Introduction: Mass gatherings, such as the Milan-Cortina 2026 Olympic and Paralympic Winter Games, have potential implications for infectious diseases, food safety and environmental hygiene. In this setting, the Local Health Authority ULSS 1 Dolomiti has developed an integrated public health preparedness model that includes Cortina dA'mpezzo and its surrounding areas. Methods: An operational model was structured by the Prevention Department around three priority areas for intervention: (i) infectious diseases and epidemiological surveillance, including the implementation of syndromic and event-based systems by a dedicated public health team; (ii) food safety, with a strengthened programme of official controls and a shared food safety policy for business operators; and (iii) public health and environmental hygiene, including drinking water monitoring, Legionella spp. detection in tourist accommodation facilities, and developing a microbiological wastewater surveillance protocol (wastewater-based epidemiology). Results: Between January and August 2025, 44 inspections were carried out in food businesses, identifying non-compliance mainly in the areas of structural and hygiene/organizational issues and cleaning and sanitization procedures. From January 2024 to June 2025, 60 water samples were collected to verify compliance with potability requirements; a limited proportion of samples required follow-up investigations, with no formal non-compliance detected that exceeded the legal limits. The investigation of seven accommodation facilities included 26 samples for Legionella spp. screening; positive results-and thus the need to implement corrective actions-were found in three facilities. Conclusions: In light of the preliminary evidence arising from our investigation, Cortina dA'mpezzo's pre-Olympic experience suggests that Olympic preparedness can strengthen local public health, enhancing legacy, prevention, coordination and response capacities among healthcare workers and the various institutions and organizations involved. The adoption of a preparedness model depicts a best practice for replication in other mass gathering settings, with potential long-term benefits for protecting public health and increasing the health system's response capacity.

Background: European health systems are increasingly reorienting toward primary and community-based care in response to population ageing, the rising burden of chronic diseases, and vulnerabilities exposed by the COVID-19 pandemic. In Italy, Ministerial Decree 77/2022 (DM 77/2022) introduces a substantial reconfiguration of the National Health Service through the establishment of Community Health Centers, Community Hospitals, and Territorial Operations Centers. The reform aims to enhance proximity and accessibility, promote multiprofessional collaboration, and strengthen the integration of health and social services. Nonetheless, Italy's pronounced regional autonomy results in heterogeneous implementation, raising concerns about equity and uniformity of service provision. Methods: This study situates DM 77/2022 within a broader European framework by comparing territorial and community-based care models in Spain, Germany, and the Netherlands. The analysis explores organizational arrangements, governance structures, financing approaches, workforce models, strategies for health-social care integration, and levels of digital development. Results: Spain's Atenci & oacute;n Primaria features multidisciplinary teams, strong continuity of care, and advanced digital interoperability. Germany's Bismarckian system relies on independent general practitioners, structured chronic disease management programs, and coordinated care networks. The Netherlands exhibits highly integrated chronic care supported by care groups (Zorggroepen), mature digital infrastructures, and systematic patient engagement. These models reveal both convergences and divergences in governance, financing, social care integration, and technological readiness. While Italy's reform reflects European principles of person-centered, community-oriented care, persistent challenges include workforce shortages, uneven resource allocation, and regional variability. Discussion: Enhancing governance coherence, reinforcing health-social integration, and investing in digital infrastructure may strengthen the implementation of DM 77/2022. Insights from European counterparts could help reduce territorial disparities, with the Department of Prevention (DP) potentially serving as a key coordinating actor. Despite limitations inherent to qualitative comparative analysis, the study offers a framework for cross-national learning and underscores the reform's potential to advance a resilient and equitable community-based health system.

Buja, Alessandra, Sandro Cinquetti, Marco Coller, Angela Padoin, Chiara Trevisiol, Ilaria Pantaleo, Claudio Palmeri, Vincenzo Marcotrigiano, Erica Bino, Silvia Flesia, and Simone Mocellin. Health promotion for sun protection: a community approach in a mountain setting. High Alt Med Biol. 00:00-00, 2026. OBJECTIVE:Alpine regions exhibit high incidence rates of cutaneous melanoma due to increased ultraviolet radiation at higher altitudes. In 2022, the "Montagna SÌ, Melanoma NO" (Mountain YES, Melanoma NO) public health campaign began promoting sun-protective behaviors in these areas. This study aims to evaluate an intervention's effectiveness 3 years after its launch and assess improvements in sun safety practices. METHODS:A before-and-after comparative study was conducted by surveying a random sample of 229 Belluno residents in the Veneto Region, Italy, in 2022, and 115 of those same individuals in 2025 using a standardized questionnaire. Data on sociodemographics, phenotypic characteristics, sun exposure habits, sunscreen use, protective clothing/eyewear usage, and campaign awareness were collected. RESULTS:In 2025, 43% of respondents (95% CI: 33.44%-52.17%) reported being aware of the health promotion efforts. A significant increase in sunscreen application during outdoor activities lasting more than 1 hour and during skiing was detected. Nevertheless, other protective measures, such as the use of caps and sunglasses, did not demonstrate any significant improvement. CONCLUSIONS:The campaign was effective. It reached its target population and improved sun-protective behaviors, confirming the value of community-engaged, tailored health promotion strategies. Further initiatives are necessary to address the remaining gaps in melanoma prevention adherence.

BACKGROUND:The Prevention Department represents the technical and functional structure of the Italian National Health Service responsible for implementing collective prevention and public health activities. Ensuring the appropriate allocation of qualified healthcare workers (HCWs) within this setting is fundamental to guarantee the delivery of essential services, maintain system efficiency, and address emerging public health challenges. METHODS:This study proposes a methodological framework for estimating the annual workable hourly rate of Environmental Health Officers operating within Prevention Departments. The model integrates multiple parameters including, for the workplace safety topic, the size of the working population subject to territorial control activities, the number of companies intended for checks according to national and regional planning, contributing to the calculation of effective working time based on Full-Time Equivalent (FTE) hours. Additional corrective factors are incorporated to account for absenteeism, indirect activities, travel time related to territorial characteristics, and specific targeted prevention programs. The approach was informed by institutional standards, European policy recommendations, and data derived from a Local Health Authority located in the Veneto Region. RESULTS:The proposed model combines two main reference indicators: one Environmental Health Officer per 10,000 workers in the sector within the territorial jurisdiction and an additional professional per 400 companies. The calculation of effective workforce availability considers an estimated average of 1,408 working hours per year per FTE, adjusted for absenteeism and indirect activities. These parameters allow for a more realistic estimation of programmable activities based on standard average times to ensure adequate inspection, surveillance, and other prevention activities. CONCLUSIONS:The investigated methodology could provide a structured approach to workforce planning within Prevention Departments, supporting evidence-based staffing decisions and improving the alignment between service demand and human resources. In a context characterized by evolving public health needs, workforce shortages, organizational transformation, and flexible allocation of HCWs, useful policies for effectively managing human capital will be essential to ensure the sustainability and effectiveness of prevention services within the public health system.

In its broadest sense, the mountain environment represents a setting useful for promoting health. This Italian project, conceived and applied in the Dolomites, aims to encourage multi-sector preventive public health policies; improve refuge hygiene; strengthen safety requirements; and implement projects aimed at promoting health. With the support of healthcare workers (HCWs) of the Prevention Department and other professionals in this field, 27 establishments in the Alpine territory have joined the project, benefiting from being recognized as a “Healthy and Safe Refuge” at the end of the quality improvement process. This process consisted of a documentary assessment, an on-site evaluation, and an assessment of analytical evidence relating to parameters investigated by both HCWs and refuge managers according to specific protocols. Data were collected from a specific database via an application to join the project and from sampling reports of parameters investigated for evaluating the quality of water intended for human consumption. The outdoor Alpine environment has recently witnessed extraordinary development and must continue to meet all health and safety requirements, especially in view of a global event—the Olympic Games—that will be hosted in the Dolomites area in 2026.

Background: The success of vaccination programs depends on a complex interplay of logistical, social, and structural factors. The objective of this study was to analyze the different approaches to vaccine administration implemented by several Italian regions since the onset of the SARS-CoV-2 pandemic. Methods: After careful qualitative review of information gathered from scientific articles, official reports (grey literature), contact with regional health authorities, and local health departments, five vaccination strategies across several Italian regions focusing on alternative vaccine providers and/or settings were identified. The innovative practices implemented by different actors covered specific topics and were then examined and described in detail. Results: In Veneto, where prevention departments were the main actor, herpes zoster vaccination coverage for the 65-year-old cohort increased from 44.4% to 54.9%; in Tuscany, family pediatricians administered 64% of all childhood vaccines; in Liguria, pharmacies delivered 70.1% of COVID-19 vaccines, while vaccinating in schools in Taranto led to higher human papilloma virus vaccination rates compared to regional and national averages. Finally, in all the regions, hospitals focused on vaccinating healthcare workers and vulnerable populations. Conclusions: The positive outcomes of these five experiences may, in a context of limited resources, encourage other national and international entities to adopt innovative practices, which offer new perspectives beyond the traditional delivery methods (i.e., local health authority vaccination centers for childhood and adolescent immunizations, and family doctors for adults and the elderly). These strategies suggest the efficacy of specific local approaches favored by regional autonomy in optimizing vaccine distribution and coverage.

The mountain area preparing to host the 2026 Olympic Games will benefit from an unprecedented increase in tourism, requiring local health authorities to perform additional checks to verify that the local accommodation facilities meet hygiene requirements. The focus of this investigation were the huts that, due to their intrinsic characteristics and location, cannot always access drinking water from the public aqueduct but are often fed by private sources, snowfields or rainwater. With the aim of improving the quality of these mountain huts, the microbiological quality of water intended for human consumption was investigated, and the analytical results were compared according to the relative types of supply. A statistical analysis was conducted on 41 huts that met the inclusion criteria, proving that the water drawn from the public aqueduct was of better microbiological quality than water from other sources (p-value: 0.016).

Abstract:The mountain context represents a suitable setting for promoting health. In view of the Olympic Games, which are expected to take place in the Dolomites area in 2026, the outdoor Alpine environment must con-tinue to meet all the health and safety requirements. Our recent experience, implemented in this area since summer 2024 through the Prevention Department of the Local Health Authority ULSS 1 Dolomiti, aims to encourage multi-sector preventive public health policies, in order to improve the "Shelters" ("rifugi", in Italian) hygiene, to strengthen the safety requirements, and to implement preventive projects.

At present, food safety culture (FSC) is a strategic dimension of food management systems, as established by EU Regulation 2021/382. Understanding how individual and organizational factors influence the safety climate is essential for designing effective training interventions. A cross-sectional observational study was conducted in Southern Italy from March to September 2025 among 216 workers from 52 food businesses located in the provinces of Bari and Barletta-Andria-Trani, using a questionnaire based on a validated scale, which is structured into five dimensions of leadership, communication, commitment, risk awareness, and resources. Descriptive analyses, χ2 tests, and multivariate logistic regressions were conducted to identify predictors of positive perceptions. The overall climate was positive for 82.9% of the sample. The strongest dimensions were leadership (88.4%), communication (86.1%), and risk awareness (84.7%), while resources were identified as a critical area (41.2% of respondents perceived deficiencies, especially in personnel and infrastructure). Overall, the results confirm that FSC is significantly influenced by ongoing training, cultural awareness and job stability. Resource-related challenges indicate a need for greater management investment to concretely support food safety practices.

Among numerous public health actions, the Prevention Departments of Local Health Authorities take charge of the migrant asylum-seeking population for health assessments, for the implementation of preventive activities, and for any consequent actions. This report describes two cases of tuberculosis in Belluno Province managed by a multidisciplinary team made up of healthcare workers that involved numerous diagnostic, clinical, and prophylactic implications, as well as an analysis of the epidemiological aspects related to the incidence of cases along the migration route. Although the cases occurred in a northeastern Italian territory, the management methods described here may represent good practices to share on this operational line, which can promote the strengthening of cooperation between Health Authorities and Emergency Reception Centers to correctly identify cases of active tuberculosis that may not have been initially screen-detected.

The structure of the management of healthcare professions in the prevention area currently appears not uniform at Italian national level, both in terms of the allocation of these professionals and concerning the role covered in the Local Health Authorities. During training events dealing with this topic, organized by the Italian Society of Hygiene, Preventive Medicine and Public Health - S.It.I., healthcare workers (HCWs) placed in the management area were evaluated through a survey, examining their level of involvement in the organization, and proposing ideas for improvement regarding the professional placement both in staff and in line. The thoughts on the new hypothetical organizational models adoptable must continue to include the valorization and career development of HCWs, also to allow to tenaciously challenge the scenarios that Public Health will be called upon to face with ever greater commitment.

Among invasive bacterial diseases, meningococcal meningitis is a serious and contagious disease caused by Neisseria meningitidis. The disease has a high lethality grade and could have long-term sequelae. This paper describes a case of meningitis that occurred in the territory under the jurisdiction of Local Health Authority ULSS 1 Dolomiti and the related management methods. The activities described concern rapid alerts, an epidemiological investigation, the administration of chemoprophylaxis and offering vaccinations, implemented according to the current Public Health protocol through different healthcare workers. This case report aims to support the management of possible similar cases, underlining the conditions that favoured the application of the envisaged measures, including an on-call ready availability service; the presence of population vaccination centres located in the area investigated; and a network sensitive to early warnings and collaboration within and between Local Health Authorities.

Abstract:Schools continue to represent one of the main settings that guarantee health promotion interventions, as it has been widely demonstrated in numerous fields that diet and eating habits are shaped in the early stages of life and maintained into adulthood. Through the food education promotion project, "Healthy Snack", implemented by the Prevention Department of the Local Health Authority ULSS 1 Dolomiti, the interventions carried out by healthcare workers have been evaluated over time to measure their effectiveness in terms of changes in eating habits considered incorrect, with a particular focus on snacks eaten at school.

School is one of the main settings where it is useful to guarantee health promotion actions, as it is well known that diet and eating habits that are shaped in the early stages of life are maintained through adulthood. The objective of this study was to carry out the “Healthy Snack” project to promote nutritional education in primary schools in the Province of Belluno in the 2022–2023 school year, in which 925 students were enrolled, and to evaluate the intervention in terms of changes in eating habits during their school breaks. Following the workshops performed by the healthcare workers (HCWs), medals were awarded, taking into account the quality of the participating students’ mid-morning snacks, considering the food pyramid. The results collected in the annual survey period were related to the type and quantity of snacks consumed at school, and allowed students to gain a final score, comparing the period before and after the educational intervention to demonstrate the effectiveness of the actions promoted by HCWs and the increased nutritional quality of meals. In light of this evidence, public health strategies must continue to emphasize the importance of implementing health promotion interventions and actions aimed at children in order to prevent weight gain in this age group, and the potential development of cardiometabolic pathologies over their lifetime.

The extraordinary vaccination campaigns of the COVID-19 pandemic era put organizational and operational systems to the test in numerous territorial contexts. In the Veneto region, the activation of population vaccination centers (CVPs) guaranteed the provision of vaccines to mountain areas. These centers, drive-in and building-based, improved the efficiency of dose administration in relation to similar conditions where healthcare workers (HCWs) were routinely involved in clinics. Overall, a comparison of the two models investigated, with the same numbers of HCWs involved and the same opening hours for the vaccination sites, has shown that the CVPs are able to guarantee three times as many vaccines administered, compared with the traditional outpatient model. This study aims to provide a detailed analysis of the adopted organizational model, highlighting the best practices and improvements required to guarantee a timely and effective public health response, and evaluating the opportunities to deploy these innovative methods actively in a standard context.

Ensuring safe meals with suitable hygienic-sanitary and nutritional features is an essential requirement to guarantee health in different settings. This study aims to evaluate the compliance of collective catering menus adopted in both school canteens and healthcare facilities in a regional area where specific guidelines have been issued, assessing many matters from food weight to single courses and from the use of wholegrain pasta and bread to the rotation of seasonal fruit and vegetables. Overall, 85 menus, edited by freelance professionals and endorsed by the Food Hygiene and Nutrition Service staff of the Local Health Authority, were assessed from 2018 to 2022, highlighting critical issues potentially attributable at a local level to the lack of complete knowledge of the existence of guidelines and official reference documents among nutrition professionals. Since the preliminary outcomes show non-compliance in both sectors investigated, it is essential to continue to strengthen the role of prevention departments entrusted with services dedicated to food and nutritional safety and promote joint official controls performed by healthcare workers and other professionals with different backgrounds in order to ensure safe food for the target population that use collective catering services. In school canteens and healthcare facilities, providing and administering food is an opportunity to promote health through a balanced diet and safe food and offers opportunities for the development of community well-being and the local economy in a sustainable manner, understood in economic, environmental and social terms.

Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of cutaneous malignant melanoma (CMM). This study focuses on the changing incidence of CMM over time (from 1990 to 2017) in the Veneto region of Northeast Italy, and its Alpine area (the province of Belluno). The clinicopathological profile of CMM by residence is also considered. A joinpoint regression analysis was performed to identify significant changes in the yearly incidence of CMM by sex and age. For each trend, the average annual percent change (AAPC) was also calculated. In the 2017 CMM cohort, the study includes a descriptive analysis of the disease's categorical clinicopathological variables. In the population investigated, the incidence of CMM has increased significantly over the last 30 years. The AAPC in the incidence of CMM was significantly higher among Alpine residents aged 0-49 than for the rest of the region's population (males: 6.9 versus 2.4; females 7.7 versus 2.7, respectively). Among the Alpine residents, the AAPC was 3.35 times greater for females aged 0-49 than for people aged 50+. The clinicopathological profile of CMM was significantly associated with the place of residence. Over three decades, the Veneto population has observed a significant increase in the incidence of CMM, and its AAPC. Both trends have been markedly more pronounced among Alpine residents, particularly younger females. While epidemiology and clinicopathological profiles support the role of UV radiation in CMM, the young age of this CMM-affected female population points to other possible host-related etiological factors. These findings also confirm the importance of primary and secondary prevention strategies.

Background In February 2021 the "Cortina2021" Alpine World Ski Championships took place in the mountain town of Cortina d'Ampezzo (Italy), thus gaining the definition of "first sporting event of global significance in the time of covid-19 pandemic". Though the event took place behind closed doors and in a context of national public health restrictive measures, it counted almost 6,000 participants. Methods A rigorous "Covid-19 Prevention and Hygiene Protocol" was drawn up by the local and regional health authorities together with the organizing committee, in order to contain the risk of viral circulation within the venue. Results Overall about 20,000 rapid antigen nasal swabs were performed to screen-detect sars-cov2 cases: only 22 of these were found positive, whereas 25 people were quarantined as close contacts. Conclusions The experience of "Cortina2021" proves that mass gatherings can take place even in times of epidemic threats, if adequately planned and by providing public health recommendations tailored on the viral circulation foreseen by the time the event is due. If new epidemics should arise in the future, hopefully the public health management of "Cortina2021" may be a template for next mass gatherings to be held, as far as possible, despite the viral circulation.

Health visitors (HVs) and environmental health officers (EHOs) are the healthcare workers (HCWs) who, in the Italian National Health Service, mainly operate in the prevention departments of local health authorities, guaranteeing the territorial activities specifically declared with the respective professional profiles. During the SARS-CoV-2 pandemic, it was necessary to reallocate all HCWs supporting Hygiene and Public Health Services involved on the front lines of the emergency, in order to perform preventive activities and to take immediate action to fight the spread of the virus. By means of an IT survey consisting of three sections, this study investigated how 960 HVs and EHOs dealt with this reallocation, with the shifting in service assignment, and with the perceived level of fatigue and pressure, through the application of skills acquired from university training. The synergy among the preventive health professions, the ability to work in a multi-professional team, and the complementary training of HCWs represent the main strengths for overcoming future public health challenges, aimed at protecting human health.