Bollettino Epidemiologico e Prospettive di Sanità Pubblica

Leading article

Paola Malvasio — 2025-12-22

The Bollettino Epidemiologico e Prospettive di Sanità Pubblica (BE-PSP) has reached its 26th edition, the second edition as an Open Access online journal. The BE-PSP has a twofold objective: to present demographic and health trends to guide public health intervention planning, and to promote a scientific approach to interpreting activity data.

Demographic analysis of the Local Health Authority CN2 (year 2024)

Carlo Di Pietrantonj — 2025-12-23

The territory of ASL CN2 consists of 75 municipalities with a total population of 168,764 inhabitants as of December 31, 2024 (4% of the regional population). Of these, 12.2% are under 15 years of age, while 25.1% are over 65. The average age is 45 years for males and 48 years for females. Between 2013 and 2024, the population experienced a progressive decline, with a total loss of more than 3,000 inhabitants, corresponding to approximately 1.8%. This decrease is mainly driven by the persistently negative natural balance, meaning that births do not offset deaths. In 2024, the birth rate was 6.2 per 1,000 inhabitants (about 1,000 newborns), compared to a mortality rate of 11.3 per 1,000 inhabitants (about 2,000 deaths). The migratory balance (i.e., the number of people settling in the ASL territory exceeds those leaving) only partially compensates for the effect of low birth rates. The foreign resident population remains essentially stable at around 11.3% of the total.

Overall and cause-related mortality in 2022

Giuseppina Zorgniotti — 2025-12-23

The report examines overall and cause-specific mortality in ASL CN2 for the year 2022, using ISTAT death certificates from the B.D.D.E. Piemonte database. In 2022, there were 2,206 deaths (47.6% males, 52.4% females), representing 3.8% of the regional mortality. Age-standardized mortality rates were 541.5 per 100,000 residents for males and 383.5 for females. The long-term declining trend observed from 1991 to 2019 was interrupted in 2020 due to Covid-19.
Cardiovascular diseases and malignant tumors remain the leading causes of death. Among men, ischemic heart diseases and respiratory tract cancers are prevalent, while in women, cerebrovascular diseases and breast cancer are most frequent. The vast majority of deaths occur in individuals over 65 years (88.9% men, 93.9% women).
Other relevant causes include respiratory diseases, mental disorders (particularly significant among women), accidental causes, and Covid-19, responsible for 5% of male deaths and 4.2% of female deaths. Additionally, smoking-related deaths (224 cases) and alcohol-related deaths (46 cases) are monitored. Standardized mortality rates show a gradual long-term decrease for most major causes.

Work and health in the territory of asl cn2: Accidental events and occupational diseases Before and after the pandemic 2019 – 2023. Focus on the construction sector in the twenty-year period 2004 – 2023

Giuseppe Calabretta — 2025-12-23

With 2023, the variables introduced during the pandemic period are definitively overcome, and the analysis of the trend in accidents and occupational diseases can resume. An initial assessment highlights the return of a positive trend in the reduction of harmful events, including in the construction sector, which has always been one of the areas most affected by accidents and occupational illnesses.
Nevertheless, the still high number of harmful events and fatal cases continues to underline the need for increasingly effective prevention measures, adapted to the rapid changes in the world of work.

Gender-Specific Medicine (GSM): Knowledge Needs. A Survey for Healthcare Professionals of ASL CN2

Annamaria Gianti — 2025-12-23

A total of 404 employees responded to the survey aimed at identifying knowledge needs related to Gender-Specific Medicine (GSM), representing approximately 23.7% of staff within the relevant professional profiles. The level of participation can be considered adequate for descriptive purposes and to guide initial organisational reflections. Overall, respondents were predominantly female, with a strong presence of nursing and medical professionals, mainly employed in hospital wards. More than seven out of ten respondents reported having only a general understanding of GSM, while fewer than one in ten stated that they possessed an in-depth knowledge of the subject. Most respondents indicated that they had never received specific training, nor were they familiar with guidelines or relevant regulations. At the same time, a broad and widespread interest in further learning clearly emerged. Awareness of gender differences in clinical practice is present but still fragmented and inconsistent; the prevailing perception is that GSM is not systematically embedded in organisational procedures and that its application largely depends on the individual professional’s sensitivity and the specific work context. The areas in which respondents reported significant gender-related differences include treatment adherence, psychological support, access to care, and the diagnostic process. The sample shows marked uncertainty regarding research in the field of GSM: the vast majority stated that they did not know whether evidence exists that has not yet been translated into practice, with greater awareness among medical/dental professionals (17.7% affirmative responses). A similar pattern was observed in relation to the question on the existence of research topics that remain unexplored. The aspects of care identified as needing strengthening include treatment planning and doctor–patient communication, followed by prevention/complications and equitable access to services. The interventions considered most urgent were staff training, awareness-raising campaigns, and the development of dedicated guidelines and care pathways.

Nitrogen oxides in the ASL CN2 area

Elisa Elampe — 2025-12-23

Among the most critical pollutants in the Po Valley of the northern Italy there are nitrogen oxides (NOx); in particular nitrogen dioxide (NO2) is classified by the IARC as a possible carcinogen for humans. So this work analyzes NO2 concentrations at a local scale, using the monitoring data of the Air Quality Stations, located in the territory of the ASL CN2.
During 2024, NO2 concentration values were the lowest of the entire series of available data, according to the regional level.
Measured data were compared with legal indicators (ex D.Lgs. 155/2010), annual average limit value and number of hourly limit exceedances;
An analysis of meteorological parameters, wind speed and precipitation, was then carried out, using the data of the meteorological stations located in the territory of the ASL CN2.

Rainfall Analysis in the ASL CN2 Area – Year 2024

Elisa Elampe — 2025-12-23

In Piedmont Region the year 2024 was characterized by large rainfall; looking at the last 70 years, it ranks among the top places for total annual precipitation.
Months such as February, March, May and October 2024 were much wetter than the relative historical average, calculated for the thirty-year reference period 1991-2020 also in the territory of ASL CN2.
All of that just two years after the great drought occurring in 2022, when in the area total annual precipitation was only a little more than 400 mm, highlighting an increasingly alternation of climatic extremes.
In the present work, total precipitation (daily, monthly, annual) was analyzed at local level, using data measured by meteorological stations of Arpa Piemonte located in the territory of ASL CN2; precipitation values of 2024 were compared with the climatic norm values of the area.
Using available historical data (1991-2020), the following climatological indicators were calculated: number of wet days (number of days/year where daily precipitation exceeds 1 mm), number of heavy precipitation days (number of days/year where daily precipitation exceeds 20 mm) and CDD drought index (maximum number of consecutive dry days in the year); obtained values were compared with the same ones computed for 2024.

Welding Fumes and Carcinogenic Risk: Reflections from the S.Pre.S.A.L. of ASL CN2 within the Framework of the Targeted Prevention Plan “Occupational Carcinogenic Risk”

Giuseppe Calabretta — 2025-12-23

Welding fumes, especially those generated during stainless steel welding, are classified as Group 1 carcinogens by the IARC, with strong evidence linking exposure to increased risks of lung cancer and other malignancies. This article discusses the targeted prevention plan implemented by ASL CN2 SPRESAL to monitor and reduce occupational exposure to carcinogenic welding fumes. While environmental monitoring is essential, it alone is insufficient; biological monitoring is crucial to accurately assess individual uptake of hazardous substances such as hexavalent chromium and nickel. Italian legislation (D.Lgs. 81/2008) mandates employers to implement technical measures—primarily local exhaust ventilation systems—to minimize exposure and to ensure continuous health surveillance of exposed workers. The article also reviews the acute and chronic health effects associated with welding fume exposure, including respiratory diseases and cancer, supported by epidemiological and toxicological data. Field inspections reveal gaps in preventive practices, underscoring the need for integrated, multidisciplinary strategies involving employers, occupational physicians, and SPRESAL to effectively protect worker health.

Analysis of the sporting-age population of the ASLCN2 Alba-Bra in 2024

Gianluca Toselli — 2025-12-23

La SSD Medicina Sportiva dell’ASLCN2 effettua annualmente le visite medico-sportive finalizzate al rilascio dell’idoneità all’attività sportiva di tipo agonistico a partire dagli 8 anni di età (anagrafica o solare a seconda dello sport praticato). La visita permette di rilevare gli sport maggiormente praticati dai soggetti di sesso maschile e femminile, la zona territoriale di provenienza e soprattutto di calcolare l’indice di massa corporea (IMC) il quale rappresenta un indice indiretto dello stato di adiposità di un individuo e viene comunemente utilizzato per valutare lo stato ponderale ed il rischio di sovrappeso ed obesità nella popolazione o in gruppo di individui. I dati relativi al 2024 evidenziano nuovamente il trend negativo di soggetti con eccesso ponderale sia in fase pre-puberale che adulta soprattutto a carico del sesso maschile che suggeriscono la necessità e l’importanza da parte del singolo e delle istituzioni di mettere in atto interventi mirati ad un miglioramento dello stile di vita, in particolar modo una corretta alimentazione ed un’adeguata attività fisica.

Food Security: From the Silk Road to Global Safety Nets

Francesco Isacco Galli — 2025-12-23

Through the simulated story of the Republic of Valloria, this article aims to show readers the importance of safety networks and global connections in managing food crises, in order to protect public health, animals, and the environment.

“Be careful about waste”: 7 years of activities

Francesca Fioretto — 2025-12-23

Started in 2018, the project “Be careful about waste!”, promoted by ASL CN2, has evolved over the years into a series of awareness initiatives aimed at promoting healthy and sustainable lifestyles among the local population. Through the use of social marketing strategies, training programs, communication, and awareness activities have been developed at multiple levels, aimed at disseminating best practices in food management, selection, and consumption, both at home and in catering. The working group’s activities have been carried out in diverse contexts, including schools of all levels, workplaces and local communities.

WORK AND HEALTH. Occupational accidents among workers in ASL CN2

Stefano Nava — 2025-12-23

This summary outlines data relating to workplace accidents among ASL CN2 employees in the period 2019-2024, with a particular focus on the year 2024. The accident trend at national and regional level (Piedmont) was influenced by the COVID-19 pandemic, with a peak in 2020 and a subsequent decrease. After a period of decline, there is a trend towards stabilization in accidents, net of COVID-19 accidents. The number of employees increased significantly (approximately 49%) in the period 2019-2024. Biological accidents (66.7% of the total) are more numerous than non-biological accidents (33.3%), but this figure is influenced by COVID-19 accidents. Excluding COVID-19, percutaneous contamination is more frequent than mucocutaneous contamination. Puncture wounds (needles, scalpels, etc.) are the most common. The most exposed professional figure is the ward nurse, and the departments most affected are those specializing in surgery and medicine. Among non-biological accidents, accidents while commuting and road accidents during shifts are the most common, followed by contusions. Also noteworthy are accidents due to assault, especially in psychiatry (SPDC) and emergency rooms. In 2024, the total number of accidents decreased compared to the previous year (81 vs. 104). Biological accidents decreased by 37%, and non-biological accidents by 14%. No cases of COVID-19 were found. Accidental punctures prevail among biological injuries and commuting accidents among non-biological injuries. Hospital wards are the most affected, with assaults in Psychiatry and biological injuries in Internal Medicine, Emergency Rooms, and Operating Rooms. Healthcare tasks are the most exposed. The total number of days of absence from work due to accidents was 1,016, mainly due to blunt trauma, accidents while commuting, and assaults. 29.6% of accidents (all biological) were ‘zero days’. A ‘stepped’ trend was observed, with peaks in March, July, and October (biological accidents) and February, July, and November (non-biological accidents).

Therapeutic Education Programs in France in the Grand Est Region: State of the Offer, Operational Challenges, and Development Perspectives (2023)

Maria Grazia Ciofani — 2025-12-23

A study is described that analyzes the current state of the offering, operational challenges, and development prospects of Patient Therapeutic Education (PTE) programs in the Grand Est region of France, within the context of recent healthcare reforms and policies aimed at innovation and sustainability of the French healthcare system. Through a descriptive survey of the 364 programs active in 2023, key areas of intervention, modes of delivery, patient and patient association involvement, as well as operational challenges such as staff availability and patient recruitment, emerged. The data highlight an increase in multi-morbidity programs and a rise in educational activities conducted externally and digitally, although challenges related to human resources and active patient engagement persist. Future prospects are oriented toward strengthening the local network, integrating education into the care pathway, and developing new structures and assessment tools. The multidisciplinary and innovative analysis of PTE is seen as a key element to promote a more effective, equitable, and sustainable healthcare system.

Infectious Disease Notifications Local Health Authority CN2 (year 2024)

Valentina Blengini — 2025-12-23

In 2024, Piedmont reported 9,512 infectious diseases, including 1,502 foodborne cases, through the national PREMAL surveillance system. The regional picture varies sharply by age: scarlet fever, chickenpox, and scabies show very high incidence among children and adolescents, while sexually transmitted infections—especially gonorrhoea and syphilis—are concentrated in young adults, predominantly males. Legionellosis and invasive bacterial diseases are more common in the elderly. Within ASL CN2, 508 cases were notified. Childhood exanthematous diseases peak in the 5–14 age group, whereas scabies is widespread across ages, with a maximum among 15–24-year-olds. The 2013–2024 trend analysis highlights the decline in varicella following mandatory vaccination and the rising incidence of scabies and gonorrhoea. Ongoing surveillance is essential to detect emerging trends and guide public-health strategies.

Foodborne Disease Surveillance in the Local Health Authority (ASL CN2): Reporting Trends from 2013 to 2024 and Public Health Implications

Giovanni Centonze — 2025-12-23

Foodborne diseases (FBDs) remain a significant public health concern. This study analyses notifications of FBDs reported in the Piedmont Region and the ASL CN2 local health authority over the period 2013–2024. The most frequently identified etiological agents were Campylobacter and Salmonella, showing respectively increasing and stable regional trends, consistent with national and European patterns. A marked decline in notifications was observed in 2020, likely attributable to the impact of the COVID-19 pandemic. Although ASL CN2 reports lower absolute numbers, incidence rates are often higher than regional values, suggesting a high sensitivity of the local surveillance system. The analysis also highlights the relevance of the broad category of unspecified foodborne infections/intoxications, which continues to represent a substantial share of notifications. Overall, the findings underscore the importance of maintaining sensitive and continuous surveillance systems, growth microbiological diagnostics, and promoting targeted preventive interventions, particularly for the most vulnerable population groups.

Characteristics of the demand for Home and Residential Care ASL CN2 Alba–Bra. Jan 2024 – Sept 2025

Mirko Panico — 2025-12-23

This report analyses the characteristics of the demand for care at the first assessment of patients seeking home care and residential care within ASL CN2–Alba-Bra, in the period between January 2024 and September 2025.
Accordingly, the report is structured into two sections: the first describes the demand for care at the first assessment in Home Care, while the second describes the demand for care at the first assessment in Residential Care.
Home Care: Among the 18,470 first assessments carried out in home care, the largest share concerns Scheduled Home Care (ADP), accounting for 41.3% of cases, followed by the Home Nursing Service (SID) (36.0%), Integrated Home Care (ADI) (20.9%), and Home Palliative Care (1.5%). Rehabilitative care (RRF) represents 0.3%.
Patients typically present with advanced age, multimorbidity and frequent cognitive or behavioural impairment. In ADP (7,627 assessments), almost 90% of users are at least 75 years old, with a clear predominance of women (68.7%). More than half exhibit moderate or severe cognitive impairment, and the clinical profile is dominated by chronic–degenerative conditions. ADI (3,863 assessments) involves a similar population: approximately 71% are aged 75 or older. Activation times remain very rapid, though with a slight slowdown in 2025. The RRF setting (48 cases) mainly includes patients with fractures, arthropathies or neurological sequelae; although limited in number, these cases require intensive rehabilitative interventions.
Residential Care: Based on 2,579 first assessments, Temporary Health Residential Care (CAVS) clearly predominates, accounting for more than four-fifths of cases (81.7%), confirming its role as the main response to post-acute and hospital-to-community transition needs. Other types of care — ordinary residential care (11.4%), temporary non-medical residential care (6.4%), and semi-residential care (0.5%) — show a smaller weight and a slight decline over the observation period.
The user profile is predominantly geriatric and frail, with a high incidence of functional and cognitive impairment, and with a significant component of social or family-related motivations in non-medical pathways.

Health status and behavioral factors in the ASL CN2 through PASSI and PASSI d’argento surveillance (2023-2024)

Anna Castiglione — 2025-12-23

Both PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) population-based surveillance system and the PASSI D’ARGENTO surveillance system are essential tools for monitoring and assessing the main health determinants in the adult and older populations, respectively. This report focuses on the temporal trends of the indicators and, where data are available, on the assessment of possible differences among population subgroups. It provides a useful overview for defining health strategies aimed at promoting well-being and reducing health inequalities. Obtained results suggest that the adoption of good health practices is more widespread among individuals with higher educational attainment and among younger age groups. Conversely, health-damaging behaviors such as alcohol consumption and smoking are more prevalent in more vulnerable population groups, including those with lower levels of education or financial hardship.

Home injuries incidence in ASL CN2 through PASSI and PASSI d’argento surveillance (2023-2024)

Anna Castiglione — 2025-12-23

Despite the strong health, social, and economic impact of home injuries in the general population, currently, the home injuries rate is difficult to estimate, especially at the local level. The prevalence of home injuries in adult population of ASL CN2 is low (2.53%; 95% CI: 1.51 – 4.20) and increases significantly in the elderly population: the prevalence of falls (which represent one of the possible types of domestic accidents) exceeds 15% among older adults (17.63%; 95% CI: 13.53–22.64). Despite these findings, only a small proportion of the population in ASL CN2 perceive themselves to be at high risk of accidents (<5% among adults and <15% among the elderly). Therefore, addressing home injuries requires a strategy that involves all relevant healthcare services in a cross-cutting manner, through integrated preventive actions and evidence-based interventions.

Telemedicine in Peritoneal Dialysis and Predialysis, an innovation initiated by the ASL CN2

Loris Neri — 2025-12-23

Telemedicine in Peritoneal Dialysis (PD) was born in Italy in 2001 at the Peritoneal Dialysis Unit of the ASL CN2, the ideal area of Nephrology for the development of a new remote interaction system.
Initiated with the aim of preserving and expanding the autonomy of patients and/or caregivers, and proven over time to be safe and effective, telemedicine has experienced a substantial expansion in its fields of application. Technological development, the increasing availability of equipment, and epidemiological changes over the past twenty years have all contributed significantly to this evolution. Telemedicine currently encompasses all aspects of PD (treatment selection, training, telemonitoring, and follow-up), but, thanks to Artificial Intelligence (AI), it promises increasingly significant changes in the near future in traditional methods of interaction between doctor/nurse and patient/caregiver.

Indicatori per l’analisi della mobilità passiva extraregionale

Amos Olivero — 2025-12-23

Passive extra-regional healthcare mobility represents a critical issue for Regional Health Services, as it expresses a demand for hospitalisation that is met outside the territory of competence, with significant organisational and economic implications. In this paper, we propose a pair of summary indicators for assessing passive extra-regional mobility: the ratio between hospitalisations lost and hospitalisations gained (F/P-Vol.) and the ratio between economic value lost and economic value gained (F/P-Val.). ‘Outflow’ refers to hospitalisations provided by facilities located outside the region to citizens assisted by the ASL; “inflow” refers to the total number of hospitalisations and the value generated by accredited public and private facilities in the company’s territory. The indicators make it possible to quantify the weight of demand met outside the region compared to the total demand met, both in terms of volume and resources absorbed, and to compare ASLs and individual DRGs. Application to a group of Piedmont ASLs on five high-flight DRGs shows how the combined trend of F/P-Vol. and F/P-Val. allows critical situations to be identified, as well as systematic differences between the average value of flight admissions and production. Finally, a statistical formalisation based on the Delta method is proposed to estimate the standard error of the F/P-Vol. indicator, which is useful for distinguishing random fluctuations from systematic variations.

Visual Representation of Trichotomous Items: A Graphical Approach to Analyzing Preferences

Carlo Di Pietrantonj — 2025-12-23

Data visualization is a fundamental tool in statistical analysis because it allows hidden structures and patterns to be revealed. Particularly when sets of three-mode categorical items such as “yes / no / don’t know” are used, such as in opinion questionnaires or in rating scales and perceptual surveys, tabular representation is not always straightforward to read, whereas a graph helps to capture differences and similarities with immediacy. This paper proposes a spreadsheet-executable approach to represent three-category items on a graph. Each item is placed in a Cartesian plane according to the proportions of positive (YES) and negative (NO) and neutral (Don’t Know) responses; the result is a visual map that allows one to identify the prevailing response of each item. The paper presents two types of triangular graph and proposes a graphical application of the chi-square test to delineate areas corresponding to heterogeneous distributions of responses within each item.