SARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The “Drummond’s checklist” was adopted for quality assessment. A synthesis of the studies was performed through the “dominance ranking matrix tool”. Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide.

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 Hospital overcrowding is a growing problem worldwide. Studies demonstrated that up to 40% to 67% of hospitalizations of residents in nursing homes may be avoidable, causing health and economic damages. Furthermore, research shows that for non-critical patients there are arguably no differences between home and hospital recovery in terms of health outcomes, with a preference for home settings in most patients. During COVID-19 pandemic, telemedicine and homecare increased its range of possible intervention, allowing efficient and cost-effective processes of care. Transdermal sensors are indeed a cheap and easy to use alternative to conventional instruments, allowing a continuously operative and ready-to-use tool to care providers. This systematic review aims to map the application fields of these technologies, demonstrating their accuracy and assessing their cost-effectiveness in chronically ill home-assisted patients. Methods Articles were retrieved from Scopus, Web of Science, and PubMed. The dominance ranking matrix (DRM) tool was applied to allow a qualitative synthesis of the studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. A comparison between wearables and conventional tools accuracy was simultaneously carried out through a literature review. Results The database search identified 1156 publications of which six articles were considered eligible for the meta-analysis. According to DRM, 80% of evaluated studies showed the cost-effectiveness of wearable devices. The pooled INB of wearables over conventional measurement was estimated at US$1280 (95% CI US$952 - US$2849). In 85% of evaluated wearables the accuracy resulted comparable to conventional measurement tools. Conclusions Wearables performances resulted as accurate as conventional methods and their application cost-effective. A continuous measurement of parameters may relate to a better process of care for chronically ill outpatients. Key messages • Wearables are a cheap and accurate alternative to conventional life parameters measurement tools. • Technology evolution might soon reduce the pressure on hospitals, changing the care process of chronically ill outpatients allowing continuous evaluation of their health status.

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