Background: The federalization of the Italian National Health Service (NHS) gave administrative, financial, and managerial independence to regions. They are in reciprocal competition according to the “quasi-market” model. A network of independent providers replaced the state monopoly. The NHS, based on the Beveridge model in which citizens are free to choose their place of treatment, was consolidated. The aim of our research was to analyze the fulfillment of need for hospital services on site and patients’ migration to hospitals of other regions. Material and Methods: We analyzed data from 2013 to 2017 of Hospital Discharge Cards (HDCs) provided by the Ministry of Health. The subjects of the analysis (catchment areas) were the hospital networks of every Italian region. The study of flows was developed through Internal Demand Satisfaction, Attraction, Escape, Attraction, Absorption, and Escape Production indexes. Graphic representations were produced using Gandy’s Nomogram and Qgis software. Results: In the studied period, the mean number of mobility admission was 678.659 ± 3.388, with an increase of 0.90%; in particular, the trend for ordinary regime increased 1.17%. Regions of central/northern Italy have attracted more than 60% of the escapes of the southern ones. Gandy’s Nomogram showed that only nine regions had optimal public hospital planning (Lombardy, Autonomous Province of Bolzano, Veneto, Friuli V.G., Emilia-Romagna, Tuscany, Umbria, Latium and Molise). Conclusion: The central/northern regions appear more able to meet the care needs of their citizens and to attract patients than the southern ones.

Background: In 2022, a new outbreak of the Mpox virus occurred outside of Africa, its usual endemic area. The virus was detected in European, American, Asian, and Oceanian countries where Mpox is uncommon or had not been reported previously and where the spread was rapid. The study aims to compare the case definition and the indications for contact tracing in case of Mpox infection among the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and four European Countries. Methods: From August 2022 to November 2022, we conducted research, first on the WHO and ECDC official websites and then on the official websites of the Ministry of Health or National Health Agencies of four European Countries (Italy, France, Spain, and Portugal). All reports found were compared to enlighten the differences in the definition of the case and indications for contact tracing. Results:The WHO divides the case definition into four categories: suspected, probable, confirmed, and discarded, while the ECDC divides cases into confirmed and probable. The ECDC defines contact as close and others, while the WHO divides it into high, medium, and minimal risk. The four countries analyzed show heterogeneity in both the case definitions and the indications for contact tracing. Conclusions: Our analysis revealed heterogeneity in the case definition between the WHO and ECDC. Different countries followed different indications or have given their indications for both the case definition and contact tracing indications. Harmonization strengthens public health preparedness and response and creates unified communication.

Background The first 1000 days are crucial for the health of the baby and the well-being of the mother-baby dyad, which forms a single complex organism with its co-metabolism expressed through sophisticated neurobiological, epigenetic and microbiome development mechanisms. This study aims to investigate how much social support can influence the path of pregnancy and motherhood. Methods The retrospective observational study was conducted on a sample of mothers enrolled through social networks who were administered a questionnaire from July to September 2021. The questionnaire consisted of 37 questions: 11 analyzed sociodemographic variables, 20 were on current / any previous pregnancies and breastfeeding, and 6 were used to calculate the Maternity Social Support Scale (MSSS-Webster et al.). STATA 14 was used for statistical analysis. Results Our sample consisted of 3447 women. 88.0% wanted the pregnancy, and 63.5% planned it. The average of the Maternity Social Support Scale (MSSS) was 23.91 points. A low MSSS score correlates with a higher risk of cessation of breastfeeding before 6 months of age, a higher risk of not having spontaneous labour, a higher risk of cesarean section and a higher risk of not having a spontaneous birth. On the other hand, a higher MSSS total score is a protective factor concerning breastfeeding duration, which is more likely to be longer-lasting (>6 months), to have spontaneous onset labour with a higher probability of spontaneous delivery. Conclusions The results showed that most of our sample have good friends who support them, can often count on their family, and receive help from their partner/husband. The outcomes of pregnancy, childbirth and motherhood are strongly influenced and conditioned by the social context in which they occur and the support the woman can receive. The presence or lack of this support can affect the health of newborns. Key messages • The first 1,000 days is a vulnerable phase in which parents, institutions and health professionals should create early interventions for the proper development and promotion of good health. • the outcomes of pregnancy, birth and motherhood are strongly influenced and conditioned by the social context, but especially by the presence or lack of support that can affect the health of newborns.

Background In the majority of European countries, sex education is mandatory, but Italy is still an exception. Despite sexually transmitted diseases (STD) are believed to be less common today, long-time “forgotten” disease, as syphilis, are returning. The aims of study are i) to examine the knowledge and perceptions of adolescents regarding sex education and STD and ii) to compare our results with Italian national survey. Methods This descriptive cross-sectional study was conducted in 6 middle schools in Siena (Italy) during May-June 2018. Data were anonymous collected using a validate questionnaire previously adopted by the Italian National Institute of Health (NIH). The results were compared with the national survey realized in 1998 by NIH. The analysis was performed using Stata 12. Results From 691 questionnaires, 540 returned fulfilled (78% response rate). The majority (95%) of respondents considered sex education “important” and thought it should be guaranteed by the school; 48% described information received so far as “sufficient”, 40% as “adequate”. “School” was indicated as the principal source of information (44%), instead of “friends” which resulted in 1998. The respondents were asked to choose from the list the STDs they knew: 96% indicated “AIDS”, 62% “syphilis”, 38% “HBV” and 36% “gonorrhoea”. In comparison to 1998, knowledge of syphilis has decresed (2018:17% vs. 1998:62%) and HBV (2018:38% vs. 1998:58%). Regarding STD, the “mass media” were cited as the principal source of information (56%), followed by “school” (41%) and “General Practitioner” (20%). Conclusions In comparison to 1998 sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened. This result can be attributed to the fact that the survey of 1998 was realized during the years when the AIDS awareness was higher. It is necessary to further improve the sex education in Italy in order to prevent STDs. Key messages The “forgotten” sexually transmitted diseases are becoming common again, the adequate sex education in schools is necessary to prevent them. In confrontation to 1998, the sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened.

Background The type of maternal caregiving impacts children’s growth and can lead to heritable changes in gene expression. When women become mothers, they adopt parents’ behaviours similar to those received in the family of origin. The study investigates if a birth’s social and cultural content can be seen as heredity transmitted from mother to daughter. Materials and methods A retrospective study was conducted on a group of mothers recruited across Italy through the social network Facebook. The study was carried out using a questionnaire administered from July to September 2021. The survey consisted of 21 questions. The analysis was carried out using STATA 14. Results Our sample consisted of 6051 mothers; the mean age was 37.7 years. Womens born by spontaneous birth has 2.1 times higher risk of having a spontaneous birth for their first child. Those born by operative labour have 2.7 times higher risk of having an operative delivery for their first child. Finally, those born by caesarean section are 2.3 times more likely to have a caesarean section for their first child. On the other hand, those born by preterm labour have 1.8 times higher risk of delivering their first child preterm. Those who were breastfed have 2 times higher risk of breastfeeding their first child. Women who have been told their birth is an extraordinary event are 2 times more likely to consider the birth of their first child as a problematic but still extraordinary event. Those who received a description of childbirth from their mother as a problematic event are twice as likely to consider the birth of their first child as a traumatic event overall. Conclusions The results show that transmission, written in the psyche, in preverbal and in internalisations derived from the relationship with one’s mother, is true and strongly present. Also, the ways of one’s own birth are so strong as to have repercussions on the daughter’s own and subsequently also on her children. Key messages • The unconscious objects, which are projected onto the children, can also take the form of both physical and psychic somatisations, which are repeated cyclically between generations. • The way in which birth is cared for and the quality of care provided at this unique time in a woman’s life will leave an imprint not only on the woman herself, but also on future generations.