The challenges posed by the rapidly ageing population, and the increased preponderance of disabled people in this group, coupled with the rising level of public expenditure required to service the complex organization of long term care (LTC) delivery are causing increased pressure on LTC systems in Europe. A pan-European survey was carried out to evaluate whether patterns of LTC can be identified across Europe and what are the trends of the countries along them.

Mortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases.

STUDY QUESTION: What is the contribution of medically assisted reproduction (MAR) to total, age-, and parity-specific fertility in Italy? SUMMARY ANSWER: MAR contributed 3.7% to Italy’s total fertility rate in 2022 and 5.9% to fertility of first order; MAR’s contribution to fertility reached 16% among women aged 40 + and 31% among women aged 40 + at first birth. WHAT IS KNOWN ALREADY: Demography, particularly via postponement of the age at childbearing for both women and men, plays a role in the diffusion of MAR techniques, and the diffusion of MAR techniques may contribute to postpone the age at childbearing. Recent studies found that the contribution of MAR to fertility rates is remarkable and increases over time in countries such as Czech Republic, Denmark, Australia, and the USA. Italy is a country distinguished by one of the lowest average number of children per woman globally, as well as the highest maternal age at first birth and among the highest shares of births to mothers aged 40 years and over in Europe. No prior study has focused on Italy. STUDY DESIGN, SIZE, DURATION: This study relies on a unique combination of administrative data sources: the Certificate of Delivery Care Registry dataset based on the entire population of live birth deliveries in Italy in 2022 (N = 393 997), administered by the Ministry of Health; the Register of Live Births to the Resident Population in 2022 (N = 393 333), administered by the Italian National Institute of Statistics; and the resident population by age and sex to identify the female population at risk of having a(n additional) child by age (N = 17 006 665) provided by the Italian National Institute of Statistics. Comparisons are made with the year 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS: We calculate the age-specific fertility rates (total and by parity) for births conceived via MAR and those conceived naturally. These rates are then utilized to assess the contribution of MAR to total and parity-specific fertility, as well as to the mean maternal age at childbearing. This study is the first estimation of its kind for Italy. MAIN RESULTS AND THE ROLE OF CHANCE: The contribution of MAR to the total fertility rate (for women aged 15–59 years) in Italy increased from 2.1% in 2013 to 3.7% in 2022. Among women aged 40 + , the contribution of MAR to the total fertility rate increases to 16.2% in 2022, up from 8.6% in 2013. The contribution of MAR to first-order fertility rate increases to 5.9% and it reaches 30.9% among women aged 40–59 years in 2022. The mean age at first childbirth among women who conceived via MAR equals to 37.8, up from 36.0 in 2013, compared to those who conceived naturally at a mean age at first birth of 30.4 in 2013 and of 31.3 in 2022. LIMITATIONS, REASONS FOR CAUTION: Our approach may underestimate MAR’s contribution to the total fertility rate in Italy: mothers in Italy may be more likely to under-report of MAR-births than in other countries, due to social norms that are more resistant to non-conventional paths to parenthood. Our estimates use unconstrained denominators based on the entire population of women in reproductive age, irrespective of parity, to compute fertility rates because the population of women by age and parity is not available from official statistics. In addition, our estimates are somewhat affected by the possibility that couples who underwent MAR treatment would have eventually conceived spontaneously. WIDER IMPLICATIONS OF THE FINDINGS: Countries characterized by low and late fertility offer a unique test ground for studying the contribution of MAR to fertility rates. In Italy, a late transition to parenthood among the general population aligns with the late transition to parenthood among mothers who conceived via MAR, mirroring that they seek infertility treatments at a relatively late age. For Italy, it will be important to monitor MAR’s contribution to fertility as a new law came into effect in January 2025, that, by recognizing infertility as a pathology, considerably reduces treatment costs hence likely increases demand for MAR. The extent to which a potentially increased demand will translate into access to treatment is uncertain if additional resources are not made available to expand the health system to meet the expected increased demand. STUDY FUNDING/COMPETING INTEREST(S): We acknowledge funding from Next Generation EU, in the context of the National Recovery and Resilience Plan, Investment PE8—Project Age-It: ‘Ageing Well in an Ageing Society’ (DM 1557 11.10.2022) and the project ‘ALFA—Aligning Law with Family Arrangements’ funded by Fondazione Cariplo 2021-1321. Open access funding provided by University of Trento within the CRUI-CARE agreement. The views and opinions expressed are only those of the authors and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them. No conflict of interest exists. TRIAL REGISTRATION NUMBER: N/A.

The ageing population in Europe is putting an ever increasing demand on the long-term care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care.

Aims: To explore factors associated with missed nursing care (MNC) in home care in Italy. Methods: A secondary analysis of the AIDOMUS‐IT national cross‐sectional study was conducted investigating structural factors, including details on services offered, waiting times, nurses’ working conditions and workload, nurses’ perceptions of the work environment, climate, staffing adequateness, opportunities for career advancements, leadership, level of burnout, and work‐life balance. Nurses’ and patients’ characteristics were hypothesized as “part of the MNC process,” while patients’ perception of care as an MNC outcome. The “Missed Nursing Care in the Home Care” (MNC_HC) instrument was developed and validated. Other instruments used were the “Practice Environment Scale of the Nursing Work Index,” the “NASA Task Load Index,” and the “Copenhagen Psychosocial Questionnaire version III”. Data from nursing directors, home care nurses, and patients were used in a quantile regression to explore factors linked to MNC. A univariate linear regression model assessed the relationship between MNC and patients’ evaluation of the service. Results: A total of 3949 nurses and 9780 patients participated in this study. MNC was reported by 3545 nurses (89.77%), and MNC_HC mean score of items of care missed was 5.23 (SD = 3.18) out of 9. When MNC was low, overtime work increased it, while staffing adequacy and leadership quality reduced it. When MNC was at a medium level, associated factors included longer patient waiting times, more home visits per shift, and inadequate staffing. When MNC was high, work‐life conflict and burnout were strongly associated with increased MNC. High perceived workload and lack of career progression opportunities were consistently associated with MNC, regardless of its level. Conclusion: A critical appraisal of organizational and staffing features is recommended in home care. To enhance both patient outcomes and nurse satisfaction, it is advisable to implement indicators to monitor care delivery, revise nurse staffing levels, and establish advanced roles, such as specialized community nursing positions.

Background: Chronic pain (CP) prevalence estimates addressing a wide phenotype are still quite fragmented and may vary widely due to the lack of standardized tools of investigation. There is an urgent need to update general population CP estimates. Methods: For this purpose, the Brief Five-item Chronic Pain Questionnaire was developed through experts’ consultations for design and content validity assessment; literature analysis of measures used to investigate CP for general population surveys; understandability evaluation through a survey on a convenience sample of affected and non-affected individuals; reliability assessment by means of two double-wave online surveys carried out by the Italian Twin Registry; criterion and construct validity assessment through the third wave of the 2019 European Health Interview Survey (Ehis). Results: Key dimensions were defined to describe CP main aspects from a public health perspective. Literature analysis showed that validated questionnaires were rarely used to address important public health CP aspects. Understandability of the measure was good. Test-retest analyses showed adequate reliability of the measure: k values were at least “moderate” with highest values regarding CP “occurrence” and “intensity”. Correlations of CP with well-known comorbidities (cancer, depression), and specific traits (age, education) as well as of CP and its intensity with “physical pain occurrence and intensity” detected in the Ehis 2019, confirmed, respectively, a good construct and criterion validity. Construct validity was also evaluated through the correlation between “perceived treatment effectiveness” and “interference of pain in daily life activities” as recorded in the Ehis 2019. Conclusion: The designed questionnaire is a brief self-administered measure, particularly suitable to detect persistent states of pain and related intensity in large-scale general population surveys by means of a first filtering item followed by four further items. It is, in fact, designed to detect CP possible underlying causes/triggers, drugs/treatments taking and frequency, and self-perceived effectiveness among CP sufferers. Further validation of the measure in different social and cultural contexts is desirable.