Northeastern Region Of Italy Research Articles

Incidence, healthcare resource utilization and costs of hospitalized patients with tick-borne encephalitis (TBE) in Italy

ObjectiveOur study's objective was to assess the incidence trends and healthcare resource utilization of hospitalizations for Tick-Borne Encephalitis (TBE) and associated costs in Italy in order to improve public awareness and preventive measures. MethodsThis retrospective observational study was based on the Italian Ministry of Health's Hospital Discharge Record (HDR) database. Data were gathered across Italy from 2015 to 2019, selecting hospitalizations with ICD-9 code 063 related to TBE, both in primary and secondary diagnoses. For each year, we collected the following variables: number of hospitalizations, hospitalization rate, mortality rate, mean length of hospital stay, hospital ward, and cost of hospitalization. ResultsThere were a total of 237 hospitalizations from 2015 to 2019; 62 % of those were male. The lowest number of TBE hospitalizations was in 2015 (21 cases, corresponding to 0.35 per million inhabitants), the highest in 2019 (64 cases, 1.04 per million inhabitants). The summer months saw a greater than average number of hospitalizations. For the years analyzed, the cumulative number of cases peaked in June (54 cases), July (46 cases), and August (35 cases). There were only two deaths registered in our study sample. TBE cases were mostly localized in the North-Eastern regions of Italy. TBE incidence during the study period in the most affected areas were: Autonomous Province of Trento, ranging from 11.2 to 42.3 per million inhabitants, Autonomous Province of South Tyrol, from 0 to 21.1 per million inhabitants, and Veneto Region, from 2.6 to 4.5 per million inhabitants. In the study period, the average length of hospital stay was largely stable ranging from 10.6 days to 12.8 days, with related costs ranging from 5,813.7 € to 7,352.5 €. ConclusionsAccording to our data, the majority of TBE hospitalizations occur in North-East Italy with an increasing trend over the analyzed period. Even though Italy has fewer TBE cases than other neighboring European countries, the health and economic impact can be high in the affected areas.

Provenance, technology and possible function of Gáta–Wieselburg vessels from the Trieste Karst (northeastern Italy)

AbstractA few scattered vessels, typologically attributed to the Gáta–Wieselburg culture, are known from the Friuli Venezia Giulia region in northeastern Italy. This culture spread during the Early Bronze Age (Reinecke Br A1b and A2, 2100–1700/1600 bc) in present‐day eastern Austria, western Hungary and southwestern Slovakia. Rare ceramic artefacts, typically biconical double‐handled jugs with well‐burnished surfaces, have been discovered in caves of the Trieste Karst (Ciclami, Tartaruga, Teresiana and Ossa) and the Natisone Valley (Velika jama). This study aims to outline the technology, provenance and probable use of these rare jugs from the Trieste Karst. Two of these vessels from the Ciclami and Tartaruga caves have been investigated using various destructive and non‐destructive techniques, including optical microscopy, X‐ray computed microtomography and prompt‐gamma activation analysis, and chemically compared to contemporaneous vessels from the core region of the Gáta–Wieselburg culture in Hungary (10 vessels specifically analysed for this project) and earlier Neolithic and Copper Age vessels, likely produced locally in the Karst, Slovenia and Hungary. Based on the obtained results, the investigated Karst vessels were imported. Tentative identification of plant and animal lipids using organic residue analysis (i.e., gas chromatography–mass spectrometry) sheds light on their possible function.

Supporting Fair and Efficient Emergency Medical Services in a Large Heterogeneous Region

AbstractEmergency Medical Services (EMS) are crucial in delivering timely and effective medical care to patients in need. However, the complex and dynamic nature of operations poses challenges for decision-making processes at strategic, tactical, and operational levels. This paper proposes an action-driven strategy for EMS management, employing a multi-objective optimizer and a simulator to evaluate potential outcomes of decisions. The approach combines historical data with dynamic simulations and multi-objective optimization techniques to inform decision-makers and improve the overall performance of the system. The research focuses on the Friuli Venezia Giulia region in north-eastern Italy. The region encompasses various landscapes and demographic situations that challenge fairness and equity in service access. Similar challenges are faced in other regions with comparable characteristics. The Decision Support System developed in this work accurately models the real-world system and provides valuable feedback and suggestions to EMS professionals, enabling them to make informed decisions and enhance the efficiency and fairness of the system.

Reintegrating Cold War landscapes? The former Trieste Barracks in Casarsa della Delizia

This paper engages with a specific feature of former military landscapes, the Cold War barracks, located in a specific territory, the Friuli-Venezia Giulia region in north-eastern Italy, at the former border between the Western and Eastern blocs. Based on several academic activities, such as an international workshop and didactical experiences, this work focuses on the Trieste Barracks in Casarsa della Delizia (in the province of Pordenone) as a laboratory for new landscape solutions to reintegrate a derelict military site into civil society. The main outputs of the research are: 1) updating the international scientific literature and the relative research gaps in the discourse of Cold War post-military landscapes; and 2) an innovative landscape-oriented approach to a former military landscape founded on locally based long-term solutions in terms of resilience and sustainable development. Our research aims to demonstrate that Cold War landscapes have primarily been neglected in the academic field, but academic work in collaboration with local actors can result in feasible solutions to export to other cases.

Relation of the work ability index to fitness for work in healthcare and public employees in a region of Northeastern Italy

PurposeWork ability indicates an individual’s capacity to match job demands according to his/her physical and mental conditions and work circumstances. Occupational physicians should take into consideration the global health status of a worker in order to correctly assess if he/she is fit for the job. The aim of this study was to verify the association between fitness for work evaluation and Work Ability Index scores, as well as individual factors (age, gender, and anthropometric characteristics) and work-related variables (job type, years of working duration).MethodsA cross-sectional study was conducted within the occupational health surveillance of health and public employers in the Friuli-Venezia Giulia region (2018–2022). The participants voluntarily agreed to answer the standard Work Ability Index questionnaire. Data were investigated by univariable as well as multivariable regression analysis.ResultsThe Work Ability Index of the workers included in the study (N = 6893) resulted negatively associated with age, female sex, and body mass index. It was averagely lower in nurses and assistive personnel, and the highest in medical doctors and public employers. The fitness for work assessments was also statistically related to WAI scores. The results obtained from the univariable and the multivariable analysis were consistent.ConclusionsThe Work Ability Index is an efficient tool to measure an individual’s capability to sustain job demands, and can be taken into account to produce a correct fitness for work evaluation and consequently preserve workers’ health status.

Shall we have another? Effects of daycare benefits on fertility, a case study in a region in Northeastern Italy

Policy attempts in Italy to raise fertility place considerable importance on subsidizing daycare. The aim of this paper is to determine whether receiving a daycare subsidy for one child increases the probability of having a subsequent child in the Friuli Venezia Giulia (FVG) region in Italy. A novel approach is used combining administrative data on the means test certification (Indicatore della Situazione Economica Equivalente or ISEE) needed to access various benefits, matched with the actual subsidy requests. Propensity score matching is applied to the resulting longitudinal data set and the matched data are analyzed with an event history analysis model. Results suggest that besides a positive impact of daycare subsidies and family wealth, non-monetary factors have a larger effect, with female employment having a possible postponement effect on subsequent births.

Statistical analysis of electricity supply deficits from renewable energy sources across an Alpine transect

While most of renewable integration studies rely on indicators that are integrated in time, little is known about the statistical properties of the electricity supply deficit periods. This study investigates the frequency and intensity of the electricity supply deficit using the Complete-Time-Analysis (CTA), an approach that allows assessing recurrence intervals of values over thresholds. Conversely to typical extreme analysis, CTA makes uses of the entire time series rather than only using values above the chosen thresholds. As such, it is suitable for short length time series and does not require the independence of the events above thresholds. Intensity-Duration-Frequency (IDF) curves are derived for the considered renewable sources and the role of the complementarity among sources and the use of electricity storage is investigated to reduce the occurrence of electricity supply deficit. The approach is illustrated for a region in North-Eastern Italy where solar photovoltaic (PV) and small run-of the river (RoR) hydropower are the main sources of electricity. Our results highlight that solar PV and small electricity storage capacities are effective to reduce significantly the occurrence of deficits, and RoR hydropower and large electricity storage is more effective to prevent long periods of deficit from happening.

Detection of Leishmania sp. kDNA in questing Ixodes ricinus (Acari, Ixodidae) from the Emilia-Romagna Region in northeastern Italy

To date, sand flies (Phlebotominae) are the only recognized biological vectors of Leishmania infantum, the causative agent of human visceral leishmaniasis, which is endemic in the Mediterranean basin and also widespread in Central and South America, the Middle East, and Central Asia. Dogs are the main domestic reservoir of zoonotic visceral leishmaniasis, and the role of secondary vectors such as ticks and fleas and particularly Rhipicephalus sanguineus (the brown dog tick) in transmitting L. infantum has been investigated. In the present paper, the presence of Leishmania DNA was investigated in questing Ixodes ricinus ticks collected from 4 rural areas included in three parks of the Emilia-Romagna Region (north-eastern Italy), where active foci of human visceral leishmaniasis have been identified. The analyses were performed on 236 DNA extracts from 7 females, 6 males, 72 nymph pools, and 151 larvae pools. Four samples (1.7%) (i.e., one larva pool, 2 nymph pools, and one adult male) tested positive for Leishmania kDNA. To the best of our knowledge, this is the first report of the presence of Leishmania kDNA in questing I. ricinus ticks collected from a rural environment. This finding in unfed larvae, nymphs, and adult male ticks supports the hypothesis that L. infantum can have both transstadial and transovarial passage in I. ricinus ticks. The potential role of I. ricinus ticks in the sylvatic cycle of leishmaniasis should be further investigated.

INFORSAT: AN ONLINE SENTINEL-2 MULTI-TEMPORAL ANALYSIS TOOL SET USING R CRAN

Abstract. Remote sensing via orbiting satellite sensors is today a common tool to monitor numerous aspects related to the Earth surface and the atmosphere. The amount of data from imagery have increased tremendously since the past years, due to the increase in space missions and public and private agencies involved in this activity. A lot of these data are open-data, and academics and stakeholders in general can freely download and use it for any type of application. The bottle-neck is often not data availability anymore, but the processing resources and tools to analyse it. In particular multi-temporal analysis requires stacks of images thus digital space for storage and processing workflows that are tested and validated. Processing image by image is often not a viable approach anymore. Basic tools for multi-temporal analysis are provided via the same web interface, allowing the user to also apply parallel processing for a faster data extraction. A study case over burned areas in the north-eastern region of Italy are reported, to show how the multi-temporal analysis tools provided can be a valid source of data for further analysis. Multitemporal data consisting on the index values of each pixel inside user-defined areas can be downloaded in a spreadsheet that provides the values, the cell ids, the timestamp and the cloud and snow percentage. Also the full-resolution raster with index values that are rendered on screen can be downloaded as GeoTIFF at each specific date.

People’s Perception of Nature-Based Solutions for Flood Mitigation: The Case of Veneto Region (Italy)

Floods have become more frequent due to a growing number of extreme rainfall events linked to climate change and increased urbanization. Additionally, 66% of the world’s population is expected to live in urban areas by 2050, making flood prevention and risk reduction increasingly important. Sustainability, resilience and ecosystem services are essential to increase human well-being in urban environments. Nature-based Solutions (NBS) can provide all the benefits of urban green spaces combined with flood mitigation. This work aims to provide useful information to promote the adoption of NBS to build communities resilient to climate change by exploring how people’s perception of and willingness to implement some NBS. To this end, an online survey was conducted to investigate the knowledge and the perception of NBS and grey infrastructures among people in Veneto, a north-Eastern region of Italy. Data analysis revealed a significant correlation between previous knowledge of water management systems and the perceived effectiveness of some NBS. Behaviors linked to the level of connection with the territory have also been found to influence the perceived effectiveness of NBS. This study provides insights into the dynamics behind the implementation of NBS to reduce the risk of urban flooding and can help policymakers adapt urban plans to promote the adoption of NBS.

Claiming epistemic access: ehciò-prefaced turns in Trevigiano and in regional Italian

This conversation analytic study describes the interactional uses of ciò [ʧɔ], a pragmatic particle that is used both in the regional Italian spoken in Veneto (a region of northeastern Italy) and in Trevigiano (Trevixàn [trevi’zaŋ]), an Italo-Romance variety widely used in the Treviso area. Preliminary results show that ciò (derived from the imperative form of the verb ciór/tòr ([ʧor]/[tɔr] ‘to take’) is mostly used as a preface in responsive position and is frequently preceded by the particle eh. In our data, the (eh) ciò-prefaced turns are designed as general, objective, obvious contributions through which participants provide a wider perspective on the topic while treating the preceding talk as defective or not dealing with relevant aspects of the subject under discussion. This study contributes to the documentation of linguistic forms that are used by speakers of an Italo-Romance variety as conversational resources in talk-in-interaction.

Local occurrence and fast spread of B.1.1.7 lineage: A glimpse into Friuli Venezia Giulia.

In-depth study of the entire SARS-CoV-2 genome has uncovered many mutations, which have replaced the lineage that characterized the first wave of infections all around the world. In December 2020, the outbreak of variant of concern (VOC) 202012/01 (lineage B.1.1.7) in the United Kingdom defined a turning point during the pandemic, immediately posing a worldwide threat on the Covid-19 vaccination campaign. Here, we reported the evolution of B.1.1.7 lineage-related infections, analyzing samples collected from January 1st 2021, until April 15th 2021, in Friuli Venezia Giulia, a northeastern region of Italy. A cohort of 1508 nasopharyngeal swabs was analyzed by High Resolution Melting (HRM) and 479 randomly selected samples underwent Next Generation Sequencing analysis (NGS), uncovering a steady and continuous accumulation of B.1.1.7 lineage-related specimens, joined by sporadic cases of other known lineages (i.e. harboring the Spike glycoprotein p.E484K mutation). All the SARS-CoV-2 genome has been analyzed in order to highlight all the rare mutations that may eventually result in a new variant of interest. This work suggests that a thorough monitoring of the SARS-CoV-2 genome by NGS is essential to contain any new variant that could jeopardize all the efforts that have been made so far to resolve the emergence of the pandemic.

A high-resolution gridded dataset of daily temperature and precipitation records (1980–2018) for Trentino-South Tyrol (north-eastern Italian Alps)

Abstract. A high-resolution gridded dataset of daily mean temperature and precipitation series spanning the period 1980–2018 was built for Trentino-South Tyrol, a mountainous region in north-eastern Italy, starting from an archive of observation series from more than 200 meteorological stations and covering the regional domain and surrounding countries. The original station data underwent a processing chain including quality and consistency checks, homogeneity tests, with the homogenization of the most relevant breaks in the series, and a filling procedure of daily gaps aiming at maximizing the data availability. Using the processed database, an anomaly-based interpolation scheme was applied to project the daily station observations of mean temperature and precipitation onto a regular grid of 250 m × 250 m resolution. The accuracy of the resulting dataset was evaluated by leave-one-out station cross-validation. Averaged over all sites, interpolated daily temperature and precipitation show no bias, with a mean absolute error (MAE) of about 1.5 ∘C and 1.1 mm and a mean correlation of 0.97 and 0.91, respectively. The obtained daily fields were used to discuss the spatial representation of selected past events and the distribution of the main climatological features over the region, which shows the role of the mountainous terrain in defining the temperature and precipitation gradients. In addition, the suitability of the dataset to be combined with other high-resolution products was evaluated through a comparison of the gridded observations with snow-cover maps from remote sensing observations. The presented dataset provides an accurate insight into the spatio-temporal distribution of temperature and precipitation over the mountainous terrain of Trentino-South Tyrol and a valuable support for local and regional applications of climate variability and change. The dataset is publicly available at https://doi.org/10.1594/PANGAEA.924502 (Crespi et al., 2020).

Determinants of length of stay after cesarean sections in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005\u20132015

Since Italy has the highest cesarean section (CS) rate (38.1%) among all European countries, the containment of health care costs associated with CS is needed, along with control of length of hospital stay (LOS) following CS. This population based cross-sectional study aims to investigate LoS post CS (overall CS, OCS; planned CS, PCS; urgent/emergency CS, UCS), in Friuli Venezia Giulia (a region of North-Eastern Italy) during 2005–2015, adjusting for a considerable number factors, including various obstetric conditions/complications. Maternal and newborn characteristics (health care setting and timeframe; maternal health factors; child’s size factors; child’s fragility factors; socio-demographic background; obstetric history; obstetric conditions) were used as independent variables. LoS (post OCS, PCS, UCS) was the outcome measure. The statistical analysis was conducted with multivariable linear (LoS expressed as adjusted mean, in days) as well as logistic (adjusted proportion of LoS > 4 days vs. LoS ≤ 4 days, using a 4 day cutoff for early discharge, ED) regression. An important decreasing trend over time in mean LoS and LoS > ED was observed for both PCS and UCS. LoS post CS was shorter with parity and history of CS, whereas it was longer among non-EU mothers. Several obstetric conditions/complications were associated with extended LoS. Whilst eclampsia/pre-eclampsia and preterm gestations (33–36 weeks) were predominantly associated with longer LoS post UCS, for PCS LoS was significantly longer with birthweight 2.0–2.5 kg, multiple birth and increasing maternal age. Strong significant inter-hospital variation remained after adjustment for the major clinical conditions. This study shows that routinely collected administrative data provide useful information for health planning and monitoring, identifying inter-hospital differences that could be targeted by policy interventions aimed at improving the efficiency of obstetric care. The important decreasing trend over time of LoS post CS, coupled with the impact of some socio-demographic and obstetric history factors on LoS, seemingly suggests a positive approach of health care providers of FVG in decision making on hospitalization length post CS. However, the significant role of several obstetric conditions did not influence hospital variation. Inter-hospital variations of LoS could depend on a number of factors, including the capacity to discharge patients into the surrounding non-acute facilities. Further studies are warranted to ascertain whether LoS can be attributed to hospital efficiency rather than the characteristics of the hospital catchment area.

Recent changes in temperature extremes across the north-eastern region of Italy and their relationship with large-scale circulation

The present study is an analysis of recent changes (1981-2016) in air temperature across the north-eastern region of Italy (NERI), located in a transition zone influenced by the Mediterranean and continental climatological regimes. Annual and seasonal trends in mean maximum and minimum temperatures as well as in selected extreme indices are investigated using high-quality and homogenised daily data deriving from a distributed network of 50 weather stations. The results reveal an overall widespread warming, particularly intense in spring and summer, with significant positive trends in mean and daytime (maximum-related) temperature extremes, especially at lower altitudes. No substantial elevation dependency is observed for trends in minimum-related temperature indices, which are generally characterised by lower spatial variability. Comparable positive and negative trends are identified in the frequency and duration of warm- and cold-related extremes indices. Finally, the influence on temperature extremes of dominant large-scale circulation modes in southern Europe (North Atlantic Oscillation [NAO] and East-Atlantic [EA] pattern) is examined. The results indicate that especially NAO-induced changes can explain observed temperature trends over the NERI, while the impact of the EA pattern is slightly weaker.

Multicenter Evaluation of the C6 Lyme ELISA Kit for the Diagnosis of Lyme Disease.

Lyme disease (LD), caused by infection with Borrelia burgdorferi, is the most common tick-borne infection in many regions of Eurasia. Antibody detection is the most frequently used laboratory test, favoring a two-step serodiagnostic algorithm; immunoenzymatic detection of antibodies to C6 has been shown to perform similarly to a standard two-step workflow. The aim of this study was the performance evaluation of the C6 Lyme ELISA kit compared to a standard two-step algorithm in three laboratories located in the northeastern region of Italy which cater to areas with different LD epidemiology. A total of 804 samples were tested, of which 695 gave concordant results between C6 testing and routine workflow (564 negative, 131 positive). Wherever available, clinical presentation and additional laboratory tests were analyzed to solve discrepancies. The C6 based method showed a good concordance with the standard two-step algorithm (Cohen’s κ = 0.619), however, the distribution of discrepancies seems to point towards a slightly lower specificity of C6 testing, which is supported by literature and could impact on patient management. The C6 ELISA, therefore, is not an ideal stand-alone test; however, if integrated into a two-step algorithm, it might play a part in achieving a sensitive, specific laboratory diagnosis of LD.

Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005\u20132015

Although there is no evidence that elevated rates of cesarean sections (CS) translate into reduced maternal/child perinatal morbidity or mortality, CS have been increasingly overused almost everywhere, both in high and low-income countries. The primary cesarean section (PCS) has become a major driver of the overall CS (OCS) rate, since it carries intrinsic risk of repeat CS (RCS) in future pregnancies. In our study we examined patterns of PCS, planned PCS (PPCS), vaginal birth after 1 previous CS (VBAC-1) and associated factors in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from its 11 maternity centres (coded from A to K) during 2005–2015. By fitting three multiple logistic regression models (one for each delivery mode), we calculated the adjusted rates of PCS and PPCS among women without history of CS, whilst the calculation of the VBAC rate was restricted to women with just one previous CS (VBAC-1). Results, expressed as odds ratio (OR) with 95% confidence interval (95%CI), were controlled for the effect of hospital, calendar year as well as several factors related to the clinical and obstetric conditions of the mothers and the newborn, the obstetric history and socio-demographic background. In FVG during 2005–2015 there were 24,467 OCS (rate of 24.2%), 19,565 PCS (19.6%), 7,736 PPCS (7.7%) and 2,303 VBAC-1 (28.4%). We found high variability of delivery mode (DM) at hospital level, especially for PCS and PPCS. Breech presentation was the strongest determinant for PCS as well as PPCS. Leaving aside placenta previa/abuptio placenta/ante-partum hemorrhage, further significant factors, more importantly associated with PCS than PPCS were non-reassuring fetal status and obstructed labour, followed by (in order of statistical significance): multiple birth; eclampsia/pre-eclampsia; maternal age 40–44 years; placental weight 600-99 g; oligohydramios; pre-delivery LoS 3–5 days; maternal age 35–39 years; placenta weight 1,000–1,500 g; birthweight < 2,000 g; maternal age ≥ 45 years; pre-delivery LoS ≥ 6 days; mother’s age 30–34 years; low birthweight (2,000–2,500 g); polyhydramnions; cord prolaspe; ≥6 US scas performed during pregnancy and pre-term gestations (33–36 weeks). Significant factors for PPCS were (in order of statistical significance): breech presentation; placenta previa/abruptio placenta/ante-partum haemorrhage; multiple birth; pre-delivery LoS ≥ 3 days; placental weight ≥ 600 g; maternal age 40–44 years; ≥6 US scans performed in pregnancy; maternal age ≥ 45 and 35–39 years; oligohydramnios; eclampsia/pre-eclampsia; mother’s age 30–34 years; birthweight <2,000 g; polyhydramnios and pre-term gestation (33–36 weeks). VBAC-1 were more likely with gestation ≥ 41 weeks, placental weight <500 g and especially labour analgesia. During 2005–2015 the overall rate of PCS in FVG (19.6%) was substantially lower than the corresponding figure reported in 2010 for the entire Italy (29%) and still slightly under the most recent national PCS rate for 2017 (22.2%). The VBAC-1 rate on women with history of one previous CS in FVG was 28.4% (25.3% considering VBAC on all women with at least 1 previous CS), roughly three times the Italian national rate of 9% reported for 2017. The discrepancy between the OCS rate at country level (38.1%) and FVG’s (24.2%) is therefore mainly attributable to RCS. Although there was a marginal decrease of PCS and PPCS crudes rates over time in the whole region, accompained by a progressive enhancement of the crude VBAC rate, we found remarkable variability of DM across hospitals. To further contain the number of unnecessary PCS and promote VBAC where appropriate, standardized obstetric protocols should be introduced and enforced at hospital level. Decision-making on PCS should be carefully scrutinized, introducing a diagnostic second opinion for all PCS, particularly for term singleton pregancies with cephalic presentation and in case of obstructed labour as well as non-reassuring fetal status, grey areas potentially affected by subjective clinical assessment. This process of change could be facilitated with education of staff/patients by opinion leaders and prenatal counseling for women and partners, although clinical audits, financial penalties and rewards to efficient maternity centres could also be considered.

Environmental surveillance and spatio-temporal analysis of Legionella spp. in a region of northeastern Italy (2002-2017).

Legionella spp. are considered an important cause of potentially preventable morbidity and mortality, making environmental surveillance a crucial component of risk assessment plans. In this work, 20,319 water samples were collected in 3,983 environmental surveys during a 16-year period by ARPA, the Regional Agency for Environmental Protection, Friuli Venezia Giulia, and the results were studied to better understand the diffusion mechanisms of Legionella. The data showed a strong seasonal signal, a prevalence of L. pneumophila serogroup 2–15 in most environments (63% of positive samples), a prevalence of L. pneumophila serogroup 1 in swimming pool-associated environments (82% of positive samples), a persistent presence of Legionella in hospitals and a recurrent presence of Legionella in other facilities such as hotels, possibly years after interventions, highlighting the difficulty of eradicating the bacteria. Retrospective spatio-temporal analyses on geocoded historical data were carried out with SaTScan using an ordinal model with risk as a covariate to identify potential clusters with an excess of cases in the higher-risk categories. Although no outbreaks occurred during the period of study, such analyses identified spatially restricted zones with unusual contamination, which sometimes were also areas in which several surveys triggered by notifications of clinical cases were performed. Simulations of periodic prospective analyses permitted the assessment of the efficacy of the method in early detection of such clusters. The proposed method may be a useful tool in environmental surveillance, prevention and control of Legionella.

Social network analysis and risk assessment: An example of introducing an exotic animal disease in Italy

Exotic animal diseases are transboundary hazards, characterized by their capability to cover global distances, affecting animal health and welfare with significant economic losses. Their prevention is complex and requires the dynamic management of potential entry points, transmission pathways, and preventative barriers. The well-timed detection of an undefined or unexpected (exotic or re-emerging) threat could minimize the consequences due to onward transmission. As a fit for purpose framework, OIE developed the import risk assessment i.e. a risk assessment model focusing on the entrance of an exotic disease into a geographical area with naïve hosts. In this paper, we propose an improvement of the model by integrating it with Social Network Analysis (SNA) accounting for within-country animal movements. Our integrated model has been used as a combined tool to better estimate the spatial probability of the introduction of at least one affected animal in Italian provinces using Bluetongue (BT) as an example. Starting from international country-specific BT prevalence data, the model estimated the probability of introduction to Italy via two different routes of release i.e. the import of infected animals or the release of infected vectors either associated with imported livestock or through windborne dispersion from Africa. The conventional OIE model estimating the probability of BT entering Italy assuming the same release probability for every Italian province was paralleled by a model integrated with outputs from SNA to account for different release probability among provinces based on animal movements. The conventional model predicted a remarkable homogeneity in the risk among the provinces with some peaks only visible during the warmest months. The model incorporating the network analysis predicted the highest risk to be in the North Eastern region of Italy but also highlighted the likely occurrence in a couple of Southern provinces, an output mirroring past occurrence of BT in Italy. Moreover, the sensitivity analysis highlighted the main role for a couple of model parameters i.e. the probability for a vector to become infected and the vaccine coverage, thus suggesting that an extra effort in vaccine campaigns could be envisaged. The ability to measure animal movements by SNA can allow the identification of geographical risk hot spots and therefore the risk-based targeting of the surveillance system.

Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015.

BackgroundBirths by cesarean section (CS) usually require longer recovery time, and as a result women remain hospitalized longer following CS than vaginal delivery (VD). A number of strategies have been proposed to reduce avoidable health care costs associated with childbirth. Among these, the containment of length of hospital stay (LoS) has been identified as an important quality indicator of obstetric care and performance efficiency of maternity centres. Since improvement of obstetric care at hospital level needs quantitative evidence, we compared the maternity services of an Italian region on LoS post CS.MethodsWe conducted a population-based study in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from all its 12 maternity centres (coded from A to K) during 2005–2015. We fitted a multivariable logistic regression using LoS as a binary outcome, higher/lower than the international early discharge (ED) cutoffs for CS (4 days), controlling for hospitals as well as several factors related to the clinical conditions of the mothers and the newborn, the obstetric history and socio-demographic background. Results were expressed as adjusted odds ratios (aOR) with 95% confidence interval (95%CI). Population attributable risks (PARs) were also calculated as proportional variation of LoS>ED for each hospital in the ideal scenario of having the same performance as centre J (the reference) during calendar year 2015. Results were expressed as PAR with 95%CI. Differences in mean LoS were also investigated with a multivariable linear regression model including the same explanatory factors of the above multiple logistic regression. Results were expressed as adjusted regression coefficients (aRC) with 95%CI.ResultsAlthough decreasing over the years (5.0 ± 1.7 days in 2005 vs. 4.4 ± 1.7 days in 2015), the pooled mean LoS in the whole FVG during these 11 years was still 4.7 ± 1.7 days, higher than respective international ED benchmark. The significant decreasing trend of LoS>ED over time in FVG (aOR = 0.89; 95%CI: 0.88; 0.90) was marginal as compared to the variability of LoS>ED observed among the various maternity services. Regardless it was expressed as aRC or aOR, LoS after CS was lowest in hospital C, highest in hospital D and intermediate in centres I, K, G, F, A, H, E, B and J (in descending order). The aOR of LoS being longer than ED ranged from 1.63 (95%CI:1.46; 1.81) in hospital B up to 32.09 (95%CI: 25.68; 40.10) in facility D. When hospitals were ranked by PAR the same pattern was found, even if restricting the analysis to low risk pregnancies.ConclusionsAlthough significantly decreasing over time, the mean LoS in FVG during 2005–2015 was 4.7 days, higher than the international threshold recommended for CS. There was substantial variability in LoS by facility centre, suggesting that internal organizational processes of single hospitals should be improved by enforcing standardized guidelines and using audits, economic incentives and penalties if need be.