Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Abstract COVID-19 pandemic represented a disruptive event for all sectors, especially the healthcare one. It revealed weakness of healthcare systems, often organised in silos, and called for a great coordination among several stakeholders. Different healthcare organizational solutions were implemented in order to address this extraordinary situation. This study investigates the impact of an organizational innovation, District Operation Centres (DOCs), of a Local Health Authority (LHA) in Rome aimed at responding overall to primary care and public health (PH) needs during the first phases of pandemic. In the DOCs health districts professionals supported general physicians (GPs) and family paediatricians (FPs), acting as a bridge with the PH Department, in order to better manage COVID-19 patients and close contacts. To understand the utility and the areas of support to GPs and FPs a survey (21 open questions or on a Likert scale), realised according the Delphi method, was admnistered to them. The sample was calculated using Epi Info, randomization was performed through Excel. A descriptive analysis of the sample and of the answers was carried out. When appropriate, statistical tests were used to understand differences among districts. 215 doctors were interviewed between Dec 2020 and Jan 2021. More than 50% declared to have found DOCs useful, above all for guiding to legislation and to activate medical equipes to deliver swabs at home. The support was evaluated not good regarding COVID-19 cases/contacts and cluster(s) management. Further needs as support in frail patients’ management, involvement of specialists, delivery of telemedicine, more involvement of GPs/FPs in district activities were identified. DOCs were an attempt to support GPs/FPs in improving care to COVID-19 patients/contacts. To provide this new service in the pandemic emergency denotes great leadership in the LHA to yield collaboration among several stakeholeders and vision about patient-centered healthcare. Key messages • Although several limits like need of more integration, DOCs represent an experience aimed at overcoming duality between primary care and public health systems and the fragmentation of the system. • DOCs could be considered an organizational innovation to make the system more resilient and patient-centered.

Abstract Problem On February 24th, 2022, Ukraine was invaded by Russian forces, forcing many Ukrainians to flee from their homes as refugees. More than 55,000 Ukrainians have since arrived on Italian territory. In response to the humanitarian crisis, the Roman Local Health Authority “ASL Roma 1” provided socio-sanitary assistance through first reception centers to more than 7700 refugees, prioritizing people with high social vulnerability. Ukraine’s vaccine hesitancy and different epidemiological landscape represented a major hurdle to be overcome. Practice ASL Roma 1’s practice served to ensure infectious diseases prevention and control, as well as continuity of care for non-communicable diseases and mental health issues. It consisted of repurposing resources, such as COVID-19 Hubs and their personnel, stipulating Public-Private Partnerships and collaborations with the local Ukrainian community, massive training, creating a centralized multidisciplinary team (with Ukrainian members) and a dedicated database/IT system. Results ASL Roma 1 empowered local Ukrainian communities by providing equipment, medical and administrative staff and socio-sanitary assistance. Ukrainian volunteers helped bridge the cultural gap for essential service provision, such as COVID-19 screening, enrolment in the NHS, health and social orientation, vaccinations and a tailored care pathway. Thus, more than 7700 refugees were assisted, with 1830 COVID-19 vaccinations administered and 170 in critical conditions promptly receiving specialized care. Lessons The multidisciplinary and cross-cultural interaction between doctors, nurses, cultural mediators, social workers, and other key actors was essential in ensuring a holistic care pathway. Services catered to Ukrainian refugees need complete integration between primary and centralized care. Flexibility and resilience are fundamental to foster an ecosystem of innovation and optimization of healthcare provision on all levels, from local to supranational. Key messages • The multidisciplinary and cross-cultural interaction between all medical and non-medical key actors is essential in ensuring a holistic care pathway and complete social integration of asylum seekers. • Health system flexibility, resilience and an ecosystem of innovation and optimization of healthcare provision on all levels are fundamental components of preparedness for future refugee crises.

Background The impact of the severe acute respiratory syndrome Coronavirus 2 disease (COVID-19) pandemic on people with systemic autoimmune rheumatic diseases (SARDs) remains to be fully established. It is unclear whether SARDs are an independent risk factor for COVID-19 infection and poor outcome. Objectives The aim of our study is to assess the incidence and prognosis of test-proven SARS-CoV-2 infection during the first COVID-19 wave in a large population of SARD patients of the Lazio Italian region. Methods We retrospectively evaluated in a cohort of 4.716.119 subjects aged over 18 years and affiliated to the health system of the Lazio Italian Region, the incidence and 30-day outcomes of COVID-19 infection in 40.490 SARD pts and compared to the affiliated population as incidence rate ratio adjusted for demographics and comorbidities (adjIRR). SARD diagnosis and comorbidities were derived from medical administrative records using the Chronic Related Group classification system. Data on COVID-19 infection were derived from a dedicated regional digital network. Results The risk of COVID-19 infection was increased in patients with Psoriatic Arthritis (adjIRR=1.21, 95% CI 1.10-1.33) and Undifferentiated Connective Tissue Disease (adjIRR=1.26, 95% CI 1.03-1.54). The risk of hospitalisation was higher in patients with Axial Spondylarthritis (adjIRR=2.16, 95% CI 1.45-3.22), and Systemic Vasculitis (adjIRR=1.81, 95% CI 1.07-3.06) while the risk of Intensive care unit admission was higher in Systemic Erythematous Lupus (adjIRR=3.67, 95% CI 1.52-8.83) and primary Sjögren Syndrome (adjIRR=4.13, 95% CI 1.71-9.96) patients. An increased COVID-19 mortality was reported in patients with Rheumatoid Arthritis (adjIRR=1.50, 95% CI 1.04-2.17), Systemic Erythematous Lupus (adjIRR=2.67, 95% CI 1.10-6.44), primary Sjögren Syndrome (adjIRR=2.51, 95% CI 1.12-5.62), and Scleroderma (adjIRR=4.60, 95% CI 2.06-10.29). Conclusion The incidence of severe COVID-19 is not increased in the same percentage in SARDs. Each SARD presents a peculiar pattern in terms of increased risk of COVID-19 incidence, hospitalisation, intensive care unit admission and death, that is not linked to the immunosuppressive behaviour of the disease. Disclosure of Interests None declared

Abstract Background Current health challenges are highlighting as Global Health (GH) is a discipline of growing importance for future physicians. Although its training is globally recommended, it has not universally entered the curricula of degree courses in Medicine and Surgery. A cycle of 6 seminars in global health has been promoted by researchers and public health residents of the Center for Research and Studies in GH of the Università Cattolica del Sacro Cuore (UCSC) in Rome, and offered for 4 consecutive years to medical students attending the UCSC. Objectives and Methods Main goal was increasing students knowledge and awareness in global health issues exploring their needs and perceptions about the impact of the topic on their future career. Two-hours frontal lessons held by experts and practical sessions (PBL) facilitated by promoters were planned on topics as determinants and inequalities in health, UHC, fragile and vulnerable population as migrants and victims of violence, SDGs, AIDS and emerging infectious diseases,international cooperation, maternal-child health. A pre-course, single event and post-course questionnaire was administered to participants. Results A mean of 48 students (± 15.7SD), 66.7% females, attending mainly the second(40.4%) and the third year (39%), joined each event. The analysis of the pre-course questionnaire has highlighted students' interest in healthcare inequalities, pandemics, migration, health in developing countries, healthcare systems. At the end, 92% of participants has considered the course interesting, 87% stated that the topic should be part of the degree course and 78% that it will influence their career. The methodology was considered adequate in 94% of cases underlining its strong incentive to work in team. Conclusions The strong interest of medical students in acquiring skills in global health seems to firmly encourage its inclusion and strengthening in study plans to prepare them properly to face the future challenges in health. Key messages Medical students consider the global health training relevant for their career encouraging its inclusion in the Medicine and Surgery curriculum. Practical sessions and team work could be useful tools to adequately train the future health workforce.

Abstract Background The “Public Health Leadership” Working Group of Italian Society of Public Health (S.It.I.) organized a two-days Workshop in Verona in January 2020. Leadership is linked to capacity of inspiring people to craft and achieve vision and goals, to provide mentoring, coaching and recognition and to encouragement empowerment, allowing other leaders to emerge and high quality of care. As in others country, in Italy investing in new generations is fundamental and far-sighted to create Leadership culture in tomorrow's professionals. Objectives The Workshop aim was to immerse Public Health residents into Health Leadership. Two types of practical/interactive experiences (Design thinking and Barometer strategy) and three speakers' interventions aroused curiosity, suggesting innovative ways to manage emerging local and global healthcare problems. Are residents interested in Leadership? Do they think Leadership could influence, motivate and enable to contribute to organization effectiveness? Results 100 residents (Male 52, Female 48), from 72% of Public Health Schools (26), attended Workshop: 46 of 1st, 23 of 2nd, 18 of 3rd and 13 of residency program last year. Satisfaction questionnaire was completed by 58 residents (7 points Likert scale from 1 [dissatisfied/not useful] to 7 [satisfied/useful]). 5.91 pts result in interventions satisfaction, increasing from 1st (5.84) to last year (6.00); interventions topics deepening results in 5.38 pts, decreasing from 1st (5.52) to last year (5.00). Overall satisfaction on practical/interactive activities was 5.89 and 5.83 pts results in these methodologies usefulness. Conclusions Health Leadership is a hot topic for residents; during residency program Leadership in not a main theme and residents want to improve non-technical skills to realise organization high quality of care. The practical/interactive activities were a winning choice to capture attention and cultivate mutual trust. This experience could be adapted in other countries. Key messages Teaching Leadership in Public Health is a main topic that needs to be strengthened in Public Health agenda. Italian Public Health residents are very interested in Health Leadership improvement during their trainings.

Abstract Background Nowadays having leadership skills is critical to manage healthcare systems. The World Health Organization Collaborating Centre on Health Policy, Governance and Leadership organized the 1st European Academy for Healthcare Leaders in Rome from 15th to 17th November 2018. Senior officials of the Ministries of Health of 16 Members Countries of the WHO European Region attended and actively participated to the event, led by experienced Italian and European experts. The Academy could be considered a moment of high training on leadership and governance of health systems. Objectives The event was aimed at creating effective networks among participants to share ideas and strategies to improve leadership skills, providing practical tools to be applied in healthcare systems and to develop a common and transferrable leadership framework in Europe. Frontal lectures and interactive workshops covered three main areas: leadership skills, current challenges of health systems and sustainability of health systems today. Results The 3-days event gave the opportunity to discuss the main issues in Public Health highlighting how to be an effective leader in healthcare. Leadership should enable the translation of knowledge into productive action pathways, providing health equity and improving population’s health. At the end of the event, participants filled a survey and the results showed high satisfaction about contents (100% out of 16 participants). Conclusions Health systems need to change in order to face the formidable challenges of our times. This event empowered the participants in order to support the creation of strategies and to develop leadership tools to apply at country level. The experiences, ideas and good practices shared during this event strengthened a collaborative network and have been useful to identify common goals and solutions. Key messages These kinds of events are fundamental to improve knowledge about leadership in healthcare. Leadership should have a major role to play in healthcare worldwide.

Abstract Background Healthcare providers (HP) need to involve the population to spread correct and useful health information and to gather feedback on the perceived quality of the service. Web 2.0, based on the use of Social Networks (SN), allows direct communication between the HP and the population. We built an automatic platform which monitors Web 2.0 usage by Italian public and private HP. Methods For each HP the platform finds the relative website using Google searches and extracts the links to SN. For Facebook and Twitter, it retrieves one year of content and identifies common topics via natural language processing. Finally, it compares the Web 2.0 usage patterns and topics with the type of HP and geographical position. Results In 2017, on 540 HP screened 97.8% had a website (309 unique sites, many HP have a common site). 37.5% of the websites had links to SN in the homepage: Youtube (YT) was the most common (74.1%), then Facebook (FB, 72.4%) and Twitter (TW, 51.7%). The presence of SN was lower in the south (OR: 0.63; p < 0.001) while is higher for research centers (OR: 5.12; p < 0.001) and private hospitals (OR: 2.12; p = 0.004). Local Health Trusts were the most active on FB (1.86 more posts, p = 0.004) but research centers had more fans RR: 5.32; p = 0.003) and likes per post (RR: 4.95; p < 0.001). On TW private hospitals had the most followers (RR: 3.35; p = 0.002) and likes per tweet (RR: 3.95; p < 0.001). The most posted topics were on healthy behaviors and organizational changes, while a lower number of posts were on healthy food and vaccines. Posts on specific pathologies information and healthy behaviors received more likes. Conclusions We propose an automatic platform that monitors the internet presence of HP in Italy, helping to define the best strategies for effective health communication. We found that in the south and in the public sector the importance of this tool is less perceived, with a lower SN presence and a gap between posted topics and those appreciated by the public. Key messages We propose an automatic platform that reports and monitors the web 2.0 presence and usage by HP in Italy, helping to define the best strategies to spread effective health communication. In Italy the presence of SN among HP is lower in the south and in the public, while is higher for research centers. HP have to engage the population maximizing the potentiality of web 2.0.

Background:Oral diseases are very prevalent chronic diseases worldwide and a great challenge to the public health professionals as is Diabetes Mellitus (DM).Both conditions are associated.Regular tooth brushing is important factor in maintaining oral health.We wanted to analyse prevalence of inadequate oral hygiene habits (IOHH) in general and diabetic population and find out its risk factors. Methods:Data from 2016 Slovenia CINDI Health Monitor crosssectional study were analysed.IOHH (self-reported tooth brushing once daily or less) was observed outcome and gender explanatory variable with age, education, employment status, self-reported social class and setting as confounders.The association was analysed using binary multiple logistic regression model.We conducted two separate analyses regarding the self-reported presence of DM. Results:In final sample there was 7851 participants, 44,0% men and 56,0% women, with 5,9% prevalence of Diabetes Mellitus.Prevalence of IOHH was 34,7% in general, while it was 33,7% in non-diabetic and 50,9% in diabetic population respectively.Non-diabetic model showed men have greater odds for IOHH than women (OR = 2.73, 95%CI = 2.43,3.04;p<0,001).Nondiabetics with primary education has OR = 3.21 (95%CI = 2.51,4,11;p<0,001) for IOHH compared to persons with university education.Odds were significantly (p < 0,05) higher for unemployed, lower social class and for rural residents.In diabetic regression model men had greater odds for IOHH (OR = 3,31; 95%CI = 2.08,5.23;p < 0,001).Housekeepers/retired had higher odds for IOHH compared to employed (OR = 2.01;p = 0,05) while persons from rural had higher odds than persons from urban setting (OR = 2.46; p < 0,001). Conclusions:Prevalence of IOHH is relatively high in general and even higher in diabetic population.Gender is most important risk factor for IOHH in diabetic and non-diabetic population while some socio-economic factors differ.Our research is basis for development of targeted interventions.

IntroductionThe addictive behaviors can be seen as attachment disorders. To our knowledge, the literature on the relationship between pathological gambling (PG) and attachment styles is still poorly represented. However, in addicted patients, the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo examine the clinical role of attachment styles in the PG patients.AimsTo study the relationships between the different attachment styles and PG and the severity of PG.MaterialsWe recruited 33 patients with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered to investigate attachment styles, the South Oaks Gambling Screen (SOGS) to investigate the severity of gambling.ResultsThe subjects showed the following attachment styles (Table 1). Ambivalent attachment style correlates with high scores to the SOGS (P < 0.001), and with a shorter period of abstinence from PG (P = 0.022). Patients with ambivalent attachment style have increased severity of PG at SOGS, correlating with higher raw score on the anxiety factor of ECR and lower raw score on avoidance factor (for both P = 0.036).ConclusionsPatients showed ambivalent attachment, and anxiety factor correlates with a greater severity of PG. Attachment style could be a severity index of PG. Our findings need to be replicated in larger groups, also widening the target of other addictions both chemical and behavioral.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe addictive behaviors can be seen as attachment disorders. In literature studies about the relationship between attachment styles and addictions are few. However, in addicted patients the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo study the relationships between different attachment styles and types of addiction (chemical or behavioral).AimsTo examine the role of attachment styles in patients with alcohol dependence (AD) or pathological gambling (PG).MaterialsWe recruited 29 with AD and 33 with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered for the study of attachment styles.ResultsPG compared to AD has higher raw scores both anxiety factor (P < 0.001) and avoidance factor (P = 0.003) at ECR. ECR ambivalent correlates with the diagnosis of PG (P = 0.010); ECR avoidant correlates with AD (P = 0.006); ECR anxiety shows a trend of correlation with the diagnosis of AD (P = 0.052). The subjects showed the following attachment styles (Table 1).ConclusionsThis is the first study that compares the attachment styles of patients AD and PG. We found differences in attachment styles of the two types of addiction, confirming the need of different approaches and then different types of treatment. Our findings need to be replicated in larger groups, also widening the target of other addictions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introductionstigma in mental illness is characterized by discrimination towards people affected by mental disorder. Consequence of the paradigm “stigma-injury-discrimination” is the social exclusion of these patients and the denial of their rights. Medical students, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesTo study the attitudes of medical students towards psychiatric patients.AimsThe present study analyzes gender differences in a sample of Italian medical students towards mental illness.MethodsA total of 339 Italian medical students completed a cross-sectional survey, in Rome and Foggia (Italy). We used the Italian version of Community Attitude towards the Mentally Ill test (CAMI) to analyze the students’ attitudes.ResultsThere is a substantial difference among the attitudes towards mental disorders in female and male students. Female students have obtained less stigmatizing results in 9 of the CAMI test items (P < 0.05), in Benevolence (P = 0.001) and Social Restrictiveness subscales (P = 0.043) and in the total score (P = 0.013).ConclusionsThese results are in line with those achieved in scientific literature, confirming that women tend to show more humanitarian attitude towards the mentally ill. Even in the original article of the validation of the CAMI test, the authors found better attitudes in women in all subscales, with the exception of Social Restrictiveness subscale (that in our analysis also correlates with the female gender).Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDiscrimination and stigmatization cause an important burden for people suffering from psychiatric disorders. The medical doctors, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesIt is extremely important to study and to know the attitudes of undergraduate medical students towards psychiatric disorders, since these individuals will be involved in the care of these patients throughout their careers.AimsThe present study analyzes the attitudes of a group of Italian medical students towards mental illness, highlighting the differences between the students who would choose surgical specialties from those who prefer medical ones.MethodsA total of 339 medical students of different medical schools, in Rome and Foggia (Italy), completed a cross-sectional survey. The Italian version of community attitude towards the mentally Ill test (CAMI) was used to evaluate the students’ attitudes.ResultsThe students that would choose medical specialties reported less stigmatizing responses in 11 CAMI items (including five items with P < 0.01), in benevolence and community mental health ideology subscales (P = 0.003) and in the total score (P = 0.003).ConclusionsIt is evident that the students that prefer the surgical specialties have more stigmatizing attitudes towards psychiatric patients. Negative feedbacks on Psychiatry from non-psychiatrist colleagues may have a fundamental role in stigmatizing mental disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionEmpathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.Objectives and aimsTo determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.MethodsWe enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).ResultsWe found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.ConclusionsIn our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ConclusionsThe participants in our study were positive towards using mHealth in emergency burn care.Contrary to theories on technology acceptance, ease of use seems to have little influence on acceptance in this context.When there is a need for ways to improve care, the benefits of mHealth may outweigh the aspects concerning the ease of use.