Background Personal protection equipment (PPE) use in hospitals has consistently increased due to the Sars-Cov-2 outbreak, in wards repurposed for Covid-19 patients and wards that kept their usual activity. This increase influenced an environmental emergency in terms of health waste (HW) disposal. This study aims to assess the economic and environmental impact of the increase in HW generated before and during the pandemic in an Italian Hospital. Methods Data from 2016 to 2019 and 2020 to 2021 was retrieved from Risk Management department. Per capita and per days-of-stay waste quantity were calculated for the hospital inpatient wards and medical service areas (anatomical pathology, laboratories, radiology, nuclear medicine). Linear regression models assessed the epidemiological impact of COVID, and LOESS analysis modeled the relationship between infectious HW generation and the percentage of COVID-related inpatient days. Average weight of HW per patient was used to estimate the monetary value of CO2 produced. Results Preliminary results show that the inpatient days related to COVID nonlinearly influenced the infectious HW generated by wards. PPE usage increased in every context, and the proportion of COVID-related bed-days ranged from 2% to 12% in low-incidence months to 17% to 31% during acute phases. Pre-COVID CO2 production weighted 487 kg per patient and cost 1705€ per-capita, whereas during the pandemic it amounted to 768 kg per patient and cost 2688€ per capita which resulted in a significant increase of 983€ per patient. Conclusions In light of the results, HW disposal is an urgent issue that should be addressed by policy makers when implementing new monitoring systems for hospitals. A more adequate disposal of HW could substantially contribute in reducing air pollution and concurrently reduce the economic impact health systems due to the coronavirus pandemic. Key messages

Issue Urbanization is a cause of climate change, as cities are where these changes are most visible. Climate change also leads to significant inequalities and health issues in urban settings. In this context, urban health promotion is mandatory to increase adaptive capacity. Since the late 1980s the World Health Organization (WHO) has emphasized schools’ role in promoting health, as they can play a crucial role in increasing health awareness to future urban inhabitants. Description The objective of this pre/post-interventional study is to measure the awareness of urban health and green spaces among high school students and to rise it through an educational intervention. Four interactive sessions were delivered to 319 students from 13 to 18 years old in a high school in Rome, Italy during spring 2022. Data was gathered anonymously and analysed using descriptive and inferential statistics. Results A total of 192 (60%) students successfully completed the pre/post-intervention surveys. An increase in students’ knowledge of urban health and urban green areas was observed. Before the intervention 11.8% of participants were aware of urban health, whereas after the intervention 87.5% were aware. A rise across different areas appeared to be related to how many times the teachers repeated that concept during the intervention. For topics discussed in more than one session, the increase in correct answers averaged 13.9%. Two different trends emerged from the data analysis: one whose post-intervention test improved on most of questions and one whose post-intervention test remained unchanged. Lessons The results of the present study suggest that school-based interventions using interactive approaches on climate change and urban health are effective for increasing the knowledge level of scholars on these topics, and can be a useful way to promote health in an urban setting. This type of approach maintains high levels of concentration and interest in most students. Key messages • Urban health training activities in schools are needed to empower youth who live in urban settings. • Interactive sessions keep student concentration high and improve their participation.

Background In Italy, primary care (PC) ensures universal health coverage while containing costs. However, the assessment of its quality still remains an issue. Evidence has shown that high-quality outpatient care, through timely interventions to prevent complications of “ambulatory care sensitive conditions”, may avoid hospitalization. Aim of the study is to analyse the performance of PC in the Italian regions, using a composite and synthetic index of avoidable hospitalizations. Methods Hospital discharge data from 119 Italian geopolitical areas were analysed for the 2017-2019 triennium and for 2020, separately. According to the “Italian National Outcomes Evaluation Programme” methodology, 9 avoidable hospitalization indicators covering 5 nosological fields (infectious, respiratory, metabolic, cardiovascular and mental diseases) were combined in a synthetic index, calculated as the weighted mean of their standardized scores (with equal weights for each field). Using “natural breaks” technique, the areas were grouped into 5 clusters: “high”, “medium-high”, “medium”, “medium-low” and “low”. Results The analysis showed a marked heterogeneity at intra-regional level for the pre-pandemic triennium, with areas of homogeneity in regions with higher levels of hospitalization. The “medium” cluster, which is the widest, included 36 areas variously distributed across regions. The comparison with 2020 confirmed the geographical patterns observed for the previous triennium, despite a general reduction in hospitalizations due to the pandemic. Conclusions As a proxy indicator of PC quality, this index can aid decision makers in prioritizing quality improvement actions. However, in order to obtain a comprehensive evaluation, a joint reading of this index with other healthcare indicators is recommended. Key messages • High-quality PC is essential in maintaining appropriate hospitalization levels. • The composite synthetic index proposed could aid PC quality assessment.