Veneto Region Research Articles

Presentation of the Triveneto Exit-Site Infections Register (RESIsT) and Warm-Up of Peritoneal Dialysis Centers

Infections related to the peritoneal catheter, whether of the exit-site or of the subcutaneous tunnel (ESI), are a predisposing factor for the development of peritonitis. The regions of Friuli-Venezia Giulia, Trentino-Alto Adige and Veneto (Triveneto) have started a collaborative network to spread knowledge and optimize the use of peritoneal dialysis. The need to collect and aggregate ESI data emerged, therefore the project of a Register of ESIs of the Triveneto (RESIsT) was launched. This work analyzes the preparation and testing phase of the Registry.

Surveillance of influenza viruses circulating from 2017/2018 to 2023/2024 seasons in Veneto Region, North-East Italy

BackgroundIn Italy, influenza viruses typically circulate from October to April, causing seasonal epidemics. The pattern of influenza virus circulation varies each season regarding the timing of the first case notification, period of circulation, and predominant influenza virus types and subtypes.MethodsThis analysis used comprehensive data from the national influenza surveillance network for the 2017/2018 to 2023/2024 influenza seasons in the Veneto Region. Influenza A (IAV) and B (IBV) viruses were detected and subtyped using real-time reverse transcriptase-polymerase chain reaction assays.ResultsOf 21,180 oropharyngeal swabs collected from 2017 to 2024, 4,325 (20.42%) were positive for influenza viruses. IAV accounted for 78.68% of positive cases overall, representing more than 65% of cases in every season except 2017/2018 (26.72%). Both A(H1N1)pdm09 and A(H3N2) subtypes were detected in all seasons with varying proportions. IBV represented 21.32% of all positive cases, with Victoria and Yamagata lineages detected simultaneously during the 2017/2018 season. No Yamagata lineage was detected after the 2018/2019 season, and no IBV cases were detected in the 2021/2022 season. In almost all seasons, influenza virus circulation was more significant in adults, especially those 65 years and older, than in children.ConclusionsIn the Veneto Region, influenza virus circulation varied considerably from 2017/2018 to 2023/2024. In the 2020/2021 season, no influenza-positive samples were detected due to circulation of SARS-CoV-2 and related countermeasures. IAVs were the predominant type in most seasons, while IBVs made a limited contribution to the overall disease burden.

Large Language Models in Action: Supporting Clinical Evaluation in an Infectious Disease Unit

Background/Objectives: Healthcare-associated infections (HAIs), including sepsis, represent a major challenge in clinical practice owing to their impact on patient outcomes and healthcare systems. Large language models (LLMs) offer a potential solution by analyzing clinical documentation and providing guideline-based recommendations for infection management. This study aimed to evaluate the performance of LLMs in extracting and assessing clinical data for appropriateness in infection prevention and management practices of patients admitted to an infectious disease ward. Methods: This retrospective proof-of-concept study analyzed the clinical documentation of seven patients diagnosed with sepsis and admitted to the Infectious Disease Unit of San Bortolo Hospital, ULSS 8, in the Veneto region (Italy). The following five domains were assessed: antibiotic therapy, isolation measures, urinary catheter management, infusion line management, and pressure ulcer care. The records, written in Italian, were anonymized and paired with international guidelines to evaluate the ability of LLMs (ChatGPT-4o) to extract relevant data and determine appropriateness. Results: The model demonstrated strengths in antibiotic therapy, urinary catheter management, the accurate identification of indications, de-escalation timing, and removal protocols. However, errors occurred in isolation measures, with incorrect recommendations for contact precautions, and in pressure ulcer management, where non-existent lesions were identified. Conclusions: The findings underscore the potential of LLMs not merely as computational tools but also as valuable allies in advancing evidence-based practice and supporting healthcare professionals in delivering high-quality care.

Women not ageing in place: managing feelings of security, social safeness and emotional wellbeing

Abstract The concept of security, with its various dimensions, is fundamental to the field of ageing literature. However, feeling safe does not always equate to feeling at ease or being comfortable with people and places. Building on these premises, this article presents and analyses the factors involved in the perception of security and social safeness among women ageing in a top-down co-housing project and a nursing home in Italy. This country has one of Europe’s oldest populations, and the ageing population phenomenon is particularly notable in the Veneto region. In response to changing demographics, the search for alternative housing solutions and associated innovative paradigms of care and support has been gaining ground in recent years. Our study analysed data gathered from women who decided not to age in place. Fieldwork was carried out in one of the most densely populated provinces in the Veneto region during 2022 and 2023. The methodology was qualitative and consisted of in-depth interviews, a focus group and a workshop. Participants were 11 self-sufficient older women, aged 75 and over, living in these facilities. Among the elements that contribute to the perception of social safeness, the following stood out: material and structural factors, physical and emotional factors, relational factors and factors linked to independence and autonomy. Finally, the article stresses the need to study social safeness in greater depth, as it could become a new line of social science research capable of providing relevant information on the housing needs of older adults.

Erratum: "Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region".

Erratum: "Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region".

Photoelectrocatalytic advanced oxidation of perfluoroalkyl substances in groundwaters of the Veneto Region, Italy

Photoelectrocatalytic advanced oxidation of perfluoroalkyl substances in groundwaters of the Veneto Region, Italy

Association of perfluoroalkyl substance (PFAS) on vitamin D biomarkers in a highly exposed population of the Veneto Region in Italy.

Association of perfluoroalkyl substance (PFAS) on vitamin D biomarkers in a highly exposed population of the Veneto Region in Italy.

Evidence of Pellagra on 19th Century Human Crania From Northern Italy by Combining Stable Isotope and Paleopathological Analyses

ABSTRACTPellagra is a disease caused by a nutritional deficiency, with fatal outcome due to multiple‐organ failure, that affected European rural areas until the early decades of the 20th century, especially Veneto region (Italy). At the skeletal level, previous studies pointed out that pathological signs left by the disease are generic and typical of many forms of avitaminosis, not useful to recognize the deaths by pellagra in archaeological contests. Here, a detailed paleopathological study was conducted on skulls of individuals dating to the late 19th‐early 20th century, for which the health state and causes of death have been well‐documented at the time. Individuals severely affected by pellagra and non‐pellagrous individuals were investigated; differential analysis was conducted considering pathologies that leaves on skeletal tissue similar anomalies, such as tuberculosis meningitis, scurvy, and meningioma. By integrating the skeletal alterations reported in literature and the intracranial alterations found in this study, we provide recommendations on a framework that could be used to demonstrate diagnostic validity in cases of severe vitamin B3 deficiency. Peculiar lesions that have been found contrasted with lesions linked to other pathologies and those indicated in the literature, and they could prove fundamental to ensure the identification of pellagra. Finally, pathological evidence observed in pellagrous skulls was compared with diet reconstruction, carried out on stable C and N isotope analysis, highlighting a poor‐to‐moderate protein consumption and possible fasting or nutritional stress, together with a large input from C4 plants, as maize. We think that this work can contribute to the understanding of adaptations and variability among past communities by more confidently identifying severe niacin deficiency. The framework allows for greater consistency in diagnostic certainty, facilitating greater comparability in research.

A population database analysis to describe the residual burden of varicella in Italy-a high vaccination coverage area-from 2004 to 2022.

In Italy, universal varicella vaccination (VV) started in 2017 with a two-dose schedule administered in children aged 12-15 months and 5-6 years, achieving 90% coverage in 2019, though with regional variations. To address the limitations in surveillance databases for capturing varicella episodes, the study aimed to evaluate the burden of varicella disease in the pediatric population using a primary care database. This cohort study used data from Pedianet, a comprehensive database of 193 family pediatricians in Italy. The incidence rate (IR) of varicella (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 052 and 052.0-52.9) was evaluated in children aged below 15 years, from January 2004 to April 2022, categorized by calendar year and region. Subjects were followed up from 2004 or their enrollment date until the end of assistance or the study period. Comorbidities and complications were identified. A total of 253,221 children aged below 15 years (resulting in a total follow-up of 1,430,249 person-years) were included in the study. A total of 35,614 varicella index cases were identified in 35,199 subjects (13.9%), with 1.2% experiencing two infections. Complications following varicella occurred in 467 children (1.3%), primarily affecting the skin and soft tissue (46.3%) and the respiratory tract (22.3%). The IR in regions that implemented the VV program before 2017 ranged from 38.3 per 1,000 person-years in 2007 to 0.8 per 1,000 person-years in 2022, while in those that implemented the VV in 2017, the IR decreased from 49.8 per 1,000 person-years in 2017 to 3.2 per 1,000 person-years in 2022. In the Veneto Region, following the implementation of VV in 2006, the IR significantly decreased by 20.5 annually (95% CI: -23.4, -17.5), ranging from 50.2 per 1,000 person-years in 2006 to 1.2 per 1,000 person-years in 2022. The implementation of VV drastically reduced the IR of varicella, further confirming the importance of universal VV coverage.

Characterisation of the prdx4 gene in Squalius cephalus and its role in freshwater environments with varying impact of perfluoroalkyl substances (PFAS).

Characterisation of the prdx4 gene in Squalius cephalus and its role in freshwater environments with varying impact of perfluoroalkyl substances (PFAS).

Integrated One Health Surveillance of West Nile Virus and Usutu Virus in the Veneto Region, Northeastern Italy, from 2022 to 2023.

West Nile virus (WNV) and Usutu virus (USUV) are neurotropic mosquito-borne orthoflaviviruses maintained in an enzootic cycle, in which birds are amplifying/reservoir hosts, while humans and equids are dead-end hosts. As northern Italy, especially the Veneto Region, is considered an endemic area for WNV and USUV circulation, a surveillance plan based on a One Health approach has been implemented since 2008. This work reports the results of entomological, veterinary and human surveillances for WNV and USUV in the Veneto Region in 2022 and 2023, through virological and/or serological examinations. In 2022, 531 human WNV infections were recorded, and 93,213 mosquitoes and 2193 birds were virologically tested, showing infection rates (IRs) of 4.85% and 8.30%, respectively. The surveillance effort in 2023 provided these results: 56 human WNV infections were confirmed, and 133,648 mosquitoes and 1812 birds were virologically tested, showing IRs of 1.78% and 4.69%, respectively. This work highlights the exceptional circulation of WNV in the Veneto Region, due to the new re-introduction of WNV lineage 1 and co-circulation with WNV lineage 2. This paper confirms the efficacy of integrated surveillance for early warning of viral circulation and gives new insights about avian hosts involved in the enzootic cycle of orthoflavivirus in the endemic region of Italy.

Surveillance of Pediatric Invasive Bacterial Diseases in the Veneto Region: Epidemiological Trends and Outcomes over 17 Years (2007-2023).

Introduction: Invasive bacterial diseases (IBDs) such as meningitis and sepsis are significant public health concerns, particularly in pediatric populations. This study analyzes the incidence, outcomes, and bacterial serotype distribution of pediatric IBDs in the Veneto Region over 17 years. Methods: An observational study was conducted using data (2007-2023) from the surveillance system of the Veneto Region, including microbiologically confirmed cases in individuals < 18 years. Differences by age groups and trends were statistically assessed. Results: A total of 535 pediatric IBD cases were reported, with Streptococcus pneumoniae (54.6%), Neisseria meningitidis (19.6%), and Streptococcus agalactiae (13.5%) being the most common pathogens. Haemophilus influenzae infections were more commonly represented in infants under 1 year (41.5%), whereas S. pneumoniae and N. meningitidis were more frequent in the 1-4-year age group (40.8% and 37.1%, respectively). Sepsis was the most common clinical presentation (57.2%), followed by meningitis (36.3%). Serotype analysis revealed that S. pneumoniae serotype 3 was the most prevalent, while serogroup B dominated N. meningitidis cases. Temporal trends generally showed a decline in cases until 2019, a drop during the COVID-19 pandemic, and a subsequent resurgence in 2022-2023. Conclusions: Our research underscores the value of evidence-based epidemiology through robust surveillance systems in tracking IBD trends and serotype shifts, essential for guiding vaccination strategies and public health interventions. These insights highlight the effectiveness of vaccination programs and the necessity of ongoing monitoring to inform public health policies. Improved data integration and completeness are recommended to enhance surveillance accuracy.

Retrospective and Prospective Surveillance and Clinical Presentation of Parvovirus B19 in Veneto, Italy, 2024.

The recent increase in parvovirus B19 (B19V) infections across Europe has underscored the need for enhanced surveillance. In Italy, B19V surveillance is not mandated nationally. This ambispective (retrospective and prospective) study aimed to assess the epidemiological and clinical characteristics of the 2024 apparent surge in the Veneto Region by implementing mandatory disease notification starting in May 2024 and collecting clinical data on confirmed cases. During the surveillance period, 3156 B19V cases were reported, with 2.9% (93/3156) requiring hospitalisation (95% CI 2.4-3.5%). Children under 1 year of age exhibited the highest hospitalisation rate (29.0%), followed by adults aged 18-40 (17.5%). Infections disproportionately affected children aged 1-5 and 6-11, and the Granger causality test showed that an increase in cases among the 1-5-year-olds was predictive of subsequent rises in other age groups (p = 0.0086). Severe complications, including myocarditis, pericarditis, and miscarriage, were observed, and one death occurred following cardiac and neurological complications in a patient without prior risk factors. The presence of concurrent pathologies, particularly haematological disorders, was associated with increased disease severity. These findings highlight the importance of early warning when cases begin rising among preschool-aged children and underscore the need for improved B19V awareness, particularly in high-risk populations. Future efforts should evaluate the feasibility of implementing a systematic, potentially EU-wide, surveillance for B19V.

NON-SMALL-CELL LUNG CANCER: Real-World Population-Based Cohorts' Study.

This retrospective follow-up study evaluates patient outcomes and treatment costs in two cohorts of incident NSCLC patients recorded in the population-based cancer registry of the Veneto Region in 2017 and 2019. This study examines two cohorts of incident NSCLC patients recorded by the Regional Veneto cancer registry in 2017 (493 patients) and 2019 (557 patients). Cancer patients were followed for three years after diagnosis to assess the disease's outcomes and analyze the overall treatment-related costs. Overall survival and cancer-specific mortality were evaluated using Cox regression models. The log-transformed overall treatment costs for the 3 years following diagnosis were analyzed using linear regression. The overall mortality risk significantly lowered in the 2019 cohort (HR 0.84; 95% CI 0.72-0.98, p = 0.024). Stage III patients were not associated with a significant overall survival rate (HR 0.71; 95% CI 0.50-1.02; p = 0.065) but were associated with significantly higher cancer-specific survival (HR 0.61; 95% CI 0.41-0.91; p = 0.015). Overall, the 2019 cohort showed significantly higher costs (coefficient 0.16; 95% CI 0.02-0.30, p = 0.025), particularly as a result of increases in the costs of drug administration, outpatient services, and medical devices. However, during the same 3-year follow-up period, this cohort featured lower average costs for hospice care and hospitalizations. These results revealed notable differences in clinical outcomes and patient-related costs in incident NSCLCs in 2017 and 2019. The study highlights the importance of monitoring clinical outcomes and management costs in real-world oncology practice.

Antimicrobial Stewardship and Infection Prevention and Control in the Veneto Region, Northeastern Italy: Governance Models, Resources, and Key Challenges Across Hospital and Community Settings-Findings from the ARCO Project.

Antimicrobial resistance represents a global health challenge, with Italy among the most affected countries in Europe. In response, the Veneto Region developed governance models to enhance antimicrobial stewardship (AMS) and infection prevention in both hospital and community settings. This study assessed the implementation of these models and explored strategies for improvement. A survey targeting hospital medical and district health management, hospital pharmacies, and primary care pharmaceutical departments was conducted to evaluate governance adherence, resource allocation, training, and reporting practices. Findings were analyzed by a focus group comprising regional experts, infectious disease specialists, microbiologists, and policymakers, which identified critical gaps and proposed actionable recommendations. Results revealed disparities in AMS implementation between hospital and community care, with key challenges including limited multidisciplinary collaboration, inconsistent resource distribution, and gaps in training. The focus group emphasized the need for stronger governance, standardized protocols, and improved communication to address these shortcomings. This study underscores significant gaps and opportunities within the Veneto Region's healthcare system and provides a framework for enhancing AMS and infection prevention strategies, bridging the divide between hospital and community care to combat antimicrobial resistance effectively.

District Functional Unit for Adolescents 2022: a pilot project in Italy to detect mental health strengths and difficulties among youth.

The COVID-19 pandemic significantly impacted young people's mental health, leading to increased distress and reduced life satisfaction worldwide. Among the worst-hit countries, Italy saw mental health services shift online, prioritizing urgent cases. Consequently, therapy for many individuals was interrupted, leaving young people largely neglected. In response, the Italian government allocated €8 million for youth mental health initiatives during the pandemic, and the Veneto region utilized €2 million to establish the District Functional Unit for Adolescents (UFDA) within its public Child and Adolescent Mental Health Services to provide specialized care for young people. The pilot phase was implemented between April and December 2022. This study reports preliminary findings on UFDA's effectiveness in Padua's Local Health Unit. The main objectives include describing patient characteristics and assessing the intervention outcomes. The study involved 255 youths, representing 71.43% of patients at UFDA (mean: 14.4; range: 12-24 years), and 170 parents. Self- and informant-report versions of the Strengths and Difficulties Questionnaire (SDQ) were administered. A regional questionnaire was used to describe the patient profiles, and the intervention progress record documented anamnestic data and clinical progress of patients. The study revealed positive intervention outcomes despite the limited number of psychotherapy sessions. Results of the SDQ highlighted improvements in all difficulty scales after the intervention. The UFDA pilot project underscores the potential of a preventive, youth-centered approach to address young people's mental health needs. The insights from this study can inform strategies to enhance youth mental health care in post-COVID-19 Italy.

Widespread Distribution of chs-1 Mutations Associated with Resistance to Diflubenzuron Larvicide in Culex pipiens Across Italy, Reaching Virtual Fixation in the Venetian Lagoon.

Control interventions against mosquito larvae are the primary measure to reduce the adult abundance and risk of arbovirus outbreaks in Europe. One of the most commonly used larvicides in Italy is diflubenzuron (DFB), which targets chitin synthase 1 (chs-1), interrupting the normal development of larvae into adults. Recent studies identified high levels of DFB resistance in Culex pipiens populations from Emilia-Romagna (Italy) associated with I1043L/M/F mutations at position 1043 of the chs-1 gene. The aim of the present study was to assess the circulation of 1043 resistance alleles in Cx. pipiens populations across Italy, outside Emilia-Romagna, with a focus on the Veneto region. Overall, 1032 specimens were genotyped. The 1043L allele was found in all examined Italian regions (Trentino-Alto Adige 19-36%; Veneto 0-91%; Piemonte 11%; Liguria 28%; Lazio 0-8%; Puglia 5%). The highest frequencies (up to >90%) were observed in the Venetian lagoon, where 1043M was also detected (6-11%). Overall, the relatively low frequencies of 1043 mutations despite extensive and longstanding use of DFB in Italy suggest a high fitness cost worthy of further investigations, while their extremely high frequencies in coastal touristic sites point to these sites as the most relevant for resistance monitoring and larvicide rotation.

Influence of environmental attitudes and time horizons on the valuation of lagoon ecosystem services: A choice experiment approach using principal component analysis.

Influence of environmental attitudes and time horizons on the valuation of lagoon ecosystem services: A choice experiment approach using principal component analysis.

Integrating AI and climate change scenarios for multi-risk assessment in the coastal municipalities of the Veneto region.

Integrating AI and climate change scenarios for multi-risk assessment in the coastal municipalities of the Veneto region.

Contact Tracing During the COVID-19 Epidemic: Insights from the Experience of the Veneto Region in Italy.

Nonpharmaceutical public health interventions, such as contact tracing (CT), have been widely implemented worldwide to mitigate the spread of coronavirus disease 2019 (COVID-19). This study investigated the association between CT activity and COVID-19 cases, as well as the impact of timely contact with positive cases on hospitalizations in the Veneto region in northeastern Italy. Data sources included a CT-focused questionnaire, regional daily CT activity data, and a regional database of daily COVID-19 cases, hospitalizations, and intensive care unit (ICU) admissions. Negative binomial regression models were used to assess associations between CT activity and the number of positive cases, the number of hospitalizations, the time to contact cases, the number of positive cases traced, and the number of CT operators. Different organizational models (OMs) were compared in terms of their effectiveness. Hospitalization rates decreased by 54% when index cases were contacted within 0-1 days compared with a five-day delay in the first period. During periods of increasing case numbers, hospitalizations decreased to 8% for contact ranges of 0-1 and 2-4 days. The increase in CT activity showed a 60% increase in daily activity per 100 cases in the third period, excluding external CT activities. These results emphasize the critical role of prompt and effective CT in controlling the spread of infectious diseases and reducing the burden on health care systems. Further research is warranted to explore the potential benefits and limitations of different organizational models in the context of contact tracing and public health management, as well as in a cross-cultural comparison.