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Fedeli U.,Veneto Region | Grande E.,Italian National Institute of Statistics | Grippo F.,Italian National Institute of Statistics | Frova L.,Italian National Institute of Statistics
World Journal of Gastroenterology | Year: 2017

AIM To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy. METHODS Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups. RESULTS HCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV. CONCLUSION Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virusrelated chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance. © 2017 Baishideng Publishing Group Inc. All rights reserved.


PubMed | Veneto Region, AUSL Reggio Emilia. Servizio Interaziendale Epidemiologia, Azienda ULSS 16 Padua, Azienda ULSS 12 Veneziana and 2 more.
Type: Journal Article | Journal: British journal of cancer | Year: 2016

HPV DNA-based screening is more effective than a Pap test in preventing cervical cancer, but the test is less specific. New HPV tests have been proposed for primary screening. The HPV mRNA test showed a similar or slightly lower sensitivity than the HPV DNA tests but with a higher specificity. We report the results of an organised HPV mRNA-based screening pilot program in Venice, Italy.From October 2011 to May 2014, women aged 25-64 years were invited to undergo a HPV mRNA test (Aptima). Those testing positive underwent cytological triage. Women with positive cytology were referred to colposcopy, whereas those with negative cytology were referred to repeat the HPV mRNA test 1 year later. The results of the HPV mRNA test program were compared with both the local historical cytology-based program and with four neighbouring DNA HPV-based pilot projects.Overall, 23211 women underwent a HPV mRNA test. The age-standardised positivity rate was 7.0%, higher than in HPV DNA programs (6.8%; relative rate (RR) 1.11, 95% confidence interval (CI) 1.05-1.17). The total colposcopy referral was 5.1%, double than with cytology (2.6%; RR 2.02, 95% CI 1.82-2.25) but similar to the HPV DNA programs (4.8%; RR 1.02; 95% CI 0.96-1.08). The cervical intraepithelial neoplasia grade 2+ detection rate with HPV mRNA was greater than in the HPV DNA programs at baseline (RR 1.50; 95% CI 1.19-1.88) and not significantly lower at the 1-year repeat (RR 0.70; 95% CI 0.40-1.16). The overall RR was 1.29 (95% CI 1.05-1.59), which was much higher than with cytology (detection rate 5.5 vs 2.1; RR 2.50, 95% CI 1.76-3.62).A screening programme based on the HPV mRNA obtained results similar to those observed with the HPV DNA test. In routine screening programmes, even a limited increase in HPV prevalence may conceal the advantage represented by the higher specificity of HPV mRNA.


Montecchio L.,University of Padua | Vettorazzo M.,Veneto Region | Faccoli M.,University of Padua
EPPO Bulletin | Year: 2016

Walnut (Juglans regia L.) is traditionally present in most European countries as an ornamental tree, and in Southern Europe in particular it is grown for both fruit and wood. Since the 1980s, to supply the increasing demand for walnut timber, large areas of southern and central Europe, from France to Hungary, have been planted with black walnut (Juglans nigra L.) to provide wood for furniture production. The fungus Geosmithia morbida and its vector Pityophthorus juglandis, causing the thousand cankers disease of walnut in the USA in the last 2 decades, were recently reported in Europe (in Italy) on both walnut species. Thousand cankers disease can have a high negative impact on the landscape and economy of many agricultural and forest areas. Following a detailed pest risk analysis performed by EPPO in 2015, both organisms were included in the EPPO A2 List of pests recommended for regulation as quarantine pests. The main biological, epidemiological and monitoring aspects of thousand cankers disease and its status in Europe are reported. © 2016 The Authors. Journal compilation © 2016 OEPP/EPPO


Dal Ferro N.,University of Padua | Cocco E.,University of Padua | Lazzaro B.,Veneto Region | Berti A.,University of Padua | Morari F.,University of Padua
Agriculture, Ecosystems and Environment | Year: 2016

Many efforts have been made in Europe to improve the environmental quality of agro-ecosystems. Since the 2000s, agri-environmental measures (AEMs) have been financed and implemented in EU countries, although their beneficial effects are still questioned due to poorly targeted environmental issues and a lack of site-specific payments. Indeed, estimates of AEM outcomes at the territorial level require considerable efforts to consider simultaneously multiple environmental objectives with multiple targets. As a result, a DAYCENT model-GIS platform was developed that integrates multiple types of pedo-climatic and land management information. The aim was to provide a decision support system for spatially evaluating and selecting the best AEMs in terms of soil, water and air quality, when compared with a standard scenario without any adopted measure. Our modelled results showed that in the Veneto Region, north-eastern Italy, the AEMs applied from 2007 to 2013 improved the environmental value of the agro-ecosystems, especially in terms of soil and water quality. Continuous soil cover, reduction of soil disturbance through grasslands, conservation agriculture and cover crops were the best simulated strategies to increase soil organic matter content (+25%) and reduce nitrogen leaching (−90%). These strategies were also able to sharply reduce soil water erosion (−86%) and as a consequence P loss, in particular in the steep hilly and mountain areas, although their application to arable lands in those landscapes is still rare. In contrast, care should be taken in the long-term regarding an increase in P leaching, since predictions up to +0.15 kg ha−1 y−1 are reached compared to the standard scenario. Finally, greenhouse gas (GHG) emissions (N2O and CH4) were reduced mainly due to increased fertilisation efficiency. The proposed method can be a flexible decision support tool for a result-oriented and scientifically-based evaluation of AEMs that may help policy makers to evaluate the most effective measures for increasing the environmental value of agro-ecosystems. © 2016 Elsevier B.V.


Fedeli U.,Veneto Region | Schievano E.,Veneto Region | Lisiero M.,Veneto Region | Avossa F.,Veneto Region | And 2 more authors.
Population Health Metrics | Year: 2013

Background: The analysis of multiple causes of death data has been applied in the United States to examine the population burden of chronic liver disease (CLD) and to assess time trends of alcohol-related and hepatitis C virus (HCV)-related CLD mortality. The aim of this study was to assess the mortality for CLD by etiology in the Veneto Region (northeastern Italy).Methods: Using the 2008-2010 regional archive of mortality, all causes registered on death certificates were extracted and different descriptive epidemiological measures were computed for HCV-related, alcohol-related, and overall CLD-related mortality.Results: The crude mortality rate of all CLD was close to 40 per 100,000 residents. In middle ages (35 to 74 years) CLD was mentioned in about 10% and 6% of all deaths in males and females, respectively. Etiology was unspecified in about half of CLD deaths. In females and males, respectively, HCV was mentioned in 44% and 21% and alcohol in 11% and 26% of overall CLD deaths. A bimodal distribution with age was observed for HCV-related proportional mortality among females, reflecting the available seroprevalence data.Conclusions: Multiple causes of death analyses can provide useful insights into the burden of CLD mortality according to etiology among different population subgroups. © 2013 Fedeli et al.; licensee BioMed Central Ltd.


Fedeli U.,Veneto Region | Zorzi M.,Veneto Tumour Registry | Urso E.D.L.,University of Padua | Gennaro N.,Veneto Region | And 3 more authors.
Cancer | Year: 2015

BACKGROUND Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) were found to reduce overall CRC surgery rates, but to the authors' knowledge data by subsite are lacking. The objective of the current study was to assess the impact of FIT-based screening on proximal and distal CRC surgical resection rates. METHODS The Veneto region in Italy can be subdivided into 3 areas with staggered introduction of FIT-based screening programs: early (2002-2004), intermediate (2005-2007), and late (2008-2009) areas. Time series of proximal and distal CRC surgery were investigated in the 3 populations between 2001 and 2012 by Joinpoint regression analysis and segmented Poisson regression models. RESULTS The impact of screening was similar in the study populations. Rates of distal CRC surgical resection were stable before screening, increased at the time of screening implementation (rate ratio [RR], 1.25; 95% confidence interval [95% CI], 1.14-1.37), and thereafter declined by 10% annually (RR, 0.90; 95% CI, 0.88-0.92). Rates of proximal CRC surgical resection increased by 4% annually before screening (RR, 1.04; 95% CI, 1.03-1.05) but, after a peak at the time of screening initiation, the trend was reversed. The percentage represented by proximal CRC surgery rose from 28% in 2001 to 41% in 2012. CONCLUSIONS In this natural multiple-baseline experiment, consistent findings across each time series demonstrated that FIT-based screening programs have an impact both on proximal and distal CRC surgery rates. However, underlying preexisting epidemiological trends are leading to a rapidly increasing percentage of proximal CRC. Cancer 2015;121:3982-3989. © 2015 American Cancer Society.


Varotto M.,University of Padua | Lodatti L.,Veneto Region
Mountain Research and Development | Year: 2014

Degraded terraced landscapes are one of the most characteristic "landscapes of abandonment" in the European mountains. Especially in the last few decades, increasingly terraces have been losing their functionality, undermining the stability of slopes. Public initiatives and scientific surveys focusing on such landscapes have recently increased, but the problems of maintaining and managing abandoned areas are still acute. A project promoting adoption of abandoned terraces, which began in 2010 in the Brenta Valley in the Veneto region, Italy, is a small but interesting attempt to revitalize a traditional landscape through new forms of social management. The success of this initiative provides an opportunity to reflect on new forms of family farming in periurban European mountain contexts that retain some characteristics of Alpine culture-generating new forms of community and solidarity, farming practices oriented toward multifunctionality, and relations marked by multiscalarity. These practices involving new family farmers differ from both traditional productive farming and modern market-based economy. However, in order to improve and expand, such new family farming will require innovative forms of governance and partnership between city and mountain residents, going beyond the tourism-and conservation-based models of the 20th century. © International Mountain Society.


PubMed | Veneto Region, University of Verona, Local Health Unit and University of Padua
Type: | Journal: Population health metrics | Year: 2015

Identifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases.The whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.In the whole mortality archive, diabetes was mentioned in 12.3% of death certificates, and selected as the UCOD in 2.9%. The death rate for diabetes as the UCOD was 26.810(5) against 112.610(5) for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1%, and selected as the UCOD in 13.4%. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm.The use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.


PubMed | Veneto Region and S Antonio Hospital
Type: Journal Article | Journal: Journal of neurology | Year: 2016

A high mortality from cerebrovascular diseases has been reported among immigrants in Europe; however, data on stroke incidence in immigrants are sparse. Aim of the study is to assess hospitalization rates for stroke across different immigrant groups in the Veneto Region (Italy). The study population was represented by all residents aged 20-64 years. Admissions for stroke in 2008-2013 were extracted from hospital discharge records based on diagnosis codes. We computed age and gender specific rates separately for Italian and foreign residents. For each area of origin (Eastern Europe, North Africa, Sub-Saharan Africa, South Asia, other Asian countries, Central-South America, and industrialized countries) we calculated standardized hospitalization ratios (SHR) by means of indirect standardization, with rates observed in Italian residents as a reference. We identified 9740 hospitalization for stroke, 8.0% of which occurred in immigrants. Overall stroke rates were higher in immigrants males (SHR 1.45, 95% confidence interval 1.32-1.59) and females (SHR 1.21, 1.08-1.36) with respect to the Italian population. The highest risk was observed in Sub-Saharan Africans, in both genders (males SHR 3.15, 2.62-3.76; females SHR 3.15, 2.22-4.34), followed by immigrants from South Asia and other Asian countries. Our findings confirm the increased risk of stroke in immigrants, with wide variations by country of origin. Further studies are warranted to investigate associated risk factors in order to shape effective preventive strategies.


Fedeli U.,Veneto Region | Schievano E.,Veneto Region | Lisiero M.,Veneto Region
World Journal of Surgery | Year: 2012

Background Contrasting findings on trends and determinants of operative mortality after surgery for esophageal and gastric cancer have been reported from populationbased studies. Methods Discharge records of residents in the Veneto Region (northeastern Italy) with a diagnosis of esophageal or gastric cancer and intervention codes for esophagectomy or gastrectomy were extracted for the years 2000-2009. In-hospital, 30-day, 90-day, and perioperative (30-day + in-hospital) mortality were computed. The influence of patient and hospital variables on in-hospital mortality was assessed through multilevel models. Results Overall, 6,500 resections were performed in the period of 2000-2009, with a 10 % decline in the second half of the study period. In-hospital mortality was 4.6 % (5.3 % in 2000-2004 and 3.8 % in 2005-2009) and was higher for extended total gastrectomy and total esophagectomy. In 2005-2009 mortality declined for all resection types except extended total gastrectomy (8.0 %). For esophageal procedures, 30-day mortality was lower than in-hospital or perioperative mortality. A protective effect of procedural volume was found for esophageal but not for gastric resections; among gastric procedures, mortality was higher in male patients and in extended total gastrectomy patients. Conclusions Analyses of discharge records allowed investigation at a population level of time trends (downward mainly for esophageal resections) and determinants of perioperative mortality (hospital volume, gender, and procedure type). © Société Internationale de Chirurgie 2012.

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