Search Results (394)

In the context of strategies for the promotion of a sustainable wine industry, the utilization of production regulations under the European Geographical Indications system is seldom contemplated. Furthermore, when such texts are considered, the focus is typically on rules for viticulture or winemaking, rather than on articles governing the boundaries of a PDO or PGI. The present study examines the manner in which regulatory innovation, when viewed from a strictly geographical perspective, can promote the sustainable growth of the sparkling wine districts of Franciacorta and Oltrepò Pavese, which are located in the Italian Lombardy region. Through a comparative analysis of Franciacorta and Oltrepò Pavese, we explore how regulatory frameworks, land-use constraints, and production capacities interact to shape environmental, social, and economic sustainability. Franciacorta’s premium positioning and global reputation are constrained by its limited geographic area, making expansion environmentally and socially challenging. In contrast, Oltrepò Pavese has substantial production potential, particularly for Pinot Noir-based classic-method sparkling wines but suffers from a fragmented identity and weak market recognition. Benchmarking the Prosecco PDO evolution, we propose a sustainability-oriented growth model integrating multiple territories under harmonized rules, termed “Grande Franciacorta”. This framework would enable controlled growth, reduce land pressure in high-density areas, enhance regional competitiveness, and support long-term ecological stewardship. This study outlines managerial implications for producers, emphasizing multi-tier product architectures, dynamic capabilities, and coordinated governance mechanisms. Policy recommendations highlight the need for regulatory frameworks that embed sustainability criteria, optimize land use, and consolidate regional reputation to ensure the long-term viability of high-quality sparkling wine production. Full article

Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article

L. infantum and L. donovani, distinct species in the L. donovani complex, show high phenotypic and genotypic polymorphism and share molecular traits. Therefore, genotyping by a single molecular target can give uncertain results. This study focuses on genotyping a set of L. donovani complex strains, including 18 zymodemes classified according to Montpellier nomenclature (ZMONs) and different clinical forms, by internal transcribed spacer (ITS), heat shock protein 70 (hsp70), and cysteine proteinase b (cpb) sequencing to evaluate their ability in species discrimination. We found an unexpected L. infantum hsp70 variability, with 8 sequence variants. Cpb-PCR could not distinguish L. donovani complex species, due to a L. infantum intraspecific allelic (cpbEF) polymorphism. By combining ITS-hsp70-cpb sequence variants, we obtained different genotypes. ITS(A)-hsp70inf(2)-cpbE identified 69.9% of L. infantum strains representing 12 ZMONs from Mediterranean visceral and cutaneous cases, ITS(A)-hsp70inf(2)-cpbF identified a non-ZMON-1 cluster. Four genotypes represented ZMON-24: ITS(A, B)-hsp70(Y)-cpbF identified a cutaneous cluster from Italy and North Africa, ITS(A, Lombardi)-hsp70(2)-cpbE identified cutaneous and visceral cases from Mediterranean areas. We believe this study contributes to an overview of L. infantum variant populations, and to the discussion on diagnostic targets, in single or multi -target-based approaches, to identify Leishmania populations in the Mediterranean area. Full article

Effective nitrogen management in dairy cow diets is essential for optimising milk production and minimising environmental nitrogen emissions. This study develops a simplified model to estimate nitrogen excretion in dairy farms, distinguishing excretion by animal category (lactating cows, heifers, calves) and organic matrix (faeces, urine), with nitrogen intake as a key input. A comprehensive literature review guided the selection of equations for estimating nitrogen excretion based on dietary nitrogen content, dry matter intake and milk yield. The model was specifically calibrated for Holstein dairy herd in the Po Valley (Italy) context using data collected from ten Lombardy dairy farms over 30 months, focusing on diet composition and nitrogen excretion via faeces, urine, and milk. Validation against established the literature and the Nitrates Directive (91/676/EEC) excretion factors demonstrated the model’s alignment in estimating nitrogen excretion. Within this context, the proposed framework may support nitrogen management at farm level by providing a practical, descriptive tool to explore nitrogen flows and to identify potential areas for improving nutrient efficiency and reducing environmental impacts. Full article

Background/Objectives: Listeria monocytogenes (Lm) is an extremely rare cause of brain abscesses, accounting for 1–10% of neurolisteriosis cases reported in the literature, associated with high mortality (approximately 23%). Data on diagnosis, management, and treatment is scarce. We report a case of listerial brain abscesses in an elderly patient in Italy who experienced progressively worsening bilateral ptosis. Methods: Diagnostic evaluation included neuroimaging, blood cultures, and microbiological investigations, followed by antimicrobial treatment according to available evidence. The isolated Lm strain underwent whole genome sequencing. Dietary history was also collected. Results: Positive early blood cultures were pivotal in identifying Lm as the aetiological agent. Neuroimaging revealed brain abscesses consistent with neurolisteriosis. The clinical course was complicated by pneumonia and opportunistic co-infecting pathogens, and despite adequate treatment according to the available literature, the outcome was fatal. Genomic characterisation revealed that the patient was infected with an strain belonged to the sequence type 206 and clonal complex 14, described as hypervirulent. The patient reported consuming several foods known to be associated with an increased risk of listeriosis. Conclusions: This case highlights the challenges involved in diagnosing and managing listerial brain abscesses, particularly in elderly patients. Even when the primary central nervous system infection is under control, the prognosis may be significantly impacted by comorbid conditions and hospital-related complications rather than the infection itself. Our findings underscore the need for improved preventive strategies and targeted risk communication regarding high-risk foods, particularly among elderly populations. Full article

Intensity–Frequency–Duration Curves (IDF curves) are a tool applied in hydraulic and hydrology engineering to design infrastructure for rainfall management. They express how precipitation, with a defined duration (D) and intensity (I), is frequent in a certain area. They are built from past recorded rainfall series, applying the extreme value statistics, and they are considered invariant in time. However, the current climate change projections are showing a detectable positive trend in temperatures, which, according to Clausius–Clapeyron, is expected to intensify extreme precipitation (higher temperatures bring more water vapour available for precipitation). According to the IPCC (Intergovernmental Panel on Climate Change) reports, rainfall events are projected to intensify their magnitude and frequency, becoming more extreme, especially across “climatic hot-spot” areas such as the Mediterranean basin. Therefore, a sensible modification of IDF curves is expected, posing some challenges for future hydraulic infrastructure design (i.e., sewage networks), which may experience damage and failure due to extreme intensification. In this paper, a methodology for reconstructing IDF curves by analysing the EURO-CORDEX climate model outputs is presented. The methodology consists of the analysis of climatic rainfall series (that cover a future period up to 2100) using GEV (Generalised Extreme Value) techniques. The future anomalies of rainfall height (H) and their return period (RP) have been evaluated and then compared to the currently adopted IDF curves. The study is applied in Lombardy (Italy), a region characterised by strong orographic precipitation gradients due to the influence of Alpine complex orography. The future anomalies of H evaluated in the study show an increase of 20–30 mm (2071–2100 ensemble median, RCP 8.5) in rainfall depth. Conversely, a significant reduction in the return period by 40–60% (i.e., the current 100-year event becomes a ≈40–60-year event by 2071–2100 under RCP 8.5) is reported, leading to an intensification of extreme events. The former have been considered to correct the currently adopted IDF curves, taking into account climate change drivers. A series of applications in the field of hydraulic infrastructure (a stormwater retention tank and a sewage pipe) have demonstrated how the influence of IDF curve modification may change their design. The latter have shown how future RP modification (i.e., reduction) of the design rainfall may lead to systematic under-design and increased flood risk if not addressed properly. Full article

Background: The healthcare sector plays a significant role in environmental degradation, particularly through energy consumption, emissions, and resource use associated with hospital operations. Despite growing global awareness of the impacts, environmental sustainability remains only partially embedded with the design, planning, management, and evaluation of hospital facilities, and empirical evidence is still limited. Methods: This exploratory study employed a mixed-method, two-phase approach. First, a scoping literature review identified key environmental dimensions and approaches for environmental sustainability in hospitals infrastructures. Second, a structured survey was distributed to Italian hospitals from Lombardy Region, between May and June 2024, to assess environmental performance and environmental strategy adoption. Results: Eight (n = 8) core environmental sustainability dimensions emerged from the review: energy efficiency, resource and waste management, transportation and mobility, materials and construction, environmental compliance, emissions, site sustainability, and design strategies. The subsequent based on these dimensions, gathered responses from (n = 18) healthcare facilities from Lombardy region, Italy. Findings revealed substantial gaps, since key measures such as on-site renewable capacity, water reuse systems, environmental certification application and health-island mitigation practices appear to be adopted sporadically. In addition, many of the surveyed facilities show consumption levels that exceed the benchmarks outlined in the literature. Discussion: The findings of this study reveal a notable misalignment between the sustainability debate, maturity promoted in the academic literature and the actual practices implemented in the Italian regional context. This mismatch highlights the importance of developing more uniform evaluation tools, policy requirements, and strengthening the organizational capabilities, to improve environmental performance in Italian hospital facilities. Full article

This study investigated the statistical association between public incentives and industrial innovation as reflected in firms’ financial performances. In particular, the analysis was carried out considering a Regional Operational Program, namely, the 2007–2013 ERDF Regional Program in Lombardy, and investigating a dataset of Lombardy-based companies that received support through the mentioned initiative. For each of them, balance sheet variables before and after the acquisition of the incentive and the development of the related innovation project were detected and analyzed by means of both standard and normalized linear regression. Notably, normalized regressions showed that higher subsidy intensity was positively associated with subsequent changes in revenues and intangible assets, especially among manufacturing firms, thereby supporting policies that target sectors with a high innovation capacity. Furthermore, this research underscores the importance of tailoring policy instruments to local and sectoral contexts, recognizing the limitations of one-size-fits-all approaches. In keeping with this exploratory stance, this study does not build a counterfactual control group and makes no causal claims; it simply documents balance sheet associations that may inform future, impact-oriented research. Given the absence of a control group, the design is observational; all findings describe associations and do not allow causal inference. Full article

Background/Objectives: Eyelid malignancies represent a clinically relevant subset of cutaneous tumors of the head and neck, with significant functional and cosmetic implications. While basal cell carcinoma (BCC) is the predominant subtype, geographic differences in the relative frequency of squamous cell carcinoma (SCC) and rarer histotypes have been reported. This study aimed at comparing the distribution of malignant eyelid tumors diagnosed in two Italian referral centers, namely Cagliari (Sardinia) and Milan (Lombardy) between 2020 and 2024, and to explore demographic and epidemiologic correlates. Methods: A total of 250 malignant eyelid tumors were analyzed: 130 from Cagliari and 120 from Milan. BCC was the most common histological subtype overall (83.2%), followed by SCC (12.4%) and other malignancies (4.4%). The proportion of SCC was significantly higher in Milan (18.3%) compared to Cagliari (6.9%, p = 0.04). Logistic regression confirmed Milan as an independent risk factor for SCC (OR 3.79; 95% CI 1.57–9.18; p = 0.003). Male gender also emerged as a predictor of SCC (OR 2.50; 95% CI 1.10–5.67; p = 0.029). Most cases occurred in patients ≥70 years; cases under 50 years were rare (≈3%). Conclusions: BCC remains the predominant malignant eyelid tumor in Italy; significant inter-regional variability exists, with a higher proportion of SCC in northern Italy. These findings highlight the role of environmental, demographic, and organizational factors, and emphasize the need for multicenter registries. Region-specific insights may inform personalized prevention and surveillance strategies for eyelid malignancies. These findings may support the development of region-tailored prevention models and contribute to the growing field of personalized oncology within ophthalmology. Full article

Microplastics and nanoplastics (MNPs) are pervasive contaminants infiltrating water, food, and human tissues. The sharp rise in plastic production—with over half manufactured between 2003 and 2022—has heightened concerns about their health impacts. Methods included: (1) a literature review of clinical studies on MNPs focusing on human health and (2) analysis of Standardized Mortality Rates (SMRs) for 44 groups of diseases in Italy (2003–2022, Italian National Institute of Statistics, ISTAT data). The outcomes suggest that MNPs have been connected to pathological alterations in a number of organ systems, such as the gastrointestinal tract (intestine, liver, and pancreas), breathing system, eyes, brain, and vascular structures. SMRs increased significantly in only eight of the 46 illness categories examined between 2003 and 2022. The analysis of clinical and epidemiological data allows us to identify a possible clinical assessment consisting of a 30-variable diagnostic questionnaire (Chicago Cluster Evaluation System, CCES), encompassing laboratory markers, clinical signs, and ultrasound findings. A binomial distribution model suggests that more than 8 positive responses may indicate a presumptive diagnosis of Microplastic Syndrome (MP-Sy). This framework reflects observed clinical/epidemiological patterns and provides a foundation for hypothesis-driven research. Prospective longitudinal studies are warranted to validate the proposed definition and its diagnostic utility. The aim of the present study is to propose a preliminary clinical framework for a potential MP-Sy integrating toxicological evidence with epidemiological data, define diagnostic criteria and assess their consistency with observed disease trends. Full article

The detection of H5N1 highly pathogenic avian influenza virus (HPAIV) in lactating dairy cattle in the United States, with high viral titers in raw milk, has raised concerns about zoonotic transmission through unpasteurized milk and dairy products. While viral inactivation during pasteurization is documented, data on persistence in raw-milk cheeses remain limited. This study evaluated the survival of avian influenza viruses (AIVs), both low pathogenic (LPAIV, H1N1) and highly pathogenic (HPAIV, H5N1), during the production and ripening of Grana-type hard cheeses from raw cow’s milk. Experimental cheesemaking was carried out with milk artificially contaminated with A/duck/Italy/281904-2/06 (H1N1; 10^7.75 EID₅₀/mL) or A/duck/Italy/326224-2/22 (H5N1 clade 2.3.4.4b; 10^6.75 EID₅₀/mL). Cheeses were manufactured under Parmigiano-Reggiano standards and ripened 30 days at 5–6 °C. Viral detection in finished cheeses was performed using inoculation in specific-pathogen-free embryonated chicken eggs (SPF-ECEs), hemagglutination (HA) assay, and monoclonal antibody-based ELISA. No infectious virus was detected in cheese samples after two blind passages in SPF-ECEs. Both HA and ELISA tests were negative, indicating complete viral inactivation. These results demonstrate that Grana-type cheese processing, including cooking, acidification, and ripening, effectively inactivates LPAIV and HPAIV. Findings support the microbiological safety of raw-milk hard cheeses regarding AIV, contributing to risk assessment and food safety policies. Full article

Several studies have demonstrated an association between impaired innate immunity and metabolic parameters, particularly during the periparturient period. However, to our knowledge, no study has been conducted under field conditions investigating the link between low milk polymorphonuclear neutrophil (PMN) levels and increased disease frequency. In an attempt to address this knowledge gap, this study examined 6209 cows from 20 dairy herds in Lombardy that were enrolled in a monthly individual dairy herd improvement milk testing program. Analyses of milk test record samples (MTR) included somatic cell count (SCC) and differential cell count (DSCC). A third variable, PLCC (polymorphonuclear neutrophil leukocyte cell count), was calculated by multiplying SCC × DSCC, thus representing PMN cells/mL. A database including compulsory records of all antimicrobial treatments applied in each herd was used as a proxy for disease frequency. In total, 58,090 valid MTR and 12,014 antimicrobial treatments (AMT) were considered for this study. Statistical analyses showed a significant association between the prevalence of cows with a low number of milk PMN and the prevalence of AMT. These results allow routine identification of whether the number of cows with low PLCC exceeds an alarm level within a herd. This threshold was calculated using an ROC curve with a cut-off point of 6% for AMT. This threshold was estimated at 2%, providing 78% accuracy in identifying herds at risk of an increasing treatment rate. This study confirms that cellular markers measured within MTR systems are useful in identifying herds at risk of impaired cellular immunity, thus paving the way for further studies assessing herd and cow immune status with routine milk sampling. Full article

Lombardy is Italy’s leading region in primary agricultural production, yet it faces a significant decline in agricultural soil, primarily due to urban expansion. This land consumption largely affects arable areas, as land is repurposed for low-density residential developments, roads, logistics, and commercial or industrial hubs. The reduction in agricultural land threatens regional food security and increases dependency on external markets. This study determines the long-term sustainability of this trend by estimating the actual quantity of agricultural land required to satisfy the food demand of the region’s citizens. The research employed a two-part georeferenced analysis. First, a cross-tabulation matrix quantified the land consumption over two decades. Second, the Planning Forecasts Map was analyzed, coupled with new road projects, to estimate future potential land consumption embedded in Land Use Plans (PGT). Finally, food consumption was converted into the required hectares of agricultural land per capita and compared to the current stock of agricultural land to quantify the deficit by municipality. The dramatic spatial deficit confirms that the current trajectory of land consumption is unsustainable, leaving Lombardy’s food security highly dependent on imports. While regional laws have reduced planned urbanization, the limitation of land take remains far from the goals. The results highlight the urgent need for effective compensatory measures and mitigation strategies that account for the true magnitude and spatial distribution of the agricultural land deficit, particularly in the most critical urban and peri-urban areas. Full article

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender differences. The present study analysed these factors in three Italian regions (Lombardy, North; Marche, Centre; and Calabria, South), where in 2019, the “Inclusive Ageing in Place” (IN-AGE) project was carried out, involving 120 senior people aged 65 years and of both genders. Methods: In this mixed-methods study, both qualitative (predominant section) and some quantitative data (e.g., socio-demographic aspects and functional limitations) were collected through semi-structured interviews. In addition to basic quantitative analyses, content analysis and the quantification of statements were performed to process the qualitative data. The results for both men and women are presented. Possible barriers to accessing health services were also considered. Results: Women reported more cases of chronic diseases than men, especially arthritis/osteoporosis, and a greater use of drugs than men. Both genders used services provided by the general practitioner (GP) and medical specialist (MS), the latter being mostly private. More women than men used rehabilitation, especially in the private sector, and reported the issue of cost for private healthcare and the travel distance to reach medical units as barriers to access. The long waiting lists/times were complained about by both males and females. Conclusions: This study, despite its simple/descriptive qualitative approach with a limited sample, could provide, however, some insights for policymakers and healthcare professionals to plan prevention policies and deliver appropriate and timely health services to older people experiencing frailty and ageing in place alone, devoting attention to gender-related issues in the design and provision of such services. Full article

Background: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease with variable clinical progression. While median survival is 2–4 years, 5–15% of individuals survive for longer. Methods: We conducted a retrospective, observational study using a population-based ALS register in Lombardy, Italy, to identify the clinical characteristics of long-term ALS survivors (≥10 years). Incident cases included in two periods (1998–2002 and 2008–2012) were considered. Results: A total of 828 ALS cases were included. Median survival for the entire cohort was 2.2 years (IQR 1.1–4.4). However, long-term survival was observed in 7% of individuals at 10 years, and 3% at 15 years. Long-survivors had a median survival of 13.4 years, significantly longer than the 1.9 years of non-long-survivors (IQR 1.0–3.6). Long-survivors were younger at disease onset and diagnosis, had longer diagnostic delay, and were more likely to have had a spinal onset. The cohort also showed a higher proportion of males among long-term survivors (75% vs. 59%). No significant difference in survival was observed between the two examined periods. Conclusions: Our findings suggest that long-term ALS survival is likely influenced by a complex interplay of clinical, genetic, and environmental factors, along with the intrinsic rate of motor neuron degeneration. Full article