Public Health Residents Research Articles

Focus on residents’ mental health: the Public Health Residents’ Anonymous Survey in Italy (PHRASI)

Abstract The ‘Public Health Residents’ Anonymous Survey in Italy” (PHRASI) represented the first study to specifically investigate mental health and its determinants among Italian public health residents (PHRs). Using a voluntary, anonymous, electronic, 88-item questionnaire, the PHRASI study generated evidence on well-being, eating disorders, sleep disorders, alcohol abuse, depressive symptoms, and anxious symptoms among PHRs. This highlights the correlation with sociodemographic, lifestyle, and work-related characteristics during COVID-19 pandemic. The data was collected in a nationally representative sample of PHRs enrolled in any of the four course years of Italian Public Health schools. The recruitment took place through the communication channels of the Medical Residents’ Council of the Italian Society of Hygiene and Preventive Medicine in the summer 2022. The key findings reveal prevalence rates of mental health conditions comparable to those seen in other healthcare workers during the COVID-19 pandemic: 61% of residents report depressive symptoms and 36% report anxious symptoms. The study also highlights a negative correlation of these symptoms with characteristics of the training and working environment, such as the level of supervision and peer-to-peer support. A stronger social network and higher levels of physical activity emerged to be positively associated with well-being and depression. These and other findings will be available in the final report of the survey that will be presented during the congress. PHRASI led the way to the Residents’ Mental health Investigation, a Dynamic longitudinal study in Italy (ReMInDIt), that aims to explore potential cause-effect relationships between risk/protective factors and mental health outcomes. This evidence could guide the scientific community, school directors, universities, and policymakers in the continuous process of improving the educational quality and working conditions of PHRs. Key messages • Residency training and work environment impact the mental health of the PHR workforce. • It is important to deploy concrete efforts into building healthy work environments and guarantee adequate training for PHRs.

Ready or not? The state of emergency preparedness among Italian Public Health medical residents

Abstract Background Italy frequently experiences major events like earthquakes, floods, and migrant shipwrecks, reflecting global concerns that also include climate change, pandemics, and wars. This study aims to assess the role of public health experts and the current state of Italian post-degree Public Health schools in addressing these challenges. Methods In June 2023, a cross-sectional online survey was administered to all Italian Public Health residents enrolled in the Italian Society of Hygiene, Preventive Medicine, and Public Health (SItI). The survey investigated the availability and frequency of training and updates related to emergencies, measured the interest and perceived importance of these topics among residents, examined the impact of the COVID-19 pandemic on their awareness, and identified their primary sources of information in the subject. Results Out of 289 respondents, a significant majority (86.2%) acknowledging the importance of being trained in emergency management and 74.4% expressed interest in topic (p < 0.001). A 90.1% of residents indicated a lack of dedicated courses and 93.1% reported an absence of specialized master’s programs (p < 0.001). There was a strong correlation between recognizing the importance of the topic and the desire to attend specialized conferences (p < 0.001). The COVID-19 pandemic had a noticeable impact: 24.6% recognized the importance of the topic pre-pandemic, while 50.9% raised awareness during (p < 0.001). Conclusions The findings highlight a critical gap in the training of public health professionals in Italy, particularly in the domain of emergency preparedness and management. There is a pressing need to establish enhanced, uniform training programs across different public health training networks in Italy. Implementing such programs would ensure a more robust and effective response to future emergencies, thereby safeguarding public health and improving outcomes during crises. Key messages • Significant gap in specialized training and awareness among health professionals. • Urgent need for emergency preparedness training in public health.

Awareness and Knowledge of the National Healthcare Transformation Program Among Public Health and Preventive Medicine Physicians in Saudi Arabia.

The Health Sector Transformation Program (HSTP) has been established as part of Saudi Vision 2030. Despite the significant progress achieved in previous years, the HSTP addresses multiple challenges. One of these challenges is that the current healthcare model prioritizes treatment over prevention. Therefore, prioritizing preventive healthcare measures is crucial. This study aims to assess the levels of awareness and knowledge among the public health and preventive medicine physicians in Saudi Arabia towards the national healthcare transformation program. In this cross-sectional study, we surveyed public health and preventive medicine physicians in Saudi Arabia. We collected data through a newly developed and validated self-administered questionnaire, which was distributed online. The survey questionnaire consisted of three sections: participants' background characteristics; measurement of public health and preventive medicine physicians' awareness of the HSTP and their confidence in their awareness; and measurement of the physicians' knowledge of the HSTP through six multiple-choice questions. In this study, 307 public health and preventive medicine physicians in Saudi Arabia participated. The mean age ± SD was 33.1 ± 5.1 years, with 54.7% being public health and preventive medicine residents, 33.2% specialists, and 12.1% consultants. Most participants showed high awareness of the HSTP and its strategic objectives. Over two-thirds correctly defined HSTP, value-based healthcare, and the new Model of Care (MOC), while about 50% demonstrated inadequate knowledge regarding Accountable Care Organizations (ACOs) and the "Keep Well" system. Older physicians, consultants, and those with more years of work experience had higher knowledge scores. Regression analysis revealed that job rank significantly influenced public health and preventive medicine physicians' knowledge of the HSTP. This study shows that while public health and preventive medicine physicians are generally aware of HSTP's objectives, they have inadequate confidence in their knowledge, highlighting the need for better information dissemination. Awareness of the MOC is high, but gaps persist in understanding specific components like the "Keep Well" initiatives. The study also found that job rank and experience influence knowledge levels, suggesting the need for broader dissemination of the HSTP concepts.

Impacts of Unhealthy Behaviors on Mental Health among Public Health Residents: The PHRASI Study.

Unhealthy behaviors (UBs) can affect mental health. The most impactful of these are alcohol abuse, sedentary behavior, and sleep disturbances. Since these UBs are not well explored in medical residents, this study aims to overcome this gap, focusing on outcomes such as depression and anxiety. The Public Health Residents' Anonymous Survey in Italy (PHRASI) is a nationwide cross-sectional study based on an 88-item questionnaire. UBs were explored through validated questionnaires: the Alcohol Use Disorders Identification Test-c (AUDIT-C), the International Physical Activity Questionnaire (IPAQ), and the Insomnia Severity Index (ISI). Depressive symptoms and anxiety were detected by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Hierarchical cluster analysis described clusters using responses from the AUDIT-C, IPAQ, and ISI. A total of 375 participants were included in this study. Three distinct clusters (CL) were identified: CL1 was characterized by a moderate risk for alcohol abuse and high insomnia dissatisfaction, with a significantly higher frequency of depressive symptoms (46%, p < 0.001) and anxiety (53%, p < 0.001); CL2 had no risk for alcohol abuse, high sleep satisfaction, and better mental health profile, with the lowest prevalence of depressive symptoms (15%, p < 0.001); CL3 had the highest risk of alcohol abuse, the highest rate of physical activity (40%, p = 0.013), and the lowest prevalence of anxiety (27%, p < 0.001). Subjects belonging to CL1 required much more attention to prevent the worsening of mental outcomes. Interventions for promoting mental health should be addressed in all Public Health schools to create more sustainable working conditions.

IJCM_271A: Concerns and Considerations of Using Artificial Intelligence in Research: A Qualitative Exploration among Public Health Residents in Kolkata

Background: The advent of Artificial Intelligence (AI) technologies has undeniably revolutionized various domains worldwide. AIs emergence has sparked significant interest from public health research domain due to its transformative potential. Thus, understanding its impact from the grass-root level: perspectives of the young research students, training in the field of public health is crucial. Objective: To explore the perceptions regarding the concerns and considerations for use of AI tools in research among students of a public health institute in Kolkata Methodology: A descriptive qualitative study was conducted among students pursuing MD degree. Focus group discussion (FGD) was done among the participants till data saturation was achieved. Audiogram, notes and sociogram were made during the FGD. Verbatims of the FGD were transcribed. Codes were obtained inductively and categorized. Data coding and analysis was done with NVivo 14 and data visualization was done using RAW graphs 2.0 Results: The various concerns that arouse were lack of trust, lack of knowledge, ethical issues, inadept to use and the impact of its use on the researcher. The young researchers also contemplated that there needs to be extensive training, ethical policy adaptation and self-checks required for its use. There is a growing body of thought to find solutions for the limitations in its use and its prospects. Conclusion: Most participants agreed to the fact their knowledge regarding its utilization was sub-optimal. There was a notable lack of trust in using AI tools for research among them. Addressing these challenges require a multifaceted approach involving extensive training initiatives, ethical policy adaptation to facilitate responsible AI use and a call for researchers to act as self-checks, while using AI in research

Influenza and Covid-19 Vaccination in 2023: a descriptive analysis in two Italian Research and Teaching Hospitals. Is the On-Site strategy effective?

Vaccinations represent an extremely effective tool for the prevention of certain infectious diseases - such as influenza and COVID-19 -, particularly for those categories at risk due to both their frail condition or professional exposure, such as healthcare workers. The aim of this study is to describe the course of the anti-influenza and anti-COVID-19 vaccination campaign at two Research Hospitals in Milan, Italy. Multicentre, cross-sectional study. For the 2023-24 vaccination campaign, the two facilities opted for two different approaches. At the Hospital A, two dif-ferent strategies for vaccinating healthcare workers were implemented: a fixed-site vaccination clinic and two mobile vaccination groups run by Public Health residents of the University of Milan. At the Hospital B, on the other hand, a single fixed-site outpatient clinic run by Public Health residents of the University of Milan was used. On the occasion of the campaign, a survey was also carried out using anonymous online questionnaires to investigate healthcare workers attitudes towards vaccination. A total of 1,937 healthcare workers were vaccinated: 756 were immunized against influenza only, 99 against COVID-19 only, and 1,082 against both. The results show a substantial difference in vaccination adherence among medical and nursing staff compared to other professional categories. In particular, the category with the highest vaccination adhesion turned out to be that of medical doctors with 55.7% adhesion while, on the contrary, the category with the lowest adhesion turned out to be that of auxiliary personnel characterized by 7.4% adhesion. At the same time, the comparison between the two hospital facilities showed a double adherence rate by the staff of Hospital A as regards both the flu vaccine (40.6% and 20.1%) and the anti-COVID-19 vaccine (26.4% and 12.3%). Finally, the survey showed that the attitude towards influenza vaccination is lower among auxiliary staff in terms of both knowledge and vaccination attitude. The results of the study show a vaccination adherence in line with that of previous years, although lower than the values recommended by the principal national and international Organizations. The analysis of the differences between the two facilities and the surveys carried out will allow for the implementation of targeted interventions to increase adherence in future campaigns.

Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Emergency awareness in Italy: The State of Art in Public Health Postgraduate Schools

Abstract Objective Italy frequently experiences major events like earthquakes, floods and migrant shipwrecks. Global concerns include climate change, pandemics and wars. We would assess the role of public health experts and the current state of Italian post-degree Public Health schools towards these challenges. Methods A cross-sectional online survey was conducted in Italy in June 2023, among all Italian Public Health residents enrolled in SItI. The study investigated the presence of trainings and updates about emergencies. It also explored interest and importance of topic, impact of Covid-19 pandemic and sources of information. Results Out of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest (both p&lt;0.001). 90.1% pointed out the lack of dedicated courses and 93.1% as for specialized master’s programs (both p&lt;0.001). Perceived importance in the topic correlates with the desire to attend dedicated conferences (p&lt;0.001). For COVID-19, 24.6% recognized the importance of topic pre-pandemic, while 50.9% raised awareness during (both p&lt;0.001). Conclusions A discussion is needed for enhanced training programs in public health emergency prevention and management across Italy, pledging for uniformity within different training networks. In this way, a more robust response to future emergencies may be ensured.

COVID-19 Regional Safety Assessment Using Evaluation Based on Distance from Average Solution (EDAS) Method

The process of assessing the safety and risk level of a particular region or area in respect to the COVID-19 pandemic is known as COVID-19 Regional Safety Assessment. It involves analyzing various factors, such as the number of active cases, testing and reporting capabilities, vaccination rates, healthcare system capacity, implementation of public health measures, travel restrictions, presence of variants of concern, and localized outbreaks. A complete evaluation of regional safety is necessary for public health professionals, legislators, and residents to successfully prevent the spread of COVID-19 and protect public health and wellbeing. Authorities may identify areas of concern, distribute resources wisely, and put targeted measures in place to restrict the virus's spread by performing a thorough examination. In order to restrict the virus's spread and protect the health and welfare of communities, it is crucial for guiding decision-making processes, identifying problem areas, and effectively allocating resources. The research carried out through regional safety assessments advances our knowledge of the pandemic, guides public health initiatives, and encourages the use of evidence-based decision-making in order to effectively battle COVID-19. Distance from Average Solution-Based Evaluation (EDAS)The evaluation based on distance from the average solution approach assesses the efficacy or quality of individual solutions or data points by comparing each solution or data point to the average or mean solution. This approach is commonly employed in various fields, including optimization, data analysis, and decision-making.In this evaluation method, the average solution serves as a reference point or baseline. It is crucial to remember that the evaluation's specific context and goals may influence the choice of the average solution and distance metric. Additionally, other evaluation criteria or metrics may be employed in conjunction with the distance-based evaluation to obtain a more comprehensive assessment of the solutions. China, Denmark, Germany, Hong Kong, Hungary, Israel, Australia, Austria, Canada, and Efficiency of the government, monitoring and detection, and quarantine Emergency Preparedness, regional resilience, and healthcare readiness .Ranking of the nation based on the Covid-19 Regional Safety Assessment survey. Hungary is shown as occupying the last slot, whereas China is listed as occupying the first spot. It has been noted that China has a significant influence on COVID-19.

Social Network Characteristics and Depressive Symptoms of Italian Public Health Medical Residents: The Public Health Residents' Anonymous Survey in Italy (PHRASI).

Despite the high impact of the COVID-19 pandemic on social interactions and healthcare workers' (HWs') mental health, few studies have investigated the association between social network characteristics and HWs' mental health, particularly during the pandemic. Therefore, we aimed to assess the associations between public health residents' (PHRs') social network characteristics and depression. We used data from the Public Health Residents' Anonymous Survey in Italy (PHRASI), a nationwide cross-sectional study. Social network characteristics were self-reported. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire. Linear and logistic models adjusted for age, sex, physical activity, and alcohol were used. A moderation analysis by sex was also performed. A total of 379 PHRs participated in the survey (58% females, median age of 30 years). More peer-to-peer (odds ratio OR = 0.62 (0.47-0.83)) and supervisor support (OR = 0.49 (0.36-0.68)), more social participation ((OR) = 0.36 95% CI (0.25-0.50)), and having a partner (OR = 0.49 (0.25-0.96)) were significantly associated with a lower risk of clinically relevant depressive symptoms. Work-to-private-life interference was significantly associated with a higher risk of clinically relevant depressive symptoms (OR = 1.77 (1.28-2.45)). Promoting a supportive work environment and social participation as well as reducing work-to-private life interference can contribute to reducing the high burden among PHRs.

Evaluation of an online-learning course in Primary Health Care for all Italian Public Health Residents

Evaluation of an online-learning course in Primary Health Care for all Italian Public Health Residents

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Impact of the COVID pandemic on mental health and training opportunities of Public Health Residents from 4 European countries: A cross-sectional study.

There is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic. Between March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors. Among the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05-2.42]), anxiety (adjOR = 2.03, 95%CI [1.33-3.08]), and stress (adjOR = 2.35, 95%CI [1.53-3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28-2.93]) and stress (adjOR = 1.98, 95%CI [1.26-3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12-2.80]) for depression. The pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

Public Health Residents' Anonymous Survey in Italy (PHRASI): Study Protocol for a Cross-Sectional Study for a Multidimensional Assessment of Mental Health and Its Determinants.

The COVID-19 pandemic has evolved into a severe psychosocial crisis affecting patients, their relatives, friends, and healthcare professionals. In Italy, public health residents (PHRs) remain essential to the national response to the pandemic. To assess their mental sphere, the "Public Mental Health" working group of the medical residents' Assembly of the Italian Society of Hygiene and Preventive Medicine has designed the Public Health Residents' Anonymous Survey in Italy (PHRASI). This is a nation-wide cross-sectional study based on an 88-item self-administered voluntary survey that evaluates how sociodemographic variables are associated with mental issues, including wellness, eating disorders, sleeplessness, alcohol misuse, depression, and anxiety. Data will be gathered by disseminating a Google Forms link across the Assembly network of medical residents. All PHRs enrolled in a four-year program in one of the Italian postgraduate schools of public health will be qualified as participants. PHRASI aims to draw a comprehensive and detailed picture of the mental health state of Italian PHRs. PHRs are a significant group of healthcare professionals that may serve as a future benchmark for developing and enacting regulations intended to support the mental health of healthcare professionals.

Public Health and General Preventive Medicine Residency Milestones 2.0

Evaluation of performance in graduate medical education has evolved into competency-based assessments over the past few decades. Milestones 1.0 were created in 2012 as part of the Next Accreditation System. Over a decade later, the updating of these competencies is underway. Milestones 2.0 for the specialty of Public Health and General Preventive Medicine were completed in the spring of 2022 and implemented on July 1, 2022. Milestones 1.0 provided a strong foundation upon which to create Milestones 2.0. There were many challenges with Milestones 1.0, including the number of themes within a subcompetency and some vague and misunderstood language. The Milestones 2.0 addressed these challenges by decreasing the overall number of subcompetencies and themes, using more concise language, and providing specific examples through a Supplemental Guide. These updated milestones better represent the breadth of the General Preventive Medicine specialty and will be a more useful tool in resident education.

American Board of Dental Public Health diplomate survey, 2021: Competency domains and practice.

To describe current Dental Public Health diplomates and list the competency domains that diplomates considered either essential or optional elements of their practice. The American Board of Dental Public Health administered an electronic survey to active and life member diplomates during September 2021. The survey included 101 items in three sections: (1) Education and Work Experience; (2) Dental Public Health Tasks; and (3) Demographics. The Dental Public Health Tasks section asked individuals how essential work-related tasks were to their current practice. Descriptive analyses were conducted using SAS. The overall response rate was 82.6% (157 eligible of 190 returned). Most respondents were women, 35 to 54 years of age, and either non-Hispanic white or non-Hispanic Asian. Twice as many had DDS or DMD degrees than BDS degrees. The vast majority completed a Dental Public Health residency and received masters level training from an accredited program. About three-fourths worked in the United States and held a U.S. license. More than 37% reported a second doctoral degree and 70% worked in academia. Responses to questions about tasks closely aligned with working in academia and less so with positions related to advocacy, regulation, and program evaluation. Current diplomates are concentrated in academia. If this trend continues, it may be necessary to restructure the competencies, so training and skills acquisition remain timely and relevant. The specialty may also need to encourage future generations to consider non-academic positions so Dental Public Health remains an impactful component of the public health care system.

Resident and supervisor perception of learning climate in public health resident training in the Netherlands

The purpose of this study was to evaluate the perceived quality of the learning climate by public health residents in the Netherlands and compare residents' and supervisors' perceptions. Residents of five public health subfields, who started their residency programs in 2019 and onwards, as well as supervisors involved in the residency program, were invited to complete aweb-based survey based on an adapted version of the D‑RECT questionnaire. Answers of residents and supervisors of the same training site and public health subfield were matched to compare perceived quality of the learning climate. One hundred fourteen residents responded (response rate 50.9%). Residents' overall assessment of the learning climate showed amean score of 4.19 on a5-point-scale. Thirty-eighth supervisor-resident matches were formed. There were no notable differences in the perception of residents and supervisors. Residents' overall assessment of the learning climate was positive. Supervisors and residents' perception of learning climate is equal. Our adapted version of D‑RECT seems to be suitable to evaluate the learning climate for public health residency programs in the Netherlands. Further research is necessary to validate our questionnaire and to confirm our findings.

Education in Urban Health: the experience of Public Health residents in an Italian high school

Abstract Background Urban health has become an increasingly important aspect of Public Health curriculum for residents as people living in urban areas will substantially rise in the next 30 years so will their impact on health. Residents are both contributors and partners in creating sustainable solutions for their growing cities and can be involved in this aim as individual learners and also educators for younger students. Objectives A group of 15 Italian residents in Public Health were involved in creating and delivering 4 lessons on urban health to 319 students at Nomentano High School in Rome during spring 2022. After the 4th lesson, semi-structured interviews were conducted with the residents in order to assess perceptions, acceptance, barriers and facilitators of the experience. Data was gathered anonymously and analyzed using standard qualitative methods. Results All the residents answered the interview. Almost all reported the experience as highly impactful for training, team building, and increase in accountability. Most of residents also felt more confident on the topic of urban health and more involved in concrete actions for tackling pollution and climate change after delivering the lessons. Most perceived barriers mentioned were difficulties interacting with students, especially during the first two lessons, and their compliance. The opportunity to give lessons in the high school setting facilitated direct contact with students and better feedback was received. Conclusions Giving responsibility and leadership roles to Public Health residents and involving them in the education of younger students could improve their self-confidence and feelings of value and helpfulness, especially for urban health and climate change issues sensed by youth. Further experiences in other settings, specialties, and countries could be valuable to notice differences related to age groups and personal involvement. Key messages • The involvement of Public Health residents in education on urban health is highly impactful and well perceived for their personal growth. • This kind of experience is applicable to other relevant topics in Public Health.

Planetary health education: a cornerstone for international sustainable public health deals

Abstract As stated in The Lancet Public Health editorial, “No public health without planetary health”, the future health of the planet and human health are inextricably linked. For this reason, global citizens, practitioners, and professionals, especially those involved in Public Health, must be equipped to address and understand the field of Planetary Health (PH), which looks at the complex connections associated with disruptions to natural systems and resulting impacts on human health. Strategies aimed at incorporating PH education into high schools and academic curricula are required to build capacity for future national and local PH leadership. One of the most relevant tools used to achieve these goals is the PH Education Framework, designed by the Planetary Health Alliance (PHA). This framework considers five foundational domains as essential for PH knowledge, values, and practice, and has been currently applied by different institutions involved in PH. The Italian Institute for PH (IIPH) applied this framework to a school-based project for education in urban health, which will be better described in the workshop presentation. The PH Education Framework domains were used for the development of four interactive sessions oriented to raise students’ interest on the topic and stimulate active participation during and after the intervention, also with simple pro-environmental behaviours. The experience was shown to be fruitful for Public Health residents as well, who were deeply involved in and led the interactive sessions held in the high school. By means of a qualitative assessment, residents demonstrated to have increased their self-confidence, knowledge and leadership skills in PH. Further research and applications of the PH Education Framework are needed in order to increase evidence and awareness in PH and strengthen PH collaboration in Europe and beyond.

Hospital discharge for stroke patients: Transitional Care is Brain

Abstract Background Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy). Methods In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility). Results Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital. Conclusions Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients. Key messages • A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients. • Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.