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Background The cardiovascular risk increases in a multiplicative way when patients present more risk factors simultaneously. Moreover, the General Practitioners (GPs) play a crucial role in risk factors prevention and reduction. This work aimed to evaluate a multicomponent intervention in the Primary Care Department in an Italian Local Health Unit. Methods A pre-post study was conducted in Northern Italy (2018). Patients were eligible if: aged between 30 and 60 years, not chronic patients, not affected by hypertension or hypercholesterolaemia. The GPs assessed body mass index, hypertension, abdominal obesity, low-density lipoprotein (LDL) values, glycaemic values, smoking and exercise habit (T0). A counselling by GPs to at-risk patients and a multicomponent health education intervention were performed. Reassessment occurred after at least 3 months (T1). Main analyses were chi-squared tests for gender differences, McNemar or marginal homogeneity tests for changes in paired data (P Results Participants were 5828 at T0 (54.0% females) and 4953 at T1 (53.4% females). At T0, 99.1% presented at least one risk factor. Significant changes in paired data were reported for each risk factor. The greatest improvement frequencies occurred in glycaemia values (51.0%) and hypertension (45.6%), the lowest in abdominal obesity (3.7%). Some differences were recorded between genders, e.g. females reported higher improvement frequencies in hypertension (P = 0.001) and abdominal obesity (P Conclusion The results showed significant changes for each risk factor, both for men and women. GPs and multicomponent educational interventions could play a key role in reducing cardiovascular risk factors.

Background Pre-exposure prophylaxis (PrEP) is suitable for human immunodeficiency virus (HIV)high-infection-risk people, foremost amongst males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. Methods An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour, knowledge on HIV and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify possible associations with PrEP knowledge. Results A total of 196 MSM completed the survey. Overall data showed very good HIV and safe sexual behaviour knowledge (94.4% of correct answers). Nevertheless, our sample rarely used PrEP because of existing barriers: high therapy price (26.9%)and fear of side effects (23.8%). Only 10.3% of partecipants were informed on HIV and PReP by institutional channels, even less (7.5%) from specialized physicians and general practitioners. The most significant association with PrEP knowledge was having regular HIV-tests (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions PreP's Knowledge was well established, but PrEP use was not widespread. It is necessary to improve communication on PrEP and to lower existing barriers in order to grant access to PrEP access. Key messages Barriers to access PrEP have to be lowered. Healthcare personnel has to be involved in PrEP's benefits communication.

Background Congenital malformations (CMs) represent a serious public health problem, both in terms of size (3% newborns/year) and severity of outcomes. The surveillance activity carried out by the Registers is an important tool for monitoring the frequency of events, to evaluate etiology, support research and public health actions. The aim is to evaluate the organization and the information network related to the diagnosis of malformation in the S. Anna presidium. Methods the retrospective study analyzed all newborns with one or more CM and all cases of TOPFA (Termination of Pregnancy for Fetal Anomaly) for CMs in the period 01/2020 - 01/2021. A forward-looking pilot study was then set up to assess the impact on the quality of data collection through the introduction of a MC sheet. Results 510 cases of CMs were found in live births, 180 in TOPFA for CMs and 4 in stillbirths. The duration of hospitalizations averaged 14.5 days (σ 36.56), with a median of 4 days. In the CMs group, an average maternal age of 33.40 years (σ 9.32), a median of 33 years and a mode of 33 years were calculated, in the TOPFA group an average maternal age of 34 years (σ 6.34), a median of 34 years and a mode of 32 years. In the live births group, 701 maternal diagnoses were detected, categorized and compared with the various national reports. The MC Sheet was compiled for 60 patients, 16 (4.30%) patients before the introduction of the sheet (01/2020 - 09/2020) and 44 (30.43%) after its introduction (10/2020 - 01/2021). Regarding the assessment of the proper use of ICD9CM an adequacy of 78% was observed in the first group vs one of 100% in the second. Conclusions Our preliminary data assess the need for a Regional registry, for a comparison with the main national and regional sources available (also with a view to possible participation in the EUROCAT and ICBDSR registers) and for regional health planning. Key messages The study underlines the need for a Regional Registry of congenital malformations. The clinical file is not always a complete source for analysing data on congenital malformations.

Introduction Social restrictions imposed by the Italian Government during the COVID-19 emergency might have had a significant impact on mental health. The purpose of this study was to estimate the prevalence of depressive and post-traumatic stress disorder (PTDS) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave. Materials and methods A cross-sectional survey was carried out between April and June 2020 using a snowball sampling. Depressive symptoms were explored through the Patient Heath Questionnaire-2 (PHQ-2), while the post-traumatic stress disorder (PTDS) was investigated through the SPAN (Startle, Physical arousal, Anger, Numbness) questionnaire. Poisson regression models were used to explore the association between the outcomes under study and sociodemographic/housing characteristics. Results A total of 10.758 interviews were collected and 7.847 (73%), complete for a minimum set of indicators (age, sex, area of residence), were included in the final analysis. The majority of the respondents were females (71%). Sample mean age was 48.6 years. The prevalence of depressive symptoms was 21.2% and that of PTDS was 43.8%. Symptoms of depression and PTDS significantly diminished across age groups, in particular in people over 70 years compared with people aged 14-29 years (PR 0.65, 95% CI 0.49-0.86). A higher prevalence was found in students compared with retired people, both for depressive symptoms (PR 1.49, 95% CI: 1.05-2.10) and PTDS (PR 1.31, 95% CI: 1.02-1.69). Conclusions Prevalence of depressive and PTDS symptoms was high, in particular among younger people and students. That could potentially lead to adverse mental health outcomes in the future, with serious public health consequences. As the pandemic emergency is not solved yet, it is necessary to implement preventive strategies in order to protect the mental well-being of particularly vulnerable subgroups in the population. Key messages The prevalence of psychological symptoms was high in this sample during the first wave of COVID-19 pandemic. The subgroups of the population at higher risk for adverse psychological outcomes were younger people and students.

Background The COVID-19 pandemic is a calamity affecting many aspects. In particular healthcare services (HCS) are facing a great stress-test worldwide. The present work aims to explore what were health needs, beyond COVID, not covered among Italian citizens, due to fear, lockdown measures and overload of HCS, also in order to understand if there are specific subgroups of populations that will need urgent access to health services in the next future. Methods COCOS (COvid COllateral impactS) is a cross-sectional study performed during the Italian lockdown between April and May 2020. A forty-nine items online questionnaire was filled by the respondents. Participation was voluntary and without compensation. Informed consents were obtained. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed in ORs. Results Totally, 1,515 questionnaires were collected. Median age was 42 years, 65.6% were females. Around 22% declared to suffer from chronic diseases. Interestingly, 32.4% of the sample faced a delay of a scheduled Medical Service (MS) by provider decision, while 25.6% reported that this issue hit a family member. More than 13% refused to access scheduled MS for the fear of contagion, and the 6.5% avoided HCS even if having an acute onset issue: this behavior was associated with scarce trust in physicians (AdjOR 0.75); alarmingly, 1.5% avoided Emergency Department when in need and 5% of the sample took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR: 2.16; 95% C.I.: 1.16-4.02). Conclusions COVID-19 immediate effects are just the tip of the iceberg. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. To estimate the effects of the pandemic on non-COVID-19 patients is required, leading to aimed efforts, to reduce the backlog that HCS incurred in. Key messages COVID-19 biggest toll on public health is still to come if not prevented, due to temporary but widespread suspensions of scheduled medical services and the avoidance of these for fear of contagion. The most in need are the most vulnerable: older patients and those with chronic conditions are the most affected by suspension of medical services and will potentially pay the greatest cost.

Background Sexual minorities are high-risk populations for mental issues. Recently, attention on medical students (MS) is growing as they might be at higher risk of depression, but few studies focused on mental health of LGBT+ minorities among MS. Our main aims were to investigate depressive symptoms (DS) among LGBT+ MS, compared with non-LGBT+ MS and explore DS predictors. Methods A multicentre cross-sectional survey was performed in 12 Medical Schools (Italy, 2018). The questionnaire included sociodemographic items and psychometric tests. The Beck Depression Inventory II was completed by 325 LGBT+ MS and by 2048 non-LGBT+. Chi-squared tests and multivariable logistic regressions were run (significance level: p Results Females consisted of 61.5% of the sample, with no differences between the two groups (p = 0.075). DS were reported by 42.5% of LGBT+ MS and 27.4% of non-LGBT+ MS (p Conclusions Depression is a great public health issue; it is essential to dedicate efforts targeted to youths at high concern. LGBT+ people confirmed to have an increased DS risk compared to their peers also in a high-risk population like the MS one. Results of non-depressed LGBT+ MS showed a higher necessity of care and a bad living environment, highlighting the need of specific preventive and supportive interventions to bolster sexual minorities.

Introduction In a recent estimation, time spent engaging with smartphones is 3h43m in 2019 in US population, surpassing conventional media such as TV. However, smartphones are not just a distraction from everyday life, but also a powerful tool by which to search for information and interface with institutions and services providers. National Healthcare Systems are not an exception, in particular for tackling vaccine hesitancy and fake news: in this frame, we have focused our research on mobile apps for vaccination. Methods We scanned Apple App Store through an API (Application Programming Interface) made available from Apple Inc. itself searching single words related to vaccination (no Boolean operators available) from both Italian and English-speaking markets, then exporting and merging the results. The univocal 121 apps obtained were then classified according by category, description, target population, informative materials and n° of reviews. Results The majority of apps falls under the “organizer” category (49 apps, 40.5%) with almost half of them (22) with vaccination as main topic (vaccine reminders and recorders), the others as part of a health management tool, mostly designed for parents. Just 32% of these apps give information regarding vaccines or preventable diseases. The second one is medical education apps (26.4%) focused on healthcare workers with guidelines and updates, mainly in English, then games (11.6%), Local Healthcare Service booking services (9.1%) of which only 4 from Italy, and lastly travel management apps (2.5%). Conclusions Organizers and reminders are a recognised tool to increase vaccine adhesion, but a complete plain-language information should be provided together with the service, to answer the most frequently asked questions from parents and dispel their doubts. In the meanwhile, Italian NHS results rarely adequate in providing a fully digital experience, from planning shots to registration of vaccine status. Key messages Mobile vaccination organizers are a helpful tool for parents, but they are undervalued as a first-hand source of knowledge about vaccination programs. Italian NHS should develop a modern mobile interface in order to book vaccination services as a big nudge towards the increase of vaccine adherence.

Background Transition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. Thanks to improved survivorship of chronic paediatric patients to adulthood, this process has assumed growing relevance. Aim of the study was to evaluate quality and effectiveness of transition of care model of one of the biggest Hospitals of Northern Italy, that has organised a common structured model, differentiated according to patients' clinical and social complexity. Methods The sample consisted of patients with chronic rare diseases transited within the Hospital in the years 2016-2019. To analyse the evolution of all pathologies, for each patient the medical record was consulted; questionnaires were then administered to patients to investigate their illness perception and quality of life. Results The average age at transition of the retrospective study patients was 19.8±4.7 years. For most disorders, 100% of patients made the first post-transition visit. More than 90% of patients who did not make further post-transition visits were patients with Neurofibromatosis 1. Only 7 out of 18 patients with NF1 continued their treatment to the indicated specialist. One-year drop-out was 13%. Regarding the perception of one's own illness, 78% of respondents consider their health status from good to excellent, but more than 30% of respondents believe not to have currently adequate psychological and social support. Conclusions Transition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. Preliminary data were positive and showed how this model could be an example for other institutions in Europe. Anyway, the transition model might be still be improved. Our data underlined the importance of a complete taking charge, with peculiar attention to psychological and social support. Key messages The study shows to the European Healthcare Providers the importance of a personalized planning of transition of care, that considers the complexity of clinical situation and concomitant social issues. A successful strategy of transition of care requires a multidisciplinary approach, that guarantees a complete taking charge, with peculiar attention to psychological and social support.

Background Recent studies have shown that low Health Literacy (HL) negatively influence people's health. In an era of fake news journalists are called to recognize reliable sources in order to provide trustworthy information, especially on health topics. The aim of the study was to evaluate the knowledge of health-related topics among health journalists and how it differs from general population. Methods A cross-sectional survey was made by administering an online 28-item questionnaire. The questionnaire was constructed by joining an introductive part assessing socio-demographic characteristics with three tests: Single Item Literacy Screener (SILS), Medical Data Interpretation Test (MDIT) and IMETER, the Italian version of Medical Term Recognition Test (METER). Results A total of 589 valid surveys were obtained. Regarding this sample, 130 participants were journalists, 142 were healthcare workers and 317 belonged to general population. Journalists dealing with health-related topics (p = 0.016) and writing for online newspapers (p = 0.035) were found to have a higher HL, as well as those having a postgraduate qualification compared to colleagues with lower educational qualifications (p = 0.012). Instead, low HL was found among those journalists considering insufficient their economic status (p = 0.031) and among those who had never or only occasionally written about health-related issues (p Conclusions These results suggest that education is a key factor for an adequate health literacy. Given the importance, writing about medical and healthcare topics should be prerogative of journalists specifically formed in those fields. Key messages An adequate education strongly influences health literacy. It is of great importance to have specialized journalists write about medical and health-related topics.

Background Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients. Methods A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted. Results Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person. Conclusions Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases. Key messages Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.

Background The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs. Methods The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel. Results Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention. Conclusions This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting. Key messages Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.

Background Well-being is essential for positive mental health among university students, influencing their later attitudinal and career outcomes. Many factors contribute to endanger students' mental health, including academic stressors, as well as unhealthy lifestyles. Following a Mediterranean diet (MD), widespread in Europe, is proved to have a protective role for mental health. Our aim was to investigate mental well-being and adherence to the MD in university students. Methods In 2019, a cross-sectional study was performed in Turin, Italy. Totally, 502 university students were enrolled. A socio-demographic form, the Mediterranean Diet Adherence Screener (MEDAS) and Warwick-Edinburgh Mental Wellbeing Scale (WEMBS), were used. Mainly, multivariable linear and logistic regressions were performed to investigate potential predictors of adherence to the MD and of psychological well-being (p Results The 24% of the sample resulted at high risk of depression (WEMWBS score Conclusions Students who reported greater adherence to the MD were those with the lowest risk of depression. The potential protective role that MD has for mental health in young adults could be used to help developing more comprehensive intervention strategies of health promotion among European university students. Key messages Adherence to the Mediterranean diet and good mental health seem to be related in a sample of university students analyzed through multivariable regressions. European policies and strategies addressing unhealthy lifestyles and encouraging Mediterranean diet adherence could be useful to improve well-being and mental health of university students.

Background Depression is a major public health issue in Europe. The prevalence of depressive symptoms (DS) in university students (US) is considerably higher than in the general population. Since few data on DS among Italian US exist, this study aimed to estimate perceived stress (PS) and DS prevalence and assess associated factors in Italian US. Methods A cross-sectional study was performed in the Social Sciences and Educational Sciences degree courses at University of Cassino through self-administered questionnaires including socio-demographic items, Beck Depression Inventory-II (BDI-II) scale and Perceived Stress Scale. Primary outcomes were DS presence (BDI-II score≥14), suicidal thoughts (ST) and PS. Multivariable analysis and linear logistic regressions were performed. Results Globally, 203 questionnaires were collected (23 BDI-II missing). DS and ST prevalence was 30.6% and 11.3 %. PS median score was 20 (IQR=11) and 87.7% reported moderate/severe PS. Family history of psychiatric disorders and not being a freshman (attending first years of courses) were significantly (p Conclusions This study found an alarmingly high prevalence of DS and ST in Italian US. Further longitudinal studies need to define risk factors for depression and stress in US. Public health actions such as offering preventive treatment interventions could improve health in European US. Key messages Depressive symptoms can be widespread up to 30% of university students and European policies should afford this issue with a strong commitment in order to reduce harmful consequences. Predictors of depressive symptoms, such as university workload and family cohesion, are recognizable and can be a target for European strategies aimed to improve university students’ mental health.

Background Poor discharge planning (DP) can increase costs for European hospitals and worsen patient's experience. Validated scores are used in internal medicine to identify clinical or social difficulties in discharges upon admission but there is a lack of such a tool in the surgical context. This study aims to detect early predictors of difficult discharge. Methods Socio-demographic and clinical data from 15,165 surgical Hospital Discharge Records (SDOs) of the Molinette hospital of Turin, including an additional pre-surgery evaluation of social vulnerabilites from a subgroup of 388 patients, were collected between 2017 and 2019. Outcomes were length of stay (LOS), discharge destination (home, Long Term Care - LTC). Descriptive analysis and multivariable regressions were performed. Results 52.3% of patients were male and the median age was 61 (IQR 22). Median LOS was 6 days (IQR 6) but 15 (IQR 30) for patients discharged to LTC. 18.7% were admitted through the Emergency Department (ED) with a median LOS of 7 (IQR 10). 17.6% of the subsample declared living alone. Linear regression showed associations between discharge to LTC, admission through ED, diagnosis of neoplasia and a longer LOS (Bs 10.76, 5.21 and 2.57 respectively, p Conclusions Surgery LOSs are extremely diversified among patients. This study identified several predictors of difficult discharge, mainly admission through ED, discharge to LTC and diagnosis of neoplasia, suggesting difficulties handling an unexpected event by patients' relatives. Further studies gathering patients' data at admission are required in order to develop a predictive tool useful for European hospitals. Key messages Clinical (cancer) and social (sudden event, no housing solutions) factors can determine a difficult discharge for European patients and should be investigated to anticipate discharge planning. Elective surgery patients seem less prone to social vulnerabilities (e.g. living alone), probably because relatives have time to prepare, while ED patients often need help in the discharge process.

Background The administration of rescue medication at school concerns, in all Europe, students suffering from chronic pathologies for which it may be essential, on doctor's prescription, to take therapy during school hours. About 16% of the school's emergency calls are related to a seizure crisis. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death. Methods Every year, the Local Health Unit “TO3”, in Northern Italy, provides training for school staff to administrate rescue medication at school. A questionnaire survey on knowledge, attitudes and fears towards seizures was conducted during the school year 2019/2020. The same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases such as diabetes, allergies and asthma completed it before the course. Results 110 questionnaires have been completed. About 60% of the sample had been trained in seizure management at least once in their lifetime. The respondents had a mean age of 48.7±9.6 years and a mean job experience of 17.4±11.2 years. Most of them were females (83%). Median knowledge score (10 points max) in subjects with no seizures training was 6, while it was 8.5 in subjects with seizures training (p Conclusions Results suggest that medical training for school staff boosts knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude towards seizures, no longer considered as a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a safer place for all students. Key messages School staff trained in the administration of rescue medication are fundamental to guarantee the right to education for students suffering from chronic pathologies such as seizures. Empowering seizures awareness in schools is very important to change the attitude of school staff no longer considering seizures as a problem, making school a safer place for all European students.

Background The diffusion of false myths and vaccine hesitancy are alarming phenomena in European countries and leads to decreasing trends in infant vaccine coverages. Aim of the study was to analyse the level of confidence and correct awareness about immunization, which are crucial for the success of vaccination programs. Methods As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency, among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee’s knowledge, beliefs and misconceptions, as well as their socioeconomic status, sources of information about vaccines and confidence in the Italian National Healthcare Service. Results Of the participants, only 9% of women completely believed to efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on the majority of the themes. There was a significant difference in level of knowledge considering educational level: women with a high educational level have less probability to obtain a low knowledge score (OR 0.43 [95%CI 0.34-0.54]). The level of knowledge was influenced also by the sources of information: women who got information from General Practitioner and from Institutional Web sites have significantly less chance to have misconceptions (OR 0.74 [95%CI 0.58-0.96]; OR 0.59 [95%CI 0.46-0.74]). Finally, results underlined the influence of trust in healthcare professional information on likelihood of having misconceptions (OR 0.49 [95%CI 0.27-0.89]). Conclusions Data suggest the efficacy of healthcare professionals and Institutional Web sites as source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence on vaccines. Key messages There is a general lack of knowledge about vaccinations among future mothers. Most of misconceptions regarding vaccinations are related to their safety: this could affect confidence and complacency. To increase vaccine confidence, there is a strong need to inform future mothers: our data show the importance and efficacy of Health Professionals and Institutional Web sites as information sources.

Background Influenza affects approximately between 5 to 10% of general population every year, leading to 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths. Healthcare Workers (HCWs) play a crucial role in spreading the infection to patients. Although the strong recommendations provided, influenza vaccination coverage rates among HCWs are globally well below the coverage target set by WHO. The aim of this study is to assess attitudes towards mandatory influenza vaccination programs among HCWs, in order to make a quantitative synthesis of the phenomenon. Methods The present study systematically reviewed published cross-sectional studies investigating attitudes towards compulsory influenza vaccination in Healthcare Workers. PubMed and Scopus scientific databases were searched and 4,198 results were returned. Of these, 23 met the inclusion criteria for the review and 13 were eligible for the meta-analyses. PRISMA statements were followed. Results Thirteen studies were conducted in North America, 4 were conducted in Europe, 3 in Asia, 2 were performed in Australia and one study collected data both from Europe and Asia. According to the assessed studies, the percentage of agreement ranged from 44% to 95% for different compulsory vaccination programs. A combined prevalence of 59.8% (95%CI 50.1-68.8) was found in the meta-analysis. Having been vaccinated against influenza in the previous year increases the likelihood (OR 4.1; 95%CI 2.8-6.1) of being in favour of mandatory vaccination policies. Conclusions Compulsory influenza vaccination programs are generally accepted by the majority of health professionals, especially by those who have already been vaccinated previously. These results could be important to improve European vaccination strategies, in order to increase influenza vaccination rates among Healthcare Workers. Key messages Mandatory influenza vaccination programs are accepted by the majority of Healthcare Workers. Having been previously vaccinated against influenza increases the likelihood of being in favor of a mandatory vaccination policy.

Background Flu vaccination rates among health workers remain low and very variable between European countries despite the recommendations. Medical schools could be the best phase to educate health workers toward flu vaccine. This study aims to evaluate flu vaccine “prejudice” and vaccine hesitancy in medical students (MSs). Methods In 2018/19 flu season a cohort study was conducted at the School of Medicine of Turin, parallel to the flu vaccination campaign. Students were surveyed for sociodemographic variables, knowledge, attitudes and practices toward vaccination, adverse reactions, overall satisfaction toward received vaccination. Data was collected from 377 students. Multivariable logistic regressions were performed. The significance level was p ≤ 0.05. Results Females were 70% and median age was 24 (IQR 22.5-25). The 73.2% of the sample was vaccinated in the campaign, although the 60% of this had never been vaccinated before. Poor knowledge on flu vaccine, both self- and objectively assessed, was associated with lower vaccination rate (OR 0.23, p = 0.006; OR 0.15, p < 0.001 respectively). Vaccination was more likely in those who had been vaccinated in the last 3 years (OR 9.14, p < 0.001). Among non-vaccinated students, most frequent reasons to not undergo vaccination was not feeling at risk of contagion (48%). Vaccine decreased flu prevalence (OR 0.33, p = 0.039). Among vaccinated students, the persuasion that vaccination should be mandatory for health workers (OR 5.91, p = 0.039) was associated with higher vaccine satisfaction score while self-diagnosis of flu was associated with a lower score (OR 0.009, p < 0.001). Conclusions Lack of flu vaccination among health workers increases flu prevalence and multiplies possible carriers in health facilities. European Medical Schools should start yearly vaccination campaigns to promote good habits in MSs. In parallel, more must be done to teach MSs the benefits of flu vaccination and thus increasing willingness to being vaccinated. Key messages Feeling poorly informed and being poorly informed about influenza vaccine significatively decrease likeliness of vaccination in medical students. Students do not feel at risk of contagion. Influenza vaccine uptake is a habitual behavior that should be promoted as early as possible among European health workers, possibly during Medical School.

Background A high prevalence of mental illnesseshave been detected in medical students (MS) during college. The aim of this study was to evaluate depressive symptoms (DS) and suicidal ideation (SI) in MS and estimate factors that can influence these conditions. Methods In November 2018 a cross-sectional survey was conducted at the School of Medicine of Turin, Italy. The questionnaire consisted of a 30-item sociodemographic part and 3 psychometric tests, including the Beck Depression Inventory II (BDI-II). Overall, 506 surveys were collected. Multivariable logistic regressions were performed mainly. The significance level was p ≤ 0.05. Results Females were 65% and median age was 22 (IQR 19-24). Median BDI-II score was 9 (IQR 4-15). Presence of DS (BDI-II score>13) and of SI was found in 29% and 15% of the sample, respectively. Preliminary results showed that females (OR 2.03, CI: 1.16-3.56), non-heterosexuals (OR 2.69, CI: 1.49-4-84), participants negative about their college choice (OR 4.79, CI: 2.78-8.26) had a higher risk to report DS. MS who consider unsatisfying their friendships with classmates had a higher likelihood of reporting DS and SI (OR 3.10, CI: 1.16-8.30; OR 2.91, CI: 1.10-7.68, respectively). While the opposite was for those with good economic condition (OR 0.39, CI: 0.16-0.91; OR 0.21, CI: 0.09-0.52, respectively) and those practicing sports more than 90 min/week (OR 0.60, CI: 0.37-0.99; OR 0.47, CI: 0.25-0.89, respectively). Choosing Medicine for profit was related to a higher risk of reporting SI (OR 3.36, CI: 1.43-7.92), having a good family bond to a lower risk instead (OR 0.42, CI: 0.20-0.84). Conclusions Since depression is the leading cause of disability worldwide, it has to be a public health priority in Europe. It is essential to consider MS as at risk and set up interventions to improve factors surrounding them and help them to face difficulties in personal and academic life, without forgetting that they will be the future health professionals. Key messages Females, non-heterosexuals, students negative about Medical School choice and students unsatisfied with their friendships with classmates had a higher risk of reporting depressive symptoms. Students unsatisfied with their friendships with classmates and students who chose Medical School for profit had a higher risk of reporting suicidal ideation.

Background The identification of diseases in an early stage is essential to improve prognosis and survival of patients. Consequently, waiting times for cardiological performances are widely recognized in Europe as evaluation items for healthcare quality. Our study aims to analyse waiting times of the main procedures in the cardiology ward of a huge hospital of Northern Italy and to compare them with the regional benchmark. Methods Data of the cardiology ward of “Molinette” hospital (Turin, Italy) about the waiting times for clinical procedures in the period 2016-2017 were collected. In particular, we gathered number of health care services and mean waiting times (MWT) for “Echocardiography” (EC), “First Cardiological Visit” (FCV), “Holter ECG” (HECG), “Percutaneous Transluminal Coronary Angioplasty performed within 2 days for people with myocardial infarction” (PTCA). We compared then our results with the benchmarks identified by the regional law. Results In the period considered, in “Molinette” hospital 11,565 ECs were performed, with a MWT of 31 days in 2016 and 16 days in 2017, well below the benchmark (40 days). The total number of FCVs was 5,156 with a MWT of 18 and 13 days in 2016 and 2017 respectively, again under the benchmark (30 days). The HECGs were 3,805, with a MWT of 53 (2016) and 32 (2017) days (benchmark 40 days). PTCAs performed within 2 days (benchmark 85%) were 160 (77.7%) in 2016 and 138 (85.2%) in 2017. Discussion In 2017, the waiting times of “Molinette” hospital were inferior to the regional benchmarks, for all the cardiological procedures considered. Shorter MWTs allow a more rapid planning of further diagnostic tests and treatments and, therefore, a consequent better quality of care. It’s important for European hospitals to assess and compare these indicators in order to guarantee a fast and appropriate care to their patients. Key messages Waiting times are an indicator of early diagnosis and treatment and are useful to assess the quickness and quality of health care provided in European hospitals. Cardiological procedures in “Molinette” hospital of Turin are provided with waiting times shorter than benchmarks. It would be interesting to compare these results with other big European hospitals.

Background The age around 50 years represents a crucial point for women: menopause leads to biological changes and it begins breast and colon-rectal cancer screening. This study aimed at assessing frequencies of cardiovascular risk factors and analyzing participation in screening and vaccination. Methods In 2017, a cross-sectional study was performed in Northern Italy. Totally, 12 249 women, aged between 50 and 54 years, were enrolled by General Practitioners (GPs). It was used a 21-item form, with information about: socio-demographic, anamnestic and clinical data, execution of a booster shot of tetanus-diphtheria-acellular pertussis (Tdap) vaccine in the last decade and of PAP-test, mammography and faecal occult blood test in the last 2 years. Descriptive and crosstab χ2 analyses were performed with STATA MP13. The significance level was P ≤ 0.05. Results Our findings showed the presence of cardiovascular risk factors, such as obesity (10.95%), hypertension (13.76%), hyperlipidaemia (11.57%), glycaemia ≥ 100 mg dl−1 (16.97%), poor physical activity (73.49%), smoking (18.28%), cardiovascular family history (FH) (51.70%). There were a lower participation in colo-rectal cancer screening (45.09%) compared with breast (85.06%) and cervical (77.16%) cancer screening and an insufficient Tdap booster dose compliance (17.56%). Chi-square analyses showed correlations between cardiovascular FH and body mass index, hypertension, hyperlipidaemia, glycaemia and smoking, and between cancer FH and participation in breast and colo-rectal cancer screening (P < 0.05). Conclusions Women with cardiovascular disease FH represent a priority target of educational interventions considering the prevalence of concomitant risk factors. Programmes aimed at increasing screening and vaccination participation should be implemented.

This European public health news is looking at the future, and foremost at putting the health of our citizens first. Public health needs to move forward and the way forward includes support, collaboration, integration and an investment in the future public health professionals. Ricciardi emphasizes both the need for collaboration and the need for science, but especially the need for a change in the culture of the public health professionals. Our EUPHAnxt coordinators emphasize this change of culture and aim to prepare the next generations of public health professionals to be committed and engaged. Jakab reaffirms the need for participatory and intersectoral health systems and Borg commits to continuous support to European Union (EU) member states to invest in our future by investing in the health of our citizens. If we all work in the same direction, the future of public health is indeed looking bright. # President's Column {#article-title-2} Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions, the control of infectious disease and the battle against non-communicable disease, are both still ongoing, but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America and the lifetime risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies, making them ‘health societies’, putting health as a main theme in social and political life, and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care …

Background: We performed a systematic review and proportion meta-analysis in order to investigate the prevalence and the adverse effects of the self-medication among the teenagers. Methods: We selected observational studies published from January 1990 until January 2014 that examined the use of self-medication in the adolescents (aged from 13 to 18 years). Keywords used on PubMed, ISI Web of Knowledge and Scopus were ‘self medication’, ‘adolescent*’, ‘self prescription’, ‘over the counter preparations’ and ‘self administration’. Results: Finally, 15 articles met the inclusion criteria, for a total of 143 213 subjects involved. Overall, 50% of adolescents use to take drugs without consulting a physician. Further analyses stratified by number of drugs used demonstrated that in the studies reporting that adolescents use more than one type of drug the prevalence rises up to 63%. Only one study reported the possible adverse effects related to the inappropriate use of drugs, which were experienced by 31.1% of the females and 19.6% of the males. Conclusions: Self-medication use among adolescents is a widespread phenomenon. It would be advisable to give more attention on this public health concern and to promote initiatives, such as mass media campaigns and governmental actions, in order to make the citizens more aware to the risks related to the consumption of drugs without medical consultation. Further studies on adverse effects are urgently needed.

Issue/Problem The situation of humanitarian emergency affecting Sicily and the difficulties highlighted by the media in the reception of migrants have made this topic interesting for carrying out the validation of guidelines for Health Impact Assessment (HIA) introduced in 2013. In particular, the HIA regional working team, in collaboration with the National Agency for Regional Health Services, wanted to investigate the potential health impacts of the reorganization of non-medical support initiatives aimed at …

Background The threat of antibiotic resistance has become a worldwide public health concern, with a substantial economic and clinical burden. In this regard, the World Health Organization estimated that this problem leads, in the European hospitals, to an excess of mortality of 25 000 people every year. Antibiotic misuse, mainly related to physicians’ lack of knowledge and wrong prescribing behaviour, is one of the leading cause of antibiotic resistance. On account of this, it is essential to focus the …

Background Currently, smokers in Italy are around 11 million: of them 43.5% are women. From January 2005 is into force the Law No 3 of January 2003 (the so called Sirchia Law named after the Health Ministry who promoted it) that banned smoking in all indoor public places. The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced. Methods Based on a national survey conducted by the National …