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The COVID-19 crisis has drastically impacted the travel medicine field worldwide. In this perspective we have captured the challenges faced by travel clinicians in three Southern European countries: Italy, Spain and Portugal. Current practices, solutions and areas for improvement in these specific countries are discussed.

Background Positive behaviour and user's collaboration improved by using choices orientation techniques; in Lucca's Hospital (North-West Tuscany Sanitary Authority) this approach has improved separate waste collection execution and has decreased cigarettes dumping in commons areas. Objectives Phase 1 (May 2019): amendment of choices architecture recyclable waste bins in commons areas and into the wards were boosted, with “islands” clearly visible from any point of common paths; in the transit areas were installed exclusively multi-material and paper bins, equipped with signs that clearly indicate which products deliver; residual waste bins were allowed exclusively in certain points.ashtrays at the hospital entrances were eliminated and replaced with signage indicating smoking cessation benefits and the presence of areas “put your cigarette out” along the structure approach routes. Phase 2 (scheduled for May 2020): “nudge” action Spreading in community (using press and social-media) and locally (using poster) of the slogan “In San Luca we are taking a step forward: don't lag behind!”. This message stimulate the perception of an ongoing change to join. Results A decrease in residual waste collection and in instances of non-compliance in separate waste collection was detected. Decorum in the outdoor environments improved, with a reduction of user's reports and extra-cleaning interventions. Conclusions The described actions have improved user's collaboration, management efficiency of waste disposal and cleaning service, perceived quality and cost. Key messages Imitating a social model appears to be successful motivator of virtuous behaviours. Choices architecture and “nudge” techniques may improve citizens’ care pathways governance.

Background In a world where travelling can play a central role among human activities, due to the migratory flows increase and to the facilitation of exchanges between distant countries, the need to ensure healthcare to all travellers becomes a key point among healthcare activities. The aim of the study is to assess Italian Travel Clinics activity, critical issues, requirements and tips for improvement. Methods During the period from May to September, the Italian Society of Travel Medicine and Migrations (SIMVIM), performed a national on-line survey addressed to all Italian Travel Clinics. Results More than a third of Italian Travel Clinics replied the survey (79 clinics). The results show that on average for each clinic there are 4 healthcare workers (2 physicians, 1 nurse and 1 health worker), about 10 hours/week are dedicated to the clinic, the users are 18 and the Visiting Friends and Relatives (VFR) are 17%. In only 25% of cases the clinic is open access and in 80% there is a digital immunization registry. More than 70% of the healthcare workers have the last update in the two-year period of 2017/2018. Major critical issues are shortage of staff, limited opportunities to update, absence of a dedicated software, expensive vaccinations particularly for VFR, reduced visibility of the clinic and difficulties in accessing, Travel Clinics not sufficiently integrated into the National Health System. Conclusions Italian Travel Clinics are carring out a good service to ensure healthcare to the greatest number of travellers, but there is extensive room of improvement. Key messages We should create a network where Travel Clinics work together with General Practitioners, Pediatricians, other Specialists, Pharmacists, travel agents and above all with stakeholders. In this way Travel Clinics can involve an increasing number of travellers through an active offer of vaccinations and a careful risk assessment based on professional skills and expert knowledge.