviso points out values higher than 90%.