National Guidelines Research Articles

Literature review, surgical decision making algorithm, and AGREE II-S comparison of national and international recommendations and guidelines in pelvic organ prolapse surgery.

The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II-S (AGREE II-S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German-speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous-hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered.

Skandinaviske retningslinjer for behandling av psykisk lidelse hos barn og unge: En kvalitetsvurdering

Children and young people with untreated mental health disorders can develop chronic disorders and severe somatic diseases later in life. The right treatment at the right time is therefore important to promote good mental health. Healthcare personnel are required to follow national guidelines, and high-quality guidelines are thus important for patient safety. We wanted to assess the quality of Norwegian national guidelines for the treatment of mental disorders in children and young people and compare these with corresponding guidelines in Sweden and Denmark. We conducted manual searches in the relevant national health authorities’ websites and selected five Norwegian guidelines (treatment of ADHD, bipolar disorders, psychosis, suicide and eating disorders), three Danish guidelines (ADHD, anorexia and bulimia) and one Swedish guideline (ADHD). For the purpose of quality assessment, we used an internationally recognised checklist (AGREE II), on which Norwegian guidelines must be developed in accordance with the Norwegian Directorate of Health’s own guide for developing guidelines. The checklist consists of 23 items divided into six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. We found that the overall quality of the Danish and Swedish guidelines was very high and met most of the 23 criteria organised within six domains. The Norwegian guidelines met the criteria for scope and purpose and stakeholder involvement, but had major shortcomings in terms of rigour of development, clarity of presentation, applicability, and transparency of editorial independence. Keywords: evidence-based practice, national guidelines, children and adolescents, mental disorders

Geochemical study of heavy metals in samples from dumpsites at Onitsha, Anambra Basin, Southeastern Nigeria

Core (0-60cm) samples were collected from selected dumpsites at Onitsha and control site at Awka, Nigeria. Physiochemical parameters (particle size distribution, cation exchange capacity (CEC), pH, Organic Matter (OM in %)) and heavy metals (Lead (Pb), Copper (Cu), Zinc (Zn), Chromium (Cr), Nickel (Ni), Aluminium (Al), Cobalt (Co), Molybdenium (Mo), Cadmium (Cd), Manganese (Mn) and Silicon (Si)) were analyzed using standard methods. The result of the physiochemical analysis shows that the samples were generally sandy with acidic pH values (4.89-6.24); OM ranged from 5.693-27.71%; CEC ranged from 0.072-0.62(Cmol/kg). Comparatively, DS 5 (Obosi) has the highest levels of these heavy metals followed by DS 2 (Woliwo). The order is Bida < Okpoko <Obosi 1 < Woliwo < Obosi 2. The levels of these heavy metals were above the control values. They were equally above national and international guidelines. Enrichment Factor (EF) values varied between no enrichment to extremely severe enrichment. Pollution load index (PLI) indicated that all the sampled sites were polluted while the ecological risk of heavy metals varied between low contamination to high contamination. The prevailing indiscriminate disposal of wastes occasioned by nonexistence of appropriate disposal facilities is the direct cause of the situation. Proactive measures and regular environmental monitoring must be taken to minimize further deterioration as the contaminants pose serious deleterious effects on human and soil organisms.

Improving health outcomes in Cameroon through competency-based curricula and stakeholder engagement in accreditation

This review article explores the accreditation process for health personnel training in Cameroon, emphasizing its critical role in ensuring quality education and improving healthcare delivery. It begins with an overview of the current state of health education institutions and regulatory mechanisms, highlighting the need for robust national guidelines for accreditation. The review examines the importance of autonomous councils for each health specialty, emphasizing their role in establishing specialized standards, monitoring compliance, and promoting ethical values in training. It also discusses the historical context and evolution of accreditation, identifying past limitations and the necessity for updated standards. The strengths and challenges of the proposed guidelines are analyzed, focusing on their potential impact on the competence of health professionals. Comparative assessments with successful accreditation systems in other African nations, such as Nigeria and Ghana, provide valuable insights into best practices. The perspectives of various stakeholders, including government agencies, educational institutions, and healthcare providers, are examined. The article concludes with recommendations for enhancing accreditation processes, including capacity building and continuous stakeholder engagement, ultimately supporting the development of a competent healthcare workforce aligned with national health goals.

A survey of availability and affordability of polypills for primary and secondary prevention of cardiovascular diseases in selected countries

Abstract Background/Introduction The recent inclusion of polypills—fixed-dose combinations of two or more antihypertensive drugs and statin with or without aspirin—in the World Health Organization’s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for primary or secondary prevention of cardiovascular diseases (CVDs). Although there exists extensive evidence on efficacy, safety, and acceptability of polypills, there is no research to-date assessing the "real world" availability and affordability of polypills globally. Purpose We conducted a cross-sectional survey of public and private sector facilities in 13 countries from around the world to evaluate the availability and affordability of polypills. Methods In the surveyed countries, we first ascertained whether any polypill was authorized for marketing and/or included in the national EMLs and clinical guidelines. The facility survey employed a modified WHO/Health Action International methodology. In each country, we collected retail and price data for polypills from at least one public sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable in a given country if the lowest paid worker spends more than a days’ wage to purchase monthly supply. Results Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius, and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. Further, none of the surveyed public pharmacies in any of the four countries stocked any polypills. Among the surveyed private sector facilities, availability ranged from 0% in India (out-of-stock on the survey day but listed for sale) to 100% in Argentina and Spain. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Although not in stock, India had a wider range of various combinations (n=5). Many combinations (63%) found in this survey were affordable in the local context, but these were limited to India and Spain. A lowest paid government worker would spend between 0.2 (India)–2.8 (Mauritius) days’ wages to pay the price for one month’s supply of the polypills. Polypills were likely to be affordable in countries that locally manufactured them. Further, two-pill combinations (one antihypertensive and a statin) were stocked by private pharmacies in Argentina, Bangladesh, Cameroon, India, Nepal, and Spain, with affordability ranging from 0.2 (India)–7.1 (Cameroon) days’ wages. Conclusion Low availability and affordability of polypills in both public and private sectors suggest that the implementation and overall uptake of polypills remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Comorbidity neural network model for personalised recommendations in cardiometabolic risk factor management: towards early precision medicine in routine clinical practice

Abstract Background and Aims Hypertension and hypercholesterolaemia often develop in tandem to confer a risk of cardiovascular disease that may be more than additive. The present study explored early comorbid therapeutic intervention, i.e., beyond individual disease silos, while minimising data bias to provide clinical decision support tools that are portable across clinics. Methods A neural network was created to reproduce UK national clinical guidelines with an accuracy higher than 95%. Relying on real-world evidence from the UK primary care Clinical Practice Research Datalink electronic health record resource, a transfer learning methodology was then applied to achieve recommended risk factor goal attainment after two years. Shapley values derived from game theory were used to define similar digital twin cohorts, and to evaluate individualised recommendations that deviated from national clinical guidelines by rejecting a no-benefit hypothesis retrospectively in a classical proportion test. The methodology was ported to an independent hold-out dataset with anonymized records from six primary care clinics in the South of England. Results The adult patient population (n=469,496, mean+SD age 61+11yr; M 56% vs F 44%; primary 84% vs secondary prevention 16%) included 101,255 diagnosed for hypertension and 112,180 for cholesterol management. While a majority of the 52,504 therapeutic decisions in a test set agree with single morbidity guidelines, for 4639 deviations from the guidance, a significant minority was identified for whom alternative therapy was recommended. Rejecting a no-clinical benefit hypothesis at the 95% confidence level in a retrospective analysis, 1367 decisions showed statistically significant better outcomes over guidelines, for example by escalating anti-hypertensive therapies for patients receiving statin therapy (1085) or by complementing anti-hypertensive therapy with a statin (158). Similar findings were obtained when tested in a hold-out dataset with 13,725 decisions for 6531 patients. Conclusions The results support the contention that machine learning can identify patient subgroups for whom comorbid intervention deviating from clinical guidelines may be appropriate. A novel aspect of the study is the demonstration of clinically portable and actionable application of machine learning in the context of comorbid cardiometabolic diseases. The results represent practical steps towards personalised precision medicine for cardiovascular comorbidity in routine clinical practice.

Integrating environmental sustainability within national food-based dietary guidelines: a qualitative analysis from five case study countries

Abstract Background The incorporation of environmental sustainability principles into national food-based dietary guidelines (FBDGs) has gained prominence as a strategy to address both human health and environmental concerns. This study aims to identify and explore the processes and considerations to integrate environmental sustainability in food-based dietary guidelines. Methods Countries that have integrated environmental sustainability in FBDGs since 2016 were identified from the UN FAO website. Background documents and interviews with key stakeholders involved in the development of FBDGs from case study countries (The Netherlands, Denmark, Chile, France and Belgium (Flanders)) were thematically analysed using the Framework Method. A coding framework explored the rationale for integration, data sources and analysis methods, stakeholder and expert engagement, synergies and trade-offs, translation into public messaging, and key learnings. Results Eight background documents and six interviews were analysed. Approaches to integrating environmental sustainability varied, from inclusion in dietary modelling optimisation to changes to consumer messaging. Nearly all countries adjusted guidelines to reduce red and processed meat and emphasise the role of plants in diets. However, issues of cultural significance, affordability, and access limited ambitions to reduce overall meat intake. Novel plant-based alternatives remain contentious due to concerns about their ultra-processed nature and potential nutrient inadequacies as substitution foods. Key barriers to integrating environmental sustainability into FBDGs include consumer acceptance, data quality and availability, stakeholder involvement and conflict, timelines, and resource constraints. Conclusions Several countries have successfully integrated environmental sustainability into their dietary guidelines, but there is still variation in the integration and acceptance of FBDGs including environmental sustainability.

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

Rapid response Task Force: addressing the detection of Aedes albopictus in Lisbon, Portugal

Abstract Issue The invasive Aedes albopictus mosquitoes are spreading in southern Europe and pose a heightened risk of mosquito-borne diseases, like Dengue and Chikungunya. On September 2023, A. albopictus was first identified in Lisbon through community-based surveillance and a multidisciplinary national Task Force (TF) was convened. Description of the problem The TF included experts in epidemiology, entomology, environmental health, laboratory diagnosis, prevention and control and communication. The objectives were to i) confirm A.albopictus presence in Lisbon and adjust the risk assessment, ii) raise awareness and prevent mosquitoes’ spread, iii) revise national guidelines on arboviruses surveillance and control. During September-December 2023, the National Network for Vectors Surveillance (REVIVE) and the Hygiene and Tropical Medicine Institute sampled mosquito-prone habitats within 2km-radius of the detection point using QGIS software. They used snowball sampling to identify any new foci. They placed ovitraps for ongoing surveillance and conducted morphological analysis and xenomonitoring for pathogen DNA and RNA detection at the national reference laboratory. Results By November 2023, A.albopictus was detected in two new foci. No mosquitoes tested positive for arboviruses, and no autochthonous cases of mosquito-borne diseases were identified. The TF developed national guidelines for vector prevention and control and awareness for arboviruses and trained municipality workers. To raise awareness, we communicated with experts and the public through existing channels and media. As of April 2024, no new foci have been detected. Lessons Community-based surveillance and REVIVE approach were crucial for invasive A.albopictus detection and monitoring in Lisbon. Rapid multidisciplinary TF coordination may have been key for timely vector control.

Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing

Abstract Background In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies. Methods We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations. Results The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test. Conclusions The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context. Key messages • Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap. • Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.

Incidence and characteristics of premature ventricular beats in competitive athletes at preparticipation exercise testing

Abstract Introduction The European Society of Cardiology preparticipation screening (PPS) protocol for athletes includes history, physical examination and resting ECG only. However, adding exercise testing (ET) aimed at evaluating ventricular arrhythmias (VAs) inducibility may increase the chances to identify cardiac diseases at-risk of sudden death that would otherwise be missed. Recent studies showed that the risk that premature ventricular beats (PVBs) at ET are associated to an underlying disease depends not just on their number but on characteristics such as morphology and complexity. However, there are no data on the incidence of at-risk PVBs at ET, thus requiring further tests to rule-out a cardiac disease, in apparently healthy athletes. Aim To assess the incidence and characteristics of VAs in a cohort of apparently healthy athletes undergoing annual PPS including ET. Methods We included a consecutive series of 1431 (24±13 year-old, 75% males) competitive athletes who underwent PPS in 2023. According to the Italian law and national guidelines, PPS must include ET with a different protocol according to age: in athletes younger than 35 years (81% of the study group) a rapid constant-load ET target at evaluating VAs inducibility was performed while in athletes older than 35 years a standard incremental ET was carried out. PVBs recorded during ET were assessed in terms of morphology, complexity and response to exercise. Results the incidence of at least 1 PVB was 14.5%, with a statistically significant increase according to age (p<0.001, Figure). If only athletes with frequent (at least 5 isolated PVBs) or complex (at least 1 couplet/triplet/NSVT) VAs are considered, the incidence was 4.3%, still with a significant increase according to age. In particular, among athletes older than 35 years, the incidence of PVBs was 34.1% and of frequent/complex PVBs was 15.2%. As shown in the table and figure, more than half of athletes with PVBs showed at-risk features such as persistence/increase (rather than suppression) of VAs during exercise and an "uncommon" morphology (i.e. different than infundibular or fascicular). Conclusions PVBs during ET for preparticipation screening occurred in a sizeable proportion of athletes, particularly in those older than 35 years, and many showed at-risk features such as complexity, uncommon morphologies or exercise-inducibility. Despite VAs at ET may be the only sign of a disease at risk of sudden death, their high incidence may substantially impact on the need for further investigations after PPS. Hence, more efforts should be put to identify which PVBs characteristics are predictive for an underlying cardiac disease, particularly in master athletes.

The 2021-2023 Italian influenza pandemic plan: a critical evaluation of its regional implementation

Abstract Background Influenza pandemic preparedness plans should be adopted, regularly updated in every country, and comply with international guidelines to ensure proper management of public health emergencies. In Italy, each region develops its pandemic plan based on a National Plan. This study, conducted within a project funded by the Italian Ministry of Health, aims to assess the level of compliance of these plans with the national guidelines. Methods The assessment was based on a checklist of 192 items reporting the actions prescribed by the national plan. The items were divided into macro-areas by pandemic phase: general, alert, inter-pandemic, pandemic, and transition. The compliance regarding the presence and contextualization of each item in the regional plans was evaluated. Each macro-area was further assessed for easy identification of actions, congruence with the National Plan, and contextualization in the regional healthcare system. Some analyses grouped the regions into North, Centre, and South/Islands. Results Some macro-areas, such as ‘Communication’ and ‘Prevention and Control measures,’ showed some weaknesses in all phases, especially in the northern regions, which reached levels of full compliance below 50%. Central regions were highly compliant in almost all macro-areas, especially in ‘Strategy/Governance’ (100%), ‘Supplying’ (75-100%), and ‘Surveillance’ (75-100%). Overall, contextualization was the weakest aspect in all phases, while easy identification and congruence were mainly better achieved. Only three regions fully met all the assessed parameters. Conclusions A strict surveillance and monitoring process of planned activities is necessary to strengthen the country’s preparedness. This study identified critical issues and key areas for improvement at the regional level. This might allow us to verify the correct implementation of national guidelines and define the best strategies for improving readiness for public health emergencies in the future. Key messages • Implementation of the Italian influenza pandemic plan was uneven across regions. • Identification of lacking areas of the regional implementation is essential to improving national preparedness.

Exploring Stakeholder Perspectives on the Implementation of WHO iSupport for Dementia Program: A Qualitative Study.

To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport-based intervention for family caregivers of people with dementia. A descriptive qualitative design was adopted. Semi-structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components. The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four-tier, eight-component conceptual framework guides the global promotion of the web-based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support. The 'iSupport for Dementia' program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination. The 'iSupport for Dementia' program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies. Adherence to the COREQ guidelines for reporting qualitative research was maintained. No patient or public contribution.

Evaluation of food pattern behaviours following nutritional education for health professionals

Abstract Background The “Work Programme - UN Decade of action on nutrition 2016-2025” highlights the importance of implementing Recommendation 19 of the Second International Conference on Nutrition of FAO and WHO related to nutrition education interventions (NEI) for health professionals (HP), in order to develop nutritional skills based on national dietary guidelines and coherent policies relating to food. The Local Health Agency integrated with Trieste University (ASUGI), since 2009, has performed 25 NEI with the formation of 910 HP. Post pandemic, the content of ASUGI’s last 5 NEI, programmed by the prevention plan of the Autonomous Region of Friuli Venezia Giulia, was aligned with the principles of the European Farm to Fork Strategy linked to Sustainable Healthy Diets (SHD). Objectives The objectives of the training programme (TP), approved for Continuing Medical Education, was to change and evaluate food pattern behaviour (FPB) of HP (n = 200) to adhere to the SHD. TP was characterized by a systemic view on complex interconnections between nutritional and sensorial food value, sustainability of food chain systems, evolution of urban food environments, as contexts into which SHD choices can be applied. The 2 days training, spread over 14 hours with 40 participants, concluded with interactive work and experiences to applied knowledge and beginning to make informed healthy dietary choices in practice. Results 6 months after the conclusion of TP it was reported that the percentage of HP who consumed the recommended portions of fruits and vegetables had increased from 62% to 70% and from 28% to 35% respectively, while those who consumed no cured meats, red meats or legumes, changed from 24% to 35%, from 19% to 25%, from 6% to 3% respectively. Conclusions The evaluation of the TP systemic structure has shown its effectiveness in improving some healthy FPB of HP and the importance of applying a continuous improvement process of the program to better adhere to the whole SHD. Key messages • The systemic and integrated structure of nutritional education intervention programs for health professionals contributes to improving their healthy food pattern behaviour. • The relationships between complex policies of food systems and the 17 SDGs included in the training programs on nutrition education are useful for promoting adherence to healthy and sustainable diets.

SustentAÇÃO: E-learning training on food sustainability for teachers in the Lisbon Metropolitan Area

Abstract Background It is essential to address food sustainability (FS) within the school community to enhance both public and environmental health. In Portugal, in the scope of AML Alimenta, teachers’ training on FS was identified as a priority. Therefore, local partners along with academia developed, implemented, monitored, and evaluated the SustentAÇÃO. Objectives SustentAÇÃO aimed to empower school teachers in the Lisbon Metropolitan Area to teach students between 6 and 14 years old on FS. The program consisted of 10 hours of asynchronous online learning (MoodleTM), structured in 4 modules, and 10 hours of autonomous learning (5 students’ educational sessions), offering autonomy and flexible time management. The contents were adapted for different age groups. The teacher’s performance was monitored and evaluated continuously. A process evaluation was conducted for both teachers and students. Results Of the 79 teachers enrolled, 47% completed the program. Teachers’ performance (0-20) on the 4 evaluation questionnaires was on average 17,9±3,13. Most teachers found the program benefited their work (94%) and considered it essential for enhancing student’s knowledge (98%). Considering overall satisfaction, 85% of teachers were satisfied or very satisfied with the training and 91% would recommend it to their colleagues. Additionally, 86% of students enjoyed the activities delivered, 76% considered that they were wasting less food, and 78% believed they had improved their ability to make healthier and more sustainable food choices. Conclusions Through a collaborative work between local partners and academia, an innovative e-learning training programme on FS was developed, implemented, monitored, and evaluated, responding to the local needs identified. SustentAÇÃO complies with national education guidelines and contributes to the sustainable development goals agenda. Key messages • SustentAÇÃO E-learning training highlights the importance of collaborative work, based on an initial assessment to target local needs. • SustentAÇÃO E-learning training improve teachers’ knowledge on FS and benefit their students.

Latent tubercolosis infection in the migrant population: an Italian surveillance experience

Abstract Background The Special Reception Center (“Centro Accoglienza Straordinario” or CAS in Italian) concept was born in Italy in 2014 to receive the large number of migrants arriving in Italy. There are around 3100 centres are in Italy, of which 200+ in Tuscany. Each Center’s objective is to support migrants’ social integration through Italian language and job orientation courses. On arrival at a facility, migrants undergo diagnostic and lab tests to highlight potentially infectious diseases; among these, tuberculosis is one of the most frequently encountered. Therefore, the objective of the study is to estimate the prevalence of Latent Tuberculosis Infections (LTBIs) among migrants hosted in CAS centers. Methods From May-December 2023, Amiata Senese, Val d’Orcia and Valdichiana Senese Public Health Unit staff, according to national and departmental guidelines, implemented a number of health surveillance protocols, with close attention to latent tuberculosis infection. This protocol includes the Mantoux TB skin test at the CAS: in case of positivity, subjects are directed to further exams (chest X-ray, TB-IGRA blood test, infectious disease specialist consultation) in order to implement a therapy. Results From May-December 2023, 259 migrants (241 males and 18 females) received the TB skin tests. Average subject age was 26. Pakistan was the most represented nation of origin with 130 migrants (50%), followed by Bangladesh (9.7%) and Ivory Coast (7.3%). 77 migrants showed a positive TB skin test result (29.7%): of these 56 (i.e. 21.6% of the migrants screened) were also positive to the TB-IGRA blood test and treated for LTBI. Conclusions The high prevalence of LTBIs found in the referenced CAS indicates the need to continue/extend these surveillance protocols. Implementing successfully this procedure requires the involvement of a range of professionals from the socio-health sector within a process necessarily coordinated by the Disease Prevention Department. Key messages • Screening and surveillance of infectious diseases among migrant population represent a major public health issue for European health systems. • Detection and treatment of Latent Tubercolosis Infections require a multiprofessional and integrated approach, coordinated by the Disease Prevention Department.

4.F. Scientific session: Progress in assessing climate change risks to health and implementation in UK and Europe

Abstract Climate change poses one of the greatest threats to health security. Climate change is increasing the frequency and intensity of environmental health threats like flooding and heatwaves and is creating conditions which heighten the risks from infectious diseases. Whilst everyone will be at some risk from adverse health impacts from climate change, the impacts will vary at individual level and the most disadvantaged both here in the UK and around the world will be disproportionately affected. Many of the anticipated adverse health impacts of climate change in the UK are still avoidable through mitigation and adaptation and that there are other benefits to health to be gained, therefore rapid action is critical to avoid the most severe potential scenarios. The Health Protection Research Unit in Environmental Change and Health, funded by the National Institute of Health Research, provides multi-disciplinary research to support decision-making relating to the impacts and responses to environmental changes that affect human health and well-being in the UK and beyond. In this workshop we present the results of recent research on the progress in assessing climate change risk factors on health in the UK and review the evidence on implementation of mitigation and adaptation measures in Europe. The workshop aims to support evidence translation for climate action that prioritises health protection and equity. The workshop will include presentations on reviewing risk assessment methods for quantifying health impacts across Europe as well as analysing the effects of fuel poverty on cold-related mortality. We present results from an analysis of primary care data to identify individual level characteristics associated with increased risk of mortality during heatwaves. Furthermore, we review national food-based dietary guidelines across Europe and South America to determine how environmental sustainability is being integrated to benefit health. The workshop will comprise 4 -5 oral presentations and we will then open the floor to have a wider facilitated discussion about what are the evidence needs for UK and European policy to further address climate risks to health. Key messages • The progress in assessment and understanding of risks from climate change on health is improving. • The health risks we face from climate change will not be distributed equally across the UK and Europe.

Enhancing Public Health: training an AI chatbot for complex tasks support

Abstract Background The evolution of Large Language Models (LLMs) such as GPT-4, Gemini, and Copilot has transformed the field of Natural Language Processing, demonstrating human-level capabilities and potential applications in Public Health. Here, we report on the training of a chatbot model based on GPT-4 designed to assist operators with relevant and complex public health tasks. Methods A scoping review of existing studies on the application of LLMs in Public Health settings was conducted to understand the landscape and identify gaps in their current implementations. We then proceeded to analyse the necessary skills and competencies required for public health professionals to adequately instruct the model on required tasks. Finally, we selected the Italian regulations and guidelines with the greatest relevance in the public health field to provide the knowledge base to the model. Results The review revealed no relevant documents on the use of LLMs in areas related to Public Health. Skills and competencies were retrieved from the Guidelines of the Italian Society of Hygiene for Public Health operators and used to instruct the model on how to address public health tasks. As for the knowledge base, we retrieved 25 documents regulating specific areas of the public health field, such as vaccinations, hygiene and safety at work, infection prevention, and school hygiene. Such documents were used to train the model, after formatting them appropriately. Conclusions Despite challenges with non-standardized and technically complex documentation, preliminary testing of our model has shown its versatility and utility in supporting daily public health operations. A validation phase is under definition and will involve a DELPHI process, in which products of the custom GPT model will be evaluated by a panel of public health operators to evaluate its performance in real-world settings, ensuring compliance with national health regulations. Key messages • Training a GPT-4-based chatbot to support complex tasks in Public Health, tailored by relevant national guidelines. • Our custom model, informed by public health guidelines, showed potential in preliminary tests.

Participation With Compensation: Ethical Considerations for Research Payment Practices With People Who Are Incarcerated.

The participation of incarcerated individuals in research is necessary to appropriately address the health disparities that affect them and to adapt and implement health services for the carceral setting. Incarceration significantly impacts health, leading to negative outcomes including accelerated aging and increased mortality, with these effects disproportionately impacting communities of color. The U.S. Department of Health and Human Services' Office for Human Research Protections outlines ethical approaches to compensating individuals who participate in research activities, yet lacks specific guidance for payment within carceral settings. Historical abuses in carceral research underscore the persistent need for robust protections for incarcerated research participants. Existing regulations offer some protection but inadequately address ethical payment practices. Substantial variability in payment policies across carceral systems and vague national guidelines pose ethical challenges in ensuring equitable treatment for incarcerated research participants. We outline the ethical concerns related to compensating incarcerated individuals for participating in research and present a framework of approaches to payment. We argue for payment parity between incarcerated and community research participants. More community-engaged research is needed to understand the perspectives of incarcerated individuals on ethical payment.

Development of rapid methods to monitor nutritional standards in sustainable healthy public catering

Abstract Background The WHO and FAO in the Second International Conference on Nutrition stress the role of nutrition standards for public facilities catering services (CS) and in the Sustainable Healthy Diet guiding principles (SHD) underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. In Italy almost one in 10 people eat a meal in CS every day. In accordance with SHD, the Italian Ministry of Health (MH) in the national guidelines for CS indicate activating procedures for the conservation of nutritional qualities (NQ) of micronutrients and bioactive substances. The central purchasing body of the Region of Friuli Venezia Giulia have applied these criteria, introducing the process of critical control points of nutrient analysis (NACCP) in the Public Procurement for the school catering of 69 municipalities and for all 18 regional hospital with more than 3 million meals per year served. The aim of the project was to develop rapid and cheap methods for monitoring the NQ of meals by applying the NACCP process. Methods 150 samples of pasta, milk and also vegetables, meat, fish with different degrees of processing, were taken from the CS and analysed both with chemical techniques and with optical rapid techniques (1300 analyses). Results The samples were subjected to conventional analyses to determine the oxidation state and the content of characterizing molecules such as polyphenols, histamine, and total compounds of Maillard. The same samples were then analyzed by color measurements. The results showed a good correlation between the two analytical systems, in particular the color measurements and the Maillard compounds and the color measurements and the oxidation state. Conclusions Project findings can be applied in the NACCP process to rapidly cost-effectively monitor the nutritional quality of CS meals, and adhere to WHO and FAO the SHD guiding principles and MH guidelines for CS. Key messages • The development of rapid methods of monitoring the nutritional standards of public catering can implement sustainable food systems thereby promoting the healthy diets recommended by the FAO and WHO. • Rapid methods of monitoring nutritional standards represent an innovative component in improving the culture of food and nutritional security in public catering.