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Purpose: This paper aims to provide an easy-to-use yet powerful tool to assess the organizational readiness to adopt effective Smart Working (SW). In light of this main objective, based on the current state of research, the study develops a maturity model to assess the SW organizational readiness (SWOR). The SWOR maturity model consists of three dimensions, each of them further detailed into two sub-dimensions. A tool was developed to make use of the model. Design/methodology/approach: The SWOR maturity model was converted into a Web-based questionnaire that includes 54 questions based on 44 items to operationalize the model sub-dimensions. The questionnaire was used in a survey conducted at the Local Health Authority (ASL) of the province of Bari (Italy). Findings: Several implications derive from the present study. From a managerial perspective, the SWOR maturity model supports companies in the as-is analysis of processes, technologies and human resources, which are the enablers of an effective SW, and in the development of a roadmap to achieve a desired "to-be" situation. Originality/value: Despite recent studies on SW have identified the key drivers that affect the success of SW implementation, there is a lack of models and tools that help companies become aware of the actions and investments to be taken to move towards an effective SW adoption. Even the analysis of the literature on maturity models reveals a gap in the research related to the assessment of SW organizational readiness. The present paper tries to overcome these limitations.

Background: The translation of research into healthcare practice relies on effective communication between disciplines, however strategies to address the gap between information sharing and knowledge transfer are still under exploration. Communities of Practice (CoP) are informal networks of stakeholders with shared knowledge or endeavour and present an opportunity to address this gap beyond disciplinary boundaries. However, the evidence-base supporting their development, implementation and efficacy in health is not well described. This review explores the evidence underpinning the use of CoP in health research and translation. Methods: A scoping review was undertaken using Arksey and O'Malley's methodological framework. A comprehensive search of health databases and grey literature was performed using keywords and controlled vocabulary. Studies were not restricted by date or research method. Results: A total of 1355 potentially relevant articles were identified through the global search strategy. Following screening, six articles were retained for analysis. Included studies were published between 2002 and 2013 in the United Kingdom (n = 3), Canada (n = 2) and Italy (n = 1). Three papers reported primary research; one used a quantitative methodology, one a qualitative, and one a descriptive evaluation approach. The three remaining papers explored seminal and evolving theories of CoP in the context of knowledge transfer and translation to the health sector. Conclusions: A paucity of evidence exists regarding the development and efficacy of CoP in health research and translation. Further empirical research is required to determine if communities of practice can enhance the translation of research into clinical practice. [ABSTRACT FROM AUTHOR]

Nursing research is rapidly increasing, yet contributions from numerous countries that may interest the international nursing community are impeded because many research articles are published in authors' native language and not in English. The objectives of this work were to systematically review papers published in Italian related to job satisfaction and the quality of nursing care, and to discuss their findings in light of the international literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used. The Directory of Open Access Journals (DOAJ) and Indice della Letteretura Italiana di Scienze Infermieristiche (ILISI) databases were consulted for eligible studies published from January 2015 to November 2022. Two hundred sixteen papers were identified, 11 of which were selected for review: 8 on job satisfaction, two on workload issues, and 1 on quality of nursing care. The quality of included studies was assessed through the Effective Public Health Practice Project quality assessment tool (EPHPP). The results of our review were in line with those of international literature, and they can help to fill the knowledge gap on the quality of nursing performance in Italian care settings. In addition, the proposed method can provide further elements of discussion among literature providers and reviewers. [ABSTRACT FROM AUTHOR]

Abstract: 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.

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. [ABSTRACT FROM AUTHOR]

Introduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia. [ABSTRACT FROM AUTHOR]

Making ethical decisions in the context of a pandemic emergency due to the limited availability of healthcare resources is a pervasive problem that health organizations are trying to counter. As the coronavirus disease emerged worldwide, some countries were experiencing unanticipated challenges regarding resource allocation. While some were consistent with following the ethical guidelines in allocating these scarce resources, others acknowledged a different approach in their respective jurisdictions. A committee in Italy recognized the need to set an age limit for ICU admissions after seeking ethical counsel because the demand for critical care surprisingly exceeded supply. On the other hand, Philippine healthcare systems responded in a way that is not the same. They allocate resources reasonably and seek help from the Philippine government to avoid the scarcity dilemma. This paper will explore how scarce medical resources should be administered by healthcare systems without leaving the elderly behind. Afterward, this gives a possible approach to be taken in dealing with pandemics and other emergencies in the future. This paper will argue that in public health emergencies, age is an irrelevant characteristic when determining healthcare resource allocation amid the COVID-19 pandemic, and decisions should not be based on how scarce resources are. This paper supports an egalitarian view, specifically John Rawls' theory of justice, to ease the deep-rooted ageism in societies. The author believed that overlooking the most vulnerable populations during the pandemic must not be perpetuated despite the lack of preparedness for this sudden public health emergency. [ABSTRACT FROM AUTHOR]

Background: Wildfire smoke exposure has become a growing public health concern, as megafires and fires at the wildland urban interface increase in incidence and severity. Smoke contains many pollutants that negatively impact health and is linked to a number of health complications and chronic diseases. Communicating effectively with the public, especially at-risk populations, to reduce their exposure to this environmental pollutant has become a public health priority. Although wildfire smoke risk communication research has also increased in the past decade, best practice guidance is limited, and most health communications do not adhere to health literacy principles: readability, accessibility, and actionability. This scoping review identifies peer-reviewed studies about wildfire smoke risk communications to identify gaps in research and evaluation of communications and programs that seek to educate the public. Methods: Four hundred fifty-one articles were identified from Web of Science and PubMed databases. After screening, 21 articles were included in the final sample for the abstraction process and qualitative thematic analysis. Ten articles were based in the US, with the other half in Australia, Canada, Italy, and other countries. Fifteen articles examined communication materials and messaging recommendations. Eight papers described communication delivery strategies. Eleven articles discussed behavior change. Six articles touched on risk communications for vulnerable populations; findings were limited and called for increasing awareness and prioritizing risk communications for at-risk populations. Results: This scoping review found limited studies describing behavior change to reduce wildfire smoke exposure, characteristics of effective communication materials and messaging, and communication delivery strategies. Literature on risk communications, dissemination, and behavior change for vulnerable populations was even more limited. Conclusions: Recommendations include providing risk communications that are easy-to-understand and adapted to specific needs of at-risk groups. Communications should provide a limited number of messages that include specific actions for avoiding smoke exposure. Effective communications should use mixed media formats and a wide variety of dissemination strategies. There is a pressing need for more intervention research and effectiveness evaluation of risk communications about wildfire smoke exposure, and more development and dissemination of risk communications for both the general public and vulnerable populations. [ABSTRACT FROM AUTHOR]

Earthquakes can generate large volumes of debris which may threaten public health, hinder reconstruction and impact the environment. The present paper aims at investigating how the current Italian regulatory framework may be further developed to improve communities' ability to manage debris from earthquakes. Since the lack of preparedness for managing disaster debris is not confined to Italy, the paper may be valuable to stimulate a broader debate on this issue. The research work is based on selected case studies (L'Aquila 2009, Regione Emilia-Romagna—Circolare n. 2 of 12.06.2012 (2012) "Provisions for the resumption of production activities according to art. 3 paragraphs 7 to 10 of Legislative Decree June 6, 2012 n. 74" and Central Italy 2016–2017 earthquakes) and the review of the relevant literature and legislation. It shows that preparedness could have contributed to reducing or avoiding significant delays and problems in managing debris after the above-mentioned Italian earthquakes. It further suggests that disaster debris management in Italy could benefit from the existence of a comprehensive ex ante regulatory framework including a range of different tools (laws, guidelines, contingency plans and the like) and from the proper implementation of laws that are already part of our legal order. The above findings may directly feed into decision-making addressing disaster debris management. Overall, the paper focuses on a research topic which is becoming increasingly relevant, given the rise in the number and severity of natural disasters, but which is still not widely explored. [ABSTRACT FROM AUTHOR]

The identification of territorial clusters where the population suffers from worse health conditions is an important topic in social epidemiology, in order to identify health inequalities in cities and provide health policy interventions. This objective is particularly challenging because of the mechanism of self-selection of individuals into neighborhoods, which causes selection bias. The aim of this paper consists in the identification of neighborhood clusters where elderly people living in Turin, a city in north-western Italy, are exposed to an increased risk of hospitalized fractures. The study is based on administrative data and is a retrospective, observational cohort study. It is composed by a first phase, in which the individual confounding variables are balanced across neighborhoods in order to make them comparable, and a second phase in which the neighborhoods are aggregated into clusters characterized by significantly higher health risk. In the first phase we exploited a balancing technique based on partially ordered sets (poset), called Matching on poset based Average Rank for Multiple Treatments (MARMoT). On the balanced dataset, we used a spatial scan to identify the presence of clusters and we checked whether the risk of fracture is significantly higher in some contiguous areas. The combination of both MARMoT procedure and spatial scan makes it possible to highlight two clusters of neighborhoods in Turin where the risk of incurring hospitalized fractures for elderly people is significantly higher than the mean. These results could have important implications for the implementation of health policies. [ABSTRACT FROM AUTHOR]

The present paper introduces present issue focused on community gender perspective and health in an Italian context. After a brief analysis of the disparity and inequity that persist in Europe and Italy, we present six papers from different Italian regions that demonstrate different elements of the complex gender matters and challenges of well-being and health in the community. Considering the differences in social vulnerability and risk between men and women, the unequal power relationships between the sexes could improve the efficacy of intervention and preventative actions. Through this series of papers, we aim to contribute to the debate about how gender perspective can shape studies and interventions that promote both individual and community health and well-being. Gender, one of the key determinants of health, is revealed in many ways; it is necessary to better understand and plan health service interventions to improve the health of women and men. Furthermore, more attention and reflection are needed to promote policy interventions for health and to consider the contribution of women to the health of the community. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Many hospitals provide some type of real time publicly available information about the crowding of the emergency departments (EDs). For example, at the time of writing, the number of patients waiting and in treatment is publicly available for EDs that cover more than half of the Italian population. However, usually, these data do not provide the key information that low‐priority patients are seeking, which is the time they might expect to wait before being seen by a doctor. Methods: In this paper, we reanalyze the prospectively collected public data from the two major EDs of the Friuli Venezia Giulia Italian region, which maintains a web page that provides a real time estimate of the average waiting time of current ED patients. The paper discusses the usefulness of the estimate from the patients' prospective. Results: We point out a flow of the methodology used on web page of the Friuli Venezia Giulia region, and further show that the waiting time of current patients reflects poorly the expected time to treatment of new patients. Discussion: The results suggest that available data should be used to develop and validate ED‐specific waiting time prediction models of low‐priority patients. The same data could also be used to estimate quantities that might be of interest for EDs resource management. [ABSTRACT FROM AUTHOR]

The aim of this qualitative study was to consider the question of whether the Italian political management of the pandemic respected the European bio-ethical and bio-juridical approaches in light of the principles of autonomy, dignity, integrity and vulnerability. As no specific consolidated literature exists on the subject, the Italian situation was taken into consideration, specifically the work of a spontaneous commission (DuPre) that collected the reflections of academics and researchers interested in discussing political decisions for the management of the emergency, which was the coronavirus disease (COVID-19) pandemic. The analysis took into account the contributions of scholars during two conferences (without proceedings), which were transcribed and examined. From the texts processed with a thematic analysis, three main themes emerged: 'pandemic as a state of exception, sovereignty and crisis of democracy', 'the value of doubt and refutation' and 'elimination of informed consent between persuasion and blackmail'. In this paper, the final bio-political considerations on the European approach and the management of the COVID-19 pandemic in Italy are presented. [ABSTRACT FROM AUTHOR]

Data about the epidemiology of primary intracranial tumours (PIT) are still heterogeneous depending on different methodological approach in collecting data. In Valle d'Aosta, north west side of Italy, we have carried out a prospective consecutive population based study to calculate the incidence of PIT in the last decade (1992–1999) and to compare these rates with the previous period (1986–1991), data reported in a previous paper. The mean annual PIT incidence rate (ri) per 100,000 inhabitants was 25.48. The mean annual incidence rates in the two period of comparison were adjusted to the 1991 Italian population by the direct method. The standardised ratio was 26.43 in the previous period and 23.24 in the second decade. There is no statistically significant difference. The mean annual PIT incidence rates by tumour types were meningiomas 13.27/100,000 (men 9.77; women 16.7), neuroepithelial group 9,3 (men 10.62; women 8,1), adenomas 1.26, neurinomas 0,7. Mean annual incidence rates by tumour class were also stable. The stable incidence rate in the two periods and the similar incidence in England (21.04 /100,000 person year), strengthen the evidence for a stable incidence rate of PIT in the last decade. These three papers used similar methodology. The homogeneous methodology allows comparison and further evaluation. [ABSTRACT FROM AUTHOR]

Background: In a clinical science-based profession such as physiotherapy, research is mandatory to update knowledge and to provide cost-effective, high quality treatments. This study aimed to provide point prevalence of Italian physiotherapists who are academics, holding a PhD degree, or being authors of scientific papers. The scientific journal productivity of physiotherapists was also thoroughly analyzed. Methods: A descriptive cross-sectional study was carried out on all Italian physiotherapists. Academics, postdoctoral research fellows, and PhD graduates were identified by searching the Italian Ministry of Education, University and Research (MIUR), Italian Society of Physiotherapy, and university websites. Then, authors of articles indexed in Scopus were searched. The following data were extracted: type of affiliation, authorship order, H-index, number of publications and citations, name of journals, year of publication, and journal's Impact Factor. Results: The prevalence of academics, physiotherapists holding a PhD, or being author was 0.01%, 0.05%, and 0.56%, respectively. We identified 1083 papers co-authored by Italian physiotherapists, and their number has progressively increased over the years (p < 0.001). There was a significant difference between researchers and clinicians in both publication productivity (p < 0.01), citations (p < 0.01), and H-Index (p = 0.05). Articles were published in 359 different journals, receiving a total of 13,373 citations. Conclusions: Despite the low prevalence of faculty members and the reduced availability of PhD programs in Italy (forcing some students to study abroad), the quantity and quality of journal productivity is growing fast, and an increasing number of physiotherapists are involved in research activities. [ABSTRACT FROM AUTHOR]

(1) Background: This paper aims to examine two relevant phenomena in the context of public health: spontaneous abortion (SA) and induced abortion (IA). SA is one of the most common complications of pregnancies; IA is a conscious choice that is made by the mother/couple. (2) Methods: Permutation tests were applied to SA and IA standardized rates detected by ISTAT (2016–2020). The NPC test, chosen for its optimal properties, was applied to compare different Italian territorial divisions (stratifying for year and age classes of women) and analyze the trend of years by stochastic ordering. (3) Results: Only for SA, there are significant differences among the three territorial divisions: the South records higher SA standardized rates than the North and the Center; the rates of IA are similar. Relating to distinct women age classes, the SA standardized rates do not show significant differences among the three analyzed geographical areas; different results are highlighted for IA. Stochastic ordering shows that only the IA standardized rates are characterized by a significant monotonous decreasing trend over the years. (4) Conclusion: The SA phenomenon has shown a decreasing trend that could be justified by the progress of science. For IA, we can certainly say that the general decrease in the phenomenon is due to the greater use of contraceptive methods that help to prevent unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Background: In Public Health, a thorough review of abstract quality evaluations and the publication history of studies presented at scientific meetings has never been conducted. To analyse the long-term outcome of quality abstracts submitted to conferences of Italian Society of Hygiene and Public Health (SItI) from 2005 to 2007, we conducted a second analysis of previously published material aiming to estimate full-text publication rate of high quality abstract presented at Italian public health meetings, and to identify predictors of full-text publication. Methods: The search was undertaken through scientific databases and search engines and through the web sites of the major Italian journals of Public Health. For each publication confirmed as a full text paper, the journal name, impact factor, year of publication, gender of the first author, type of study design, characteristics of the results and sample size were collected. Results: The overall publication rate of the abstracts presented is 23.5 %; most of the papers were published in Public Health journals (average impact factor: 3.007). Non universitary affiliation had resulted in a lower probability of publication, while some of the Conference topics had predisposed the studies to an increased likelihood of publication as well as poster form presentation. Conclusions: The method presented in this study provides a good framework for the evaluation of the scientific evidence. The findings achieved should be taken into consideration by the Scientific Societies during the contributions selection phase, with the aim of achieving a continuous improvement of work quality. In the future, it would be interesting to survey the abstract authors to identify reasons for unpublished data. [ABSTRACT FROM AUTHOR]

This paper explores the dynamics of health system decentralization and recentralization in Italy, investigating why and how the territorial organization of the health system has changed over time. Drawing from discursive and historical institutionalism, the explanatory framework revolves around the role of ideational and institutional factors. The methods include process tracing and interpretive‐discourse analysis. Empirical material is drawn from documents and in‐depth interviews to experts and decision‐makers. Through the analysis of the reform trajectories in light of decentralization and recentralization processes, the paper shows that the territorial organization of the Italian health system has changed through a mechanism of gradual transformative change that I here call ideational and institutional bricolage, which involves the interplay between ideas, discourse, and institutions. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to analyze the COVID-19 policies of 10 European countries, including Sweden, Finland, Norway, Italy, France, Germany, Poland, Belgium, the Netherlands, and Hungary, with a time-series policy analysis tool. Subject and methods: The results of the COVID-19 policy analysis are based on a single time-series indicator, or daily population mortality rate: the number of COVID-19 daily cumulative deaths divided by the population in millions. The lower the score, the better the policy. Although many experts believe that the COVID-19 policy outcome analysis is premature, time series analysis is an excellent analysis that can provide information on the progress and transition of policy outcomes. In other words, the proposed time series analysis tool allows policymakers to identify and quantify when mistakes were made during the on-going COVID-19 pandemic. Results: The COVID-19 policy analysis discovered many useful facts. Sweden failed due to the herd immunity approach. Hungary made a fundamental mistake in COVID-19 tactics. Countries such as Sweden, Hungary, Belgium, and Poland showed time-series changes that differed from the others. Conclusion: Public health interventions can play a key role in mitigating the COVID-19 pandemic. The proposed policy analysis tool, hiscovid demonstrated the effectiveness of the time-series score behavior for discovering when policymakers made mistakes. [ABSTRACT FROM AUTHOR]

Background: While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries.Methods: We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.'s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis.Results: 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category.Conclusions: This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps. [ABSTRACT FROM AUTHOR]

Background: The paper aims to review, design and implement a multidimensional performance measurement system for a public research hospital in order to address the complexity of its multifaceted stakeholder requirements and its double institutional aim of care and research.Method: The methodology relies on a participative case study performed by external researchers in close collaboration with the staff of an Italian research hospital.Results: The paper develops and applies a customized version of balanced scorecard based on a new set of performance measures. Our findings suggest that it can be considered an effective framework for measuring the research hospital performance, thanks to a combination of generalizable and context-specific factors.Conclusions: By showing how the balanced scorecard framework can be customized to research hospitals, the paper is especially of interest for complex healthcare organizations that are implementing management accounting practices. The paper contributes to the body of literature on the application of the balanced scorecard in healthcare through an examination of the challenges in designing and implementing this multidimensional performance tool. This is one of the first papers that show how the balanced scorecard model can be adapted to fit the specific requirements of public research hospitals. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has emerged as one of the most dramatic health crises of recent decades. This paper treats mainstream news about the current pandemic as a valuable entry point for analyzing the relationship between science and politics in the public sphere, where the outbreak must be both understood and confronted through appropriate public-health policy decisions. In doing so, the paper aims to examine which actors, institutions, and experts dominate the SARS-CoV-2 media narratives, with particular attention to the roles of political, medical, and scientific actors and institutions within the pandemic crisis. The study relies on a large dataset consisting of all SARS-CoV-2 articles published by eight major Italian national newspapers between January 1, 2020 and June 15, 2020. These articles underwent a quantitative analysis based on a topic modeling technique. The topic modeling outputs were further analyzed by innovatively combining ad-hoc metrics and a classifier based on the stacking ensemble method (combining regularized logistic regression and linear stochastic gradient descent) for quantifying scientific salience. This enabled the identification of relevant topics and the analysis of the roles that different actors and institutions engaged in making sense of the pandemic. The results show how the health emergency has been addressed primarily in terms of political regulation and concerns and only marginally as a scientific matter. Hence, science has been overwhelmed by politics, which, in media narratives, exerts a moral as well as regulatory authority. Media narratives exclude neither scientific issues nor scientific experts; rather, they configure them as a subsidiary body of knowledge and expertise to be mobilized as an ancillary, impersonal institution useful for legitimizing the expansion of political jurisdiction over the governance of the emergency., Competing Interests: The authors have declared that no competing interests exist.

Purpose: The purpose of this paper is to study four cases of the adoption of co-production and compare them according to the type of user involvement, contextual factors and the organizational structure. Design/methodology/approach: In total, 30 interviews were conducted in four mental health organizations which are implementing co-production in the North of Italy. Interviews were conducted with clinicians, nurses, patients and family members. The data collected was triangulated with further sources and official documents of organizations. The results have been compared by means of a validated international framework (IAP2) regarding the contextual factors and the level of co-production adopted. Findings: The adoption of co-production in the four cases differs by the activities implemented and how organizations involve informal actors. It seems to be influenced by the contextual factors specific to each organization: power, professionals' opinions and leadership. Organizations whose practitioners and leaders are willing to distribute their power and value informal actors' opinions seem to facilitate the systematic involvement of users. Overall, the results highlight the importance of considering contextual factors when evaluating and describing co-production activities. Originality/value: This paper contributes to describing how mental health organizations are implementing co-production. It examines the influence of contextual factors on the type of co-production adopted. [ABSTRACT FROM AUTHOR]

This paper responds to the article by Pietrapertosa et al., doi:10.3390/ijerph17124434, published previously in the International Journal of Environmental Research and Public Health. Its aim is to discuss the appropriateness of the studied method, to analyze its weak sides and to propose its robustness improvement. Thus, data presented in the above study were examined and recalculated, yielding, among others, indicators of annual energy savings (in kWh per m 2 of total heated area) and specific proposals investment costs (in € per m 2 of total heated area). By analyzing the obtained data for all public buildings, a significantly simplified approach to this problematic has been suggested while several other features of the research method and some presented results lack proper reasoning and discussion. Individual approach to each public building has been proposed and discussed point-by-point to enhance the method's applicability. As a result, more realistic outcomes are obtained, and suitable investment actions can be proposed.

This is a reply to the paper by Miroslav Variny [...].

On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March-May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 in early 2020 created dangerous public health conditions which pressured governments and health systems to respond in a rapid and effective manner. However, this type of rapid response required many governments to bypass standing; bureaucratic structures of health sector administration and political governance to quickly take; essential measures against a rapidly evolving public health threat. Each government's particular; configuration of governmental and health system decision-making created specific structural and functional challenges to these necessary centrally developed and coordinated strategies. Most East Asian governments (except Japan) succeeded relatively quickly in centralizing essential disease control and treatment initiatives in a timely manner. In contrast, a number of European countries, especially those with predominantly tax-based financing and politically managed health delivery systems, had greater difficulty in escaping bureaucratic governance and management constraints. Drawing on data about these governments' early stage COVID-19 control experiences, this article suggests that structural changes will be necessary if low-performing governments are to better respond to a pandemic. This paper also summarizes other relatively successful strategies. By adopting such strategies, nations can help overcome structural bureaucratic and administrative obstacles in responding to further waves of COVID-19 or similar future pandemic events. [ABSTRACT FROM AUTHOR]

BackgroundVeneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic.AimThis paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020.MethodsInformation on the public health response was collected from regional health authorities' official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case-fatality ratios (CFRs) were calculated.ResultsKey elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Hospitalised cases (n = 3,623; 34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age.ConclusionIn the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.

Evidence is accumulating of the negative impact of the COVID‐19 pandemic and related public health measures on mental health. In this emergent field, there has been little research into the role of risk perception on depressive symptoms and the contribution of health‐care resources to model risk perception and mental health. The aim of this paper is to describe the relationship between individual‐level perception of risk and depression, controlling for a set of confounders and for country‐level heterogeneity. A cross‐sectional and observational online survey was conducted using a non‐probability snowball sampling technique. We use data on 11,340 respondents, living in six European countries (Italy, Sweden, United Kingdom, France, Poland, Czech Republic) who completed survey questionnaires during the first months of the pandemic. We used a fixed‐effect approach, which included individual and macro‐level variables. The findings suggest that a high proportion of people suffering from depression and heightened risk perception is positively associated with reporting depressive symptoms, even if this relationship varies significantly between countries. Moreover, the association is moderated by contextual factors including health‐care expenditure as a percentage of Gross Domestic Product, hospital beds for acute care, and number of medical specialists per head of population. Investment in health care offers a concrete means of protecting the mental health of a population living under pandemic restrictions. [ABSTRACT FROM AUTHOR]

The objective of the work described in this paper was to design and test a new performance evaluation system to be used to plan, monitor and evaluate the Italian public healthcare authorities’ results and support policy-making. After examining the weak points in existing models and researching the published academic literature, the new system was developed by researchers from different backgrounds and with the involvement of practitioners. The paper illustrates the importance of a continuous interactive process in designing effective performance evaluation and monitoring systems. [ABSTRACT FROM AUTHOR]

The paper focuses on the social, economic and environmental trends of recent years in Italy, highlighting the issue of housing emergency, both in quantitative and qualitative terms. What emerges are several shortages in housing especially in the suburbs of large cities, emphasizing the relevance of this issue in terms of health consequences and its priority for the definition of local policies. The authors underline that the availability of accessible and healthy housing is a human right, and a multisectoral responsibility, achievable only if a contribution is made by all relevant sectors including housing, environmental, social welfare, urban planning, building management and public health. The authors conclude by stressing the strategic role of training and illustrating a proposal addressed to all stakeholders, aiming to provide health evidences in terms of impact of housing hazards on health and to describe good building practices, helpful in order to obtain safe and healthy homes.

Public Health professionals and academics have been on the frontline of Italian history during the COVID-19 response like they never did before. Ancient professors of Hygiene such as Celli, Pagliani, Sclavo, Petragnani, Seppilli and Giovanardi flanked politicians in other critical moments. They helped them to manage healthcare reforms, earthquakes response, Seveso Dioxin disaster, cholera and poliomielitis epidemics and other health threats.   The ongoing COVID-19 epidemic has highlighted the paramount importance of the practical application of basic concepts of public health, which were considered so far became obsolete, such as personal hygiene, quarantine, individual protective devices or basic epidemiological measures. Hygiene and Public Health used to have a targeted audience in professionals and lecturers. Nowadays, these topics are critical and of concern of a much larger audience. Public Health women and men are now asked to act in task forces, media broadcasts, webinars and consulting activities.   In phase 2 of this epidemic - which is about to begin when this volume is to be published - the role of Public Health professionals could become even more relevant. However, this unexpected season must be managed with seriousness and intelligence, capitalizing it also for the future. If our Post-Graduate Schools of Public Health ("Igiene e Medicina Preventiva"), our scientific associations, our academic lecturers and our officers do not prove to be up to the situation, a dull future for the discipline might very well be. On the contrary, if as we all hope, we will be able to ride the wave of a dramatic health crisis, transforming it into a relevant scientific and professional opportunity, then we will be able to build on the post-COVID-19 a cutting-edge, a more attractive, relevant and modern discipline. This Supplement of Acta Biomedica, planned before the onset of the epidemic emergency in Italy, but already successful in presenting two papers on COVID-19, is further proof of how current and lively our discipline is.

Various factors have been implicated in vaccine hesitancy and loss of vaccine confidence, but the specific ways and particular moments in which immunisation programmes and vaccine scares are politicised, exacerbating negative attitudes about vaccines and leading to retrogressive policies, have been relatively under-examined. This paper applies the concept of 'medical populism' [Lasco, G., & Curato, N. (2019). Medical populism. Social Science & Medicine , 221 (1), 1-8. doi:10.1016/j.socscimed.2018.12.006] to examine these under-studied dynamics, looking at political actors and how they 'construct antagonistic relations between "the people" whose lives have been put at risk by "the establishment"' in the performance of vaccine-related crises. Four illustrative cases - from Nigeria, Italy, Ukraine, and the Philippines - are presented to demonstrate the descriptive and analytic value of medical populism beyond the framing and characterisation of the politics of health. The study underscores the need to understand people's perceptions and 'explanatory models' of vaccines and vaccine failures, to look at the political milieux that underpin immunisation programmes, and to anticipate and address knowledge claims made by political actors.

Purpose: This paper aims to investigate the role that Italian third sector organizations have in the process of social and administrative categorization of newly arrived migrants living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/Aids) or hepatitis b. In Italy, free access to health is provided to all migrants and residence permits for medical treatment is granted for migrants living with a "serious illness" since the 1990s. The case of HIV/Aids and hepatitis b shows how this political openness, however, clashes with the tightening of migration policies. Design/methodology/approach: The study is based on ethnographic research conducted between 2014 and 2016 within an associative centre that deals with the socio-health care of newly arrived migrants in Rome. In addition to the participant observations, the study is based in semi-structured interviews conducted with 10 health-care providers (nurses, health-care assistants and socio-cultural mediators) and doctors and with 22 migrants coming from Sub-Saharan Africa and living with HIV/AIDS (10) and hepatitis b (12). Findings: In Italy, the two infections have been identified as top diseases among migrant populations in the country but if HIV/Aids is always considered as a "serious illness", hepatitis b is considered as a public health priority only in the case of a treatment prescription. These aspects have an important impact on the interactions between medical and social professionals and migrants affected by HIV/AIDS and hepatitis b, contributing differently to the creation of legal categories assigned to migrants. Originality/value: The case of HIV/Aids and hepatitis b shows how the political openness of the public health system, clashes with the tightening of migration policies and analyse the role of the third sector has in this issue. [ABSTRACT FROM AUTHOR]

The paper presents the information on COVID-19 policy response in Italy in in the second half of 2020, when the second wave of the pandemic occurred. It builds on the authors previous report that addressed the first wave of the COVID-19 pandemic. In Italy, from October till December, the number of SARS-CoV-2 infections increased significantly. However, the Italian government, unlike many other European governments, re- frained from introducing a second nationwide lockdown. The pandemic was managed through a system of localized interventions (on a regional andor provincial basis) which significantly varied across the regions. At the end of December 2020, a national plan for vaccination against COVID-19 was approved. In February 2021, together with the change of government, a new public policy against the COVID-19 pandemic was formulated. [ABSTRACT FROM AUTHOR]

Cities with their innovative capacity are key places to address critical climate, environmental and health challenges. Urban experimentations, such as Living Labs, can represent a starting point to reintroduce resources into the production cycle and reduce environmental impacts, embracing the paradigm of the circular economy (CE). According to recent studies, Living Labs at a city scale could generate significant environmental benefits, improvements in quality of life and positive impacts on citizens’ health.1 This paper aims at presenting the case of the Torino Living Lab on Sharing and Circular Economy (LLSC) to point out possible future scenarios of urban sustainable policies. The case study is analysed in five sections: (1) the description of the new permanent laboratory proposed by the City of Turin; (2) the past experiences of Living Labs in Turin; (3) the birth of LLSC and the involvement strategy; (4) the introduction of the eight admitted experimentations. In the light of the results collected, the last paragraph (5) came up with the Strengths, Weaknesses, Opportunities, Treaths (SWOT) analysis in the LLSC. Eventually, it deals with the research question by offering a common ground for global and local policies focused on sustainability and CE. [ABSTRACT FROM AUTHOR]

In this paper I discuss the ethical justifiability of the limitation of freedom of movement, in particular of the ban on running outdoors, enforced in Italy as a response to the COVID-19 outbreak in the spring of 2020. I argue that through the lens of public health ethics literature, the ban on running falls short of the criterion of proportionality that public health ethics scholars and international guidelines for the ethical management of infectious disease outbreak recommend for any measure that restricts essential individual freedoms, such as the freedom of movement. The public health ethics framework, however, falls short of explaining the widespread public support that the running ban has had in Italy. I discuss possible factors which could explain the public support for the ban in Italy. Finally, I raise the question of what societal implications the abandonment of the public health ethics framework based on proportionality might have. I conclude that if it is the case, as the history of pandemics teaches us, we will experience further waves of COVID-19 outbreaks, it becomes very important to raise these questions now, with an eye towards informing public health policies for the management of future COVID-19 outbreaks. This discussion should not become politicized along the lines of liberal pro-lockdown/conservative anti-lockdown. Instead, we should reflect on the trade-offs of lockdown policies according to a pluralist framework, in which COVID-19 related deaths are not the only possible value to pursue. [ABSTRACT FROM AUTHOR]

Background: the employment relationship with a public health service foresees a remuneration that in many cases is the main income, it takes place within a hierarchical structure, whose top management is nominated by politics. Therefore, objectives and priorities can change according to the prevailing policy., Objectives: to verify the existence of the perception of a potential conflict of interest in the employment relationship with a public health service., Design: descriptive study. SETTING E PARTICIPANTS: authors of the papers published in the years 2016-2017 in Epidemiologia&Prevenzione (E&P)., Main Outcome Measures: numbers of authors and of declarations of conflict of interest., Results: in the 12 issues published by E&P in the two years under review, 144 contributions, drawn up by 630 authors, were evaluated; 16% of the contributions did not have the declaration of conflict of interest; the authors declared the existence of some conflict of interest in 10 contributions (6.9%). Thirteen of the 630 authors (2.0%) declared a conflict. Two of these declarations (2/630; 0.3%) referred to their employment relationship., Conclusions: This context does not seem to foster the independence of thought: only 0.3% of the authors indicated the working relationship among their conflicts of interest. In general, the declaration of the conflict of interest involved 2% of the authors. The need to discuss the conflict of interest, its awareness and its control should be a priority action of the scientific community, scientific associations, and scientific journals.

Civil society engagement around health care and population health improvement is an important driver towards Health for All. Research can improve the effectiveness of health activism by examining the resources, structures and strategies of civil society engagement. However, research to support such engagement faces epistemological and methodological challenges which call for specific research strategies. A four year multi-country study was undertaken by the People's Health Movement, a global network working for health for all. The research took place in six countries (Brazil, Colombia, DR Congo, India, Italy, South Africa) and globally, and was directed to understanding five domains of civil society engagement: movement building; campaigning and advocacy; capacity building; knowledge generation, access and use; and engaging with governance. The research plan and methods of data collection and analysis were tailored to address the objective of improving activist practice, while negotiating research challenges identified during the design phase. Results include insights into the practice of civil society engagement in relation to the five domains of activist practice, as well as experience gained in managing six methodological challenges which we describe as: making meaning, aligning research and action, managing power relations, valuing experiential knowledges, chaos and contingency, challenging preconceptions. Researching activism can produce useful insights into practice as well as support continuous improvement in the effectiveness of such activism. However, there are significant methodological challenges that can be addressed through appropriate strategies. More research, building on the approach described in this paper, can contribute to more effective civil society activism for health. [ABSTRACT FROM AUTHOR]

The paper analyses health and public health representation within RAI (Radiotelevisione Italiana) programmes in the shift from neo-television to post-television. To this purpose, it presents the result of a qualitative media content analysis on three different RAI programmes, attributable to different television genres and aired in the two periods considered. The analysis shows that in the shift from neo-television to post-television a recurrent genre arose which we call healthentainment: evolving from health representation to health storytelling, this genre integrates varied expert knowledge with new topics and new means of public involvement; flexible regarding information content, it is however firmly science-based. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) is a mosquito-borne infection that is emerging in temperate areas of Europe, following the expansion of one of its vector species, Aedes albopictus. Although CHIKV fever is a self-limiting disease, with a clinical syndrome often resolving within few days, it can also cause severe sequelae, including chronic polyarthralgia lasting up to 5 years. Additionally, CHIKV outbreaks may limit blood bank donations, adding economic burden on the health system. Public health authorities in Europe need to increase their preparedness against this emerging threat. Two large CHIKV outbreaks occurred in Italy in 2007 and 2017, with hundreds of cases and significant geographical spread. The aim of this paper is to review and compare the 2 Italian outbreaks in terms of available estimates of key epidemiological features, patient clinical presentation, virus and immunological characteristics, and public health response. Recommendations for public health and future directions for research are also discussed and highlighted. Key results: Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8–6 (2007) and 1.5–2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low. Major conclusions: Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks. Author summary: In Europe, vector-borne diseases have been increasing during the last decades. CHIKV is an example of a neglected emerging disease transmitted by the alien mosquitoes Ae. albopictus that caused 2 large outbreaks in Italy in 2007 and 2017. It is important to compare the main epidemiological, clinical, virological, and immunological features, as well as the public health responses, to increase preparedness to face future outbreaks. [ABSTRACT FROM AUTHOR]

Background: In many countries, including Italy, there are few national data on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), despite these being important predictors of maternal and neonatal health outcomes. This dearth of information makes it difficult to develop and monitor intervention policies to reduce the burden of disease linked to inadequate BMI status and/or GWG in pregnant women. This study describes the setting up and initial implementation of a regional surveillance system on pre-pregnancy BMI and GWG. Methods: Between 1 January 2017 and 31 December 2018, anthropometric data were collected from all pregnant women accessing public health services in the Friuli Venezia Giulia region (Italy) for first ultrasound check (T1) and at delivery (T2). Anthropometric data collected at T1 (self-reported pre-pregnancy weight and measured weight and height) and T2 (measured weight and self-reported pre-pregnancy weight and height) were compared. Results: The system was able to reach 43.8% of all the women who gave birth in the region, and provided complete data for 6400 women of the 7188 who accessed the services at T1. At the beginning of pregnancy 447 (7.0%) women were underweight, 4297 (67.1%) had normal weight, 1131 (17.7%) were overweight and 525 (8.2%) had obesity. At delivery, 2306 (36.0%) women were within the appropriate weight gain range, while for 2021 (31.6%) weight gain was insufficient and for 2073 (32.4%) excessive. Only minor differences were observed between measured and self-reported anthropometric data. Conclusions: The surveillance system offers an overview of the weight status of women during pregnancy. About 1/3 of women entered pregnancy with unsatisfactory BMI and 2/3 did not achieve the recommended weight gain. This surveillance system can be an effective tool to guide public health interventions. [ABSTRACT FROM AUTHOR]

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

Legislators have implemented policies to improve food labelling to protect consumers and to make the presentation of ingredients and nutritional information more transparent. Proper food labelling allows consumers who may suffer from food allergies or intolerances to know exactly what ingredients a product contains, and it also helps them make more informed health and nutrition choices. This paper deals with the most current European and Italian legislation on food labelling, actions taken in non-EU countries to increase health choices, and the expected impact on Public Health.

This paper seeks to contribute to a more nuanced discourse on vaccination policy. Current polarization between either mandatory and entirely voluntary is misleading, as virtually all immunization programs feature a combination of instruments that comprise mandatory and voluntary elements. We develop this argument by presenting five case studies from the European Union (EU). By systematically acknowledging the nuances of political and institutional varieties, we build the case for reframing the terms of the debate in the EU and beyond. [ABSTRACT FROM AUTHOR]

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The Italian health system has changed its welfare model three times over the course of its 160-year existence. From a form of «residual welfare» during the liberal period (1861-1921), it became «meritocratic welfare» during the fascist period (1922-1943) and in the years of the first republic (1945-1977). Finally, in 1978, the «universalistic institutional» model of health protection was approved. For a long time, therefore, the main responsibility for citi- zens' well-being was attributed to families, to the Catholic Church and its welfare networks, to entrepreneurial paternalism, and to the different health insurance institutions associated with employment sectors. Only with Law 833, which established the National Health Service (NHS), did the State recognise full and direct responsibility for citizens' health. This paper describes the complex path that led to the establishment of the Italian NHS, highlighting the diversity of the actors involved, the multiplicity of their social and health claims, the configuration of the public health service designed in the 1960s, and the political and social conditions that led to the effective enactment of Law 833. On the whole, it was a long, non-linear path with various barriers, where the conditions of implementation were determined by the particularity of the Italian political, economic, and social events that characterised the 1970s. [ABSTRACT FROM AUTHOR]